Phil Baumann wrote this week on the importance of attribution.  He describes the creeping trend of healthcare bloggers to avoid attribution and outbound links.

I’m a good example.  And for good reason.  I make every effort to link as little as possible and only where absolutely necessary.  Contrarian, you say?  Perhaps.

For years the social media gurus have propogated what’s known as ‘link love.’  Link love is about how we improve our standing with other bloggers.  It’s about how we can look good, get traffic, and ‘remind’ other people that we’re boosting them up so that we can have the ultimate social reward of being boosted ourselves.

For too long the blogosphere has been self-absorbed with little regard for the reader.  Bloggers ruminate over metrics, SEO terms, cross-linking, blogrolls, where their blinking ads are placed and other things that have little to do with anything but themselves.

Bloggers instead should obsess about the experience of their readers.

And when it comes to links the intent is what’s important.

Links have their place when they serve the needs and interests of the reader, not the social currency of the writer.  I add links when my idea or concept can be attributed primarily to one person.  I link when the outbound content is so remarkable that it will add to the reader’s experience.

This experience we create for our readers speaks for how we respect their time.  And links created with the intent of selling ourselves should be seen as piece of blogging’s narcissistic past.

 

If you’re an Evernote fanatic you’ll be excited to see that my posts now have the new Evernote Site Memory button nestled comfortably below.  If you like what you read just press the Evernote button and the post will magically wind up in Evernote.  And it renders beautifully.

I live in Evernote.  It’s where I capture everything.  Every idea, every thought for this blog, every book I find that I plan to read winds up in Evernote on my iPhone.

Chris Brogan tells us that we should give our ideas ‘handles’.  Evernote is gaining real traction these days and the Site Memory button represents just another way for your readers to get a handle on your content.

You can download the Evernote Site Memory button here.

 

Last night Susannah Fox put up the Bat Signal.  It seems she’s been charged with addressing the American College of Surgeons next month and she’s looking for some creative input from the medical social community.  Not surprising, really.  Interest in social media among physician groups is growing fast.

I thought it might be worth sharing a few random thoughts on the care and handling of the physician audience.

Doctors think in 1.0

Remember that the average physician is naïve when it comes to social media and its role in health.  Most physicians see e-patients strictly as consumers.  The concept of true socialization and active involvement by patients and physicians will likely be foreign to your audience.

With that said, you’ll get more mileage with a thorough, basic discussion of what this is all about and why it will change healthcare more than you will with a detailed how-to-do-it dialog.

A doctor is a doctor

Don’t sweat the audience.  While you could probably come up with some tailored, specific examples for surgeons or OBs, the core social issues for physicians are not specialty-specific at the introductory level.  In social terms, a doctor’s a doctor.

Raise your expectations

Based on their anemic adoption we sometimes think that doctors are resistant to the idea of social media.   I remember speaking this summer to one of the local medical societies in West Texas.  The audience was much older than I had expected and as I waited I prepared myself for resistance to what I had to say.  But, in fact, the opposite happened.  This audience of older generation physicians saw social as a way to potentially bring medicine back to its focus on connecting with patients.  Who knew?

Even if slow to adopt, physicians are intrigued and increasingly interested in social media’s potential.  We’re a malleable group.

Manage their expectations

It should be understood that we haven’t figured out where and how doctors should make social work for them.  Let’s face it, it’s time consuming and the applications that measurably impact care are few and far between.  The power lies in the potential that comes once we have the entire physician population in the loop.

And be careful of selling the fantasy:  While it makes great fodder for the media, selling “live tweets from the OR” as the saving grace of the next medical generation won’t win over any physician audience.

What keeps doctors up at night

As you think about your physician audience, consider why none of them have blogs or are found on Twitter:  1) Physicians naturally have issues with transparency 2) they haven’t got time and 3) they have concerns over liability and privacy.

But transparency is generational.  Time you can’t fix.  And issues surrounding patient engagement in the public forum are educational.

This patient contact issue and the theoretical potential for liability is a huge preoccupation.  I’ve found that a lot of physicians believe that their social entree obligates them to discuss patient issues in public.  I always convey my bias (possibly a slowly evolving standard):  discussion of patient-specific issues in public forums is off limits; discussion of patient non-specific issues is encouraged. Any attempt at patient-initiated discussion of specific medical issues immediately goes offline and onto the EMR for issues of record, liability and safety.

Doctor-patient dialog surrounding individual care should be limited to HIPAA compliant networks that integrate with the EMR.  I like to cite HelloHealth as an early example of this model.  The screen grabs always wow the crowd.

And if you can discuss an ethical dilemma or two you’ll have the academic elements of your audience drooling.  Bring towels.

