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Writing

About a month ago I got an invitation by John Schumann, who authorizes the Glass Hospital blog to go to Iowa.   Now, I don't consider going to Iowa a particularly bad thing, but it is an unusual place to be invited to.  I am all in favor of corn and abundant use of the word "Sioux," but it's not quite like Las Vegas, DC, or Buenos Aires (all of which have been previous invitations).

It turns out, I wasn't invited there to gaze in wonder at "America's Breadbasket," but to be part of a pannel of speakers at a writer's conference called The Examined Life: Writing and the Art of Medicine. John invited me to speak along with him and with Michelle Au, who authors the wonderful blog, The Underwear Drawer (no, it's not about boxers, briefs, and thongs - just go over there and read her explanation for the name). We would have a pannel discussing the subject of doctors who blog - the why, what, where, and how.

So why Iowa?  First, it would have been a mistake to go somewhere else, as the conference is being held in Iowa.  We really wouldn't have gotten anyone to come to our pannel discussion if we went to North Dakota.  Second, it turns out, Iowa is a hotbed of writers.  Here is their explanation:

The University of Iowa is among the nation’s premier centers for creative writing, and its programs attract writers from all over the world. A dozen Pulitzer Prize-winners, numerous National Book Award recipients, and four recent US Poet Laureates have attended the University of Iowa. The University is home to the International Writing Program, the Nonfiction Writing Program, the Iowa Summer Writing Festival, and the Iowa Review. It is also home to the Iowa Writers’ Workshop, the first creative writing degree program in the United States, and the model for contemporary writing programs.

So that's why it's in Iowa.  Who'd have thought that it was such fertile soil for writers?  (Sorry).  The conference runs from April 21-23.

So why go to a writer's conference?  Why talk at it?  I've come to a stark realization about myself recently: I am a writer.  I write this blog, I write podcasts every week, I write for other publications.  I have written articles, and have written a chapter of a book.  I even have tried my hand at novel-writing.  I write, and I write a lot.  That's a big change in the past five years.

This blog is the cornerstone of my writing experience.  When I started it 4 1/2 years ago, I didn't really know I could write like this.  I just wanted to blog because, well, I think I just liked the word "blog" and wanted to be able to say "I have a blog."  It sounds impressive.

Whatever the reason, I now spend a good portion of my free time writing.  It's gone from experiment, to self-realization, to chore (sometimes), to a natural part of who I am.

Since there are many of my readers who have a blog, or have other areas in which they write, I will share what I've learned about writing on my journey over the past five years.

1.  Just Write

I am always practicing and always learning in my writing.  There is always a lot of room for improvement, and I see myself still as a novice at this.  I get paid from several sources, but overall I do it for the love of doing it.  But when I look back on my writing back when I started, I see a lot of progress.  It's much easier to take a vague idea and turn it into a blog post than it was back then.  There is one thing that has made this happen: practice.  Writing is something learned by doing, not by instruction.  Instruction is OK, but I think it is far more beneficial after you've been writing for a while.

2.  Force Yourself

I am fortunate in the fact that I've not had a prolonged case of writer's block.  That is not to say that I haven't sat and stared at a post totally lost as to where I wanted to go with it.  The podcast is especially hard because it requires that I write on a deadline.  Yet the act of repeatedly going back to write when I didn't think I had it in me has made it much easier to get the juices flowing on demand.  The more you force yourself to get the job done, the less you will have to force it in the future.

3.  Keep it Varied

I tend to exhaust my thoughts about a subject (no snide remarks, please).  I write about something until I don't know what else to write.  Yet because I have allowed a huge variety of topics on the blog, I can always turn to something different.  When I write about healthcare reform enough, I turn to humor.  When I feel like I am becoming trite or too opinionated, I write about some personal thoughts or feelings regarding being a doctor.  The best decision I ever made early on was to not put significant boundaries on what I should write about.

My recent dive into creative writing (through NaNoWriMo) has opened up a whole new area of writing for me.  I honestly didn't think I had the constitution to write a book, especially one that's fiction.  The important thing was a willingness to try it.  Stepping out on that limb, and accepting that I could fail at it, gave a whole new area I would have otherwise never known.  Heck, doing the blog in the first place was that same sort of step.

4.  Keep Perspective

I write from my own perspective -- the sum of my roles in life.

