Docnotes

Weblog posting, Audio CME

Wow .. it's been quite a while since I've made an entry.  Here's why:

1. I'm busy.  Yeh .. I was always busy .. so .. no excuse
2. There are hundreds of other weblogs now.  Many are very good.  The reasons that I started writing this were:
1. Put annotated bookmarks up on the www so that I could find interesting and important information again .. once I had found it.
2. Expose some of the human side of the physician's world.  Much of what we do is mystery to our patients.  I wanted to reveal some of that .. and openly reflect on what I do .. and why.
3. In the context of #1 and #2 above -- both are now being done rather well by others.  In the 4+ years since I started writing the weblog, many other physicians have gotten on board and are in fact doing this just as well as I was.  Perhaps better.  I don't feel the ned to write a post today on the availability of influenza vaccine and the panic of OVERsupply that is now occurring.  Many others have commented on this already .. and I agree with many of the opinions.  There are a handful of weblogs that I continue to read  (Kevin, Sydney, Dr Bob, Enoch).   And of course I see who's writing what by checking medlogs.com every day.
   
   So the weblog isn't so important for me anymore.  I will still use to to put up links to things that others may not have found yet.

Today's tidbit:  Audio Digest is giving away some free MP3 CME programs.  When I was a resident - I would listen to an Audio Digest tape every day.  I had a 30 minute drive to work .. so .. "Side A" on the way to work and "Side B" on the way home.  This was an extraordinary adjunct to my residency education.  With a 5 minute commute these days ... I don't do this anymore.  Too bad.  I enjoyed it.  Perhaps with the growing presence of MP3 players .. we'll all get in to this ...  and I can do CME on the treadmill at the "Y" ...  and of course it makes an ipod tax deductible now .. doesn't it!?

I think that the next wave in medical blogs will be the merging of traditional medical publishing and weblog-like information sharing.  They won't be called blogs, but they will borrow from the technology and in fact from the techniques quite a bit.  I've already posted (a bit too much) about this in the past.  Here's an abstract overview of what's going to happen:  Both traditional medical publishers and web-based medical publishers will recognize that the way that a weblog communicates and retains information is valuable to physicians.  There are a few principles that we might usefully apply to such communication:

• Editorial Integrity.  the information that is selected for today's "news" must be selected because the editors believe this to be important to me. 
• They need to know who I am - and they need to know what I'm going to consider useful.  Yes - if Yahoo knows what books to show me on their "login" page .. I DO expect the medical publishers to know what kind of physician I am .. and therefore what information I would find most useful.  I'll blab about usefulness later. 
• Integrity also means that the advertising never influences the content.  Never never never.  I understand that advertising may be necessary.  Physicians will tolerate SOME of it - but not much. 
• Usability.  Easier said than done.   Medical information needs to be delivered to me in a form that makes it usable.  Not too many graphics.  Don't make me click a billion times.  Don't make me log in to click-through a big Flash advertisement.  Use words sparingly.
• Usefulness.  I've written about this before - so I won't bore you too much this time.  The key is that the user will get the most value with the least effort. 
• Transparency & Personality.  Perhaps these two are not the same .. but they're related enough that I think they can live in the same paragraph.  Transparency means that the readers know who is speaking to them - and why.  If we're talking about medical information - and perhaps even medical news - there is still an author of the story - and an editor - and if I know a little about them - I am better prepared to judge what it is that I am reading.  "Personality" may be the means to the "transparency" end.   Humor, even in "news" is appropriate and maintains the attention of the reader.  Makes everyone more human.  Sometimes when the author says WHY something is important - or offers an editorial summary - they are providing a framework for the reader.   Ever read Robbins' Pathologic Basis of Human Disease?  No?  Too bad.  It's a wonderful medical textbook - with wry humor sprinkled throughout.  2nd year medical students -- trapped in at their desks for hours at a time will stumble on these gems of humanity and remember that they are human.  Medical news sources should do the same.

Maybe there's more .. but that's all I've got for today.  Experimenting with a wiki for the FMDRL project.  Fun.

