On Media Snobs and Darwinism in the Blogosphere

Last week Aaron Sorkin wrote for The Atlantic a piece in which he details his daily news feed, in What I Read. He’s not into blogs:

When I read the Times or The Wall Street Journal, I know those reporters had to have cleared a very high bar to get the jobs they have. When I read a blog piece from “BobsThoughts.com,” Bob could be the most qualified guy in the world but I have no way of knowing that because all he had to do to get his job was set up a website–something my 10-year-old daughter has been doing for 3 years. When The Times or The Journal get it wrong they have a lot of people to answer to. When Bob gets it wrong there are no immediate consequences for Bob except his wrong information is in the water supply now so there are consequences for us.

PZ Meyers, whose tagline for Pharyngula at ScienceBlogs is a bit crass for my taste, but with whom I often agree, writes On What’s Wrong With the Media:

This is the problem, that people blithely assume that because it is in the NY Times or the WSJ that it must be right — I’d rather read BobsThoughts.com because there, at least, poor lonely Bob must rely on the quality of his arguments rather than the prestige of his name and affiliation to persuade.

I’ll also add that when Bob throws the wrong information into the “water supply”, he’s only contaminating his own well; when Brooks or Friedman do it, they’re soaking the whole nation. And if Sorkin thinks that having a position on a big name newspaper means you’re exempt from the problem of bad information, then he’s dumber than his writing makes him sound. It was the Times and the Journal that pounded the drums of war…

Meyers is right; the big platforms don’t always get the story straight. That much is clear.

There is value in blogging: Open coverage of news in all fields – including science and medical reports published in top-tier journals – by writers who may think “out of the box” promotes careful analysis from more varied perspectives, critical discussion of developments and, ultimately, progress.

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Shoutout: This Week’s Grand Rounds Hosted by the Prepared Patient Forum

Yesterday’s medical-blog Grand Rounds, on What it Takes, is hosted by the Prepared Patient Forum. There’s a nice array of diverse posts. Among my favorites this week are from patients’ perspectives: by Warm Socks, on complex and simple physical systems for remembering to take pills and by Heart Sisters, on ditching the bucket list.

I recommend the Prepared Patient® blog in general; it covers patient-doctor relationships, medical ethics, health care economics and related issues. The forum includes a “dial 411” section with links to on-line, telephone and community resources for patients. The website is sponsored by the Center for Advancing Health, a D.C.-based institute.

The center’s stated mission is to conduct research, communicate findings, and advocate for policies that support everyone’s ability to benefit from advances in health science.

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E-Patient Dave Explains What It Means to Be An E-Patient

Med-blog grand rounds this week is hosted by e-patient Dave, who is Dave deBronkart, a real man who was diagnosed with a renal cell (kidney) cancer a few years back. He’s a terrific speaker and an Internet friend.

By coincidence I was searching for the definition of an e-patient, and came upon it there, in a video of his presentation at the TED (for those of you in the 1990s, that would be Technology, Entertainment, Design ideas worth spreading) “x” – meaning independently-organized meeting held in Maastricht a few weeks ago. Dave and others spoke on the topic of “The Year of Patients Rising.”

Dave explains: An e-patient is empowered, engaged, equipped and enabled. Got it?

e-patient Dave, in Maastricht

In Dave’s bio, he attributes the “e-patient” term to the late Dr. Tom Ferguson, a physician and author who, with Dave and others, founded the Society for Participatory Medicine.

All for today –

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Blogging Addiction Disorder

The author has been concerned for a while that she might be addicted to blogging. Symptoms include wanting to post instead of working on a book proposal and other, likely more important projects. She was thinking of crowd-sourcing how best to describe this disposition, but it turns out the Internet already provides a diagnostic term:

Blogging Addiction Disorder, a.k.a. BAD, a possible variant of Internet Addiction Disorder.

That’s enough for today. (NTW, I’ll get back to work now.)

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On My Mind

Yesterday I checked in on the Cancer Culture Chronicles, a thoughtful and sometimes funny blog by Anna Rachnel, who lives with metastatic breast cancer.