  • I am a doctor, a primary care doctor in private practice
  • I work in the US at a time in which the system is going through huge changes
  • I am also a guy in his 40's who has made many mistakes, but has also learned a great deal just from living
  • I love humor, and I like to make people laugh
  • I am a husband and a father.

I try to stay true to my own perspective.  The wide variety of topics comes from the wide variety of roles I have.  When I write, it is always from at least one of those perspectives.

So, to those of you with time on your hands and a hankerin' for some corn, why not attend the conference in Iowa?  I'd love to meet more of my fellow writers and readers.  And to those who are thinking about or are struggling with writing, I say: do it.  To me, writing is a means by which we let our minds grow.  It takes ideas and expands them, it takes risks, it travels down new paths.  Writing makes life bigger.

Taking that plunge has definitely changed my life for the better.

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Getting Social

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Moving to the south is an eye-opening experience.  First, there's the friendliness of everyone; I remember the first time a stranger talked to me in the grocery store, it made me nervous.  In Philadelphia, where I went to med school, anyone talking to you in the grocery store was either hitting on you or crazy.  Add to that list: "or from the south."

Then there's the politeness factor.  Kids are expected to say "yes sir" and "yes ma'am" when answering questions asked by adults.  Most northern-bred transplants to the south that I've talked to think this is a good thing - a refreshing change from the rudeness you often get from kids.

But perhaps the most foreign thing in coming to the south is something called "Social."  Yes, the picture above is from their website.  Social is a manners school where kids are not only taught how to eat right at the dinner table, but also how to address members of the opposite sex and to perform various dances with a partner.  The formal training happens around 6th grade, but the talk of who will get partnered with whom is fodder for many parental discussions for several years leading up to the actual course.  Parents arrange partnerships between their children - kind of like arranged marriages.  My two oldest kids participated in Social (which is run by a local family), and gave it mixed reviews.  We didn't force it (although we did get calls regarding our kids' availability), and one of them liked it enough to do it three years, while another barely tolerated one.

All of this came to mind because of a phone call I got this morning requesting an interview about social media and the medical field.  How are doctors handling blogs, Twitter, and Facebook?  What are the guidelines I abide by, and should the professional societies (AMA, ACP, etc)  be involved it directing their members on how to use social media?  The interview was particularly timely because I was working on a post that quoted some funny patient/doctor interactions, but was having second-thoughts due to confidentiality concerns.  How do I quote patient interactions without making it sound like I'm making fun of them?

So, I thought it would be fitting to write my "Ten Commandments of using social media."  They aren't really commandments, but I like to feel like Charlton Heston every once in a while.

1. HIPAA is the final say. HIPAA has privacy statutes that set clear boundaries of what can and cannot be said about individual patients.  The bottom line is that the only way we can reveal information about patients to others is by their consent.   Social media has a lot of pitfalls in this area, including: doctors blogging about individual patients and direct communication over Twitter and Facebook about doctor/patient matters.  Breaking this rule is not just an ethical violation, it is a legal one.

2.  Obey the "elevator rule."  In medical school we were taught the "elevator rule," which states that you should never talk about patients in the elevator when there is anyone else present.  You must assume you will be overheard.  In the same way, social media is about communicating with a large number of people and so should be used with the same assumption.  Don't write anything you wouldn't want your patients to read.

3.  Think before using social media. The lines of what can and cannot be written using social media become gray quite quickly.  Is it OK to talk about people you saw today, or should you wait a few weeks?  What facts do you need to change to make identifying the patient impossible?  What do you want your patients to know about you?  All of this springs from your overall philosophy of using social media.  My blogging is driven by a desire to show doctors to be regular humans, so that is what I write about.  Facebook, on the other hand, is for me to connect with friends (except on my Fan Page, where I interact with readers).

4.  Don't friend your patients on Facebook. This springs out of rule 3, as there are things patients don't need to know about me that I want my friends to know.  I want to be able to show vulnerability and frustration.  I am Rob, not Dr. Rob or Dr. Lamberts on Facebook, and I want it to stay that way.  Too many lines can be crossed when friending patients, so I don't do it.

5.  Beware of Twitter.  Unlike Facebook, Twitter is not a walled-garden.  People can follow you without your permission.  Twitter is a truly public forum that should be seen that way.  The elevator rule definitely applies in Twitter.  I think of Twitter as advertising; we are putting ourselves out there for all to see, letting them decide how worthy we are to be followed or responded to.  The public nature of the forum can be engaging, as can the banter between friends.  But there is a great temptation to post Tweets about frustrating patients after walking out of the exam room, or exposing too much of your feelings for the world to see.

