33 Charts

Your Lists Define You (or why you should call me Gary)

In residency I worked with a pediatric cardiologist who thought my name was Gary.  On rounds he would say things like, “Gary, what’s the normal QT interval in a newborn?”  Or, “Let’s get a 15-lead EKG, Gary.”  He never hesitated.  He was so confident.  I corrected him initially but ultimately I gave up.  To him I was Gary.

That was 1992.  Fast forward to branding in the 2010 social space.  Not much different, really.  Be it absent-minded cardiologists or Twitter followers, we’re defined by how people see us. 

And twitter lists can help you understand how you’re seen.

Twitter lists provide a spyglass into the minds of the people watching you.  Check it out.  As lists continue to propagate you can find out so much about how you project yourself.  My listings are predictable.  I’m found on healthcare and physician listings but I do wander a bit into pharma, tech, writing and social media.

While you may not like it, it is what it is.  Or in the words of Jay Baer, you are what you are, not what you wish you were.

And you can call me Gary.  

The Reality of Open Source Health Advice

Last week someone posted on Twitter that they had swallowed a plastic toothpick.  What to do?  So they turned to the hive for help.

“What should I do?” I thought as I read my Twitter feed.  I was paralyzed in a way.  I wanted to share my experience with hundreds of patients had swallowed pins, toothpicks and other pointy things.  I specialize in just this sort of thing.

But short of a random comment about gastric emptying, I kept to myself. 

Why?  Because once I lend a hand I’m all in.  The simple offer of patient-specific advice constitutes a relationship in the eyes of the law.  Once involved, I potentially share responsibility in whatever happens to someone.  Crazy but true.  It’s just a matter of time before slip-and-fall lawyers hold physicians accountable for helping out in the social sphere.

Doctors aren’t the only ones wearing targets.

In the virtual land grab to get a piece of the chronically ill we’ve witnessed the growth of a cottage industry composed of alternative providers.  I suspect that well-insured health sites providing safe harbor for mavens, disease experts, gurus, advisors and other self-anointed authorities will at some point feel the sting of the trial bar. 

Attorneys and gurus aside, health professionals need to worry about doing the very best for those looking for help.

Here’s a thought:  Unless a practitioner has the critical details of someone’s current complaint, a complete history, record of medications/allergies, a medium by which crystal-clear communication can be exchanged and a reproducible record where it can all be recorded, it’s risky and potentially irresponsible to offer passing medical advice.

That’s the kind of advocacy you won’t hear much about.

The heady exuberance of open source medical advice will play itself out.  The market’s never wrong.  Good, responsible care, however, will never go out of style.

And one last thing:  What if you know I read about the toothpick and failed to lend a hand?  Let’s not go there…

Doctor-Patient Dialog on Social Media: A Bad Idea?

Recently I wrote about how to handle things when patients try to engage doctors in the social media space.  If you missed it you can read it here.  If you want to save yourself 5 minutes consider the bottom line:  Doctors and patients shouldn’t be discussing patient-specific issues in the social space.

I heard from Ted Eytan regarding my post:

The question is interesting:  If the patient initiates the dialog is open discussion of a specific medical problem then okay?  

I wish it were that simple. 

It’s important to discriminate between what patients do on their own and what patients and physicians do together.  Patients (lets call them people, shall we?) can effectively do as they please.  You can live tweet your vasectomy or post your pathology report on your blog.  Transparency is, after all, a badge of honor.

But when patients (I mean people) and doctors get together it gets a little trickier.

Here's why:

If it’s okay with you is it okay with me?  Open discussion of privileged medical information requires written consent.  Healthcare attorneys have suggested that the initiation of communication by the patient implies consent.  But don’t look for me to be the guinea pig when this one’s tested in the courts.  Bottom line:  permission to discuss is a little more complicated than you might think.

Documentation.  Physicians bear the responsibility of documenting everything that happens between doctor and patient.  From state medical boards to third party payers, physicians are obligated to get it all down.

More importantly, the documentation on most social platforms isn’t detailed enough for other medical professionals or auditors to follow what’s gone on between you and your caregiver.  Let’s not forget that Twitter has a habit of disappearing after a couple of weeks.

What are you really saying?  Then there’s the issue of assessing a febrile infant in under 140 characters.  If you’ve ever cared for the sick you know that sorting out problems isn’t always easy.  Assessment of even the simplest medical issue requires clear responses to clearly understood questions.  Current technology isn’t built for this kind of exchange (HelloHealth not included).

It just isn’t smart.  Sharing detailed personal health information in a public forum isn’t smart.  Sure the tongue-in-cheek comment about your ingrown toenail isn’t likely to create problems.  Discussions about anything more serious isn’t for others to hear.  Keep in mind that everyone from employers to insurance companies are tuning in to what you have to say.

So do we shutter the idea of any interaction between doctors and patients?  Absolutely not.  E-patients and physicians need to be together socially.  This only helps our relationship.  This is where the real power of social health lies. 

