Mr Chairman, ladies and gentlemen, Good morning. I would like to thank our chairman, Ronan Kavanagh for his kind introduction and for his invitation to speak to you here today.
The topic I will be talking about is ‘why blog?’
My name is Philip Gardiner and I am a rheumatologist in Northern Ireland. Ireland is knows as the land of saints and scholars but I am neither a saint nor a scholar. After today you will probably think of Ireland as the land of bloggers and bluffers!
I have no disclosures
I have listed three useful references, particularly the first one by Francis Berenbaum.
Those of us who use social media are not really content to focus just on evidence based medicine. We think that the practice of medicine is broader and richer than this. You can call it EBM cubed.
In terms of evidence based medicine, the big problem is getting the important messages across, and I will propose that blogging can do a good job of helping to get the message across. I will consider if academics should be more involved in blogging.
If you want to be an eminent rheumatologist you will probably not want to spend time on social media. However, in the wider sense of professional profile, having a positive profile on social media is likely to become ever more important as the media and the public do their research about us online. I will consider if blogging can help us re-awake our creativity or light that spark of innovation.
If you want to be a more empathic doctor, you need to spend time reflecting, and I will be proposing that blogging can help us do this.
I will begin by a reminder of the challenges of information overload
I will briefly discuss some of the pitfalls we face
I will talk about social media and the world of academia and education
I will then give you a few brief examples from the rheumatology blogosphere
It will then be up to you if you want to take this story on to the next level…
Everyone here at the ACR is aware of the vast amount of information we are faced with. Many of you will have looked at the vast array of posters and experienced a pang of anxiety in case you might be missing the pearl of knowledge you have been looking for. How can we pick the needle from the haystack – where do we begin? As you can see from the graph, the number of articles indexed on Pubmed is rising every year, currently at over 900,000 peer reviewed articles per year.
Once we have taken in the vast amount of information at a conference like this, how can we digest it properly and make good use of it?
And how do we cope with the issues we come across in practice where there doesn’t’ seem to be any helpful information in the presentations or abstracts that prepare us for what we have to deal with in the real world.
Most of us are attending ACR to enjoy a gourmet diet of high quality educational material and avoid low quality ‘junk food’. We may also use reviews and books to further limit the amount we read, and then we may use tools like Evernote or Mendeley to further classify and store that information.
At conferences like this we also spend time discussing hot topics with colleagues, and these discussions often continue via Twitter and Blogging.
After a conference like this you may return home feeling somewhat bloated with the amount of information you have tried to cram in. My advice is to let go of the information that you are not going to use.
My top tip for the conference is to highlight the most important practical points that are really likely to make a difference in your practice. When you return from the conference review and reflect on these points and perhaps write a blog for your colleagues. This will help you to contextualise the points and integrate them in your daily routine.
William Osler once said that ‘Medicine is the Science of UN-certainty and the ART of probability. The more one practices medicine, the more shades of grey we find
A recent quote from Mark Reid on Twitter puts this very well: EBM should always be used for the 5% of clinical decision for which we have good evidence.
Atul Gawande in his excellent book ‘Being Mortal’ says that his education in medical school hadn’t prepared him for the stark reality of death and what to do when it happens to one of your patients.
So our diet may seem more than sufficient, but there are ‘missing elements’ which are essential for the health and good practice of every physician. In my own experience, blogging has helped me to become more aware of these issues.
Now some of you will still be undecided. You probably have some excuses.
You may have no time You may feel that social media doesn’t pay the bills You may have concerns about copyright You may have technical fears
If you DO decide to take the plunge into social media, you need to be aware of some ground rules. These have been neatly summarised by Bryan Vartebedian, a very experienced blogger. Some are obvious professional issues but others relating to drawing boundaries around families and avoiding airing work grievances may be less apparent to the beginner.
Greysen surveyed the Federation of State Medical Boards in 2013 about their attitude to doctors using social media. He found that they took a very dim view of the usual professional issues but they were not likely to investigate a doctor (for instance) for presenting a narrative blog around a patient encounter as long as there were no identifiers. It is a good idea to carefully read the social media guidance from the regulatory medical council in your area. There are further links on the blog that will help with this.
So do Physicians misbehave online? Chretian surveyed the tweets of 260 Physicians who were regular users of Twitter. Around 3% of tweets were considered unprofessional, and 0.7% contained potential privacy breaches. So it can happen, but the numbers are low. If people are careful there is unlikely to be a problem.
This is an example of a blog post that caused a bit of a stir in rheumatology circles. The rheumatologist concerned was dipping his toe in blogging and had come up with a post which tried to counteract some of the excessively gloomy information about SLE out there on the Internet. Most of us would not have noticed anything wrong with what he had written, but some patients took exception to the use of the word hysteria and set off a little flurry on social media, particularly FB. This was not the desired effect and has sadly put off that rheumatologist from continuing his involvement in social media.
At this meeting we have the privilege of hearing presentations by eminent academics and experts in their fields. However, very few of them are active in social media.