6.  The Internet is Forever.  What I write about using social media is recorded for posterity.  There is no way to take back what you sent over your RSS feed.  Unlike spoken words, which are (usually) gone after the airwaves stop vibrating, everything is recorded on the Internet.  You may not bear the consequences of your writing for years, but it is there to be found once you have written it.

7.  Anonymity is dangerous. I understand why some bloggers choose to remain anonymous, as their workplaces my not understand or appreciate what they do while online.  Yet many anonymous bloggers lose the ethical boundaries holding other bloggers in check.  Anonymous bloggers are much more likely to talk about actual patients, assuming they will never know it's them and can't find out.  Early in my blogging career, a blogger who went by the name "Flea" was exposed in court during a malpractice trial.  He had to settle the case.  Anonymity is a very thin shield and invites abuse.

8. Don't do it for ego. When I started blogging 4 1/2 years ago, I was a nobody.  Pretty soon, however, people started reading my blog and actually liked my writing! This is a big boost to the ego, as is the follower count on Twitter or fans on Facebook.  After struggling with the addictive nature of this ego boost, I went back to my core reason for blogging: showing people doctors are ordinary people.  I go back to that core reason whenever I am led astray by a moment of fame, or a particularly hurtful comment.  This is the only way I could keep doing this for so long.

9. Enjoy the community. Social media is not a contest.  Strive only to be who you are, and enjoy all of the other good writers in the medical blog world.  Some of the best friendships I've made over the past 4 years have been through social media.  I learn much from what they write, and really appreciate their different perspective.  This is not "king of the mountain."  The strength of the blogosphere is its diversity.  Besides, there are some really nice folks out there who write  very well.

10. Share. I have never worried too much about people quoting my content or even republishing it.  Once you put something out there, it is infinitely copiable.  As long as people say who wrote it and don't take credit, they can use it all they want.  My biggest asset is not my blog or what I've written in the past; my biggest asset is my ability to write and express myself.  Nobody can ever steal that from me.  I find it a compliment when people include my stuff in their blogs, it means I am giving something worthwhile to the world.

Kind of like Charlton Heston.

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To Know and be Known

A thought struck me when reading an excellent post on Warmsocks' blog.  The vast majority of responses to my recent posts on doctor/patient relations have been positive.  Yet a vocal minority of people have read what I wrote in a negative light - that I am somehow projecting my doctor arrogance into those posts and am patronizing people with chronic illness. Warmsocks' interpretation of my posts was that I was asking people with chronic disease to act like normal patients and pay attention to whether or not they were part of the problem.  This is relationship 101; when there is a dysfunctional relationship, it happens because there are two people involved.  The times that I have really messed up in relationships have been largely due to the fact that I ignored my own pathological behavior and assumed the other person was the one who needed to change.  My experience teaches me that there are usually equal parts of pathology on both sides of the equation.  My job is to heed the serenity prayer:

"God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference."

As I was thinking about this, I saw a very striking parallel between what has transpired on this blog over the past few days and the subject of doctor/patient relations.  The people who are regular readers of this blog, those who know how I think (and are not totally terrified) will read my words with a level of understanding that new readers can't have.  They have a much larger experience with my personality, my writing style, and my overall attitude, and so can read me without misinterpreting what I am saying.  They know me, and so don't have to wonder as much what I mean.

The same thing is true with doctors and patients.  If you build a relationship that is non-adversarial, it will make listening a lot easier.  This definitely applies from the doctors perspective; docs need to listen to their patients, get to know them, and understand their perspective to be able to give good care.  When I see a patient for the first time, I have to guess as to what certain things mean.  The quality of the guess is dependent on my skill with listening and the patient's skill at explaining themself.  As time goes by, however, I can understand them much better through experience.  It is key that I do this based on what I know about the patient.  I have to have a relationship with them - a real relationship.  I have to know them.

The same thing goes for patients.  Going to the doctor is as much about building relationship as it is about receiving care.  The jerky docs out there are not going to be willing to accept relationship, while the sensitive docs will listen and open up much better.  But still, it is very important to figure out who it is that is sitting across the room.  It is important to put down agendas as much as is possible (I do realize it's not always possible), and to build relationship.  You need to know your doctor.

