The Public Progression of Physicians

5646822351_d8af810d49_z (1)When it comes to doctors and social media, the past few years have been occupied with how doctors can make the transition to public life. Our dialog has traditionally focused on digital immigrants – established physicians adjusting to life with new tools and a public voice. The discussion begins with the argument for why a physician should be there.

But another population gets little dialog: digital natives who come to medicine already engaged. They are our future colleagues comfortable with tools of public dialog but without a clue as to how to it should be used as a professional.

It’s remarkable. Students with no idea how to use social tools as professionals come to medical education under the supervision of teachers who have never used the tools themselves. Students leave medical school with, at best, token discussion of how to conduct themselves beyond the IRL space.

Yet communication, education, and translation of knowledge are at the core of what physicians do. Increasingly, this happens in the public realm. The failure to prepare physicians for the realities of our new social environment is a failure of medical education to keep up with the realities of physician life in a connected age.

I have found that young physician trainees go through a public progression as they transition from personal to professional use of democratized media. It’s a sequence of thinking about how they fit in to the broader discourse. It’s an early concept that I plan to expand. I would love feedback.

College – In the beginning, public media use is almost exclusively personal and social. More engagement-centered and less focused on content. The risk and impact of conversations is barely a concern. Students have little sense of accountability until the point when they realize they will apply to medical school. Public visibility is seen almost exclusively as a liability. Concern is with what their friends think.

Medical school – Students begin to realize that they are part of something bigger than themselves. Students begin to process the fact that their public presence must be balanced with responsibility to community and patients. They recognize that there are actual professional risks associated with public dialog. Students are too far away from professional practice to understand, grasp or be concerned with the opportunities that a digital footprint can afford. They begin to identify and deal with issues of patient boundaries, privacy and personal and professional identities online.

Residency – Aware of the implications of a screwy public profile, residents are more reserved with their outward presence. Some of this may be time/schedule limited. Public visibility begins to be recognized as an asset that can serve their professional needs.

Professional life – This is the culmination of the transition. Our public presence is more centered on our professional interests and passions. We’ve learned to balance our personal and professional identities and are comfortable with and around patients in conversation. Our concern with social tools is centered on what our peers and patients think. We recognize that tools can be used for education, advocacy, professional promotion and learning. What and how we do what we do in a networked world must also be integrated into continuing medical education (CME).

Thinking about the sequence and stages of public professional transition is important as we must deliver content in the context of where the trainee is at. Students must learn to mitigate risk early in their training. Students beginning their clinical training must understand the specific issues that they’ll face when in contact with patients. Residents must understand how social tools can be used for professional growth. Trained professionals must recognize how to specifically leverage these tools for their specialty and work situation.

We have approached this issue at Baylor College of Medicine with our Digital Smarts curriculum. It is an undergraduate program that takes students from orientation through to graduation with the delivery of material specific to the student’s context and stage of development. Exclusively case-based, the program is entering its third year and it represents the first and only curriculum of its kind.

I would love feedback on this concept of the physician public progression. I may be reached at bsv at bcm dot edu.

If you are interested in the evolving role of the physician in public, please download a free copy of my book, The Public Physician.  

[Image via phlubdr on Flickr]

The Risk of Not Participating

9629531748_b3df8871df_oAt a social media healthcare conference last week, a physician speaking warned that when posting, think how it could affect your work. I’d turn the question on its head and ask if you don’t post how will that affect your work.

What’s the professional risk of not sharing your ideas?

The original warning reflects our tendency to look at public dialogue only from the perspective of risk and almost never from the perspective of opportunity.

Image via Flickr

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Social Media Has Been Introduced to Physicians

There’s a national organization that I’ve done some work with.  And for the past few years I have run social media sessions at their annual meeting.  Social Media 101 and other programs with non-threatening names intended to draw in frightened doctors.

This year I suggested that the days of the new thing have passed.

At some point we must go beyond the introduction and  into application.  The leadership of physician organizations need to begin to pay attention to the adopters and what they can do to move the needle.  Repeatedly pitching the terminally skeptical doesn’t work.  Tired arguments about the dangers of communication will never be won.  While newbie public physicians need to be educated, there are great resources available for doctors new to the public realm.

We’ve reached a point where social media is now part of the professional workflow.  While it’s a minority that understand and leverage these tools, the ones who are onboard are helping reshape the image of our organizations and our profession.  Those of us creating, curating and conversing in the great wide open will continue to benefit from our public presence.

And what about those looking to join us? The genuinely curious and motivated will figure it out just like we did.

Is Social Media Over?

Or is it just part of the background? Cyber-swami Fred Wilson has suggested that ‘the social media phase’ of the internet is over. This is important because so many within my reach continue to proselytize on social tools as the next big thing. And despite the vast numbers of technologically frightened physicians who continue to play catch-up, none of this is new anymore. It’s part of the landscape.

