If you’re a physician who uses Twitter, you’ve probably seen tweets from Medical Axioms. Medical Axioms is a Twitter-based collection of wit and wisdom created by Dr. Mark Reid, a Colorado-based Hospitalist.

As simple as his wisdom may be, Medical Axioms gets amazing engagement with RTs and likes sometimes numbering in the thousands. Beyond just metrics, you get the clear sense from the public conversation that Medical Axioms brings something bigger than just clinical tips and advice. There’s a motivational thread running through this feed that’s hard to tease out.

So what’s at the root of Medical Axiom’s success? I can only guess. But in a medical world that is increasingly driven by technology, Medical Axioms pulls us back to our roots. When I read these bits of wisdom it makes me remember that there is still so much that I can shape at the bedside given a little judgment and thought. His words hang where doctor, patient and thinking come together. His constrained bits of advice always put the patient first.

I was thrilled to get some time with Dr. Mark Reid to learn more about his motivations and processes. As you will see, how he landed with one of the hottest physician Twitter feeds is a function of his passion and some very unique personality traits. I was most interested in why Dr. Reid’s style and format seem to resonate with physicians and medical trainees.

I would characterize Mark Reid as one of the most interesting physician voices in the public realm. He offers a great example of how a physician can poke at a medium and make it work in the most unique way for reach and engagement.

You can find his book, Medical Axioms, over on Amazon. I hope you enjoy the interview.

When I look at powerful physician voices I think about what value they bring to their audience. What value do you bring?

I’m a straight talker. There is a lot of bluff in medicine—people afraid to say they don’t know and afraid to be outsmarted by others. It goes back generations. Traditionally it’s been a tough crowd with high standards. What this means is that there is a lot of hidden truth to the practice of medicine. There is a lot of material that everyone knows (or believes in their heart) that they have never discussed in public or even with a closed-mouth colleague.

Why do Medical AXIOMS resonate and what do you think are the circumstances that have lead to your following?

This project is no accident. I set out to build a community of doctors and to build a library of “truisms.” I started with books of quotes by Hippocrates and Galen, Osler and Francis Peabody. I realized their accomplishments were great for their time but a) many of their “truths” had been broken by science and b) there were a lot of daily lessons taught in the wards of the world’s teaching hospitals that had never been documented.

Are there individuals or writings in history that have influenced you or what you do?

I have four primary texts I go to when I need inspiration: The Quotable Osler, A Little Book of Doctor’s Rules by Clifton Meador, Kill as Few Patients as Possible by Oscar London, and a book of medical quotations by Oscar London.

Any idea about the demographics of your audience? Who follows you? Or more importantly, who responds to you?

My core group is med students, residents, fellows and the academic physicians who teach them. Interestingly, many of my closest friends on social media are like me —mid career physicians and many of them practice in the private or non-teaching world. Some students and pre-meds seem a little timid about replying to me but I am a non-hierarchical person. I believe good ideas can come from anywhere just like bad ones do. Last time I checked about 50% US, most of the rest Canada, UK, middle east, AUS and NZ

What do you think inspires young doctors?

Young doctors show up inspired. Then we ruin them with our sarcasm and bitterness. In my view, we should borrow their optimism and stop teaching cynicism.

If Osler were alive, what would he think of new media formats like Twitter and how would he use them?

I think he would love it! He was a man of letters and read many books trying to connect himself to other great minds. He would be giddy to be able to open up his laptop and join in an exchange like we have here. One thing he would not like is the Google search bar. Turns out as a guy who spent more time with books than most people, he also became a bit of a thief of good words. Some of his attributed quotes are word-for-word the work of someone else. Others are paraphrased. Don’t think I am judging. I do the same thing every day. More than once I have searched my database to find when I first tweeted something only to find that someone else had written something similar days before, which I had certainly read!

Did you publish or share medical AXIOMS before Twitter?

My teaching style has always been the same. I have had doctors who rotated with me as residents who still recite memorable quotes. My mom said when I was a kid, I talked like Mark Twain—sort of turning everyday sense into little rules and funny sayings. He is one of my heros.

On rounds do you walk around regurgitating medical AXIOMS or is it only on Twitter?