So, to those who are new to this blog I say, read other stuff.  You will understand me much better if you don't base your conclusions on a single post.  I will continue to listen and try to figure out if I am communicating badly (which is my responsibility as a writer) and correct where needed.  That is the benefit of social media - that people give me immediate feedback as to how good of a job I have done at communicating.

To those who have stuck with me and read regularly: thanks.  I thrive on that relationship as a writer.  I write to be read and write to be understood.  It's nice to be known.

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Four

My world changed four years ago today.  Today is the 4th anniversary of when I started distractible blogging.

Beginnings

I had actually written a couple of posts on another blog called "Rob's Odd Blog," but it was panned by Oprah and Steve Jobs, so it never went far.  I was also writing for Dmitriy at trusted.md (mainly about EMR issues) and had an EMR-oriented blog at ambulatorycomputing.com (which no longer exists).  All of this seemed divided and confusing, so I began to think about putting all of these together in a single blog.  I didn't want to have a single focus; I just wanted to blog as me.

So on May 21'st 2006, "Musings of a Distractible Mind" came into existence, and I wrote the following:

I Need a Home

I now am accumulating a lot of different blogs. I need somewhere that is my main site. This will be it. My home away from home. My blog away from blog. I don't know what I will write in this thing - just thoughts I guess. But the point is to give a jumping point to my many other writings.

I am not certain how exactly I came up with the name, but the point was that I could write about whatever I wanted.  This became clear in the second post that I wrote on the same day:

My daughter just got a splinter in her foot. It was barely visible but it made her weep as if she had lost a limb. It happens every time and it did again this time...she wanted me to take care of it but wanted me to do so without touching it. Now the fact that I am a doctor makes splinters something I have a great deal of experience with, but I have yet to develop telekinetic powers strong enough to remove splinters without touching them. I need to keep working on that.

That makes me wonder: what would I do with Telekinetic powers?

  1. I'd play fun tricks on my Cat
  2. Clean the room from the comfort of a nice chair.

You know, I can't think of a lot of things to do with telekinesis (at least, not a lot of nice things). Now, teleportation is a different issue. Good telportation would be quite handy, both to cut down on travel and to avoid certain people. Yes, I would like to be able to teleport.

Although it wouldn't be much good on splinters.

It would be fun to play tricks on my cat with telekinesis.

I didn't get much in the way of readers for the first few weeks (as you can imagine), but I was content to just write.  My first comment was by "The Laundress," who continues to send me interesting articles.

Animal Magnetism

Llamas, which are now a staple of my blog, were not the first animal I obsessed on. Monkeys were actually my first animal obsession, which started when I found an article about a monkey getting drunk on beer.   It turns out, there are a number of animals that regularly get drunk (even bears).  The post that thrust me into the spotlight, however, was not about monkeys, bears, or llamas; it was about cows.  This post, for some reason, was quoted by Moof, a good friend of everyone in the medical blog world at that time.  Her endorsement was the key to what I am today.  I hope someday she forgives herself.

Why Blog?

I didn't blog to become famous.  I didn't even know I could write very well.  I just started blogging and haven't stopped - which to me is the most remarkable thing.  Being as distractible as I am, I tend to be a "new-a-holic" - wanting to try new things often.  The nice thing about not tying myself down with a single subject material or writing style is that I don't get bored.  It's even a nicer thing to have readers that enjoy the variety.

Which brings me to the main point of this post.  There is absolutely no way I would still be blogging if I hadn't had such great readers.  I thrive off of that interaction (OK, and also the attention), and have always felt pleasantly surprised when I got any acclaim.  Blogging is different than other media, as it is interactive.  Without the interaction, it is much harder to grow, to develop, to learn, and to explore.  I have enjoyed podcasting, but the blog is where I feel most at home.

And so I say to you, my readers: thanks for a great four years!

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Just Keep Writing

Taking a break (or at least a slow-down) from writing has its risks.  One of the things that has helped me over the past four years (yes, I am soon upon my 4th blog-o-versary) is that I kept writing.  Writing begets writing.  The more you write, the more you write.  Once you start to slow down, your mind is not so honed in on things to write about. I have justified my recent silence by the fact that I continue to write weekly for my podcast - something that can't be put off.  So I am not getting rusty.  But much of writing (at least writing worth reading) comes from passion, and passion is a hard thing to reignite once it has gone cold.  I don't mean passion about the state of healthcare, the doctor-patient relationship, or the unorthodox use of nonperishable items by the Armenian government.  I am referring to a passion to communicate.  I write because I think I have something worth being read.  Don't believe anyone who writes otherwise.  I write because I think there is something out there, lighthearted or serious, that is not being said by someone else.