Shel Israel called this nearly 5 years ago when he suggested that social had achieved the status of the fax machine.

And I’ll eat the dog food: When I give 33 charts a facelift this year you’ll see ‘social media’ gone from my tag line.

Doctors and social media: Damned if you engage, damned if you don’t

Like symbol on white backgroundHinda Mandell felt creepy after being followed by her OB on Twitter.  Her post on Cognoscenti, Brave New World: Your Doctor, Your Private Parts, Twitter And You, is provocative on a number of levels.

Think perverts, not OBs.  It’s funny that the author’s friends and husband are concerned with her OB.  There’s little regard, however, for that serial pervert in a dimly lit room enjoying her recently shared images.

(That troubling little scenario puts things in perspective)

‘Following’ is irrelevant.  Your conversations are likely visible to every member of the planet whether or not you are followed.  Your comments are publications.  So if you’re uncomfortable with your ideas and images being seen, don’t publish them.  Or think about what you’re publishing.

Engagement is relevant.  What’s done with regard to engagement between a doctor and patient is what’s important.  Any social encounter has the potential to cross the line.  This isn’t specific to social media, however.  If you don’t like what a doctor does in the office, at the bedside, at a PTA meeting, on the phone, in church, or on Facebook, vote with your feet….or your mouse.  Relationships go both ways.  By assuming we have no control we make ourselves victims of our own visibility.

Damned if you engage, damned if you don’t.  One e-patient wants engagement, the other thinks it’s creepy.  No wonder doctors are confused when it comes to their public voice.  Let’s just face the fact that every social relationship is different and those participating need and want different things.  Policies at checkout windows will never fix that.

If you want a delineation of what I’ll do on every social platform, be prepared to wait.  I’m not sure if I follow any patients at this point but I suspect I will never have a Twitter policy on who, when and why I follow.  If, for example, a parent happens to run a blog, company, or organization that deals with technology and medicine, it might be something that I’m interested in.  I have plenty of patients who run non-profits for their children and associated diseases.  I might want to support these patients.  I won’t rope myself into a written policy because someone’s husband chooses to puff his chest out.

Committees are unlikely to legislate social engagement.  Just as there are no AMA guidelines on how I should deal with a mother who approaches me at a cross-country meet, there will likely never be actionable and practical guidelines that direct doctors to the seemingly limitless situations we face in the public space.

I could come up with another 20 points.  Where have I gone wrong?

h/t to Greg Matthews for pulling this story into my feed. 

Just found an excellent post on this story over at the Mayo Clinic by @LeeAase

Social Media: Managing Expectations with Doctors

iStock_000016431625SmallI frequently speak to doctors about social media and the management of their public presence.  There are 4 listeners who show up to my talks:

  1. The doctor who isn’t convinced social media is worth thinking about.
  2. The doctor who’s convinced it’s important but wants to know specifically how and where to get started.
  3. The doctor who’s started but needs help understanding how to apply these tools as a provider.
  4. The doctor who comfortably uses social media as a provider but wants to be a power-user.

Each group wants something different.

Some meeting planners don’t understand that these 4 audience members exist.  And when you tell them, they typically request ‘something for everyone.’  But when you try to please all 4 listeners, you risk that no one will come away with anything.

I find it helpful to manage expectations up front with both meeting planners and audiences.  With planners you may have to inquire about the audience and make your best guess.  They may need help in understanding what might work best for a certain population.  The focus of your presentation should be reflected in the program materials.  At the outset of a talk, be sure to outline what you’re trying to do…and what you won’t.

Times are changing.  3 years ago all talks to physicians were centered on the first group.  Increasingly I find myself gravitating further down the list.

Does your next meeting need a keynote speaker on social media or the new, emerging role of the physician?

Social Media Mishaps: 3 Steps to Take When You are Misunderstood

bThis week I posted a brief comment on a doctor friend’s social page.  It was a quick thought that, when taken out of context, came across the wrong way.  He got sore and emailed me about it.  I was upset because my relationship with him means a lot to me.

It was a misunderstanding.  I emailed to explain what I meant and where I was going with my question.  We caught up by phone.  We’re good.  4 years of regular engagement and connection don’t fall apart over something like this.

If this hasn’t happened to you, it will.  Because things move quickly in the stream.  Short-form dialog is ripe for wild interpretation.

The more you do, the more you’ll fail.  And the more you say, the greater the odds that you’ll come off the wrong way when viewed through someone else’s lens.  Every communication tool has its weakness.  We all need to accept and understand the shortcomings of these platforms and have simple mechanisms in place for righting the ship when it tips a bit.

In cases like this

1.  Don’t be defensive.  Recognize that perception trumps reality and what you intended to say always falls a far second to what it sounds like.

2.  Apologize and explain yourself.

3.  Then move about your business.  This is a two-way street and your relationship will depend upon the other person seeing the mishap.  If they can’t see it and your intent was really not maligned, then it’s someone you need not engage with.

