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Category Archives: Neurology

For doctors: How to be a Twitter star in two easy steps

Warning: The purpose of this article is to inspire you to use Twitter, not to scare you. There are plenty of other blog posts and newspaper articles about doctors posting pictures of body parts on Facebook and getting fired. This is not it. Social media is amazingly useful for doctors and patients if you use the tools responsibly, have common sense, and never share the 18 HIPAA identifiers online or offline with unauthorized parties. The advice below is derived from extensive personal experience. I have used social media for professional purposes, as a physician, for more than 7 years, while working at some of the leading institutions in the U.S. such as the Cleveland Clinic and the University of Chicago. My account @DrVes has just been ranked #6 on the list of the Most Influential People from Chicago on Twitter (selected by Chicago Tribune and Klout.com). My blog websites have had more than 7 million page views. Just as an example, every time I hit the "publish" button of the sites, the message reaches more than 25,000 people every single day: 15,700 RSS and email subscribers, 7,000 Twitter followers, 2,200 daily visitors, and 1,000 Facebook fans (statistics for the sites ClinicalCases.org and CasesBlog, AllergyCases.org and AllergyNotes, and the Twitter accounts @DrVes and @Allergy).

This is somewhat of a typical example nowadays. There are many other physicians who are much more popular than me on social media and make the stats above look minuscule. You can be one of them. Here is how.

The basics of Twitter use for busy doctors

Most doctors are really busy. Several questions always come up when doctors consider the use of social media for professional purposes: Who has time for Twitter? What am I going to say there? To whom? And why Twitter, to begin with? What about Facebook or YouTube? My office is a mess and I always say "ehhh" when recorded -- I don't want to do video. Do I need a blog too?

Good questions. Here are the answers.
The circle of online information for me is as follows: Google Reader -> Share on Twitter -> Get feedback -> Write a blog post -> Share via RSS and Twitter -> Get feedback, go on. You don't need to use all services.


The circle of online information (full version) (click to enlarge).

1. Who has time for Twitter?

You do. Twitter should take no more 30 minutes per day and it will be beneficial for you, your colleagues and your patients. You will learn more and will feel better about it. Make it part of your normal routine - just like checking the news. In fact, Twitter is just that - checking the news - and then sharing the ones that you find most interesting with your followers. This takes a single click, and 2 seconds. Ten tweets per day, 2 seconds each. This is 20 seconds. You can do it.

2. Why Twitter?

Start on Twitter because it is quick and relatively easy. Twitter has the lowest barrier to entry among all social media services. "Being on Twitter" requires just 10 short sentences per day, with approximately 7 words each. You can reach thousands of people with a single sentence. Would you like to share the latest guidelines for food allergy? Just click and all your Twitter followers will know about them instantly. You will also get feedback to your tweets via replies and re-tweets.

3. What am I going to say on Twitter?

The answer is simple. You are an expert. There is a flood of medical news that hits the wires every day. I want to know what YOU think is important. Share the 3-10 news items per day that you find interesting. I will subscribe to read them. Many will do the same.

4. Who is going to read my tweets?

As a physician, you are an expert in your field. You provide valuable insight - just be selecting what you think it’s important from the news of the day. Embed this little personal news stream in your practice page. Your patients will appreciate the helpful updates, hand-picked by their doctor. Your colleagues may find it interesting too.

5. What about Facebook or YouTube?

Those are nice but I would start on Twitter first, and then expand if you see the need to do so. It may be a good idea to start a like/fan page on Facebook for your practice and re-post some of the tweets there. This is simple and not time-consuming. It can be done automatically.

6. Do I need a blog too?

Only you can tell if you need a blog. If you feel that you need to expand beyond 7-8 words on Twitter, by all means, start a free blog on Blogger.com by Google or WordPress.com and see how that works for you. Start on Twitter and expand to a blog as a natural extension if you need to write longer or provide some background. Post your blog items in your Twitter feed.

How to be a Twitter "star" in two easy steps

This is easy. It’s a two-step process for beginners and it takes about 30 minutes per day. The best time is just after your kids go to sleep.