For those who have followed this blog for some time, you may have noted previous slow-downs during trying periods of my life.  But I also tend to write a certain style of writing over a period of time, going through streaks where most of my posts are political, and others when they are mostly humor.  I am a sprinter, not a long-distance runner on a single subject.  I don't like to beat the same drum that I have beaten a lot in the past.  It's not just that I think my readers will grow bored with hearing the same stuff, I grow bored of it as well.  I guess that's the price I pay for being distractible.

You all know I am frustrated with the state of our system - especially in the way it treats primary care.  You also know that I am passionate about the fact that communication (or the lack of it) is at the center of the waste in our system.  We run medicine in a way that would bankrupt businesses in any other industry.  But as a writer, I am looking for new angles on this stuff.  I am looking for ways to explain things that I have not used before.  This takes energy and time.  This takes a lot of persistence.   Lately I haven't had much time, energy, or passion to persist.  I have gone through such times in the past and they have opened up again into creative periods, and am banking on that happening this time.

Given all of this, I have been able to continue this blog for nearly 4 years, which is longer than I have done a lot of things.  In some ways, it kind of contradicts the name of the blog.  In thinking about why it is that I have continued writing as I have, I see a few important things.  These things I would like to pass on to any who blog or wish to blog.

  1. Write about something you think others want to hear.  Each person has a unique perspective, and that is what blogging gives us the opportunity to share.  What is it like to be a self-employed person dealing with our healthcare system?  What's it like to be a specialist in a hospital system?  You are the only one who sees the world from your perspective, and showing others what it looks like from your vantage point can help them understand the whole better.  It's much easier to be passionate from your own perspective.
  2. Read others' blogs.  One thing that has fueled this dry spell for me is that I have stopped reading what others write.  This makes me sink into my own perspective and not speak as one adding to a whole.  I start to see the world from my own little corner and that makes my writing more repetitious and less relevant.
  3. Keep writing.  Writing is a muscle that needs to be used.  If you are not putting your thoughts and opinions into words that connect with readers, you will stop being able to do so.  I have the blessing of being able to write for multiple sources, so I have some means of keeping my writing going.  Still, it is hard to sit down and write for the blog again when I haven't done so for a couple of weeks.
  4. Understand the big picture.  Dry periods happen, and so do very productive times.  Yet the dry periods are not always nonproductive.  I really think that hitting the restart button and writing with a clean RAM is useful.  It may take time to reboot the ol' writing style, but writing is a long-term thing, so people will wait.
  5. Don't force it.  I have about 10 half-written posts I have done over the past month.  All of them felt forced, so they didn't get published.  You have to be yourself when you write, and it's better to take a break than to become something you aren't.  Blogging is about being who you are - it's journalism done by the people in the trenches.  If I have to sound like someone else to get something written, then I should take a break.

Musings is too big a part of my life (in the big picture) for me to put it down.  It has been a source of delight and of self-identity.  I don't know what I would be now if I had not started this blog 4 years ago.  I am writing this post to keep the embers from dying and to let my readers know I am not going anywhere.  I can't predict when I'll get back into writing full-swing, but if the past is any predictor, it shouldn't be too much longer.

I have said this in the past, but I'll say it once again:  I love to write because I love my readers.

Peace.

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What is a Medical Blog?

I have to confess, I really get into lists of the "Top X blogs."  X doesn't have to equal "Medical;" I just like seeing what people find worthwhile. OK, I will also confess a mild obsession about where my blog stacks up.  That obsession starts when you begin to blog and continues regardless of your success as a blogger.  I was very tickled (not literally) by Mike Cadogen, an Aussie Emergency Physician, listen your's truly among the top 10 clinical medicine blogs, describing the blog as:

Dr. Rob Lamberts is a primary care physician from the Southeastern United States. This roller coaster of a medical blog is intelligent, witty and eclectic racing from the serious to the absurd from one blog post to the next.

Wow.  He never used the words "strange" or "harmful."  Thanks Mike.

