BMA News magazine article

BMA News magazine article

Net assets

Sat, 18 Mar 2006 - Features section

For Shrinkette it is an opportunity to engage with patients, the Cheerful Oncologist likes to tell it as it is, while Barbados Butterfly likes a good rant (among other things). Welcome to the world of medical bloggers. Graham Clews (aka BMA News feature writer) asks them why they do it

Who created the earliest blog, and when, is hotly debated among the internet fraternity. They may have existed as long ago as 1993, but the term ‘weblog’ appears to have been coined in 1997. Later shortened to ‘blog’, the phenomenon really took off in early 1999 when one of the first web pages to catalogue blogs identified 23. By the end of the year, the number had mushroomed so that the same web page had given up counting.

Now numbering hundreds of thousands, the term blog covers a cornucopia of online pages offering information, insight and interference. They need not fit any particular form, but one of the best definitions has been published by salon.com (www.salon.com). It says: ‘Weblogs, typically, are personal websites operated by individuals who compile chronological lists of links to stuff that interests them, interspersed with information, editorialising and personal asides.’

Warts-and-all accounts of medicine

This is entirely true of medical blogs. MedEdNews, which first appeared in 1998, was one of the first. Now there are hundreds.

One of the earliest medical bloggers was Jacob Reider, a family doctor from Boston, Massachusetts, who set up his site Family Medicine Notes (at www.docnotes.net) in 1999. He explains why doctors and other medical staff feel the need to commit their thoughts to websites.

‘Before weblogs it was uncommon for healthcare providers to reveal their thoughts and feelings about their work in a public forum,’ he says. ‘Our patients know us as either wonderful and kind, or uncaring, thoughtless and hurried. But little was revealed or understood by the general public about who we were and what we think.’

London ambulance paramedic Mark Myers (not his real name) provides a warts-and-all description of life in the health service at his blog Nee Naw (www.neenaw.co.uk).

One of the few UK bloggers working for the NHS, he says: ‘I’ve kept a diary since I was ten years old, having been inspired by The Secret Diary of Adrian Mole Aged 133⁄4. I did it to keep a record of my life that I can look back on — it’s amazing how you forget all the little details. Publishing my diaries on the internet just seemed like a natural progression from using a paper diary.’

He uses his blog to raise awareness of issues he faces as a paramedic. These include ‘inappropriate use of the service, rudeness to call-takers, the unrealistic expectations of the public and their unwillingness to perform first aid under instruction’.

‘Shrinkette’, a psychiatrist in Eugene, Oregon, and a blogger for three years (www. shrinkette.blogspot.com) says: ‘It’s a marvellous way to engage people in ways that aren’t easily available in our professional lives. Blogging offers a way for patients and doctors to look behind the scenes and share experiences. I’m finding a great deal of curiosity on both sides.

‘Patients seem amazed at some of the feelings that doctors describe in blogs. And doctors seem equally amazed by their “commenters”. In America, the doctor-patient relationship has been changing. Some feel it is in crisis. Fifteen-minute appointments are frustrating for doctors, patients, and families. I see blogs as a way to bridge gaps in communication.

‘Patients say some things in their comments that they would never say to me in person. The anonymity provides a shield, of course. Sometimes it’s easier to share online stories than to talk about difficult issues during appointments.’

Other doctors blog simply for the enjoyment of writing and sharing. ‘Maria’ (www.intueri.org), a trainee psychiatrist in Seattle, Washington, says: ‘Even though our experiences might be considered “unique”, the writings of physicians frequently reveal many facets of the human experience. For example, one need not be a doctor to understand the pain of loss (whether through death or otherwise), the joy of relationships (whether or not one has taken care of the same family for many years in a medical context), or the beauty of life (whether one has viewed a smear of blood through a microscope or not).’

‘Barbados Butterfly’ (www.barbadosbutterfly.blogspot.com), a general surgical registrar in Australia, says: ‘Blogging is an outlet for me to vent my frustrations. I can talk about emotions I don’t feel able to express in everyday life, and I can think about what I have felt and why.