An editorial in Nature in 2009 suggested that academics should engage with the blogosphere, since work presented at conferences has already entered the public domain. However, they need to be careful not to actively promote their work for media coverage. This is a fine line to tread, and academics may also have concerns about breaching copyright or disclosing Intellectual property before their ground breaking paper is published.
Professor Francis Berenbaum in his article on social media produced this graphic to depict the change in information flow over the past couple of decades. We have moved from a one way linear flow from expert to clinician to patient to a more two way exchange of information between a variety of stake holders.
To put this into the context of the ACR meeting, Let’s consider how important information filters through from an ACR conference.
In the 1990s we had a traditional conference with presentations and a very large abstract book that usually ended up in the bin of our hotel room at the end of the conference. Papers might have been published in A&R a few years later but if you were not a subscriber very little was read by clinicians and even less by patients.
Moving on to 2005, we had some blogging to summarise the keynote presentations at ACR and we could subscribe to updates by email. We would also get the journal table of contents list by email. However, the flow of information was not much better.
In 2014 we have so many types of media that information is flowing in all directions. We now have the excellent ACR app that is twitter aware and bookmark-able for later reference. We have blogs, tweets, newsletters and even videos to review. As Dr Kavanagh put it in one of his memorable blog posts, you can now enjoy some of the delights of the conference ‘in your dressing gown’. And when the article comes out there will be another round of exchange among patients, doctors and other professionals to discuss the latest advances. And if your paper is especially important, it might even be the focus of a Rheumatology Podcast!
Does anyone actually read my research paper?
Research suggests that the readership of some articles is extremely low and the vast majority of articles are never cited once. The figures shown come from a study of a science journal Physics World. In contrast, blog posts frequently attract over 5000 viewers and feedback is quite often given.
Some of you will have noticed the appearance of the Altmetric logo – this is a new way of measuring the real impact of an article judged by sharing in social media or downloads on Mendeley. The trend towards open access journals looks likely to continue this trend as articles in OA journals are more likely to be cited than those in traditional journals.
So, can blogs be used in medical education? Cheston reviewed the literature in 2013 and found 14 studies, only one of which was an RCT. They reported that blogs were used in 71% of studies in comparison to 14% use of Twitter and Facebook respectively.
The results suggested that students who engaged in regular blogging did better in exams, developed better reflective writing skills and scored higher on empathy.
Systematic Review of Social Media in Medical Education. Cheston C et. al. Acad Med 2013:88;893-90
As an example, one of the studies looked at the use of social media to support a 10 month course in ultrasound where content was ‘pushed’ to the user regularly by daily ‘tweets’ to their mobile devices. They found a high degree of engagement and user satisfaction.
Facebook used by 91% of students age 18-25 in 2012
How we use social media to supplement a novel curriculum in medical education 2012, Vol. 34, No. 6 , Pages 439-444 (doi:10.3109/0142159X.2012.668245) David P. Bahner, Eric Adkins, Nilesh Patel, Chad Donley, Rollin Nagel, and Nicholas E. Kman1The Ohio State University, USA Read More: http://informahealthcare.com/doi/abs/10.3109/0142159X.2012.668245
However, if you are considering using social media with medical students, it is important to be aware that breaches of professional conduct are more common than among qualified physicians. Students need to be warned and protected. This survey of the deans of medical student affairs found that although most deans had come across examples of misconduct, the numbers were quite low.
So, is social media useful for the practicing physician? This survey by Bryan McGowan suggested that around 46% of respondents were contributing to SoMe at least once a week, and importantly 58% said that SoMe was helping them to improve patient care.
Before you start planning your own blog, it would be wise to consider your target audience and look at some examples.
However, you don’t have to restrict yourself to one particular group.
Blogging gives you the freedom to write about a variety of topics. My own blog is a bit like that, with a variety of topics directed at different groups. I use Twitter and LinkedIn to publicise the article to the particular group who might be interested using hashtags.
This is a sample post from my blog: I tend to write about things that you might not find in a medical journal. I put links to recent and older posts on the left as well as links to other useful blogs and websites
You need to think about how your website will appear to mobile visitors. Howard Luks, an orthopedist on social media, recently tweeted that a third of the visitors to his website had used a mobile device to connect.
One of my earlier blogs was set up a Charity campaign for a colleague in my hospital. This is quite easy to set up and can include a dynamic element with a link to a fund-raising website.
Campaign of awareness Antoni Chan – AS awareness
This graphic shows some of the rheumatologists involved in social media and blogging. Apologies to those colleagues I have omitted from the slide.
It would be great if a few more women would join the band of bloggers!
If you want to explore the best of rheumatology blog articles, I would suggest going to Carlo Caballero’s excellent meta-blog, which is essentially a scrapbook of some of the best blog posts from around the world. You can find this on Paper.li or Flipboard.
If you want to blog I would suggest that you take time to study Irwin Lim’s blog BJC Health. Irwin is a young rheumatologist in Sydney who writes regular posts on patient information related topics. His style is engaging and there is a high degree of participation by patients both local and elsewhere.