But that's not the point of this post.  This post is a gripe I have with Technorati and Wikio, two resources where people can find blogs of interest.  I am listed on both of them, but on neither as a medical/health blog.  I have pointed this omission out to each of them, but have never gotten a response.  I have begged, pleaded, and openly wept to get their attention to their sorrowful omission, only to be met with a spooky silence.  Is this a conspiracy?  Is it a plot by Oprah to spurn me once more?

Or perhaps the name of my blog is a bit misleading.

Regardless, the bigger grief comes from what is listed as a medical blog on each of these sites.  Here's what Technorati includes in its "Top 100 Health Blogs."

This one is #7, just behind Kevin, MD

Here's Technorati's #35

Wikio is  quite a bit better, but still with some questionable inclusions:

Both of which are clearly made to market products and/or books

Am I mad about my non-inclusion?  Only a little - given the quality of the inclusions in this list.  My real frustration is the dilution of quality medical information with this kind of content.  This is given equal time to physician bloggers - even put ahead of them.  This is elevated above patient bloggers who really live with disease, instead of profiteering off of their disease.

Substance is being buried with the slime out there, and even more reputable sites are getting sucked in.  When we were forming the Healthcare Blogger Code of Ethics, we were frequently hit with requests from blogs that were hucksters cleverly masquerading as content-providers.  Being somewhat dim-witted about this kind of thing (trusting soul that I am), I had to rely on the eyes of other bloggers to separate the wheat from the chaff.  If I found it hard at times, non-medical folks will have even harder time.

What to do about it?  Complain loudly, link to quality blogs, and continue to put out quality stuff.

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Expertise

It's interesting to see how different things are over at The Health Care Blog.  First, it's different to have to write "health care" instead of healthcare.  I personally am all for not using up or resources by adding the space between the two words.  Ihaveconsideredeliminatingspacesaltogether, but it gets confusing.  Iwon'tdothat. One of the big differences I see is the perspective of the readers and commenters.  I write here for a group of people I largely consider friends, cohorts, or at least sympathetic to my cause.  After all, people are coming here by their own volition (I assume nobody is getting this blog forced upon them as some sort of punishment, although that may be a bad assumption).  But the readers at THCB (as we insiders call it) are much more argumentative and much more likely to be "experts" in the area of healthcare delivery.  Certainly the other folks writing there are far more sophisticated than me (not that that's a hard thing), and are much more well-read in the area of HC reform.  The debates in the comments section are quite stimulating, although sometimes you have to wipe a little blood off of your screen.

What has struck me, however, is the entirely different perspective I have from most of the people they are reading.  I am a practicing physician, and so I know the HC system intimately (I am using "HC," by the way, to save even more pixels).  I deal with it every day.  I speak with patients dealing with it every day.  I suffer the consequences of policies.  I have an enormous stake in the whole debate about reforming the system.  The other "experts" these people are reading are certainly worth listening to; they have a knowledge base that I can't rival.  But seriously, who knows more about baseball: a player or an analyst?  Does Derek Jeter know more about baseball than Peter Gammons?  If Jeter wrote a column about his knowledge of the sport, would it be worth reading?

I think this is yet another example of the importance of medical bloggers.  Up to now, the debate has been left to the "experts" and the people who read their stuff.  Up to now, doctors, nurses, and patients have been largely represented by proxy.  Blogging changes that.  Blogging lets the alternative perspective be heard.  Blogging shows where the theories of the "experts" succeed or fail in real life.  Medical blogs are not only of value, they are a crucial part of the debate.

I am not saying that our perspective is more valid than the "experts."  I would probably trust Peter Gammons' knowledge in many areas of baseball over Derek Jeter's.  But a view of the debate that ignores the reality of what goes on in the hospital, pharmacy, and in the exam room is highly flawed.  The debate over HC reform is not just a theoretical discussion; it's not just a political squabble.  The debate over HC reform is personal to anyone who is in the system, either giving or receiving care.

So I welcome the addition of many new bloggers to the medical blogging community (I find it impossible to keep up with them).  I hope their voices continue to rise and be heard more and more.  I hope their perspective is not only put out in the mainstream, I hope it is actually listened to by those who have to act on HC reform.  Yes, politicians, I am talking to you.

