Marketing Tips for Physician Websites

Times have changed for physician practice websites.

Older sites included static content such as the practice name, location, hours of operation, fax and telephone number, procedure instructions, office policies, physician photos and bios, and mission statement.

New websites are dynamic, maintained by the physicians or the office manager, updated weekly, and often include the following:

- Twitter feed and Facebook page

- blog, in addition to the main website

- YouTube-hosted videos

- photo galleries on Facebook, Picasa Web or Google+, Flickr

- interactive options such as a "game corner"for pediatric patients

- contact form via Google Docs, with appropriate HIPAA-related disclaimer

- online scheduling via Google Docs form, with HIPAA-related disclaimer; or ZocDoc (expensive option at $250 per month)

- disease-specific education

- links to other sites

- patient portals

- referring physician portals

- prices for common procedures and typical visits

- virtual tours

- real-time communication

- demonstrations of value and quality

My suggestion would be to start with a few simple steps:

1. Start a free blog on Blogger.com by Google.

2. Share news items and quick tips on Twitter.

3. Launch a practice page on Facebook.

4. Make a few videos about common conditions and procedure, upload them on YouTube and embed in the practice blog.

After all, it only takes seconds to start a blog on Blogger:



References:

Online Marketing 101 for Physicians
Image source: Wikipedia, public domain.

Comments from Twitter:

@dreamingspires (Heidi Allen): Nice and simple

@drmavromatis (Juliet Mavromatis): thanks--some good tips there

How to manage your online reputation as a physician in 5 steps

1. Google yourself - repeat on a regular basis, at least once a month, and set up Google alerts to catch new mentions.

2. Correct mistakes and false information about you that is published online. Contact the site authors.

3. Create your own content - start a blog, Twitter account and Facebook page, use Google+ for draft posts. Send selected news to Twitter, try Facebook for updates from you practice. Link you own blog posts from Twitrter and Facebook.

Setup professional profiles on Google+ and LinkedIn.

Push irrelevant or non-reliable content down in the search results. The farther down the better, as 90% of people won't go past the first page of search results and 99% won't go past page 2.

4. Embrace constructive online criticism. Consider it a 360-degree evaluation.

5. Address actionable items such as "hot button issues" among patients - long waits, lack of response or slow responses.



Cycle of Online Information and Physician Education (click here to enlarge the image). An editable copy for your presentation is available at Google Docs.

I developed the concept of Two Interlocking Cycles:

- Cycle of Patient Education
- Cycle of Online Information and Physician Education

The two cycles work together as two interlocking cogwheels (TIC):



References:

5 ways to manage your online reputation. American Medical News, 2011.

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

Patients directed to online tools don't necessarily use them: 25% checked website vs. 42% read same material on paper. Am Medical News, 2012.

Image source: Wikipedia, public domain.

"Doctors make mistakes. Can we talk about that?" ED physician Brian Goldman's TED talk

Dr. Goldman asks if you know your surgeon's "batting average" of operations with good outcomes. He mentions the three words you never want to hear: "Do you remember?" It's a good TED talk:



Every doctor makes mistakes (just like everyone does). But, says Dr. Goldman, medicine's culture of denial (and shame) keeps doctors from ever talking about those mistakes, or using them to learn and improve. Telling stories from his own long practice, he calls on doctors to start talking about being wrong.

Here are some simple steps to avoid medical errors from a patient's perspective (source: CNN):

1. Say: "My name is Mary Smith, my date of birth is October 21, 1965, and I'm here for an appendectomy."
2. Say: "Please check my ID bracelet."
3. Say: "Please look in my chart and tell me what procedure I'm having."
4. Say: "I want to mark up my surgical site with the surgeon present."
5. Be impolite (this particular piece of advice is obviously controversial).

References:

CNN video: Steps to avoid medical errors

Physician Communication PEARLS from Cleveland Clinic

The video features my former colleagues and hospital medicine stars Drs. Moises Auron and Vj Velez:



Some key messages:

- Establish rapport and plan an encounter with the patient

- Elicit the patient perspective using FIFE (function, ideas, fears and
expectations)

- Apply PEARLS (partnership, empathy, acknowledgment, respect,
legitimation and support) to convey empathy

- Incorporate the patient into decision making and education using ART
(ask, respond, tell)

References:

Relationship-Centered Communication for Physicians (PDF) from Cleveland Clinic Academy

Evaluation of Scrotal Masses - 2014 review from Am Fam Physician

Scrotal masses are caused by a variety of disorders, ranging from benign conditions to those requiring emergent surgical intervention. Painful scrotal masses require urgent evaluation.

