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.