There I learned that the author of Living With Cancer, a blog I’d read occasionally and has been in the back of my mind lately, is dead. Sadly, I never had the chance to meet or speak with Daria.

From a eulogy in the final blog entry: She was born in 1961 in Alberta, Canada. Her breast cancer diagnosis came on in 2000, when she was 39 years old. She received surgery, chemo and radiation and additional meds. According to her first blog entry of August 2008, she’d had a local recurrence in 2004. The disease came back on the other side and elsewhere around then she started her blog. Among other things she accomplished in her life, about which I know too little, she participated in a clinical trial of an experimental drug, Brivanib, and advocated for cancer patients by speaking with members of the Canadian Parliament. She died this past January, a few days before her 50th birthday, survived by her mother, sisters, brother and husband.

From Daria’s first post, upon her 2008 recurrence: “…It is still too difficult to discuss the details. I’m hoping that sharing my experience will help me cope with the reality of my illness.”

Based on what’s evident on the blog, it seems likely that the on-line writing probably did help her, personally and individually. But perhaps, even more so, the blog is instructive for others, now. I suspect there’s a lot more I and others might learn from her story and digital afterlife.

With respect

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Live-Blogging a Book, and the Earthquake

I don’t know if makes sense to blog on a book by a woman who’s dead, who wrote about photographs and the news. But new media allows us to try new things, unedited. Here goes:

In Regarding the Pain of Others, which I began, unknowingly, on the evening before the recent quake and tsunami, Sontag begins Chapter 2:

Being a spectator of calamities taking place in another country is a quintessential modern experience <she refers mainly to war photography>…’If it bleeds, it leads’ runs the venerable guideline of tabloids and twenty-four-hour headline news shows – to which the response is compassion, or indignation, or titillation, or approval, as each misery heaves into view.

This observation, published in 2003, would account for CNN’s sending so much of its lead staff – Anderson Cooper, Dr. Sanjay Gupta, Soledad O’Brien and others – to northeastern Japan now. Some of us are drawn to the images of devastation, and these do sell.

(AP Photo/Asahi Shimbun, Toshiyuki Tsunenari)

The author continues, later:

…But there is shame as well as shock at looking at the close-up of a real horror. Perhaps the only people with the right to look at images of suffering of this extreme order are those who could do something about it – say, the surgeons at the military hospital…or those who could learn from it. The rest of us are voyeurs, whether or not we mean to be…

So maybe (as she sees it, in Chapter 2) it’s OK to look at the images if there’s a good reason to do so – for examining how others cope with a catastrophe by distributing food in limited amounts in orderly lines in order to learn, for example; or for demonstrating which structures withstood the quake and flood, which breezed over the seawall; or for planning the location and cooling protocols for nuclear reactors elsewhere…Also, quite plainly, the images may serve to raise money and needed support for the devastated region.

A soldier carries an elderly man on his back to a shelter in Natori city, Miyagi prefecture on March 12, 2011. (Photo credit: STR/AFP/Getty Images, via Flickr, as permitted)

Back to medicine – today, people are quite familiar with images of sick people. There are open, on-line communities of people sharing heartache and complications, sometimes with wrenching images. TV and the movies familiarize us with catastrophes to such a degree they may seem ordinary or unimportant. We’re desensitized, I fear, in which case the news audience’s attention is strangely reassuring.

"Japan Earthquake: Watching the Terrible News on TV" (flickr by LuisJouJR)

Maybe the people who are looking at the pictures are doing so because they really care about the people in northeast Japan. Or maybe it’s because they’re wondering – could this happen to me, all of a sudden, in the middle of an ordinary day, i.e. do I need to worry about this? Or both.

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A Video About a Robot and a Patient

Since Watson won on Jeopardy, there’s been lots of talk of robots assuming doctors’ roles. Ten years into our future, machines with programmed empathy and nuanced diagnostic skills will solve diagnostic dilemmas, deduce optimal treatment and make us well.