Physicians have an obligation to be in the online space

Maybe I get away with it because I wear a stethoscope, but I always tell doctors that they have an obligation to participate in the dialog.  I always use autism and vaccines as the example.  The search engines in this regard are ruled by a loud, vocal minority linking vaccines and autism.  Consider that the American Academy of Pediatrics has 60,000 pediatricians.  If each of them were involved in the creation of some kind of content with reliable information, we would rule the search enginges.  Powerful stuff.  Always has an impact.

Think mobile

It’s estimated that some 81% of physicians will own a smart phone next year and mobile may be the segue into soft social adoption for many MDs.  Touch mobile and win your physician audience.

Tweet by example

One of the most powerful take home messages I pass to physician audiences is to study other doctors who are in the space.  Spend time watching and listening before taking the leap into the public forum.  I encourage people to look at what other doctors are doing and see how it applies to their setting.

Remind them to cultivate their digital footprint

I look at my role with physician audiences as one where I seek to motivate and empower.  And that’s when I feel rewarded. The idea that they can potentially control their digital footprint has huge value.  Ask the audience to do a vanity search and remind them that their reputation is under the control of sites like Healthgrades.  Remind them that they themselves are actually in control what people see when they are searched.

I encourage them to get started with a LinkedIn profile for one thing.  It’s soft social and a nice entrée into an online identity.

I’m not Joe MD

In a strange way I have to warn you to be careful of my advice.  Docs like myself and Howard Luks and others see the world through a very different lens than the average internist or general surgeon in middle America (who I refer to as Joe MD).  When thinking about our approach to the digitally naive physician we have to be careful about how we apply what we know about those of us who have already arrived.  Keep it basic and remember where they’re at.

Finally, I should say that Susannah Fox’s willingness to reach out to the physician community is a testimony to her understanding of how this social stuff is all supposed to work.  Even when we don’t know exactly how to approach something, there’s always someone who does.

I could go on all day.  What else would you add?

 

I don’t think doctors should be socially anonymous.  We need to be seen.

Here’s why going underground isn’t good policy for physicians:

Anonymity makes you say stupid things. When you’re shouting from the crowd it’s easy to talk smack.  Come up to the podium, clear your throat and say something intelligent.  You’re a physician, not a hooligan.

It’s 2010 – anonymity died a long time ago. You think anonymity offers shelter?  You’re funny, you are.  Anonymity is a myth.  You can create a cockamamie pseudonym but you can’t hide.  And if I don’t find you the plaintiff attorneys will.  They found Flea.

Being a weanie is no excuse. Just as you’re unlikely to consult a lawyer before speaking at a cocktail party, commenting as Dr. You is unlikely to kill you or land you in court.  Just a couple of pointers:  Don’t talk about patients, help people out and be nice.  Trust me, I’m a doctor.

We need you, dammit. There are like 12 doctors in the free world with regular blogs.  And all the rest are either working or peeking from under their desks hopin’ this social stuff all goes the way of the hula hoop.  If we all just spoke up we could change the world.  As for me, I’m typing as fast as I can and I’m tired of doing it alone.

Anonymity soils credibility. We need to be out there helping to keep check on the nonsense circulating in the infosphere.  I think it was Dr. Val Jones who once said that the Internet needs lifeguards.  Of course patients can swim.  No one needs to be rescued but there’s nothing wrong with a few strategically placed lifeguards to blow the whistle every now and again (mind you, these aren’t paternalistic lifeguards but lifeguards seeking a partnership with empowered, engaged swimmers).

“I’m not a doctor but I play one on the internet.” In the end, no one trusts a lifeguard in a ski mask.  Unless we know who you are, you don’t count.  If you’re anonymous I have to assume you’re actually a disgruntled medical assistant with an axe to grind.  Show your face and create a digital footprint that we can all see.  Look at me.  Look at my blog.  Cross-check me with Texas Children’s Hospital, Baylor College of Medicine the quarter million other ventures I’ve been engaged with.  I’m real.  Those links are real.

Go and be real so that your voice can be credible.

What am I missing here?

 

I once knew a blogger tormented by a troll.  I suggested that he disable his comments.  “But then it wouldn’t be a blog,” he whined.

Says who?

I must have missed the email suggesting that blogs have to have comments.  Apparently Seth Godin missed it as well (you can read why he disables comments here).

Perhaps comments don’t often add much to a blog (The only exceptions are the universally insightful comments left here on 33 charts by my readers, the greatest minds in social health).  True conversation, after all, is a dying art.  And despite our social obsession, broadcast is the order of the day.  But if you get beyond the platitudes and self-promotion, comments can (all sarcasm aside) have value.  Great comments make a post stronger.