‘In the past few months I have also blogged to educate others in my “Tips for Surgical Interns” series. Blogging is all about expressing and sharing my thoughts.’

He continues: ‘Being a doctor is a huge part of who I am. Being a surgical trainee I spend the majority of my waking hours in the hospital. I get a day off on two days out of every 21. So when I express and share my thoughts they are naturally about the situations I encounter as a doctor.’

Blogging has a momentum of its own, and medical blogging is no different. Shrinkette explains how one blog can set off a chain reaction among the blogging community.

‘A medical student or resident might blog about a bad night on-call, or a difficult problem with a patient,’ she says.

‘Early career doctors [and bloggers] such as Dr Charles or Kevin MD might then pick up the theme, link to that post, and add their own insights. Doctors with more experience like Medpundit might also post their perspective. I might get involved if there’s a psychological aspect. Dr Bernstein might blog about ethical subjects, and RetiredDoc (who has seen it all and then some) might teach all of us about some key aspect or history. Nursing and patient blogs often chime in on the same issue.’

The internet is a truly international phenomenon and while medical blogs are dominated by doctors practising in the US, there are contributors across the world.

Aniruddha Malpani is a consultant IVF specialist in Mumbai, India, who says his blog (www.doctorandpatient.blogspot.com) fulfils his need to communicate.

‘It breaks my heart when I see patients receive poor medical care,’ he says. ‘I feel the reason for this is because they do not take a proactive role in their treatment. I hope my blog will inspire and motivate them to do so.’

Like many internet-related phenomena, medical blogs are growing at a fantastic rate.


Information and insight

‘The Cheerful Oncologist’ Craig Hildreth (www.thecheerful oncologist.blogsome.com), says: ‘It seems to me that medical blogging is exploding in popularity. I think it is because those who work in the medical profession are bursting with stories and knowledge that are as esoteric as they are fascinating, and they want to share them with the public.

Second, medical bloggers recognise what a terrible job the mainstream media does in honestly and accurately conveying medical information and insight. They believe they can fill this void with the truth.’

Shrinkette predicts a healthy future for blogging doctors. ‘I discover more medical bloggers every week, and it’s hard to keep up with so many,’ she says.

‘I wish some leaders in my field were blogging. I would happily tell readers, “go read those blogs”.’

Blogging, a bit like nuclear weapons, cannot be ‘uninvented’, so doctors are stuck with it for better or worse. Allen Roberts — aka ‘Gruntdoc’ (www.gruntdoc.com) — is an emergency room doctor in Fort Worth, Texas. He, for one, will carry on.

‘Why not?’ he says. ‘I find it enjoyable to rant, and very occasionally educate and entertain. I tell people it’s theatre for people with short attention spans, and they agree.’

And Alwin Hawkins, a long-time medical blogger who spent 20 years as a critical care nurse in Oregon, perhaps sums up both the attractions and distractions of blogging that are likely to affect its future.

‘I’ve never been able to focus on an individual topic. There’s no real reason to go on, no real reason to stop. I’m blogging and I can’t give up.’

* Want to know more? Visit www.medlogs.com


A Dr J Crippen writes

Why I blog

I have been a full-time GP now for 20 years. I am up to speed on EMIS [primary care clinical software] but I’m not a computer geek. So when a friend who works in the city said: ‘Have you read my blog?’ I felt rather like the judge in the 1960s who asked: ‘Who are The Beatles?’

‘It’s a weblog,’ he said, ‘an internet diary. You can say what you like. You can vent your spleen. You can rant and rave. You like that. Try it.’

So I did. Those nice people at Google have a system called Blogger. It’s free. Even a computer incompetent like me was able to master it.

What to call my new blog site? Well, I’m a doctor, I work in the NHS, it’s a blog. So I called it ‘NHS Blog Doctor’. No one can accuse me of lack of imagination.

But what to write?

Earlier that day, a patient whom I had referred to the colorectal clinic had been seen by a nurse specialist. That made me cross. I wanted him to see a doctor. I’m fussy like that. I hate this dumbing down of the health service. Air hostesses are charming but I do not want them flying the plane. So I wrote 500 words about colorectal nurse practitioners entitled ‘Who is flying up your backside?’ I pressed ‘enter’ and there it was, on the internet, for the world to read.

