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In the October 2008 issue of the American College of Emergency Physicians’ (ACEP) Journal, an op-ed was posted entitled “Medical Blogs: Communication Vehicle or Social Contract?” (if the link takes you to a sign-up page, close the window and click it again–there’s a strange cookie that’s set that will bypass the registration screen) As I read it, the first thing that struck me was the comically dated language and information. The death knell of this article’s significance was already ringing in the first paragraph (all emphases below are mine):

According to the Internet phenomenon Wikipedia, blogs (short for Web-logs) are Web sites, usually maintained by an individual, with regular entries of commentaries, descriptions of events, or other materials such as graphics and video. They can serve as online interactive diaries where bloggers pour out ideas, feelings, and opinions, and invite readers to respond with comments of their own that are often equally fascinating and spontaneous.

Technorati, a blog searching service, reports there were 112 million blogs in 2007.

Wikipedia is relegated to a “phenomenon?!” Someone needs to tell these folks at ACEP that they don’t need to qualify what a blog is with enumerated reference; it’s not 2005, and wasting a paragraph on the obvious made me want to stop reading altogether.

Moving on, any person in the blogosphere worth their salt knows the once mighty Technorati has long since lost almost all of its relevance. Nobody uses it for anything useful, its continued existence being somewhat of an anachronism. However, the ACEP authors cite 2007 data from it in July of 2008!!(as referenced in the footnote) WTF?! They aren’t even trying to appear as though they care at this point.

The painfully protracted exposition continues:

[Other blogs] serve largely as public journals, providing authors’ insights and anecdotes without the peer review or editorial vetting that occurs in more traditional journal venues. However, the personal nature of many blogs lends them an intimacy and an immediacy that is often missing from mainstream outlets. Arthur Caplan, a prominent ethicist, compared blogs to an extended form of chatter and conversation.

I noticed here already a condescending tone that would get more and more pervasive throughout the article, that the notion of a peer-reviewed journal is the pinnacle of scholarship and a blog being gossip and nonsense. Wrong and wrong–it’s a comparison of apples and oranges. No one would argue that “big” journals get their gravitas from their editorial boards, but even peer reviewed journals suffer from bias, politics, and other non-scientific factors, and published studies often come under fire after publication for being extensions of corporate/non-scholarly interests. On the flip side, many blogs can honestly stand against some of the giants of the print world in terms of their solid content–far from idle prattle–the “peer review” being the entire world of reading scholars, all free to leave commentary, positive or negative, in an open forum.

It is this point in particular where the “good old boy” stripe of physician is most chafed. There’s a strong sense of “you kids get off my lawn!” as a new medium threatens to tear away the fabric of order and control as seen through the eyes of these authors. The very notion that a patient or layperson has a potential standing of equivalence to published physicians is the fundamental reason behind why this article is being published in 2008 without embarrassment: the ACEP still doesn’t “get it.”

Most of the above is petty quibbling compared to what I’m going to quote here, though:

Dr. Rita Charon, a physician and a leading authority in narrative medicine [whatever the hell that means], believes patients own their stories, and she takes the strong position that physician-writers must have patients approve narratives written about them before publication. Two other writers and experts in literature and medicine - Dr. Jack Coulehan, internist and poet, and Ann Hawkins, Ph.D. - invoke the argument of relational ethics. What will happen if particular patients discover that they were featured in an article, story, or blog? Will they find such attention beneficial, perhaps therapeutic? Or will embarrassment or betrayal boil their blood?

“Patients own their own stories?” Well, yes, in a fundamental ethical way, no one would argue that it would be wrong to publicly share that which is private between doctor and patient. In today’s world, HIPAA guarantees*cough* that their information is kept confidential, and every medical blogger I know goes well out of their way to mask any indentifying features of a story so that any semblance to the original would either be complete coincidence or not specific enough to be unique (”a woman came to the ER last night” would apply to potentially half the emergency patient population, for example, even if it were found to be true). However, the authors aren’t even bringing up confidentiality or legal concerns; they are ridiculously invoking the idea that in a doctor-patient encounter, the patient is the “owner” of the encounter’s narrative.

RUBBISH!

There isn’t ONE story, but TWO stories, at least: one from the point of view of the patient, and one from the POV of the physician. The ACEP doesn’t seem to be concerned with nurses, techs, etc. but the reality is that everyone in, say, a trauma bay (this is the ACEP after all, and ER environments are hardly ever private one-on-one encounters), could feasibly walk away from that encounter and have something to write about and each would be unique representing a distinct POV. You can’t equate or assign ultimate ownership of the experience of any one person, the different jobs being performed, etc. It is the height of arrogance to say that any one person actually “owns” the unique narrative of another. It’s sickening, in fact.

