Why Blog? An

Overview

Philip Gardiner

Rheumatologist, N.Ireland

@philipgardiner

Disclosures

I have no commercial interests related to this talk

EBM References

1. The social (media) side to rheumatology

Francis BerenbaumNature Reviews Rheumatology 2014(10):314–318

2. Systematic Review of Social Media in Medical Education.

Cheston C et. al. Acad Med 2013:88;893-90

3. Understanding the Factors That Influence the Adoption and Meaningful Use of Social Media by Physicians to Share Medical Information

Bryan McGowan J Med Internet Res. 2012 Sep 24;14(5):e117

[Details to be posted on my blog for later reference]

EBM3

Evidence Based Medicine

Can medical bloggers help to get evidence based learning across more effectively and accurately?

Should academics use social media?

Esteem Based Medicine

Can doctors earn public trust by blogging responsibly (taking good care of our online profile)?

Can blogging stimulate creativity & innovation?

Empathy Based Medicine

Reflection is an essential ‘grounding mechanism’ for the empathic physician

Can Blogging help doctors to reflect and empathise?

Outline

Information Overload

Pitfalls

Academia & Education

Blogging

Rheumatologists

YOUR SPECIALTY NEEDS

Overload?

Information Discovery

Information Consumption

Information gap/mismatch

A Problem of Ingestion

Towards a Healthy Diet…

Aggregation

Books, Reviews, Conferences

Evernote, Mendeley/Zotero/Endnote

Social Discovery

Discussions with colleagues

Blogs & Twitter

A Problem of

Digestion

What really matters?

Just let it go: ‘flatus and flatulence’

What new information should inform a change in my

practice?

Highlight practical points at a conference

Reflect and summarise after the conference – ?prepare a

blog for colleagues

Contextualize & apply

The Missing Elements“Medicine is the Science of Uncertainty and the Art of Probability” –

William Osler

"Evidence based medicine should always be used for the 5% of clinical decisions for

which we have good evidence. Mark Reid, MD @medicalaxioms

“What I was taught in medical school didn’t prepare

me for what I feel when a patient dies…”

– Atul Gawande ‘Being Mortal’

Can blogs / reflective medical literature help?

Ground Rules for Health Blogs

Avoid discussion of…

Your alcohol consumption

Your patients (unless ‘aggressively de-identified stories’)

Your relationships & your children

Your work grievances

Avoid/Be very careful

Bad language; Photos of patients; religion & politics;

‘Black Humour’, Racist or sexist language .

‘Prescribing without a professional relationship’

Not declaring financial interests

Bryan Vartabedian, MD @Doctor_V

Survey of FSMB

We WILL investigate…

Misinformation on physician practice website

Misleading information about clinical outcomes

Use patient images without consent

Misrepresent credentials

Inappropriate contact with patients

We MAY investigate…

Depiction of alcohol intoxication

Violating patient confidentiality

Using discriminatory or derogatory speech

We WILL NOT investigate…

Narrative blog of patient encounter with no identifiers

Greysen SR, Ann Intern Med.

2013;158(2):124-130

Do Physicians Misbehave

Online?

260 Physicians with >500 followers on Twitter

Country: 76% US

Content of >5,000 tweets analysed:

3% of tweets ‘unprofessional’

0.7% potential patient privacy breaches

0.3% sexually explicit material

0.3% conflict of interest

Chretian KC JAMA 2011 Feb 9;305(6):566–8

Oops…

Should Academics Blog?

“More researchers should engage with the blogosphere,

including authors of papers in press” Nature Editorial ‘It’s

good to blog’

Nature 457, 1058 (26 February 2009)

Work presented at conferences becomes public

knowledge so blogging doesn’t break Nature’s embargo – but

avoid active ‘promotion’ for media coverage

[Used with Nature Publishing Group License]

Figure 1 Personal view on the evolution of the flow of knowledge and health

information reaching patients

Berenbaum, F. (2014) The social (media) side to rheumatology

Nat. Rev. Rheumatol. doi:10.1038/nrrheum.2014.20

Dissemination of new

research findings

from ACR meeting to

Clinicians

1995

20051995

20141995 2005

Does Anyone Read My

Research Paper?