There are lots of excuses for avoiding public dialog.  But for me the opportunities of connection have always outweighed the risk of being misunderstood.

If you like this you might be interested in Rhode Island Doctors: Don’t be Misunderstood.

Doctors and Public Media: Failure is Inevitable

DisciplineI met with some high level educators not long ago and was talking about doctors and their public presence.  As often is the case, the conversation came back to risk and all that can go wrong.  They wanted me to tell them if they did everything right, it would be smooth sailing.  Everything was going to be okay.

But I couldn’t tell them that.

I surprised them by suggesting that the transition from silo to public wouldn’t be smooth.  There would be failures, mishaps, difficulties and growing pains as their faculty found their way.  Good training would not preclude problems.  But despite these mishaps, the opportunities outweighed the apparent risks.

Doctors are programmed to believe that failure is bad.  And thinking you’ll go out into a connected world and not stumble has got nothing to do with social media and everything to do with the way we see ourselves as professionals.

The Implosion of the Medical Blogosphere

businessman with gas mask watching TVWes Fisher’s take on the slow death of the medical blogosphere is something to look at.  I suspect most doctors reading his post will have no idea what he’s talking about.  To understand the fabric of the medical community before social media requires having seen it.  It was a world connected by nothing other than blogrolls, dynamic comment threads and the memorable blog carnival.

More doctors, less organization.  While the traditional medical blog may be going the way of FriendFeed, physicians are present in public in greater numbers.  They would appear, however, increasingly disconnected.  I would agree with Wes that their presence is less about doctorly togetherness and more about personal presentation.  Perhaps this reflects the broader trend of physician disorganization.  Some physician-to-physician bonds have given way to physician-patient connections.  Many physicians find community in their own corners of the web in their specialties or areas of interest.  We just don’t see it.

New forms of creation.  There’s an assumption that the only way that doctors can meaningfully create and share is in long-form copy delivered in reverse chronology, Blogger style.  But the world relates differently now.  Video is the preferred medium of some.  Microblogging is a viable means of communication and it suits the piecemeal schedules of others.  Images do things that copy can’t.  These media are different, not better or worse than long-form writing.

Very few create.  Keep in mind that the vast majority of the planet consumes information, few create.  Doctors are no exception.  In the early days the medical blogosphere attracted and amplified the voice of a courageous minority who ventured out to find themselves and create the earliest iteration of digital culture.  Still, very few created.

The web amplifies our differences.  Most importantly I think we’re all finding our voices and recognizing that we don’t say and think the same thing.  Public media amplifies our passions and beliefs that aren’t always about medicine.  The most passionate physician voices aren’t sharing journal articles or talking shop.

So while the blogosphere of the early-mid 2000’s may be part of history, I don’t think public doctors are going away.  We just share, create and relate differently.

How Antique Thinking Will Make Higher Ed Irrelevant

SThe Kansas Board of Regents recently put the kibosh on open thinking.  A new social media policy within  University of Kansas institutions restricts “improper use of social media” and the posting of material “contrary to the best interest of the university.”  Better put, if your superior doesn’t like how you think, you could be out of a job.

This reminds me of Rhode Island where it was recently mandated by the Board of Medical Licensure and Discipline that physicians should avoid saying things that could be misunderstood at the risk of losing their medical license.

(The further along we get with social media the more it feels like 2008 all over again.)

Institutions are charged with balancing reputation and brand with the cultivation of an environment conductive to open thinking.  Admittedly, it isn’t easy.  But the black and white legislation of human dialog is impossible.  And open-ended, Draconian restrictions like this represent the first step in putting traditional higher education on the fast track to irrelevancy.

Microreview: Writing on the Wall by Tom Standage

imgresThe book.  Writing on the Wall – Social Media, The First 2,000 Years

The author.  Tom Standage.  Digital editor for The Economist.  

What it does.  Puts the current revolution in communication into broader historical context.

The angle.  Social media is not new.

Readability.  Comfortable.  History that reads like a story you don’t want to put down.

Why you should read it.  Like every generation believes that they invented sex, we believe we invented social media.  Writing on the Wall offers a 250 page reality check.  We’ve just reiterated what humans have done for millennia.

Favorite subheading:  ‘Are coffee houses making us stupid?’  A section that illustrates that the fears of social media and information exchange expressed today were raised surrounding socialization in coffee houses in the 1600’s.  “Coffee houses gave physical form to the previously immaterial social networks along which information passed, making it much easier to connect to them.”

Favorite quote:  “Revolutionaries always find it easier to agree on what they want to get rid of than what they want to replace it with.”

Bottom line:  Anyone invested in understanding where we’ve come from and where we’re headed with regard to communication should read Writing on the Wall.

If you’re looking for something more substantive check out Paul Krugman’s pithy endorsementFrank Rose in the New York Times found Standage ‘short on insight.’  Hilarious.

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