Yesterday I found a new Xtranormal video, this one crafted by Dr. Charles of his excellent Examining Room blog, on Dr. Watson and the 7 Qualities of an Ideal Physician.

from the Examining Room of Dr. Charles

Dr. Charles cites a 2006 Mayo Clinic Proceedings review on what patients say are essential characteristics of a good physician: The ideal doctor is confident, empathetic, humane, personal, forthright, respectful, and thorough. In this clever, short movie crafted by Dr. Charles, the robot-doctor tries to demonstrate his capability in each of these dimensions in his interaction with a cartoon patient.

I hope the folks over at IBM, who are collaborating with real medical centers now about designing artificial doctors’ intelligence, might take a close look at this video.

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Doctors Enjoy Smoking Camels, in an Old Cigarette Ad

A new Twitter follow led me to LongartsZwolle, a blog by a pulmonologist in the Netherlands. A February 1 post needs no translation:

More Doctors Smoke Camels Than Any Other Cigarette

The clip is said, on YouTube, to be a 1949 commercial for Camel cigarettes. I tried to find more on this, first by clicking on the Camel website, sponsored by the R.J. Reynolds Tobacco Company, but the virtual age filter checkpoints asked me for too much information, so I gave up.

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Note: Using Google translator, I initially found that longarts means “lung” in Dutch. Zwolle is a city north and east of Amsterdam. But @longartszwolle clarified via Twitter: longarts means pulmonologist. – updated by ES, 2/4/11, 9AM.

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Discovering Google’s Art Project

Today’s Wednesday web sighting ranks high in awesomeness. I discovered Google’s Art Project through molecular biologist Jessica Palmer’s always-gorgeous Biophemera blog.

The find is Google Art:

The Battle of the Nile, by Philip James De Loutherbourg, Tate Collection

I couldn’t make up my mind which image to capture for this post.

So take a break and explore some of the world’s finest art collections, right at your computer. Call it a mental health exercise if you like, or just go ahead and take a look. It’s fabulous!

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Regional Dialects on Twitter, and Other Things You Gotta Know

I was listening to All Things Considered yesterday while preparing dinner. A short, interesting story came on: You Have An Accent Even On Twitter. The NPR host, Robert Siegel, interviewed Jacob Eisenstein, a post-doc at Carnegie Mellon who has been examining regional variances in Twitter usage.

Some highlighted examples of Twitter dialecticisms:

In New York, people tend to do “suttin” (i.e. something, and usually having nothing to do with Sutton Place)

The use of “hella” to mean “very” as in “I’m hella tired” is more commonly iterated by people who’ve lived in Northern California.

(LOL is universally understood.)

I was sufficiently intrigued to track down Dr. Eisenstein’s paper, A Latent Variable Model for Geographical Lexical Variation, presented on January 8 at the annual meeting of the Linguistics Society of America in Pittsburgh. It’s a technical article befitting an MIT graduate, with un-trendy headings like “Cascading Topic Models,” “Inference” and heavy math. Still, I enjoyed the perusal.

Eisenstein and his colleagues started with a Gardenhose Twitter sample stream, which they say contained ~15% of public messages, from the first week of March, 2010. They whittled those down by selecting for tweets geo-tagged to the continental U.S. by authors who sent at least 20 messages during that period, and without URLs. Ultimately, they examined at some 380,000 Twitter messages (tweets) from 9,500 users.

The findings are really cool. (To be clear – that would be “coo” in Southern CA, or “koo” in Northern CA.)

Good to know that “af” signifies “as f-ck” (as in “very”), and is more commonly typed in Los Angeles than in some other parts. “Ima” for “I’m going to” is a New York kinda thing. “Gna” for “going to” is popular in Boston, but sounds familiar to this mother of a teenager in NYC.

From the Carnegie Mellon press release:

Studies of regional dialects traditionally have been based primarily on oral interviews, Eisenstein said, noting that written communication often is less reflective of regional influences because writing, even in blogs, tends to be formal and thus homogenized. But Twitter offers a new way of studying regional lexicon, he explained, because tweets are informal and conversational. Furthermore, people who tweet using mobile phones have the option of geotagging their messages with GPS coordinates.