BMJ.com closing free access

Close free access: Some of the content on bmj.com goes behind access controls on 7 January 2005. Original research articles will remain completely free from the moment of publication. The full text of all other articles appearing in the print journal (eg editorials, educational articles, and reviews) will be free for the first week after publication and then under access controls for the next 51 weeks. After one year, access controls will be lifted, and all content will once again be free. Abstracts and extract views of all articles will remain free, as will other website content and functions. Access to bmj.com will be free to BMA members, personal subscribers to the print BMJ, and users from developing countries. This is too bad. I have enjoyed free access .. and will consider a subscription.

Belief Systems

So Mrs Smith ("Not her real name") sends her physician a printout from the Internet (or a clipping from a magazine or a flyer or whatever) describing JOE'S SNAKE OIL which she is certain has saved her life and lowered her cholesterol and made her hair grow longer and now she is exercising and dancing and running around the house and she is happy for the first time in years and she is eating better and no longer has to take her blood pressure medicine and so on.

And .. yeh .. no kidding .. it all happened and the BP is down and the cholesterol is better and the diet is MUCH improved and the exercise is happening and the smoking stopped and ...

So the physician wrinkles his nose and wonders what to do.  Clearly (to him) the changes are from the improvments in lifestyle.  Better living "cured" the patient of the ills that were all likely due to her previously rotten lifestyle. 

To her, the changes in lifestyle couldn't have been possible without Joe's Snake Oil and now she is certain the the physician is going to embrace this and sell it to all of his patients and everyone will be happy and then THEY too will live better and go off all of their medications.

But he's one of these "I Like EBM" nuts and there were no confidence intervals or p values or likelihood ratios or even NNTs in her literature so ... this ain't really flying his kite at all and he's thinkin he's going to set her straight and tell her right out that it wasn't the Snake Oil at all .. but her own good choices and actions that made her do so well.  Had nuthin to do with the Snake Oil.

(He thinks fondly of Dumbo's Magic Feather .. which enabled him to fly .. until he realized that he could fly without it too!)  ...

But maybe that's silly of him to "set her right." 

What does it matter?  So long as Joe's Snake Oil won't hurt her ... who cares if she belives it helped her so much.

He does.  He hates to see her waste her money on such a silly thing.

But it's a lot less than those $30 co-pays .. which really add up -- eh?

...

Where's MY magic feather?  I haven't been able to fly since I lost it!

Blogrank

What's Blogrank?

If you use Movabletype .. and you are bleeding-edge nerd ... and you want to get your blog ranked so the new-car-smell cool new 2005 version of medlogs lists you as one of the best ... you can follow these directions to get ranked.  What's it do?  You'll have to wait and see.  But the sooner you get votes .. the more you'll have .. and the more you have ... ;-)

I'll write up directions for blogger and typepad and wordpress etc sometime .. but for now ... try this .. and if you don't understand this stuff .. then it's probably not something you should do yet.

Back from Vacation ... journalists, professional writing, HIPAA

Back from vacation.

Journalists & Medical writing & Blogging:

Dave Winer's post this morning brings up the differences between journalists and bloggers. Dave says that bloggers provide the reader with a better context, since they (we?) are transparent about our opinions - while the journalist attempts objectivity. Of course they can't be objective - so the reader always wonders about the hidden (or even subconscious?) agenda.  He's right. But in medicine there may be a difference.  My exposure to medical journalism last month was a bit of an eye-opener. A well-established medical publisher is working on a plan to develop a daily medical news product.  It's a bit like a weblog. Likely to be e-mailed and/or web-based. Likely to be very good, if the beta (?alpha) test that I was involved in is any indication.

I was impressed with how good writing conveys information much more clearly than bad writing. Not that medical bloggers are bad writers.  Some are very good indeed.  But many are not. 

I was impressed with how the journalists worked hard to understand what was important and what the readers needed to understand about the topic.   Physicians and writers worked together to pull out the important information .. then whittle it down and provide clarity and depth in a concise manner. 

I think that's too much work for bloggers -- as we simply don't have enough time to work this hard at it.  Not that we couldn't do it .. but that the weblog posting is in addition to our day jobs, and to do this right ... we'd compromise the attention we devote to our day jobs.

More tidbits today:

HIPAA Security is coming. Most covered entities must be in compliance with the final HIPAA Security Rule by April 21, 2005.   Educational materials from CMS ... and ... for the full text (great bedside reading!) here's a pdf of the full HIPAA Security Rule