1. Review the news of the day from Google Reader. I have ready-made subscription RSS bundles for you below. Alternatively, you can check a service such as Webicina.com for RSS feeds in your specialty.

2. Post the news items that you like best on Twitter. Don’t post all 10 tweets at once. Schedule them evenly throughout the next day. The first tweet goes on at 7:30 am EST and the last one at 8:30 pm EST. You can use Seesmic Web to schedule tweets - it is simple, free, and just works. The alternatives include HootSuite and any number of scheduling services (some of them have a limitation of up to 10 tweets per day).

This summary did no address the other Twitter activities such as listening, engaging, search, chat, HIPAA compliance, etc. They will be discussed in future articles.

RSS bundles of medical news

You can use the following RSS bundles to subscribe to medical news items. The bundles are exported from my personal Google Reader page. They update automatically several times per day. When in Google Reader, just select the ones that you find interesting and share them on Twitter. Feel free to add your own comments to some of the tweets.

Top Twitter Doctors

This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:

Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.


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Postural Orthostatic Tachycardia Syndrome (POTS) – Mayo Clinic video

Phil Fischer, M.D., discusses the latest research on Postural Orthostatic Tachycardia Syndrome (POTS).

Two free full text reviews are available via Dr. RW Notes.
Comments from Twitter:
@drjohnm (John Mandrola, MD): For EPs, POTS is one tough nut to crack.>>Helpful video.

Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.


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Video: Teens See Dangers of Texting While Driving

AssociatedPress — May 16, 2010 — Teenagers are driving through an obstacle course with their cell phones in hand to see why texting while driving is so dangerous.

Related:
Proposal: All cell phones sold in Chicago to allow parents to block their children from texting while driving. Chicago Tribune, 2011.

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For doctors: How to start using social media

How to start

My advice for doctors who are interested in starting using social media for professional purposes is simple:

- Start on Twitter, expand to a blog as natural progression.

- Input your blog posts automatically to a Facebook like/fan page.
- Listen to the leading physicians, nurses and patients' voices on Twitter, and reply.
- Comment on blogs.
- Do not be afraid to share your expertise.
- Comply with HIPAA and common sense.

I posted this on Twitter yesterday: Doctors, when you don't have time to write a blog post, record a video - the orthopedic surgeon @hjluks shows how it's done: http://goo.gl/jL73J

Howard J. Luks, MD

@Doctor_V (Bryan Vartabedian) said, "My blog is my home. Twitter and Facebook are outposts."

I actually disagree a bit. My use of Twitter goes beyond a simple outpost though. It's my digital notebook and idea feedback system.

The circle of online information for me is as follows: Google Reader -> Share on Twitter -> Get feedback -> Write a blog post -> Share via RSS and Twitter -> Get feedback, go on.


The circle of online information (full version) (click to enlarge).

Substance over style

Going back to the video embedded above, I think that @hjluks is the current leader in creating original, honest, tell-it-like-it-is clinical content among physicians. This is an example to follow. The technical execution does not have to be perfect, as you will see from the discussion started on Twitter and summarized below. However, the content must be factually correct and professional.

@yayayarndiva (P. Mimi Poinsett MD) had a few comments about the technical aspects of the video such as "if you are going to do a video - make your background a tad less busy:)"

I actually liked the background - it's "authentic" and gives you something to look at during the 8-minute video.

@hjluks actually polled 100 patients on that. They like the laid back office view.

@yayayarndiva P. (Mimi Poinsett MD) thought that "authentically messy AND 8 min video with a head in bouncing chair - think I would rather read the transcript... I think docs like everyone else can sharpen their presentation skills with video... still good to continue. Video? A talking head doesn't confer authenticity- just a new toy:)... Or you could use Dragon software and dictate your post..."

@ePatientDave (Dave deBronkart) convinced @hjluks to do the transcripts, primarily for Google. "Otherwise, thy pearls of light are hidden under a YouTube bushel. I emphasize it's not just *marketing* SEO - it's for being findable for those in need", said @ePatientDave.

I agree. You need the transcript for SEO and quick info. SEO doesn't just apply to marketing - it's a way for people (real humans) to find you online.

