It was a quiet year….

Two Thousand Thirteen was a quiet year for my blog. But it was a busy year of doctoring with 10-12 hours in clinic most days, an additional 2-3 at night, plus a few hours on most weekends. [We can analyze why over a drink sometime]. Of many sacrifices a full-time primary care practice necessitates, blogging was one of them. Also falling victim to the work schedule were guitar lessons, dinners with friends, and medical conferences I had planned to attend. Reading? Shopping? All of those seemed like luxuries. I missed writing on this blog, which was a nice way for me to reflect on this complex world of medicine.

However, in 2013, I did continue to work out regularly (for my own sanity, and – yes – I think of this as an achievement considering my schedule) and I wrote regularly for the Seattle Times as a columnist for the On Health section of the paper. I continued my position as a committee member with the Women in Medicine group of the Washington Chapter of American College of Physicians, and we hosted various increasingly successful events during the year. I continued to serve as an advisory board member for an IT company, learning more about the complexities of IT systems, networking, and EHRs. I mostly listened on Twitter, often inspired to write posts, but lacked the time and energy to put my best work into it. However, it was wonderful to keep up with some of writing of some of the colleagues I admire. And the best part of 2013 was that I had the honor of having one of my pieces published in a book (more on that in a future post).

We are fully into 2014 and New Years’ Day already feels like it was long ago. My schedule has not changed, but there is one thing I know for sure – this year won’t be so quiet for my blog.

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Social Media Encourages Initiators in Medicine

Funny how the blogosphere echoes some of the thoughts that have been incubating in my own mind… A few posts have caught my eye recently. One that I have been meaning to comment on was Dr. Vartabedian’s piece “Do You Initiate or Respond?” which characterizes physicians, in general, as trained responders rather than initiators [give it a look, it’s a quick read].

I had myself been concurrently pondering the same idea (though classifying it as reactive versus proactive in my own mind, but we mean the same thing). As Dr. V points out, doctors are reflexive and very much good at it.  We are nimble thinkers on our feet when faced with problems, calculating a large number of variables to try solve problems in -let’s face it- a very short period of time, all the while doing our best to navigate through a myriad of emotions along the way. The importance of this notwithstanding, I wonder if immense talent is being untapped when leadership (aside from hospital/clinic administrative roles) and innovation is not instilled, honed, or even valued from the start of medical education to the end of one’s career.

After all, how much can one learn about leadership when working essentially in isolation (particularly in the outpatient setting) and with a compensation system that rewards “doers” more than “thinkers”? Sure, doctors can work effectively with their medical team and with patients. But the creative energy and solutions that can come from putting some of the brightest minds – ones who work on the frontlines of medicine – together to really tend to the larger problems in healthcare has been sorely missing.

Physicians who blog or create content online are Initiators, and their passion for innovation can awaken the creative part of the mind that has been quieted by the noise of daily clinical work. (If you tell me that part of your mind does not exist, you really have not gotten your head out of the charts for some time). And this is why I keep coming back to social media despite the growth of my full-time practice and its demands for my time. When used more as a learning tool rather than an advertising tool, social media can do more to teach a doctor about leadership and initiation than can a lifetime of working in a clinic or hospital.

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A Message Worth Repeating

I thought to myself, “I am not going to post a link to this article. It has been circulated many times already on Twitter over the past week.”

But I read it. Not once. Not twice. THREE times. I shared it on Twitter twice.

And I changed my mind.

When doctors recirculate a blogpost over and over again, especially one about such a thing as death, they are sending us all an important message.

So, I share it here with you, as well:

How Doctors Die

After you read the article, if you do not know what a POLST form is, please see this link.

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Social Media Adoption by Physicians. It’s A Little Like Quitting Smoking

Today, Mark Britton, CEO of Avvo (a physician rating site that also provides answers to health questions), gave a presentation to our clinic regarding the role of social media in healthcare. He gave an excellent background on the evolution of social media, as well as general principles to consider when embarking on this path.

 “If you don’t have a meaningful web presence, you don’t exist.”

This quote, from Britton, is poignant and true – true, at least, to the many doctors already utilizing social media. But many doctors feel the opposite is true. They might say, “When I take care of patients, make phone calls, am physically present and working tirelessly in clinic or the operating room… that is when I exist. Social media is a fad for kids and I really don’t have the time for it.” This is the oft-referenced head-in-sand approach – never a good one. Others might feel that social media in healthcare is ALL about marketing and self-promotion. (By the way, the vast majority of physicians do the latter poorly, quite frankly. This is usually due to a fear of the impression it would make on others. In fact, for years, I deliberately did not reveal my profession to many non-healthcare acquaintances I encountered unless specifically asked. ) Some doctors feel their years of experience and employer reputation – rather than fancy web pages – should be enough to convince patient that they are good doctors.

All of these are valid concerns and points. As I have now been blogging, tweeting, and using LinkedIn and Facebook since November of 2010, I almost forgot that I was a nay-sayer once, too. It occurred to me today, as I observed the faces in the room during this social media talk, that educating physicians about social media adoption is akin to smoking cessation counseling for patients. That is to say, one will encounter differing levels of interest depending on which doctors you meet.

PRECONTEMPLATIVE STAGE

Typical response involves using the word Twitter with a sneer or not even recognizing it.  “I don’t do Facebook. I don’t do Twitter.” Doctors in this stage might also wonder, “Why would I change the way I practice now? I have plenty of patients. I don’t have time for this.”

CONTEMPLATIVE STAGE

An individual in this stage might be someone who already uses Facebook for personal reasons (keeping up with family, using Facebook as a photo album,  etc). He may be curious about how social media can work for him. Some doctors in this stage might want to get involved but are afraid of the time commitment. After all, EHR adoption and meaningful use requirements are eating up more of the limited time that is not spent in direct patient care.