…Automated analysis of Twitter message streams offers linguists an opportunity to watch regional dialects evolve in real time. “It will be interesting to see what happens. Will ‘suttin’ remain a word we see primarily in New York City, or will it spread?” Eisenstein asked.

I guess we’ll see how this progresses. I’m reminded of sometime around 8 years ago, when I tried cracking the IM code: “POS” meant “parent over shoulder.” That was easy. “Code 9” meant suttin similar, if I recall.

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Internet Surpasses TV as Prime News Source for Young Adults

I must have been reading a magazine when Mashable reported on new findings about the news from the Pew Research Center. A December 2010 survey confirmed that Americans are turning away from newspapers and logging onto the Web. Among young people, the Internet exceeds TV as a news source:

In 2010, for the first time, the internet has surpassed television as the main source of national and international news for people younger than 30. Since 2007, the number of 18 to 29 year olds citing the internet as their main source has nearly doubled, from 34% to 65%. Over this period, the number of young people citing television as their main news source has dropped from 68% to 52%.

The survey, which involved asking 1500 adults in the U.S. about their main source of national and international news, was conducted by phone with land-line and cell phone connections. It follows from other Pew studies, which together reveal some other, interesting trends.

Radio news consumption has been relatively flat over the past decade. The proportion citing TV as their main sources declined in all age groups. However, among people with limited education, TV dominates:

College graduates are about as likely to get most of their national and international news from the internet (51%) as television (54%). Those with some college are just as likely as college grads to cite the internet as their main source (51%), while 63% cite television. By contrast, just 29% of those with no more than a high school education cite the display internet while more than twice as many (75%) cite television.

Pew Research Center for the People & the Press, findings on Americans' news sources, Jan 4, 2011

You can visit the Pew Research Center for the People & the Press analysis for more graphs and information.

As for health care implications – I can only speculate on these trends’ significance and how doctors’ input might shift these curves, or not.

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Watching the Happy Hospitalist’s Xtranormal Videos

Some weeks ago I discovered Happy’s hilarious Xtranormal videos on his anonymous blog. Yesterday I laughed watching the Hospitalist vs the ER:


I can’t tell you much about who the Happy Hospitalist is. His is one of the few anonymous blogs I read. Based on the apparent relevance of cars and parking lots in his everyday life, I doubt he’s anywhere close to Manhattan. On politics – a tangent on the said Hospitalist’s site, most often I’m not on the same page. But on the ins and outs, and ups and downs of hospital care and personalities at work, most often he’s spot on – with instructive, occasionally deep, specifics and humor.

At the footer of Happy’s blog, beneath an image with a picture of two perky dogs in a vehicle, a caption reads: “IF YOU ARE READING THIS, YOU NEED TO FIND SOMETHING ELSE TO DO. GO SPEND TIME WITH YOUR FAMILY.”

Yes.

Xtranormal’s mission is to bring movie-making to the people, according to its website. (I aspire to try the “text to movie” function after I’ve published my first book, in 201?)

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Twitter, The Notificator, and Old Social Media News

A series of clicks this morning brought me to an interesting web finding in a Wiki-like Dead Media Archive that links to NYU’s Steinhart School of Media, Culture, and Communication.

Dead Media Archive, NYU Steinhardt School of Media, Culture and Communication

And there rests the Notificator, said (by me) to be Twitter’s great-great-great grandfather, with details:

On September 9, 1932, the London Times printed an article following up on a “correspondence in The Times proposing that British railway stations might, like those in Japan, provide facilities for messages from one person to another to be displayed.” An electrical engineer had written to the paper, agreeing, and noted a device that he had heard of; an “automatic machine…to be installed at stations and other suitable sites, and on the insertion of two pennies facilities were given for writing a message that remained in view for two hours after writing.”

The archive cites the August 1935 issue of Modern Mechanix & Inventions Magazine: “To aid persons who wish to make or cancel appointments or inform friends of the whereabouts… the new machine is installed in streets, stores, railroad stations or other public places where individuals may leave messages for friends… The machine is similar in appearance to a candy-vending device.”