I really do teach this way. It’s funny because we all know science and evidence based practice is more reliable than n-of-one “I saw a case once,” but it is also very hard to remember. If you can hook the learner with something memorable, as long as it’s mostly right, it will stick with them better than the p-value from the study or the exclusion criteria from the methods. It is truly more efficient to learn a rule and its exceptions than the detailed analysis of every situation. Medical judgment is done on the fly and must be done efficiently .

What does your wife or partner think of what you do?

I’m a divorced guy and in general my lady friend is supportive of the project but not particularly interested in the details. Which is good. I have become mildly famous among a tiny subset of medical professionals and I wouldn’t want that to go to my head. She does say I check Twitter to much and I’m figuring out how to keep this project inside some boundaries.

Does your hospital have any idea of what you do?

I gave a talk at a medical staff meeting about my project and what I have learned. They appreciated it because the topic was how to stay out of trouble on social media. Although it may seem like a stream of consciousness, there is heavy editing going on all the time and probably 50% of the tweets are never posted. There is a basic standard I maintain: Am I okay having any of these 4 people read this tweet: A patient, my boss, my mom, and the cover of the Denver Post newspaper. If the answer is yes, no problem. I will publish it.

Has a patient ever commented on what you do? Or are they unlikely to know?

I have had 2 patients look me up and read my own writing back to me in the hospital. This happened early on and it was very helpful to me in a cautionary way. Fortunately neither were anything bad. Taught me to be cautious though.

Where and when do your best ideas come to you?

This is a great question. My recipe for success involves taking advantage of inspiration when it hits. If you read about any artist or writer they will say the foundation of success is discipline. Sit down and force yourself to work a lot. I do exactly the opposite!! I just go to work, go to the gym, go on a hike, whatever. The words float down on a little slip of paper like a fortune cookie fortune right out of the sky. Twitter is my notebook. I jot them there, sometime to publish and sometimes for editing later. What I can’t do is wait to write. I have about 15 seconds between when I think of something and when it is gone. A few last until the next day but hundreds of times I have waited until I got out of the elevator or waited until I sat down and some super brilliant thing was just gone.

If you think of a medical AXIOM in the shower what do you do?

Say it over and over and over until I can write it.

Tell us about your process. Where do you capture ideas? Tell us about your hardware for penning medical AXIOMS? And how do you catalog them?

I write down the axioms on my phone. Very stream of consciousness. The cataloging is a very different story. The only way I can do it is to download the entire twitter stream (one button on Twitter). Then I have to try to put them into groups. The problem is I repeat myself and it’s a huge file like 40,000 tweets. The result is what you see in the first edition Medical Axioms book—a lot or original material and some repeats. Some threepeats. One of them appears something like 8 times. It’s a good one, but still. The solution would be to hire an editor and literally pick a keyword out of every single aphorism then week out the duplicates. As they say, ain’t nobody got time for that.

Tell us something about yourself we could never tell from Twitter?

I have horrible social anxiety and fear of public speaking. I really can’t do it and I really can’t present the same tone and content as I do writing. I write everything. I never talk on the phone. I text people who are in the same room as me. This may be why I have developed such a causal conversive style of writing, but its really a bit of a handicap! And it explains why while I might have a certain success with the Medical Axioms project, I will never be one of those writer guys who goes around public speaking everywhere all famously. It gives me hives.

Tell us about your internal logic for scheduling tweets. Do you cluster at certain times?And how many do you post per day?

Early on I tried to figure out when to use the medium for maximum effect. Then I gave up. At any moment, somewhere in the world, there are medical people sitting around, not sleeping, whether working, getting ready for work, or trying to decompress after work. I find them wherever they are, whenever I happen to be inspired and available.

What percentage of medical AXIOMS on a given day are new vs slightly used?

Somewhere between 0-100%. All aphorism are spawned either by me reading someone else’s words that day, seeing a patient that reminded me of something in the last few months, or remembering something I say all the time.

Have your medical AXIOMS ever been used or copied without attribution?

This happens often. There have been ghost accounts that basically copy and paste my work exactly for days on end. I have 2 solutions for this: 1) I don’t care as long as they aren’t making money from it and 2) I write in a very idiosyncratic style. Speechwriters and songwriters write words that can be used by anyone. They adhere to rules of syntax and grammar and use words conventionally. I break these rules intentionally to leave a “fingerprint” in my writing so I can spot my work even when it is presented by someone else as their own. If they change it a lot, I might not notice, but it’s not stealing then. When I see my words written in my style, it kind of makes me giggle because they are sometimes so awkward! I’ve always played with language and words a lot and when I hear something strange and different in someone else’s speech pattern, I sometimes just borrow it!

