The evolution of a physician's blog

Dr. Smith presents his research poster, which charts the tremendous growth of his eponymous blog, Dr Smith’s ECG blog. The blog is practically free to maintain, hosted by Google's service, Blogger.com, and will break 1,000,000 page views this year. The site itself represents a living and breathing, dynamic textbook: http://hqmeded-ecg.blogspot.com



Dr. Stephen W. Smith is a faculty physician in the Emergency Medicine Residency at Hennepin County Medical Center (HCMC) in Minneapolis, MN, and Associate Professor of Emergency Medicine at the University of Minnesota.

Physicians and social media - ACP Hospitalist features Dr. Rob

From ACP Hospitalist:

"Dr. Lamberts’ words aren’t just vanishing into cyberspace. His blog, Musings of a Distractible Mind, gets about 20,000 visitors who view 50,000 pages a month, according to his own analytics data. By the end of 2009, his list of Twitter followers numbered nearly 1,500 and counting.

Today’s physicians have an ever-expanding number of social media vehicles through which to express themselves. Tools like Twitter, Facebook and blogging can potentially help physicians better educate and interact with patients, perhaps even humanizing themselves in the process. But mishandling that powerful online megaphone can potentially risk, or at the very least blur, the doctor-patient relationship, according to social media-savvy physicians.

Initially, when he was virtually unread, Dr. Lamberts said he blogged about a few interesting cases, always cloaking the patient details. But he soon halted that practice."

I follow a similar approach described in detail in the website disclaimer:

"There is no real life patient data on this website. Please note: we do not write or “blog” about patients. All case descriptions are fictional, similar to the descriptions you can find in a multiple choice questions textbook for board exam preparation. Cases course and description do not follow real cases."

http://clinicalcases.org/2002/01/disclaimer-and-terms-of-use-agreement.html

Image source: OpenClipArt.org, public domain.

Related:

Risks and Benefits for Physicians Who Use Social Media/Web 2.0

From the newsletter of the AMA, AmMed News: "Social media behavior could threaten your physician reputation and job prospects. Less is more." How do you expect doctors to use social media more when they are "bombarded" with headlines like this. There is little on the positive aspects of social media in this particular article although the AmMed News has published some better, more nuanced and balanced, reports on social media use in the past.

Practical benefits of social media for a physician practice

In addition to the obvious benefits for a physician practice to be open and social, there are some practical advantages of using social media. KevinMD shares the example of a patient who searches for "primary care doctor Nashua" (where he works) and Kevin is in the top search results due to his heavy use of social media - blog, Twitter, RSS, email subscriptions and Facebook. He also employs some "white hat" search engine optimization to ensure that his relevant pages are well-ranked by the search engines.

Benefits of social media in day-to-day clinical work

I use my own blogs as an useful archive of hand-picked and reviewed articles that is classified with appropriate labels (e.g. asthma, food allergy, etc.) and is fully searchable from any Internet-connected device: desktop PC, laptop, netbook, iPhone and even Kindle. All doctors may benefit if they use a similar resource created by them.

Let me give you a few real-life examples of social media use in clinical work:

- A patient needed instructions on dust mite control - I pulled my own mind map on the screen and discuss it with them http://bit.ly/cSxpQW

- A patient wanted to know about the new angioedema therapies - I pulled a different mind map and we discussed the different options http://bit.ly/caWmS7

- A colleague was unsure about "wine allergy" and its connection to wasp and bee venom - I searched my own blog on the cell phone: http://bit.ly/cykR2g and found a relevant article that I had read months ago which answered his clinical question http://bit.ly/bCdoeg

When working on the blog, I am often more like a "curator" of medical content (collecting the best articles and links) rather than a "producer" (creator of de novo content). Sometimes a doctor with a smartphone is more helpful than "a crowd" ("wisdom of crowds" or not) trying to recall an obscure fact, disease or complication from distant memory.

Benefits of social media for academic collaboration

The benefit of social media in academia is well-proven at this point if one is inclined to use such tools. For example, I have co-written more than 100 abstracts and 25 articles with the help of the online office suite Google Docs.

However, I don't think that a physician not using social media is at risk of becoming irrelevant (something mentioned recently). This is a limiting view.

I look forward to your feedback Please let me know what your think in the comment form embedded below this post.

Image source: OpenClipArt.org, public domain.

Scaring physicians away from using social media

Is there a doctor who wants to spend 3 hours per day on social media while running the risk of being sued?

This useful critical review by a freelance journalist at the NEJMJobs site has a focus on some of the litigation risks inherent to the use of social media in healthcare:

http://www.nejmjobs.org/career-resources/social-media-and-physicians.aspx

"Dr. Pho, who spends up to three hours a day in social media activities, is surely in a minority of physicians who devote considerable time to blogging, Twittering, or engaging in Facebook updates.

Social Media Activity Risks Difficult to Predict

Despite the potential professional benefits of social networking participation, some physicians are approaching the social media realm with trepidation, for fear that personal and professional presences will overlap in a manner that increases liability exposure.

That’s a valid concern, because the medico-legal aspect of social media activities has been little explored and is not well understood. In addition, the obvious risks of incurring HIPAA violations should patients’ health information be unwittingly exposed are a deterrent. “The laws haven’t caught up with social media and networking, so to be safe I don’t blog about my patients,” Dr. Pho said. “Even though I think that interesting or challenging cases can be used as a learning tool, too much of my professional livelihood is at stake.”

None of the physicians interviewed for this article have accepted patients’ requests to become Facebook friends, and all cited concerns that doing so would “cross the boundary” between a personal and professional relationship.

"I think that very few doctors are interacting with patients directly on Facebook because we’re so terrified of being accused of practicing medicine and getting sued. Whatever you type is eternal and a perfect record of whatever you said,” she said. “That makes it all even more scary.”