The day’s hiccup, that little aliquot of stress, had gone.

A patient with awful palpitations had been waiting for nine months for ablative surgery. He needed the same operation that Tony Blair had had immediately ‘on the NHS’. I was cross again. So I wrote an article entitled ‘Healthcare for the great and good’. I felt better. I did the same the next day, and the next and then the next. And people started reading it. A handful at first, but it rapidly built up to 500 readers a day and it continues to increase. So I keep doing it. It’s a big commitment now but it’s fun. It’s also stress relieving. It’s better than biting people.

And yes, before you ask, it’s good for the ego too.

‘Dr John Crippen’ is a GP principal who works in a semi-urban practice somewhere north of London, just outside the M25. As far as he knows he is the only blogging GP in the UK. The NHS Blog Doctor can be found at http://nhsblogdoc.blogspot.com

What’s in a blog? Go online with Kevin MD or Dr Dork

www.kevinmd.com/blog/

A rant on patient expectations vs patient entitlement. A patient could expect to be seen on time but is not entitled to this. An expectation not an entitlement… Patients with a displaced sense of entitlement are actually quite annoying. Almost as annoying as doctors who have disdain for patients and don’t respect their complaints enough to listen fully to their problems. Almost. Close to 5,000 office visits move across me on the river of medicine I call my practice. Not a day goes by when I either fail to meet someone’s expectations or come across an unreasonable SOB with a sense of entitlement that their issue should dominate the entire attention of my office because, for example, they are the CEO of the Whaterthehellitis Corporation. It upsets me to not meet a patient’s expectations and it enrages me when the entitled cross the threshold.

Not that the Declaration of Independence represents an authoritative piece of work but there is some good quotable stuff in there. Life, liberty and the pursuit of happiness.

Pulled out my copy of the declaration and looked intensely for the section on free medications.

Not there.

I looked for the section on ‘no waiting more than ten minutes in a doctor’s office’. Not there.

I looked for ‘having the doctor call every family member on their private jet with constant updates about Grandma because we are too busy to get our rich, fat butts into the hospital to see her ourselves’. I originally thought that was there and then realised I was wrong.

Not there. Life, liberty and the PURSUIT of happiness. Pursuit. The opportunity to have the freedom to pursue a dream or a goal. Not the entitled attainment of that goal.

www.drdork.blogspot.com

Dr Dork is interested in weight loss. He is not a dietitian. But many of his patients have obesity as a comorbidity of the conditions for which they see him. It often complicates treatment. It puts them at risk of diabetes, heart disease and certain cancers, among other things. He often gives dietary and exercise advice to his patients. As should any doctor with a patient who has health problems due to their weight. This involves some finesse and delicacy to say the least. It is really up to the patient, of course. There is no miracle cure for this one.

Dr Dork knows it is hard work. He was once 30kg (4st 10lb) overweight. He was working very long hours — that was his excuse. At this time he changed career path and decided to lose the pork. Despite still working 60-80 hour weeks, plus doing a specialist training program, plus doing postgraduate university study, he lost the weight in five months.

He changed his diet and exercised for an hour three out of four days. Dr Dork knows he is going on a bit … but this is a common problem. Most studies show about 25 per cent prevalence in the UK and Australia, and about 35 per cent in the US.

Dr Dork has complicated views about dietary adjustments. He recommends monitoring calories as the primary intervention. He believes in ‘outsmarting your body’. Our brains live in the 21st century. But our physiognomy [sic] thinks we are still hunting mammoths.

If you eat lots of calories before you go to bed, your body will store them. It is thinking: ‘I don’t know when I’ll next catch a mammoth.’ If you eat lots of calories at breakfast, you will generally use them to a greater extent. Your body is in active mode, not storage mode, during the day.

Dr Dork changed his main meal from evening to breakfast. It was hard for a few weeks. Then he got used to it.

When he has breakfast with his friends nowadays, they accuse him of ‘feasting’. But it worked. It boils down to two things. Eat less. Exercise more.