Traditional Journals – Very Few!

90% published papers never cited

50% papers only read by authors & peer reviewers

How many people bother to respond?

Blog posts – often >5k readers, comments common

Measuring the REAL impact factor:

Altmetrics

Measuring impact on Twitter, Blogs, Mendeley

Open Access vs. Subscription only Journals

Can Blogs Improve Medical

Education?

Systematic Review of Social Media in Medical Education. Cheston C et. al.

14 studies, only one RCT!

Results:

Blogs were used in 71%, Twitter 14%, Facebook 14%

Evidence of improved learner engagement: 166 of 177 student entries on blog were ‘reflective’

engaged students had better exam scores, better reflective writing skills, higher empathy scores

BUT Blog facilitation did increase faculty time

Acad Med 2013:88;893-90

Can Social Media Help to

Support a Course?

4th year elective course on Ultrasound spread over 10 months

Methods

Focus on emergency U/S (Monthly topics on Trauma, critical care, cardiac and Ob/G)

Daily Twitter feed @EDultrasound: 101 Followers

Regular posts on Facebook (78 followers): students can ‘Like’ or comment on posts and interact

Results:

89% found it user friendly

81% agreed that the content was useful

Bahner DP et al. Med Teacher 2012

Do Medical Students

Misbehave online?

Online posting of unprofessional content by medical

students: Survey of deans of student affairs (78 of 130

replied to the survey)

13% had come across an incident deemed to violate patient

confidentiality

60% had seen an example of unprofessional conduct, but

<5/year for 78% of deans

Greysen SR et al JAMA 2012;307(11):1141

Do Physicians Use Social

Media? (2011)

Email survey: random sample of 1695 practicing oncologists and

primary care physicians in the United States in March 2011: 485

respondents (29%)

61% scan Social Media at least once a week

46% contribute to Social Media at least once a week

58% said Social Media helped them to

improve patient care

Bryan McGowan J Med Internet Res. 2012 Sep 24;14(5):e117

Who is my Target Audience?

(Me)

My Patients

Specialty Colleagues

Other Colleagues

Other Professions

The Wider Public

Opinion leaders

My Blog Topics

Diet/Drinks

Patient Focus

Historical

Patient Safety

Frustrations

New Ideas

Education

Research

Outcomes

Tech

Use #Hashtags on Twitter to direct your

blog post to the right audience

Formats Don’t forget the mobile visitor!

Desktop/Tablet version

Smartphone enabled version

Irwin Lim @_connectedcare

Rheumatologist, Sydney

Antoni Chan @synovialjoints

Rheumatologist, UK synovialjointsblog.blogspot.com

Ms Rheumatologist

Blog of Blogs

Carlo Caballero’s blog on Paper.li

Twitter pic & pic of page

‘Professional’

Blogging

Dr Irwin Lim & the ‘Connected Care’ blog

Engaging

Regularly updated

Focused, patient related topics

Team engagement with the public

Branding and design

Description of services

iSpondylitis app

Dr Suleman Bhana, Dr Michael Laccheo, Dr Paul Sufka

Refresh, Reboot, Blog!

“Physician, know thyself”

Are you suffering burnout?

Are you stuck in a rut?

“The task of the doctor is to recognise the

man” John Berger 1997

Can you face up to your own

limitations?

'Confessional blogging'

Narrative Skills

“Good story-telling is all about

emotional connection” Tyler

DeWitt

Attention:

to be able to think WITH, not ABOUT

Representation: using

written/spoken/performed/visual arts

Develop Affiliation/’Resonate’:

create bonds between clinician and patient

Narrative Competence

‘Creative non-fiction’ – co-construct stories and use to

teach students.

Louise Aronson

Use blogging to develop these skills:

Jordan Grumet’s Blog

Listening and reading

Attention, reflection, affiliation

Absorb, interpret, allow yourself to ‘be moved’

So…why DO you blog?

“When once the itch of literature comes over a man,

nothing can cure it but the scratching of a pen.

But if you have not a pen, I suppose you must

scratch any way you can.”

Samuel Lover