Here are some causes of scrotal masses:

- Characteristics that suggest testicular torsion include rapid symptom onset, nausea and vomiting, high position of the testicle, and abnormal cremasteric reflex. Doppler ultrasonography or surgical exploration is required to confirm the diagnosis. Surgical repair must occur within 6 hours of symptom onset to reliably salvage the testicle.

- Epididymitis/orchitis have a slower onset and are associated with a C-reactive protein level greater than 24 mg per L (228.6 nmol per L) and increased blood flow on ultrasonography.

- Acute onset of pain with near normal physical examination and ultrasound findings is consistent with torsion of the testicular appendage.

- Testicular malignancies cause pain in 15% of cases. If ultrasonography shows an intratesticular mass, timely urology referral is indicated.

- Inguinal hernias are palpated separate to the testicle and can cause pain. Emergent surgery is indicated for a strangulated hernia.

- Hydrocele, varicocele, and scrotal skin lesions may be managed in nonurgent settings.

- A biopsy should be performed to rule out cancer in patients with scrotal skin lesions that are erosive, vascular, hyperkeratotic, or nonhealing, or that change color or have irregular borders.

References:

Evaluation of Scrotal Masses. Crawford P, Crop JA. Am Fam Physician. 2014 May 1;89(9):723-727.
http://www.ncbi.nlm.nih.gov/pubmed/24784335

Image source: The shield and spear of the Roman god Mars, which is also the alchemical symbol for iron, represents the male sex. Wikipedia, public domain.

Unintentional Weight Loss in Older Adults - 2014 review of Am Fam Physician

Unintentional weight loss in persons older than 65 years is associated with increased morbidity and mortality.

What are the causes?

The most common etiologies are:

- malignancy
- nonmalignant gastrointestinal (GI) disease
- psychiatric conditions

Overall, nonmalignant diseases are more common causes of unintentional weight loss in this population than malignancy.

Medication use and polypharmacy can interfere with taste or cause nausea and should not be overlooked. Social factors may contribute to unintentional weight loss.

A readily identifiable cause is not found in 16% to 28% of cases.

What tests may be done?

Recommended tests include a complete blood count, basic metabolic panel, liver function tests, thyroid function tests, C-reactive protein levels, erythrocyte sedimentation rate, glucose measurement, lactate dehydrogenase measurement, and urinalysis.

Chest radiography and fecal occult blood testing should be performed. Abdominal ultrasonography may also be considered.

When baseline evaluation is unremarkable, a three- to six-month observation period is justified.

What are the treatment options?

Treatment focuses on the underlying cause. Nutritional supplements and flavor enhancers, and dietary modification that takes into account patient preferences and chewing or swallowing disabilities may be considered. Appetite stimulants may increase weight but have serious adverse effects and no evidence of decreased mortality.

References:

Unintentional Weight Loss in Older Adults. Gaddey HL1, Holder K2. Am Fam Physician. 2014 May 1;89(9):718-722.
http://www.ncbi.nlm.nih.gov/pubmed/24784334

Image source: Wikipedia, public domain.

Cirrhosis - 2011 update from Am Fam Physician

Cirrhosis is the 12th leading cause of death in the United States. The mortality rate is 9.7 per 100,000 persons.

The most common causes of cirrhosis are:

- alcohol abuse
- viral hepatitis
- nonalcoholic fatty liver disease is emerging as an increasingly important cause

Patients with cirrhosis should be screened for hepatocellular carcinoma with imaging studies every 6-12 months.

Causes of hepatic encephalopathy include:

- constipation
- infection
- gastrointestinal bleeding
- some medications
- electrolyte imbalances
- noncompliance with medical therapy

Treatment

Lactulose and rifaximin are aimed at reducing serum ammonia levels.

Ascites should be treated initially with salt restriction and diuresis. Physicians should be vigilant for spontaneous bacterial peritonitis.

Patients with acute GI bleeding should be monitored in an intensive care unit, and should have endoscopy performed within 24 hours.