“We’re concerned about this because there have been instances in which physicians have used Facebook in an inappropriate manner,” said David Troxel, MD, The Doctors Company’s medical director. “Social media networks are not HIPAA compliant and are just not appropriate for any physician-patient communication, so it’s a real liability threat because it’s so easy to lapse into a casual conversation.”

The NEJMJobs article linked in the paragraph above does not discuss the use of social media for medical education of students, residents and patients.

Another area that was not highlighted enough was the widespread use of Facebook "fan pages" by hospitals and physicians to attract patients and create relationships. Does this mean that the patients can be "your fans" but not "your friends"?

Overall, this article is a good review of some of the risks involved with the social media adoption in healthcare.

However, for a more nuanced approach to social media use by physicians, please review this detailed primer by the cardiologist Dr. Wes:

http://drwes.blogspot.com/2010/03/for-cardiologists-twitter-primer.html

Related:
Facebook Friend Request - A young doctor gets a message from a dying patient - NYTimes, 2010.

Social Media Raise Liability, Ethical Questions for Doctors as Internet is challenging traditional boundaries. Boston Globe, 2010.

Image source: OpenClipArt.org, public domain.

Updated: 04/13/2010

"Physicians - grumpy and getting grumpier"

By the numbers:

According to Sermo.com and their Physician Sentiment Index℠ (PSI):

- 64% of physicians cited the current healthcare climate as somewhat or very detrimental to their delivery of quality care

- Only 22% are optimistic about the ability of the American physician to practice independently or in small groups

- 59% are of the mind that the quality of medicine in America will decline in next five years; only 18% believe the quality of medicine will improve

- 53 percent believe pay-for-performance will have a negative/very negative impact on the effort required to get paid

Comments from Google Buzz:

Nicholas Genes - Sigh. This poll was comprised of 1000 docs on Sermo, which might very well be a self-selecting group of grumpy physicians. Also, this poll was sponsored by Aetna, an insurance organization with perhaps a vested interest in sabotaging health insurance reform and publicizing physicians' negative perceptions of health care. I wouldn't put too much weight on these results.

Ves Dimov, M.D. - Exactly. The title catches some of the sentiment of many doctors though.

References:
http://www.thehealthcareblog.com/the_health_care_blog/2010/03/the-numbers-tell-the-story.html

Image source: sxc.hu

7.2% Decrease in Work Hours of U.S. Physicians Between 1996 and 2008

After remaining stable through the early 1990s, mean hours worked per week decreased by 7.2% between 1996 and 2008 among all physicians (from 55 hours per week in 1996-1998 to 51 hours per week in 2006-2008.

Excluding resident physicians, whose hours decreased by 9.8% due to duty hour limits imposed in 2003, nonresident physician hours decreased by 5.7%.

Physician fees decreased nationwide by 25% between 1995 and 2006, coincident with the decrease in physician hours.

A steady decrease in hours worked per week during the last decade was observed for all physicians, which was temporally and geographically associated with lower physician fees.

References:
Trends in the Work Hours of Physicians in the United States, February 24, 2010, Staiger et al. JAMA 303 (8): 747.

From Happy Hospitalist:

"That means your doctor earns 25% less today than they did just a decade ago. If you went to college and joined a company that said up front you would be paid 25% less in a decade than you were paid on the day you were hired, would you join them?

Why are physicians working fewer hours, a trend unique to doctors? The conclusion was reduced pay. Physicians just don't seem inclined to spend long hours in the office and hospitals to sacrifice their family life for the life of their patients when the the economic reward of doing so just isn't there.

I've talked with many subspecialists at Happy's hospital about the declining payment for their efforts. They all tell me exactly the same thing. They are going to work less and limit their hours as payment reductions come down the pipeline."

Image source: sxc.hu

The Lancet: Nephrology is not for normal doctors - it is for exceptionally skilled specialist physicians

From The Lancet:

Many doctors may view nephrology as a remarkable kind of intensive care. A patient presents in an acute crisis, close to death. Immediate transfer to the renal team follows, then the magical effects of dialysis, and finally recovery. Nephrology is not for normal doctors. The kidney is for exceptionally skilled specialist physicians.

Unlike fish, mammals do not seem to have renal regenerative capacity.

The silence of the kidney leads medicine to overlook its importance. This lack of awareness means that immense opportunities to prevent not only renal, but also cardiovascular, diseases are being lost.

References:
Protect the kidney, protect the heart. The Lancet.

Image source: Wikipedia, public domain.

Physicians as a group are leaner, fitter and live longer than average Americans

From the WSJ:

Physicians as a group are leaner, fitter and live longer than average Americans. Male physicians keep their cholesterol and blood pressure lower.

However, doctors are less likely to have their own primary care physician—and more apt to abuse prescription drugs.

Lifestyle habits

Exercise: Many physicians say they "embed" it into their lives, making it a non-negotiable part of their daily routine, often early in the morning before demands pile on. One doctor says he gets up at 4:45 a.m. virtually every morning to train for marathons he runs. "But by 8:30 at night, I have the IQ of a zucchini," he says.

Smoking: Only 2% to 4% of physicians smoke cigarettes, compared to roughly 24% of the U.S. population.

Stress: For all their good habits, it's no secret that doctors are under enormous pressure.

References:

What Patients Can Learn from the Ways Physicians Take Care of Themselves. WSJ.
Chicago doctors talk about healthy habits in their own lifestyle - not surprisingly ladies do a lot better than the guys http://goo.gl/jFf7w

Image source: OpenClipart.org, public domain.

Comments from Twitter:

@IrfanDhalla (Irfan Dhalla): Wonder if they still would be after adjusting for income? MT @DrVes: Physicians as a group are fitter and live longer goo.gl/b5C3