In case you’re interested, my starter source was today’s post on Get Better Health by Dr. Westby Fisher on the Pros and Cons of Social Media for doctors. There, a link in a list “you may also like these posts” drew my eye: Twitter First Conceived By British Hospital In 1935. That July, 2009 post by Berci of ScienceRoll, included an image of an unidentified old-appearing newspaper with an intriguing photo of a man with a hat pointing to a strange device with the word “Notificator” at its top.

A Google search of the headline, “Robot Messenger Displays Person-to-Person Notes in Public” led me to a 1935 Modern Mechanix issue (with the fabulous logo, “YESTERDAY’s Tomorrow TODAY”), some Russian blogs and, finally, the Dead Media Archive, based in principle if not in fact, somewhere near my home in Manhattan, 3 miles or so north of NYU.

This Web find is a good example of how social media and on-line reading can accelerate learning and finding new (and in this case old) ideas. And what goes around comes around –

The Dead Media Archive brims with interesting stuff, worth a virtual visit!

I may go check it out in person, sometime later, for real, if that’s possible –

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Engage with Grace: Talking About the Hard Stuff

When I practiced oncology, I relished time spent talking with patients and their loved ones about tough decisions – when an indolent condition accelerated and it seemed time to start treatment, or when a cancer stopped responding to therapy and it seemed right to shift gears and, perhaps, emphasize palliation instead of more chemo, and at every value-loaded decision checkpoint in between.

These conversations weren’t easy; speaking of levels of care, palliation and end-of-life wishes are discussions that many doctors, even oncologists, still avoid. But I, in what I hope was a healthy way, always enjoyed that part of my work. My thinking was that even if I couldn’t change the course of an aggressive tumor, I might make a difference in the quality of a person’s end of life.

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At Thanksgiving, when family and old friends come together, we face similar choices in the topics we discuss: we can chat about the weather, or delve into relatively heated topics like global warming, politics or religion, but it’s rare that we get into the existential stuff, where my thoughts tend to wander, or into the most-avoided topics of all: what to do when our loved ones get really sick.

This weekend, Medical Lessons is participating in its first blog rally. I learned about this last year from Paul Levy, who’s Running a Hospital in Boston, and was reminded earlier today in an email from Dr. Christian Sinclair of Pallimed. The purpose of the rally is to draw attention to the Engage With Grace project, which is, ultimately, about communication in non-trivial health decisions.

From the Engage With Grace website:

  • 73% of Americans would prefer to die at home, but anywhere between 20-50% of Americans die in hospital settings.
  • More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they’ve talked to them about their preferences.
  • Eight out of ten people say it is “very” or “somewhat” important to write down EOL wishes, but only 36% actually have written instructions.

The project goal is to get the conversation started – to get families talking about values and medical decisions when they’re together over the Thanksgiving holiday, instead of waiting until there’s an emergency and they’re forced to make critical decisions under pressure and without clear directive.

I don’t mean to suggest that this is an ideal or even a good subject for conversation at the Thanksgiving table, or in a house filled with neighbors or casual acquaintances. (I don’t think it is.) But maybe when you’re washing dishes in the kitchen with your brother, or driving your mom to the airport, or sitting on the bus with your son…

There’s never a good time, or enough time, to talk about these kinds of things. But these matter a lot, especially if you or someone you love becomes really sick, which happens sooner or later to most mortals. PBS aired a special on this topic last night, on the kinds of tough decisions families face when someone is acutely ill, which is available on-line and I suggest to my readers.

For tomorrow, my recommendation is to enjoy the holiday, as I intend to do!, and to eat lots of fresh fruits and vegetables, and to connect with the people you care about and don’t see as often as you’d like or wish you could –

And maybe on Friday, or Saturday, some of you will begin that difficult conversation.

Happy Thanksgiving!

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Medical Lessons is One Year Old!

Today Medical Lessons is one year old. That’s an important milestone in any blog’s life, as I suppose it is in this author’s.