Prevention

Mechanisms to reduce the incidence of cirrhosis:

- treat alcohol abuse
- screen for viral hepatitis
- control risk factors for nonalcoholic fatty liver disease

Cirrhosis: Phil's story (video):



From NHSChoices: Many people enjoy a drink in the pub after work without realising how social drinking can damage health. Phil didn't realise the harm his alcohol intake was doing until he was diagnosed with cirrhosis of the liver. He talks about his experience and the shock he felt at being diagnosed.

References

Cirrhosis: diagnosis, management, and prevention. Starr SP, Raines D. Am Fam Physician. 2011 Dec 15;84(12):1353-9.

Cirrhosis - JAMA Patient Page, 2012.

A Physician with a Smartphone: Endless Possibilities for Patient Care Improvement

"In this video, Ivor Ković, a physician from Croatia, talks about how he uses the iPhone in his daily medical practice. He shows how even simple technology (starting with SMS) changes work behavior of physicians and patients. He goes on to showcase some of the apps he uses and introduces us to "Little Anne". But the most interesting part of the video is possibly where Ivor shows his own innovation on how the iPhone can be used to deliver quality CPR."

There are several health-related talks from Mobile Monday Amsterdam 2010 available on YouTube at http://bit.ly/c0bMF0

Genital ulcers - 2012 review from Am Fam Physician

Here is an excerpt from a review article in the official AAFP journal American Family Physician:

Causes of genital ulcers

Herpes simplex virus (HSV) infection and syphilis are the most common causes of genital ulcers in the U.S.

Other infectious causes include:

- chancroid
- lymphogranuloma venereum (LGV)
- granuloma inguinale (donovanosis)
- secondary bacterial infections
- fungi

Noninfectious etiologies of genital ulcers include:

- sexual trauma
- psoriasis
- Behçet syndrome
- fixed drug eruptions



CDC Streaming Health | This video, produced by Be Smart. Be Well., raises awareness of Sexually Transmitted Diseases (STDs): 1) What are they? 2) Why they matter? and, 3) What can I do about them? Footage courtesy of Be Smart. Be Well. http://www.besmartbewell.com, featuring CDC's Dr. John Douglas, Division of Sexually Transmitted Disease Prevention.

Diagnosis

The following tests should be considered in all patients:

- serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum
- culture or polymerase chain reaction test for herpes simplex virus (HSV)
- culture for Haemophilus ducreyi in settings with a high prevalence of chancroid

No pathogen is identified in up to 25% of patients with genital ulcers.

Treatment

The first episode of herpes simplex virus infection is usually treated with 7-10 days of oral acyclovir (5 days for recurrent episodes). Famciclovir and valacyclovir are alternative therapies.

One dose of intramuscular penicillin G benzathine is recommended to treat genital ulcers caused by primary syphilis.

Treatment options for chancroid include a single dose of intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin.

Lymphogranuloma venereum and donovanosis are treated with 21 days of oral doxycycline.

Treatment of noninfectious causes of genital ulcers varies by etiology, of course. Topical wound care for ulcers caused by sexual trauma. Subcutaneous pegylated interferon alfa-2a is considered for ulcers caused by Behçet syndrome.

References:

Diagnosis and management of genital ulcers. Roett MA, Mayor MT, Uduhiri KA. Am Fam Physician. 2012 Feb 1;85(3):254-62.

Physician Burnout - Mayo Clinic video

Researchers at Mayo Clinic reviewed 54 burnout studies worldwide to see if there is any validity to the longstanding belief that practicing in the hospital incites greater burnout. The studies included data from more than 5,000 outpatient physicians and more than 1,300 inpatient physicians.

"Burnout is everywhere and if you look for it you'll find it," says Daniel Roberts, M.D., an Internal Medicine physician at Mayo Clinic Hospital in Arizona and lead author of the study. "What this study tells us is that it is as much a problem for clinic-based doctors as it is for hospitalists and others who work in shifts. It's a little reassuring to find that hospitalists aren't particularly prone, but it's more concerning how burnout spans different specialties and practice locations."



Reference:

Burnout in inpatient-based versus outpatient-based physicians: A systematic review and meta-analysis. Daniel L. Roberts et al. Journal of Hospital Medicine Vol 8 Issue 11.
http://onlinelibrary.wiley.com/doi/10.1002/jhm.2093/abstract