I laugh when the commenters at THCB criticize the incomplete nature of my posts.  When I post, I am usually trying to make a point, not to give a complete discourse.  Even if you read my entire blog, you wouldn't get a complete perspective on the issue (although you may require years of psychotherapy to be able to re-enter society).  In the same way, a debate among experts is incomplete.  The experts are important, but without the real perspective of those who live their theories, the talk is no more than a lively debate (give or take a little blood-letting).

To fix this problem, we need all hands on deck.  We need everyone's expertise.

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What I (Blogworld) Learned in Las Vegas (Blogworld)

I was sitting in the third session of the medical blogger track at Blogworld Expo and noticed something.  On the screen to the right of the speakers was a live feed from Twitter.  It seemed that everything posted there had the word "Blogworld" in it, so I twittered the following:

Like magic, my tweet went up on the screen!

Then began a series of responses:

Which looked like this:

So all the world of Blogworld saw our antics; yet we were not Blogworld kicked out.  Clearly there was poor Blogworld monitoring.

Overall, the Expo was wonderful.  I have gone to medical and EMR conferences over the past 10 years and, truthfully, get bored in them.  I learn things in the medical conference, but having done EMR for the past 13 years, there are not a lot of new tricks to learn.  Blogging is a whole different thing.

The medical track was especially good, with excellent discussions on several very pertinent subjects:

  • The history of medical blogging - Was just plain interesting.
  • The ethics of medical blogging - I talked on this panel and despite that fact, it was good.  There are very big issues around being in a business that emphasizes privacy, and blogging - which is public by nature.
  • How to influence healthcare through blogging - Very good discussion about what the point is of what we do as bloggers.  What is happening as a consequence of what we do?
  • The value of blogs to corporations and hospitals - The issues around these institutions are much different, but are important for all of us.  How do pharmaceutical companies, hospitals, and the media handle medical blogging?  Where does blogging fit in and what are the pitfalls?

It was truly a joy to meet many of the medical bloggers I have read for years, especially my chance to meet the wonderful South African blogger Bongi and his fiancee Delre Roberts.

So what of the rest of Blogworld?  Here are some of the take-home messages I got:

  • Google AdSense is not a good way to make money.
  • Design of your blog will do a lot to retain visitors.  I changed the tagline of my blog because the haiku kept things mysterious to new visitors.
  • Don't apologize for advertising.  You work hard on your blog and good enough content will retain serious readers.
  • Put things on your blog that will bring readers who get posts via RSS feed.  Things like contests, polls, and other interactive things are examples.  Increased traffic allows you to attract advertisers and increase your income.

Let me add, however, that medical bloggers are under a different level of scrutiny.  Our legitimacy is based on our independent voice.  Our job is to speak for our profession and for patients.  Just as people don't want doctors' prescribing habits influenced by pharmaceutical companies, our voice as a blogger should never be perceived as influenced by outside forces.

So, I recommend that (Blogworld) all of you go (Blogworld) to the Expo put on by....

You know.

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Why I do This

It was a legitimate challenge. When I mentioned to a fellow blogger that I was appearing on NPR, and he raised a very important question:  "Is that really a good thing?  I thought that the point of blogging was to pose a challenge to the mainstream media, but it seems like bloggers feel like they have made it when that same media pays attention to them."

This hits at the core of what I do as a blogger (and a podcaster).  Why do I spend so much of my time doing something on that takes a bunch of time and energy, when I already have a very busy life?  Why blog?  Why podcast?  Why do interviews?  Why llamas?  Why spend a weekend in Las Vegas?  OK, the last question has any of a number of answers, and I have no idea about the llamas.  But you get my drift: given the busyness of my life, why should I do all of this?

My answer is this: I blog and do all the rest of this stuff to give my perspective to as many people as possible.

I know that there are those out there who claim that they blog "for themselves" and "don't write to the audience."  Bull.  If you don't care if people read what you say, why do you say it on a public platform that can reach anyone on the Internet?  Why not just write it in a journal?  No, bloggers blog so that they will be read by others, the larger number the better.

This seems to be egotistical, and maybe it is, but the only reason anyone reads a blog is because it interests them.  My readers think what I write is interesting (except my Mom, who reads it to make sure I am keeping out of trouble).  What makes my blog different from the "traditional media" is its subjectivity.  I am a practicing primary care physician, and that perspective is a large part of why people read me.  People want to know what doctors think - what it's like to be a doctor.  If I quit my practice and went into writing full-time, I would lose that unique subjective perspective and the legitimacy it lends.