Why blog, a mother in medicine might ask me. I’m having fun with this project, for starters. Since November 17, 2009, I’ve taught myself how to use WordPress, learned the ins and outs of website hosting companies and faulty servers, experimented with Twitter – on which I’m now hooked and, best of all, engaged a growing on-line group of interesting people.

What I like best, I think, is the freedom of modern penmanship in this strange, new mode. “It’s my blog and I’ll write what I want” is my motto in this ongoing real life-segment. How cool is that?

Where ML is headed, I’m not entirely sure. It’s been picked up by the ACP Internist blog and, as of today, the Get Better Health network. I’m a firm believer in the concept that anything can happen. So far, so good!

So thank you everyone, for reading and subscribing to ML. And for those who’ve commented, double-thanks!

I’m headed to the gym,

– ES

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Links Add Value to On-Line Reading and Medical Blog Content

This post is intended mainly for medical bloggers, but it has applications elsewhere. It’s about links and uniform resource locators (URLs), terms that I didn’t fully appreciate until the last year or so. That’s because like most of my colleagues and readers, I grew up reading printed books, newspapers and magazines. Now, perhaps as much as 90 percent of the non-fiction I read is on-line.

The Web has a lot of advantages for readers – you can see multimedia presentations, or double-click to enlarge a graph of interest. What I think is best, though, is the third dimension of information that’s sometimes provided: supportive links.

Hyperlinks, which come as urls embedded in on-line text, provide immediate access to relevant ideas and sources. For example, any reader here should be aware that what prompted this mini-essay was a recent piece on the med-blog 33 Charts in which the author, Dr. Bryan Vartabedian, suggested that link over-use can detract from the reader’s experience. As he indicates, appropriately, his post was prompted by Phil Baumann, who wrote on the value of links, particularly for the purpose of author attribution.

I suppose that excessive links might distract a reader or might even be self-serving, especially if they lead to content for which the author has some ulterior motive to connect, such as a website where my book is for sale (a strictly theoretical concern, for now). Turns out that bloggers have debated the link-bait problem for years; some suggest we insert links to acquire Google Juice, i.e. connections that support search engine optimization (SEO) and blog rankings.

But I don’t care about that, at least not primarily. Rather, an author’s responsibility to credit someone whose ideas influenced her work overrides other concerns. Consider this: if at, an academic conference a lecturer draws upon another researcher’s data but doesn’t mention that person, for fear of seeming like a brown-noser or for not wanting to draw her listeners’ attention to that investigator’s work. The presentation would be considered sloppy, at best, and might border on plagiarism. Another “reason” for omission is laziness; it takes work to find an on-line reference or supporting data to justify a point you’re making. You might not remember exactly where or when you heard of an idea, so you just spell it out in a post and, over time, might even forget that you were influenced by another’s post, full-length article or even a book you read years ago.

From the reader’s perspective, links enhance an article’s utility by providing related articles and data. With appropriate connections, a reader can easily take at look and judge for herself what she thinks of whatever it is you’re talking about in a blog post. Take a real example, for instance: if I refer to the number of individuals in the U.S. who are diagnosed with cancer of the brain and nervous system, you could click and check that the National Cancer Institute estimates that would be around 22,000 for 2010. Without the link, you’d just have to take my word for it.

So I wish bloggers, and medical bloggers in particular, would provide more links to support what they write. Otherwise, what we say amounts to “I think X,” and nothing more.

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Wednesday Web Sighting A Blog on Medicine in Art

Some months ago I came upon a unique blog, Ars Medica, by Paul O’Connor. The title means “medical arts” in Latin. O’Connor studied medicine before delving into the humanities. Now he writes and gives a seminar on Literature & Medicine at Trinity College in Dublin.

The site’s theme is portrayals of physicians, medicine and illness. There are short book reviews, essays on film and among other items lately, work posted by students. I am particularly drawn to a recent post on reading poetry to people with dementia.

Worth a visit!