There are plenty of very accessible and private formats by which you can communicate with your doctor.  And if your doctor isn’t available by those means it’s really unlikely you’ll find her rootin’ around on Twitter.

Are Twitter Lists Exclusionary?

Two of social media’s key thought leaders see Twitter lists differently. 

Chris Brogan yesterday wrote that he felt Twitter lists were exclusionary and put people at risk for feeling left out.  Robert Scoble shot back with the idea that lists are, by their very nature, exclusionary but necessary.

Despite his liberal use of capital letters, I have to side with Scoble on this one.  After just a few days with Twitter lists I can say that my lists are quite exclusionary.  That’s what makes them so useful.  When I want to hear what doctors and nurses are talking about I can turn the channel to healthcare.  This allows me to exclude all the social media wonks like Scoble and Brogan.  And when I want Scoble, Brogan, Armano or Rubel I tune everyone else out by watching my Thought Leaders.

Will lists become the new metric of power?  I’m not sure about that.  I have some concern that ‘list ranking’ will miss the influentials who hang in niche areas on Twitter.  

Right now the real benefit would appear to be the egos of our beloved social media gurus who can’t seem to keep up with their listings.  Twitter attracts social media people who in turn want to pay homage to their social media heros.  I anticipate they have the most to gain.  

Power metric be damned, Twitter lists allow me to tune my human signal just a little bit better.  And that puts me closer to where I need to be.

Who Needs Twitter?

I had lunch with a physician colleague recently.  In the course of our discussion Twitter came up and I tried to explain its potential benefits.  But despite my spot-on analogies he just didn’t understand why this would be of value to him.

Then I realized it may very well have no value for him.

As a middle-aged divorcee with college-aged children and a stable practice he freely admits that he doesn’t yearn for much.  Investment into his career isn’t a priority.  He has few aspirations beyond digital photography which he prefers to do alone.  He’s actually very happy just as he is.

So what’s value proposition for Facebook with someone like this?  What’s the return on involvement with Twitter?  I’m not sure there is one.

There are those who recognize the value of relationships and there are those who don’t.  There are those who recognize the value of relationships but find them less important.  While the benefits of social media are obvious to those who reap the benefits, there are those who have no aspirations beyond what’s in their immediate environment.

And technology will never change that.

Medical Blogosphere Rising

It would appear that doctors and nurses in the social space have finally arrived.  This week marked the first Blog World Expo with a track dedicated to the medical blogger.  BWE brought together some of the web’s most visible medical minds including Kevin Pho (KevinMD), Rob Lamberts (Musings of a Distractible Mind), Kim McAllister (Emergiblog), Bob Coffield (Health Care Law Blog), Paul Levy (Running a Hospital) Mike Sevilla (Doctor Anonymous), and Nick Genes (Blogborygmi), and many more.

From health privacy to the ethical obligation of doctors to be visible on Twitter, the panel-based dialog at Blog World Expo raised as many questions as answers.  Medical professionals in the online space face remarkable challenges, especially with regard to transparency, personal boundaries, and the definition of patient privacy.  It's clear that our technology is ahead of our legal and ethical dialog.

Despite those challenges, doctors and nurses in the social space have a remarkable opportunity to build on what’s been done.  Many of those at the Blog World Expo medical track have created the digital inroads that are changing the way the world sees doctors and nurses.

Among other things, the experience at Blog World Expo proved to me that online socialization will never replace the power of just getting together.  It's amazing to meet people you have watched for so long.  And when you’ve sat and visited, a writer’s online voice seems to make more sense.

Thanks to Johnson & Johnson for sponsoring our track.  And an even bigger thanks to Dr. Val Jones (Better Health) for pulling it all together and giving medical bloggers a voice at one of the world’s largest social media meetings.

Hopefully the role of medical professionals at Blog World Expo will continue to grow.  Here are a few things I’d like to see in meetings to come:

• Think outside the blog.  While he had a lot of discussion about blogs, they’re slowly evolving as a secondary notion in the social media space.  The online world now runs in real time.  We need to explore the role of live socialization in medicine. 
• Bring in the smart people.  We need to import the wisdom of non-medical social gurus to help our messaging on health.  I would love to hear Steve Rubel tell me now lifestreaming could be applied in some creative way as a physician.  We could all take some lessons from Chris Brogan on ways to cultivate our networks.
• Expand the role of social patient.  Ultimately they are why we’re here.  I expect we could all learn a lot from their involvement in the dialog.

Perhaps there are other things social health professionals need to be talking about.  Let me know what you think.  

Should Hospitals Shut Out Social Media?

This post by Paul Levy is interesting.  He comments on a Boston hospital that has shut down employee access to Facebook, MySpace and Twitter.  The administration cites violations of the hospitals electronic policy and potential HIPAA violations.

But Paul Levy, CEO of the Boston’s Beth Israel Deaconess, says ‘not in my house.'

