Keeping Pace With a Blog

Today, more than ever, the Internet has become an indispensable source of health news and information for both patients and physicians. As patients find they are increasingly responsible for larger portions of their healthcare bill, many turn to the Internet to develop an understanding of their ailment, evaluate their symptoms, or learn about the doctor they are about to see. Doctors, then, must have a credible and professional web presence to remain competitive in today’s increasingly wired healthcare environment. Most physicians look to an information technology department or specialized website developer to create their online presence. While useful, these websites can be expensive to develop, cumbersome to update, and limited in their ability to provide interactions with visitors to the site. More recently, a growing number of physicians are turning to a web log, or blog, to meet the ever-growing Internet marketplace head-on. For colleagues in the cardiovascular or cardiac electrophysiology fields, blogs can serve as a rich resource for information for patients, lab staff, hospital administration, and colleagues regarding one’s program or interests. What is a Blog? Blogs are nothing more than electronic diaries containing a reverse chronological set of entries, called posts, that can be authored by one or more individuals. Posts can contain writings, photographs, videos, music (like MP3 recordings), or audio (podcasts). Because these diaries are electronic, not only can they contain a rich variety of electronic media forms, they can also link to virtually any web page on the Internet, enriching the information content delivered to the reader. Some blogs contain short, brief entries. Others contain long, detailed discussions with extensive cross-references. In addition, some blog entries extend over several days, while other blogs have daily or only sporadic posts. While some corporations use private blogs to communicate within their organization, the majority of blogs exist in the public domain. Once developed, a public blog can be syndicated so its content is distributed worldwide to potential “subscribers” each time a new post is added. This powerful feature has developed into an Internet standard called RSS (Really Simple Syndication). By registering your blog with a syndication service (e.g., Feedburner at https://www.feedburner.com) and adding a small bit of the software to your blog’s web page, subscribers are alerted to new content. To receive these syndicated “feeds,” many news-aggregating programs exist (e.g., BlogLines at https://www.bloglines.com or Google Reader at https://www.google.com/reader) that accumulate multiple feeds into one easy-to-access location. Professional bloggers and news organizations routinely use these “feed-readers” to review hundreds of news sources daily. What a Blog Isn’t Despite the easy pathway provided by blogs to disseminate information and provide two-way communication with readers, extra caution must be applied to blogs that deal with healthcare issues, particularly topics regarding patients. Blogs are an inherently public communication vehicle, and patient discussions or communications could violate the Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”) imposed by the Health Insurance Portability and Accountability Act (HIPAA). To avoid this challenge, most physician blogs use disclaimers to limit their liability in this regard. My Blog History My blog, “Dr. Wes” (https://drwes. blogspot.com), had its humble beginnings in November 2005. In May 2005, I hit on an idea to use t-shirts to help patients cope with the psychological and emotional impact of automatic defibrillators, and created Medtees.com with my wife, a clinical psychologist. Shortly thereafter, Dr. Helen Smith, a forensic psychologist and defibrillator recipient from Knoxville, Tennessee purchased one of our shirts. Unbeknownst to me at the time, Dr. Smith was an avid psychologist blogger (https://drhelen. blogspot.com) and also was the wife of Glenn Reynolds of Instapundit (https://instapundit.com), which is one of the top 100-visited blogs on the Internet (100,000 average daily visits). After Glenn posted a picture of his wife on his blog with a link to MedTees.com, the site was inundated with thousands of visits in a matter of hours. Compared to traffic we had garnered from print media about the site, the blogs won hands down. My eyes were opened. After investigating, I decided to start my own blog using Google’s Blogger software because it was free, intuitive, and readily available (https://www.blogger.com). Other third-party software programs to develop blogs include WordPress (https://www. wordpress.com) or Typepad (https:// www.typepad.com). At the time, I viewed the Internet as an incredible forum to discuss the varied, complicated, and even the ridiculous aspects of health care. I used my blog as a means to educate patients about areas I felt I had some expertise, discuss certain carefully selected patient care experiences (while disguising patients’ identities), describe my thoughts on new healthcare innovations, articulate my concerns about healthcare policies and share the challenges I had coping with the death of my father. I started slowly, but gradually grew to trying to post once per day. The commentary I began to receive was stimulating, and I was hooked. However, I soon found that maintaining a blog and posting regularly took discipline. It takes time to develop a topic on which to write daily. I have found through trial and error that it is better not to post anything than post something I later regret. I also realized that considerable caution was required to verify content and remain credible, since syndication meant anything I wrote could end up on the front page of the Chicago Tribune. Nowhere was this better demonstrated than the case of an anonymous pediatric physician blogger who decided (regrettably) to blog about his upcoming malpractice trial preparations. His pointed and often disparaging comments toward the prosecuting attorney and the frivolous nature of the suit were highly entertaining to the physician community and garnered a huge following online. This blogger even