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Why Physicians Shouldn’t Tweet About Their Patients Or O.R. Cases

I fear this post may be a bit of a downer for some e-health enthusiasts, Internet addicts and others who might otherwise follow @medicallessons, but after nine months of “studying” medicine on Twitter, I’ve reached the conclusion that it’s probably not a good idea for most practicing physicians to use 140 character Web-broadcasted messages for communicating with or about their patients.

Sorry if I’m ruining a tweetchat, tweetup or doctors’ virtual party somewhere. I just don’t think these belong in the doctor’s office or, especially, in the O.R.

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On Patient Empowerment and Autonomy

Yesterday a Tweet crossed my screen that got me thinking. The source of was Gilles Frydman, founder of ACOR (Association of Cancer Online Resources) and a pioneer in the e-patient community:

@gfry: Participatory Medicine evangelists say “Engaged, empowered patients are better, healthier patients.” Where is the evidence?

What makes this question so ripe, in my oncologist-patient-teacher-blogger’s way of thinking, is that we may never, even if formal studies do provide data on this issue 10 years ahead, reach an objective conclusion on this matter.

The problem is this: To prove that empowered patients are “better and healthier,” how would we design a trial? If we were to compare those engaged – who almost by definition are more educated or at least have Internet access, or who are one way or another are linked to people who can help them find needed information – they’d likely do better than the disconnected patients. But the outcome might be a function of confounding variables: their education, economic status, on-line connectivity, etc.

I think the answer is inherent in the goal of being engaged, and this has to do with the concept of patient autonomy – what’s essentially the capacity of a person to live and make decisions according to one’s own set of knowledge, goals and values.

Autonomy in medicine, which borders on the empowerment idea, can be an aim in itself, and therefore valuable regardless of any measured outcome. For autonomy, or patient empowerment, to be meaningful and maybe even “better” in the strictly medical sense, as measured by outcomes like survival or quality of life, there needs be stronger public education in the U.S. and everywhere.

You can read all you want on stem cells, gene therapy or rare forms of chronic leukemia that are driven by a turned-on oncogene, but if you don’t know the basics of science and math, or don’t have sufficient language skills to read and absorb new knowledge or at least ask pertinent questions, it’s easy to get lost in that information, overwhelmed or – worse – suckered by those who’d try to persuade you of something that’s not true, cloaked in pseudoscience, that’s abundant and available on-line and, occasionally, in some doctors’ offices.

This is why public education matters, so much.

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Some Notes after Grand Rounds, and Questions for Medical Blogs and the Internet

Earlier this week I had the opportunity to host med-blog Grand Rounds. This honor – or assignment, depending on your perspective – came just in time for the new academic year.

(That would be today, July 10, 2010 – welcome new students! and interns! and “mature” doctors without supervision!)

Coincidentally, or not, over the past year I’ve made it my business to study what some might call on-line medicine. Since completing my J-School (that would be J for journalism, just to be clear) degree, I’ve spent much of my time reading, clicking and otherwise navigating through the medical blogosphere and greater Web.

So far I’ve tried to examine what’s out there – websites, on-line newspapers, magazines, blogs, advertisements, academic medical journals, Twitter, videos and more – as best I can, to understand how people find and share information having to do with health. What I’ve learned, largely confirming what I thought previously, is that the Internet as a source of medical information is a complex, evolving, powerful and largely unregulated instrument.

Some key questions for the future:

1. What is a blog and how might that be distinguished from, say, a website with ads and text, or from a newspaper or multimedia conglomerate with an engaging on-line section?

2. How might a reader identify a medical blog or health-related website? Is there a reason to separate these kinds of Internet domains from those concentrating on wellness, health care delivery, science, ethics or policy issues?

3. How much value, if any, should we assign to articles for which the author is unknown?

4. The issue of conflict of interest (COI) is slowly working its way into academic medical journals and continuing medical education programs for physicians. But on-line there’s essentially no regulation and it would be hard to implement any disclosure requirements even if there were. How the public might be informed of COI regarding on-line content – whether that’s provided by individual bloggers, newspaper-employed journalists, med-tech companies or pharmaceutical corporations – seems a critical issue for the future.

Any thoughts?

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