Have you ever edited a medical AXIOM and made it better?

There are aphorisms that I have worked and reworked 10 or more times. In fact, as I published the book this past winter, I touched and edited at least 20% of the quotes as I went. I’m not sure if I actually make them better but it becomes a little bit of a compulsion to get them to sound just right. When there aren’t that many words and I am trying to summarize something as important as medical judgment, it matters to get it very close.

What’s your issue with raisins?

I hate them. They look like chocolate chips but they are dead grapes and it looks like a good cookie and then it’s a fruit funeral.

I notice that you don’t engage heavily with your audience. I mean in terms of back and forth with your commenters threads. Do you have any internal guidelines you adhere to?

I try not to waste too much time. I’m really just taking notes and everyone is reading them! I like to connect people, show appreciation for good work, and build a community. But I’ve learned that too much discussion achieves the opposite. So what you see is a struck balance.

Have you ever had a medical AXIOM troll and how did you handle it?

Any people who attack me personally I simply block. My feeling is I am giving away something worthwhile for free (experience, knowledge, aces to a professional). As my pop used to say, you can’t look a gift horse in the mouth. People aren’t paying enough to criticize and they’d need to pay me $50 a line to attack me personally. Last time I checked I had blocked about 200 people. I’ve unblocked a few. Two, actually.

Do medical AXIOMS have a downside, potentially?

You can’t actually summarize medical judgment in 140 or 280 characters. There are always exceptions and it’s possible that an aphorism could lead an inexperienced provider to make a mistake. For that reason, I often choose to bias my axioms towards caution. Insufficient caution causes more errors than excess, although a balance between is where good medicine is practiced.

I notice that you don’t have a disclaimer on Twitter. Why not?

My little bio thingy does say “Tweets are not medical advice.” Beyond that, I don’t feel that I can take more responsibility for the reader.

Have medical AXIOMS ever gotten you into trouble?

No.

I think medical AXIOMS were better in 140 than 240. What say you?

I still try to live in the “half a tweet” world. I definitely had to work much harder to squeeze them in back in the old days. But I honestly think 240 is beyond the modern reading comprehension limit. So I usually only of over with lists, references, when writing a story in prose, etc.

Any interests in writing beyond the constraints of twitter?

This may surprise you but I kind of can’t write. I can write a short poem or a tweet. When I get into a bigger space, I lose my way. My conversational tone starts to feel like I am dictating into Siri while driving in my car. I definitely can’t write fiction. I might be able to write sort of a set of short stories. More like Pulp Fiction than Glengarry Glen Ross.

What will become of you when Twitter sunsets?

Hopefully by then I will have moved into the paper book world.

Why did you choose an analog tool like a book to curate something popularized in a space like Twitter?

Funny thing that. I wanted to collect the tweets in case I die or something. I honestly thought people would only get the ebook version. I put up the paper book file as an afterthought and when it started to sell, I realized it was very ugly—full of misspellings and bad formats. So I spent every spare minute for about a month trying to fix it. I don’t know why people like the paper. I guess it just feels consistent with my message which is very old fashioned.

Where do you see the potential with medical AXIOMS? Or do you see any extension onto other media formats?

I have a web site. My brother the engineer thinks I should have a tear off calendar like the Far Side with an axiom a day. I might go there if I ever had a real live publisher. The problem there is that my audience is tiny. Pretty much anyone who ever needs to hear about me has already heard about me!! Part of my schtick is that I talk straight and use the current medical vernacular. When lay people (like my other brother the engineer) tries to read this stuff, they have to keep a google search bar open to look up all the nicknames and acronyms. So that’s one place I could go—a book or something that stands right in between Medical Axioms and Grey’s Anatomy. Right where the 70’s show Quincy used to reside.

Anything else you’d like to share?

I’d like to thank all the people who interact with me on the Twitter. It looks like my project but I’m often just the curator. It’s the exchange that is rich. If I sat in a quiet room and tried to write medical aphorisms, I would maybe get to 20, not 1000+. So if you are reading this and you’ve been a part of these exchanges through the years, thank you!

Links to Amazon within Dr. Reid’s answers were placed by 33 charts and are part of the Amazon Associate program.