When you think about what a blog should look like, keep in mind that the concept and definition of a blog is a moving target.  The standards of the past don’t hold today.  Early blogs, for example, were rants.  I remember reading advice from a ‘guru’ at the time who suggested that deliberate misspellings, poor grammar and strategically placed profanity raised your credibility.  It made you … authentic (at the time this was a revolutionary quality).

Advice to my blogger friend:  Worry less about your disabled comments.  Consider yourself a maverick.  And work to create content so remarkable that the commentary carries on elsewhere.

 

I recently got into a discussion with a couple friends about doctors and blogging.  Why don’t we more doctors out there?  Of the hundreds of thousands of doctors I’d expect more taking a voice.  Even during the U.S. health care reform debate.  Crickets.

Of course there are doctors who blog, but the numbers are slim.  What’s behind it?

Passion.  Pushing great content requires a passionate interest in changing ideas and making a difference.  There’s malaise in medicine right now.  Margins are slim.  Physicians are losing control of what’s happening around them. The fire in the belly that drove so many doctors to choose medicine has given way to a preoccupation with survival.

Late adopters.  Most doctors think a blog is something that deviant teens do on a cell phone.  There’s endemic ignorance in the medical community surrounding social technology.  Can we teach ‘em?  Maybe.  But I think this is a generational issue that will work itself out with time.  The use of social technology to facilitate dialog between doctor and patient will evolve over the next several years as 1) technology evolves and 2) digital communication becomes a standard.  Keep in mind that many of us still work with doctors who grew up using rotary phones.

They don’t need the business. Sure there are the tummy tuckers and the lapband docs who are lobbying for customers.  But for most primary care doctors, the market is such that more patients doesn’t necessarily add up to a healthier bottom line.

They don’t have a business.  Physician practices are folding faster than beach chairs at high tide.  Consolidation of medical business will mean that personal and practice branding will take a back seat to hospital and clinic marketing.  If it hasn’t happened already, your small town solo practice doctor will be working 9-5 under a hospital or large managed group.

Blogs are so…2000. Communication is moving closer to real time.  The revolution that started as Moveable Type has given way to new platforms.  Blog entries are becoming shorter and lifestreaming applications like Posterous gaining ground.  I see more physicians finding their voice in the fast moving streams of Twitter and Facebook.  Maybe these better suit the mindset and lifestyle of today’s doctor.

As the medical profession is redefined and resurrected expect excited, passionate voices to emerge.  I’m just not sure that the weblog will be where those voices will live.

 

I read Crush It earlier this week on a flight from Houston to South Carolina.  This really quick read written by Gary Vaynerchuk shows how to leverage social media tools to push your personal brand to the next level.

So you’re thinking, “DrV, what’s a doctor like you reading a book like Crush It?  Isn’t that for crazy, fast-talkin’, wine-pushin’ internet entrepreneur types?” No, actually.  While Vaynerchuk uses his personal story of Wine Library TV as the foundation of his book, his core principles apply to just about anyone with a message, mission or goal.

And I think that’s most of us.  Even doctors (Crush It actually references pediatricians once and vaccines twice).

Vaynerchuk’s easy voice and straightforward advice make the book immediately applicable.  In fact, Crush It has motivated me to experiment with other forms of media – I’ve realized there’s so much more I can do to push my message.  Look for me to experiment in video and audio in the very near future.

If you’re planning to go beyond where you are now, read Crush It.  Too many great points to make here but one thing that struck me is Vaynerchuk’s three simple rules:

Love your family.  Work super hard.  Live your passion.

Good advice for anyone … even a doctor.

 

We love to talk about our own health. It’s our right and our business. But how liberal should we be when talking about our kids?

Should the health information of children be protected?

I’ve been thinking about the concept of the personal health footprint and I wonder what the future holds for publicly disclosed health information. Will the painful struggle with your baby’s ambiguous genitalia revealed on your blog create issues as your child grows into adulthood? When we publicly deliberate the meaning of a 9p chromosomal duplication in an otherwise normal appearing child are we potentially doing her an unknown disservice?

I ask because I’ve seen a sharp rise in parents writing about their kids and their problems – and for good reason.  Health transparency has advantages for the family struggling with a chronically ill child.  Most dialog is centered around a community that provides critical support for these families. The benefits to parents are too numerous to count.

But I have to wonder where all this information will settle? How could your child’s personal health footprint be used? Twenty years from now what will your child’s network know about her? And how will your daughter feel when a personal detail from 2010 surfaces?

No one knows the answers to these questions.

Balancing the needs of parents with the needs of a sick child might be described as impossible. But just as we should think about the light we shed on the shadowed crevices of our health history, we might consider how much we say about our kids.