won a “Best Medical Weblog” award in 2006. Unfortunately, the blogger’s identity was later exposed in court despite his attempts to maintain anonymity, prompting the doctor to quickly settle his malpractice case and remove his blog from the Internet. So while blogs are remarkable for their ability to inform and market a program or profession, discretion is the better part of valor when placing content on a blog. How Do I Start? Determine your motivation. While a blog can be created in under 10 minutes, maintaining a blog takes a serious time commitment. As such, the purpose and mission of the blog should be carefully considered to estimate the work effort required. Is the blog merely a creative outlet or will it be used to inform, rant, market or advocate? The choice is yours, but the underlying success of the blog will be directly coupled with your ability to post consistently to maintain an adequate readership for the effort involved. Anonymous or not? Some bloggers choose to remain anonymous, in hopes they can discuss their views honestly and without fear of repercussion. While anonymity might be assumed, realize that all computers are assigned a specific Internet address and have identifiable locations. While the majority of readers are not likely to have the expertise to track people online, rest assured others make this their hobby. So while some physicians use blogs as an expressive outlet or to covertly discuss challenging or interesting cases, they usually change significant aspects of the case to conceal identities and to avoid liability. Others, like me, have decided to not be anonymous. For me, the lack of anonymity increases my online presence, since entering my name on a search engine invariably locates my blog in the top several search results. Additionally, my blog allows me to publish topics of importance to me for patients, policy makers and the medical device industry, and through this discourse, has resulted in several patient referrals. Obtaining permission or not? I would encourage anyone who is considering maintaining a blog at work to ask permission from their employer. It is no secret that blogging takes time, and employers may not always look favorably to physician or nurse bloggers for this reason. My institution still considers their blogging policy as a work in progress, but I believe that they have found more positives than negatives to the practice so far, in terms of the improved market exposure of their physician clientele. Nonetheless, I have chosen to rarely discuss any issues regarding my workplace that might put me in conflict with the hospital leadership (I like my day job). How often should I post? A blog is a dynamic entity, and as such, requires constant, though not continuous, attention. Technorati (https://technorati.com) tracks over 109.2 million blogs on the Internet. Of these, over 99 percent received no traffic in the past year, suggesting that individuals created their blog but never maintained it. While many blogs come and go, enduring blogs receive posts regularly to assure continued readership. The frequency of posts is entirely up to you. Start slowly — maybe once every other week — then try slightly more frequently or less often depending on your time commitment. While some blogs reiterate news, usually the most interesting add commentary above and beyond what is reported, thereby adding value to the topic discussed. Irrespective of the approach one chooses, the key is to become consistent when posting to the blog. Should I include advertising? Some blogs contain advertisements (see Google Adwords at https://www. google.com/adwords or BlogAds at https://blogads.com) to generate revenue for the blogger. While these advertisements earn a few pennies for each click they receive, the ads also direct web traffic away from your site. While some highly trafficked blogs can earn several thousand dollars per month in advertising revenue, you’ll have to decide how badly you need typical smaller advertising revenues to offset your declining Medicare reimbursements. Track your site. Several free services such as Sitemeter or StatCounter (https://sitemeter.com or https://www. statcounter.com) track where readers of your blog come from. These software plug-ins are easily installed and give interesting statistics about the city, state and country of the reader, the time they spend reading and what content they read. Using this technology, you’ll soon find what interests your readers and identify others with similar interests or blogs. Create a blogroll. One of the best ways to garner readership is to visit blogs that interest you, place a comment, and add their blog’s web page to a blogroll in your blog’s sidebar. Readers can get a feel for your interests and click to see what others like you are saying. Often, fellow bloggers will reciprocate and add you to their blogroll, increasing your web traffic. Also, helpful links to professional web pages can speed your patients to content that might be helpful. Be creative. Varying your posts with new and original content builds readership best, but adding reader polls, summaries of interesting literature and links to fellow bloggers’ insights also promotes your blog. Blogging has forced me to stay abreast of innovations and trends in medicine far better than I ever could by just reading the cardiology literature alone (I mean, there are so many journals and so little time!). Although maintaining a blog takes a significant time commitment, as I delve ever-deeper into the electronic cosmos, I have stumbled upon some remarkable insights and perspectives from my fellow blogging colleagues, many of whom are much more eloquent at prose than me. Doctors, nurses, medical students, hospital administrators, patients, businesses, and politicians all have blogs out there, and each adds their own unique insight to the collective Medical Zeitgeist. As such, I think we doctors, nurses, patients, politicians and big businesses are better for it. So go ahead, give it a try: make your own blog. If it works, drop me a line so I can add you to my blogroll! To visit Dr. Fisher’s blog, please visit: https://drwes.blogspot.com

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