But is shutting out social media such a bad idea?  Is there ever a time when it’s a good idea to keep healthcare employees a little disconnected?  Whether or not the prohibition of social media in a hospital is appropriate depends upon who’s house you’re talking about.  While I’m not privy to the inner workings of the Beth Israel Deaconess, I would venture to guess that Mr. Levy has created the appropriate measures to insure social media is used in a safe and constructive way.  For a hospital behind the curve, however, stopping to regroup may be the right thing.

While the dangers of inappropriate use of social media in a medical setting may be obvious to some, I would suggest that it isn’t the case with the typical 21-year-old employee.  Real time connection between the hospital and the world comes with real risk. Irrespective of how strongly we may believe in importance of social media, the confidence and safety of patients is priority one.  And regarding the cited Boston hospital, I think that until the right measures are in place I too would pull the plug.

Guidelines for the safe and appropriate use of social media in the health arena are the foundation for its wide acceptance.  Privacy infractions stemming from casual adoption will only embolden the naysayers. The transition to real-time socialization in healthcare will come.  Every hospital will come to the table on their own terms.

When Patients Contact You via Social Media - 9 Pointers

It happened again last week.  A patient contacted me via Twitter with a clinical question about her child.  As always, I never engage patients in the social media space.  When they try to initiate an online encounter I track ‘em down immediately to let them know the safe of social media and our relationship.

Here are a few things I think about when discussing the matter with patients (or parents):

1. Take the discussion offline.  All dialog concerning attempts at online contact are done by phone or in person.

2. Understand they're just looking for help.  Keep in mind that when patients try to reach you via Facebook they’re just looking for help.  Twitter and Facebook are now becoming standard means of interaction so why would it be so strange to contact your doctor?  In my dialog with patients who have crossed the line I try to approach the issue in a way that respects where they’re coming from. 

3. Give them the facts.  While I’m not a lawyer, I do my very best to discuss the importance of online health privacy.  Social media is for casual conversation, not privileged health information.  While we will likely see the proliferation of secure social media platforms for doctor-patient communication in the future, we’re not there yet.

4. Remind them you’ll get in trouble.  When I remind parents that they’re going to get me in trouble they feel bad.  I don’t want to make anyone feel bad but they have to understand the potential gravity of the situation when it comes to the law, state licensing bodies and hospital privacy.

5. Point out why social media represents a risky means of communication.  After detailing how I could find myself in hot water, I then try to illustrate how social media isn’t built for patient care.  Among other things it's not easy to follow what happens between a practitioner and patient on a social application.  Who said what or, more importantly, was the intended plan even understood by the patient?  And how do you and other members of the healthcare team refer to a plan of care?  Very high tech but very sloppy.

6. Document everything.  Any attempt by my patients to discuss clinical matters via Twitter or other platforms is immediately documented in the patient’s medical record.  I also document that I have discussed with the patient or family the appropriate ways to contact me.  

7. Make a social media policy of your own.  One way to keep your patients from reaching out to your online is by creating an office social media policy of your own.  Rules of engagement via social media should be just as important as on call or billing procedures.  Along those lines I occasionally post friendly online reminders that public discussion of care with health professionals isn't appropriate.  I keep a few clipped screen shots of these posts in the event that my social medial judgment is ever called into question.

8. Block repeat offenders.   Patients who don't understand the importance of health privacy represent a risk to themselves and a major liability to you.  Offer one warning and block after that.

As physicians we have the responsibility to help patients understand what isn’t always obvious.  And teaching the pitfalls of online health dialog fit with that responsibility.

To Unfollow is Human

Recently on Twitter I unfollowed a friend who had become too noisy.  Long strings of banal tweets were interfering with those in my stream who had something to say.  I launched a tweet reflecting my decision but didn’t disclose the perpetrator.  I then received a handful of direct messages reflecting anxious concern (“I hope it wasn’t me”).

Interesting, but not surprising.

So why do we get so upset when people stop following us?  Or why do we fear losing followers?  And why do some grow so painfully obsessed with their blog traffic?  Perhaps we just want to be loved.  Vanity is, of course, the social web’s most potent fuel.

To some extent my view of social media is unforgiving and increasingly driven by what I need.  I work to follow people who offer value.  I use Twitter and other feed as human filters that work for me on a variety of levels.  But my interests and personal direction change from time to time.  That, of course, involves regular adjustment of the filter.  And adjustments involve unfollowing.

Conversely, I can’t predict the needs of my followers.  I suspect that my stream’s balance of awkward insight and occasional dry humor distributed in evenhanded way has relevance to someone.  But I accept that I can’t please all the people all of the time.

Now follow me out on this limb.

If social media is as much about transparency and altruistic benevolence as we’ve been lead to believe, we should be thrilled when we’re unfollowed.  We have, after all, helped someone refine their human filter and get closer to where they need to go.

I suspect this idea won’t achieve widespread adoption.

Engagement in the social media space requires a real appraisal of what we want and why we're here.  And if it’s all about needing love and someone to follow you, I might suggest a lapdog.

You can unfollow me here.

Is Social Media a Fad?

Think social media is a fad?  Check out this eye opening video which showcases the dramatic rise in online social networking.  Perfectly suitable for SM skeptics.

Via Ted Eytan