 

Online socialization is growing. Information is flowing faster than ever and the fastest flowing stuff relates to health. As the dissemination of health information via social platforms escalates, should physicians look more seriously at weighing in? Perhaps more importantly, do physicians have an ethical obligation to participate in health-related dialog?

Sounds crazy, I know. After all, physicians have always viewed the Internet as a place that nosy, hypochondriacs go to snoop around. “Go online at your own risk and be careful of chatrooms,” patients are told. Then they’re left alone at the edge of cyberspace.

Perhaps its time to change the mindset

I believe physicians and their organizations have an obligation to participate in online dialog. Sound reason, good clinical judgment, and evidence-based thinking need to be part of the information stream.

And doctors could change the way the world thinks if they would only get together. 60,000 is a number I reference when discussing physicians and social media. There are 60,000 members of the American Academy of Pediatrics. Every pediatrician fights vaccine misinformation, especially as they relate to autism. Consider the fact that the first two pages of a Google search for vaccines and autism are polluted with anti-vaccine propaganda driven by a loud, socially-savvy minority. If every AAP member wrote a myth-dispelling post concerning immunization just once a year, Google would be ruled by reason.

So what do physicians need to do?

Three steps for organized physician entrée into the social space:

1. Presence. Physicians need to be present. Until physicians adopt some of the basic tools of online socialization this will never happen. To be present, organizations like the AMA, ACP and AAP need to create tracks at national meetings to educate physicians on the power and critical importance of social media.
2. Organization. Unless we’re following one another or are connected under communities or networks our presence is irrelevant. While it’s been said that organizing doctors is like herding cats, social media breaks some of the traditional barriers to organization. It’s doable. It’s a way physicians can influence health behavior on a macro level.
3. Motivation. Physicians need to be motivated to change health behavior, attitudes and beliefs. Even if we’re online and organized, without a passionate and persistent interest in setting story straight the message will never be heard.

Doctors need online socialization

Physicians may need social media more than patients do. In fact, social activity may be necessary to our professional survival. With the steady march towards participatory medicine physicians are slowly becoming marginalized. Complete disconnection from the conversation doesn’t help. It’s time for physicians to see themselves as the invested other half in participatory medicine.

The role of the physician in the 21^st century will be defined by its role in the social health space. As they say in Washington DC, if you don’t show up at the table you’re likely to wind up on the menu. And so far zealots peddling misinformation are eatin’ us for lunch.

 

It would appear that doctors and nurses in the social space have finally arrived. This week marked the first Blog World Expo with a track dedicated to the medical blogger. BWE brought together some of the web’s most visible medical minds including Kevin Pho (KevinMD), Rob Lamberts (Musings of a Distractible Mind), Kim McAllister (Emergiblog), Bob Coffield (Health Care Law Blog), Paul Levy (Running a Hospital) Mike Sevilla (Doctor Anonymous), and Nick Genes (Blogborygmi), and many more.

From health privacy to the ethical obligation of doctors to be visible on Twitter, the panel-based dialog at Blog World Expo raised as many questions as answers. Medical professionals in the online space face remarkable challenges, especially with regard to transparency, personal boundaries, and the definition of patient privacy. It’s clear that our technology is ahead of our legal and ethical dialog.

Despite those challenges, doctors and nurses in the social space have a remarkable opportunity to build on what’s been done. Many of those at the Blog World Expo medical track have created the digital inroads that are changing the way the world sees doctors and nurses.

Among other things, the experience at Blog World Expo proved to me that online socialization will never replace the power of just getting together. It’s amazing to meet people you have watched for so long. And when you’ve sat and visited, a writer’s online voice seems to make more sense.

Thanks to Johnson & Johnson for sponsoring our track. And an even bigger thanks to Dr. Val Jones (Better Health) for pulling it all together and giving medical bloggers a voice at one of the world’s largest social media meetings.

Hopefully the role of medical professionals at Blog World Expo will continue to grow. Here are a few things I’d like to see in meetings to come:

• Think outside the blog. While he had a lot of discussion about blogs, they’re slowly evolving as a secondary notion in the social media space. The online world now runs in real time. We need to explore the role of live socialization in medicine.
• Bring in the smart people. We need to import the wisdom of non-medical social gurus to help our messaging on health. I would love to hear Steve Rubel tell me now lifestreaming could be applied in some creative way as a physician. We could all take some lessons from Chris Brogan on ways to cultivate our networks.
• Expand the role of social patient. Ultimately they are why we’re here. I expect we could all learn a lot from their involvement in the dialog.

Perhaps there are other things social health professionals need to be talking about. Let me know what you think.