I am not doing journalism when I blog; I am writing a personal narrative and giving my opinion on things.  I am explaining things that I know about and entertaining people with my own personal style.  Journalists gain legitimacy from their objectivity.  People rail on MSNBC and FOX because of their bias.  I don't want to do journalism; I would lose interest very quickly.

What makes this even more important for me is that I see my perspective as one that is not heard and one that is really important.  Prior to the Internet, primary care physicians could only reach a large audience with their opinions if they stopped practicing medicine.  They could only influence the debate on issues that mattered to them by giving up their perspective.  Blogging, podcasting, and doing all the other stuff gives me an incredible opportunity.  I can voice my opinion to millions of people, and those people seem to really want to hear what I have to say.  It is really remarkable to me.

When I first started blogging, I did it to see if I was a good writer.  I thought I might be able to write entertaining stuff, but had never had much of an opportunity to do so.  It was a hobby for me.  I had no designs to become famous.  It still surprises me that a primary care physician in a small city with an odd sense of humor could actually be seen as important.  It's not something I would have ever expected; and had I known, I would have been really nervous.

But it still isn't the fame that makes me want to blog.  The truth is, the more people who read me, the more pressure I have to give them something worth reading.  I could write lots of bad posts when I was unknown and could take extended breaks from writing if I wanted to.  Now there is much more pressure, which is definitely a negative from my perspective.  But what keeps me coming back to this stuff is one thing: passion.

I feel strongly about things.  I sit in a room with people pouring out their lives.  I see suffering and struggle, and I see people doing incredibly hard things.  They will never be famous, and their situations and accomplishments might not even be recognized by those close to them.  But I have been given the opportunity to see underneath the hoods of a bunch of people, and I am honored by their trust.  They are what health care is about.  They are the reason I work the long hours I do. But they don't have the power to change things, and for some mysterious reason I have been given a small chance to do so.  I owe it to them.  Blogging has given me the voice to give them a voice, and that's a thing worthy of passion.

Even my humor is fueled by this.  I don't think I could have ever spent three years writing about llamas and muppets.  It's a wonderful diversion and it keeps me from burning out; but it is not my passion.

So the reason I am so excited to get attention like this NPR piece is the same reason I do the blog and the podcast.  I think my perspective is important and needs to be heard.  It's about people's lives.  It's about giving a voice to them.  Maybe I can even make a real difference.

That's why I do this.

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Medical Bloggers Frolicking at Blogworld

I am sitting now in the medical blogger track at the Blogworld Expo.

As is generally the case, I got here too late to bum around with the med bloggers last night.  It happened when I went the the "Putting Patients First" summit in DC as well.  I just seem to have that kind of luck.

Anyway, the medical bloggers are forgiving and did not think I was being snooty.  They also didn't mind it when I missed breakfast with them.  Why did I miss breakfast?  I was being interviewed by Ira Glass from NPR.  For some reason, this little ol' blog got the attention of the producer from This American Life, the show that Ira hosts.   They are doing a series on health care costs being out of control, and read the post I did in January about the insanity of medical codes.  She felt that I would be a good person to discuss the reality of medical codes in the daily life of a doctor.

This is clearly a wild and madcap gang.

I spoke for almost an hour, and really enjoyed the conversation.  In fact, I can say with confidence that was the only time I have had any pleasurable experience associated with medical coding.  The piece should air this weekend, and I think it will be on the American Life podcast as well.

So then I went on to the Blogworld Expo (brought there by the sound engineer from the local NPR station - a very nice guy from Brooklyn).  This is the first year that we have a specific track, and so this is a terrific opportunity to get together with people I know well but have never met.  I can say categorically that I like medical bloggers.  I haven't met all of them - I am sure there are some I wouldn't like, but every one I've met so far is great.

Yes, I did talk on a panel about the ethics of blogging (book your ticket to the apocalypse, kids), and it went fine - especially because I am hard to shut up.  I'll post more on that subject later - medical ethics, not me shutting up.

Perhaps the highlight of this (with other lights being of nearly as high altitude) is that Bongi, the South African surgical blogger, is here with his significant other.  I thought my flight was long.

The take-home of this post is to say that medical bloggers have arrived.  We have been working for an identity for a long time, but now we are not only being recognized by the general blogging community, but also by the mainstream media.  That's either great or really scary.

You make the call.

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