PREPARATION

In this stage, the doctors are ready and researching tools. They might be observing the behavior of other social-media-savvy doctors. They might get inspiration or ideas from some of the physician bloggers/tweeps that I follow most frequently: SeattleMamaDoc, 33 charts, Dr. Wes, John MD , KevinMD, Clinical Cases and Images: Casesblog and – ahem- my own blog.

ACTION

Here, doctors are committed and are actively embarking on the social media path.

MAINTENANCE

This is tricky because social media CAN be consuming and it is easy to get frustrated (especially if you are only looking to increase revenue quickly).  It is doable, however,  and takes a little discipline – doctors are good at that, right? – to get just the right balance so that you don’t lose steam. It helps if you receive input on topics that you find interesting and relevant.

****

I was thrilled to see the number of physicians from my clinic attend the presentation. I underestimated the level of interest in the topic. Ultimately, no one should feel pressured into social media for the sake of social media itself or for the sake of generating quick revenue. One thing is true with social media; motives are more apparent than we would like to think.

If a doctor is passionate about his/her work in the healthcare industry, the realm of social media is one that cannot be ignored. To expand on Mark Britton’s words, not only do you not exist if you don’t have a meaningful web presence, you might even have an inaccurate and less than favorable existence, a web portrait painted by reviews on Yelp or Angie’s List or Healthgrades and generated from very limited interactions or experience. This might come as a shock to even the most experienced and well-meaning doctor.

Furthermore – and most important, in my opinion – patients get their information from the internet. If more reputable and qualified physicians are not there to direct them, someone else – even a celebrity without any medical training– will be more than happy to “educate” them.

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Twitter Church

Engaging in Twitter as part of healthcare social media can feel a little like being part of a church. Here’s why:

1. There are preachers and notable figures (those with higher Klout scores) and there are followers.

2. There are prophets (proposing the healthcare of the future).

3. There is a belief in a metaphorical “witchcraft” (poorly supported healthcare information that most doctors engaged in healthcare social media are trying to dispel.)

4. Nonbelievers (skeptics) do not attend.

5. Nonbelievers are being encouraged to convert. (Recruiting other healthcare individuals into social media).

6. Reading your Twitterfeed is like getting your “Daily Bread.”

7. There are a lot of “Amen!”s from the crowd (apparent as comments or retweets)

8. Support and advice are freely given within the group.

9. There is a desire to reach the farthest corners of the earth (with the goal being the safety, health, and well-being of patients.)

10. Oh, and the most obvious similarity? If a regular attendee is missing, people start to worry (“Has anyone seen @insertnamehere?”).

Entering the Healthcare Social Media World: An Analogy

photo by jscreationzs at freedigitalphotos.net

OK. So it took me a little while to accept the idea of writing things for the world to see. I mean, I have done that before (written blogs about music and art and other random musings), but under a pseudonym. This time I write as me, myself, and I, without an identity crisis, and under my professional name. That is, my lay-my-reputation-on-the-line, name. This was a scary start and not dissimilar to signing my first order on the hospital wards followed by the letters “MD.”

What I didn’t expect is that entering the Health Care Social Media world as a physician feels a bit like going to a new school.  

I got accepted into this public school a few months ago – it is easy to get into, after all – and like a good student, I was quiet and listened astutely first and learned some of the nuances of this new environment.  I was slow in picking up on colloquialisms (I only just figured out that #FF does not stand for Freaky Friday, Fish Friday, or Fast Forward) and am still a little uncertain of the etiquette (do you ask to be retweeted or just hope to be?).

When you’re the new kid, there are a lot of dubious people who “follow” you (spammers, for example, or Twitterers whose interests seem quite different, even antithetical, to yours and seem to be lurking there, just waiting there for you to “slip up.”) It is easy to pick out who the popular kids were.  Or who tended to talk a lot. Or who tended to be funny. There are the brainiacs, the dreamers, and the pessimists, too. 

Of course, in this school there is a BMOC, of whom I knew before I thought social media might even be a good idea. For those of you currently involved in Health Care Social Media, you know who I am talking about. He is like the star quarterback. Everyone knows him and follows him. I secretly want to be followed by him but am too nervous to tell him. I just might faint if I see him in person.

I digress.

As long as I was in lecture and doing my homework, I felt comfortable in this school, the Social Media world. But the real truth comes out in recess (as in real life).  At some point, I had to go out and play. Was I going to play alone or try to play a pick-up game and hope to make friends? Since my twitter activity mimics my real personality for the most part – I don’t want to be a Dr. Jekyll and Mr. Hyde, which is easy to do in any online format – I am a little more reserved. I initially bring up random, non-controversial topics. No biters. No interest. It was easy to get disenchanted. I wanted to be part of the cliques. (Yes, there appear to be cliques here.)

At some point, though, you see a ball coming your way and you can either let it fly right past you or you can catch it and pass it (retweet). Do that a few times, and you demonstrate you are a team player. Choose your moves (tweets) wisely and you can be a trusted member of the team every time you play the pick-up game.  I have made a few good passes. I haven’t made it into the popular crowd, but I am always learning from them.

Lest you think it is all fun and games in this school, there is homework to keep me busy. A few hours a week of writing and editing keeps me out of trouble. I have even been graded at this school. What did I get on my report card for the first quarter? Well, according to Professor Klout, my score is 32. “You actively engage in the social web, constantly trying out new ways to interact and network. You’re exploring the ecosystem and making it work for you. Your level of activity and engagement shows that you ‘get it’, we predict you’ll be moving up.”

So, as the new kid in this school, I am doing ok. After all, it is better to pace yourself here. You don’t want to burn out too early and drop out before you earn your credits.  

OK, enough daydreaming…. Back to my homework.