Dr Lim also uses a clear strategy which involves a branding of his business and a clear description of his services. He could also promote his iAnkylosingSpondylitis app although he is very discreet about promoting his services.
An example of one of Irwin’s blogs is this post on Methotrexate. Irwin has an engaging style which would mimic the sort of things rheumatologists say to patients as they hand over the formal patient information sheets. We want to say something to allay their fears about the drugs.
You may be surprised at how many people want to read this sort of information: this page alone has had over 8k people viewing it, and his site as a whole has had over 300,000 views. That is a lot of exposure.
Another example of innovative blogging is this post by Ronan Kavanagh in which he shares some of his work developing VidScripts. I would strongly suggest that you visit his site to see what this is all about. You can see that a lot of thought has gone into the design of his website, and I think that the quality of the writing matches the design.
Another example of innovative communication is the Rheumatology podcast by Drs Bhana, Laccheo and Sufka. You should tune into the podcast, but remember to check out the blog which gives links to the papers being discussed.
Finally, sometimes the physician just needs to take time out to refresh.
The first task of the physician, often forgotten, is that we need to take time to know ourselves and recognise when we are getting stuck in a rut or burnt out.
If we can’t see ourselves as humans in the mirror, we will be unable to see the humanity in our patients
A recurring theme among bloggers is self reflection, and I like this confessional blog post from Dr Kavanagh’s blog. There is something about openly admitting our weaknesses that comforts us and endears the physician to the public.
One of the great things about blogging is that you are not restricted to the typical passive restrained scientific language required by most journals. There is ample evidence that story-telling or narrative writing can be very memorable. Tyler deWitt said that good story telling is all about emotional connection.
This demands that we put ourselves in the shoes of the person in the story, that we use imaginative ways of getting the story across and we allow the story to resonate with the listener.
There are some wonderful medical writers who have developed and used these narrative skills. You should read Louise Aronson’s book and see how she has reconstructed patient narratives without losing their emotional force.
You should check out Jordan Grumet’s blog for an example of how a physician can show empathy about their patients – that it isn’t a sign of weakness to allow yourself to be m
[Rita Charon 2000 – Founder Programme Narrative Medicine, Columbia University]
At the end of all this, you may still be wondering why some of us take the time to blog. I’ll leave you with this quote from Samuel Lover:
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.
I’m going to leave you with a slide depicting illustrations from the Book of Kells in the library of Trinity College Dublin. Saint Columba and his team of monks on Iona were forerunners of the modern blogger. They embellished the standard Latin text with artistic decorations that communicated their love of the gospel text far more effectively than simple copying
Acr talk blogging for rheumatologists_final
Why Blog? An
I have no commercial interests related to this talk
1. The social (media) side to rheumatology
Nature 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
J Med Internet Res. 2012 Sep 24;14(5):e117
[Details to be posted on my blog for later reference]
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
Can Blogging help doctors to reflect and empathise?
Academia & Education
YOUR SPECIALTY NEEDS
Towards a Healthy Diet…
Books, Reviews, Conferences
Discussions with colleagues
Blogs & Twitter
A Problem of Ingestion
A Problem of
What really matters?
Just let it go: ‘flatus and flatulence’
What new information should inform a change in my
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” –
"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
Use patient images
Survey of FSMB
We MAY investigate…
Depiction of alcohol intoxication
Violating patient confidentiality
Using discriminatory or derogatory
We WILL NOT investigate…
Narrative blog of patient encounter
with no identifiers
Greysen SR, Ann Intern Med.
Do Physicians Misbehave
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
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
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
[Used with Nature Publishing Group License]
Dissemination of new
from ACR meeting to
Does Anyone Read My
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:
Measuring impact on Twitter, Blogs, Mendeley
Open Access vs. Subscription only Journals
Can Blogs Improve Medical
Systematic Review of Social Media in Medical Education.
Cheston C et. al.
14 studies, only one RCT!
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
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
89% found it user friendly
81% agreed that the content was useful
Bahner DP et al. Med Teacher 2012
Do Medical Students
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
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
Email survey: random sample of 1695 practicing oncologists and
primary care physicians in the United States in March 2011: 485
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?
The Wider Public
My Blog Topics
Use #Hashtags on Twitter to direct your
blog post to the right audience
Formats Don’t forget the mobile visitor!
Smartphone enabled version
Irwin Lim @_connectedcare
Antoni Chan @synovialjoints
Rheumatologist, UK synovialjointsblog.blogspot.com
Blog of Blogs
Carlo Caballero’s blog on Paper.li
Twitter pic & pic of page
Dr Irwin Lim & the ‘Connected Care’ blog
Focused, patient related topics
Team engagement with the public
Branding and design
Description of services
Dr Suleman Bhana, Dr Michael Laccheo, Dr Paul Sufka
“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
Refresh, Reboot, Blog!
“Good story-telling is all about
emotional connection” Tyler
to be able to think WITH, not ABOUT
create bonds between clinician and patient
‘Creative non-fiction’ – co-construct stories and use to
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.”