Nothing beats video for authenticity though. I understand the concept of creating technically flawless presentations but if you wait to do a perfect video and you are a busy doctor, you may never do it. The same applies to blog posts - if you are going to write a blog post for 2 months, write a journal article instead.

I had some final encouragement for @hjluks: "You don't have to be pro with video. You are pro as orthopod - who uses video."

I think he liked that.

Do you need a social media policy for your medical practice?

Another good discussion point was brought up by an office manager of a pediatric group in Chicago: Do you need a social media policy for your medical practice? http://goo.gl/7APvI - I think you do.

John Sharp and I worked on a social media policy for Cleveland Clinic back in 2005 when all that was a big unknown in healthcare. It still is for many organizations - in terms of professional involvement and outreach. A social media policy provides some much needed guidance and boundaries.
The number one rule is very simple: comply with HIPAA and do not share any of the 18 identifiers: http://goo.gl/WR5MR
Top Twitter Doctors

This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:

Comments from Twitter and Facebook:
Bryan Vartabedian: "When I present this stuff I recommend doctors find 2-3 role models in their specialty and follow them. Watch and study how they do things. Great place to start."

Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.


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U-shaped link between Internet use and children health – beware of heavy use or very little/none

Study participants were categorized into 4 groups according to their intensity of Internet use:

- heavy Internet users (HIUs; >2 hours/day)
- regular Internet users (RIUs; several days per week and 2 hours/day)
- occasional users (1 hour/week)
- and non-Internet users (NIUs; no use in the previous month)

Health factors examined were:

- perceived health
- depression
- overweight
- headaches
- back pain
- insufficient sleep
U-shaped link
Heavy Internet users of both genders were more likely to report higher depressive scores.

Only male users were found at increased risk of overweight and female users at increased risk of insufficient sleep.

Non-Internet users (NIUs) and occasional users also were found at increased risk of higher depressive scores.

Back-pain complaints were found predominantly among male non-Internet users.

There was a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents. Heavy Internet users were confirmed at increased risk for somatic health problems.

Regular Internet use (up to 2 hours per day) is OK
Health professionals should be on the alert when caring for adolescents who report either heavy Internet use or very little/none. Regular Internet use as a normative behavior without major health consequences.
Take home point
Whatever the intensity of your Internet use is (if you are reading this, my guess is that the "intensity" of you sedentary lifestyle is high), don't forget the benefits of regular exercise:

"Health Promotion" video: Benefits of exercise.

References:
A U-Shaped Association Between Intensity of Internet Use and Adolescent Health. PEDIATRICS Vol. 127 No. 2 February 2011, pp. e330-e335 (doi:10.1542/peds.2010-1235)

Image source: Wikipedia, public domain.

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Chronic pancreatitis – The Lancet review

There are two forms of chronic pancreatitis

Chronic pancreatitis is a progressive fibroinflammatory disease that exists in 2 forms:

- large-duct forms (often with intraductal calculi)
- small-duct form

Causes of chronic pancreatitis

Chronic pancreatitis results from a complex mix of:

- environmental factors - alcohol, cigarettes, and occupational chemicals
- genetic factors - mutation in a trypsin-controlling gene or the cystic fibrosis transmembrane conductance regulator (CFTR)
- a few patients have hereditary or autoimmune disease

Management of pain

Pain is the main symptom that occurs in two forms:

- recurrent attacks of pancreatitis (representing paralysis of apical exocytosis in acinar cells)
- constant and disabling pain

Management of the pain is mainly empirical, involving:

- potent analgesics
- duct drainage by endoscopic or surgical means
- partial or total pancreatectomy
- steroids rapidly reduce symptoms in patients with autoimmune pancreatitis
- micronutrient therapy to correct electrophilic stress is emerging as a promising treatment

Steatorrhoea, diabetes, local complications, and psychosocial issues associated are additional therapeutic challenges.

References

Chronic pancreatitis. Dr Joan M Braganza DSc a , Stephen H Lee FRCR b, Rory F McCloy FRCS c, Prof Michael J McMahon FRCS d. The Lancet, Volume 377, Issue 9772, Pages 1184 - 1197, 2 April 2011.

Image source: Wikipedia, public domain.

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