You have to hand it to bioethicists, though. I love that they exist, and like the ACLU, you’re happy they’re there for the “big stuff” that require their unique talents, but like this they’re often involved in issues more for the intellectuo-ethical masturbation debate than for yielding something tangibly better for the patient.

There’s a lot more as the article continues about what kind of “tone” the physician-blogger should strive for, and other paternalistic drivel from authors who have already demonstrated their incompetence on the subject matter. It’s insulting enough as a physician reading this to be told they “should aspire to a voice that is respectful and professional,” much less by these authors who can’t even utilize the very tools they are professing to teach.

Ultimately, however, the relevant question is raised, “What kind of ethical code should be used to protect patients’ confidentiality?” Had this not been the article of two online amateurs, the last section could have served as a wonderful teaching tool. Instead, it turned into yet another demonstration of hubris demonstrating, “Look how I’ve offered a solution to this problem!”

The solution for a “code of ethics” had already been actively addressed, voluntarily, in the medical blogging world, without the need of paternalistic mandates from out-of-touch organization chairpersons. The Heathcare Blogger Code of Ethics (HBCE, also knowns as “Medblogger Code”) was created by communal referendum with each blog’s participation vetted beforehand. Nowhere in the HBCE will you find paternalistic directives like “Wait one week before posting [clinical encounter] material to your blog.” We (and I say ‘we’ because I’m an active member in this community) assume that bloggers who care enough to announce due diligence with the HBCE badge don’t need to be micromanaged about their own posting habits, timing, or frankly judgment on any subject.

In fairness, I’d love to see what these two ACEP bioethicists would make of the HBCE and even the sibling patient-focused community, the Patient Blogger Code of Ethics (on the same site above). Perhaps that can be the subject of a future article, once the authors get this whole “blogging” thing down.

Grand Rounds, the Election Edition is up at Nurse Ratched’s Place. Go check out the best of the medical blogosphere.  Although these posts have already been vetted and voted upon, YOU can still vote in the BIG election if you haven’t already.  Exercise your right or don’t complain later!

After careful consideration of some advice I read online and my own personal feelings, it’s with a sense of ultimate inevitability that I am shutting the blog down. After all, “text-based websites aren’t where the buzz is anymore.” I mean, social media sites like Facebook and Flickr are all the rage. “Blogging is so 2004.”

If you are wondering why the quotes above, it’s because they are lifted from a fine example of Silicon Valley douchebaggery in a turd of a piece written by Paul Bou …. tin of Valleywag. I’m not linking anything, and I certainly don’t want Google bots picking up more attention to the likes of that hack.

So to be clear (which I haven’t been on purpose): I am not shutting down the blog. It might be presumptuous of me to say, but if you are reading this you might have felt a pang of “What? Oh no!” or maybe that pang was just GERD (stay away from spicy foods already!). It just bothers me that individuals in Silicon Valley so predictably decide they are going to steer the direction of technology single-handedly because “they” are tired of what they consider “yesterday’s” technology, all on the basis of what was talked about at a drunken Michael Arrington party. Not surprisingly, I’m not alone in my opinions. (you can get the original link to the Wired article from these links)

Look, I’m not even a D-list blogger. My blog still exists for two reasons: 1) I’m stubborn, so I don’t pack it in easily, and 2) while I love comments and community, I still write for myself primarily. It’s why you don’t see ads on my site (no personal issues with those who do have them), and it’s why you’ll never see me write about search engine optimization or ‘monetizing’ (no word/phrase is more annoying except perhaps ‘game changer’) my site. If I were to throw up some AdSense text in the corner to see if I can make enough to pay my hosting, I’m open to that, but I have enough problems posting on a regular basis just with my life the way it is than to have to feel it’s a “job.” If I’m not #1 or even on the first page of Google page ranks for search queries, I couldn’t care less right now (that may change as my needs change).

All signs point to the fact that I should have died a blog death a year ago, but I’m still here. Why? Because the people I’ve made connections with are still out there, and this blog is one way I keep in touch. It’s still the journal of my personal life journey at this time, whether I’m currently in classes or not. It’s still my primary identity online, before Facebook, before Twitter, before any number of Web2.0 sites that won’t be here next year.

Regarding Twitter and Web2.0 media, here’s more of what Paul excreted:

Twitter — which limits each text-only post to 140 characters — is to 2008 what the blogosphere was to 2004. You’ll find Scoble, Calacanis, and most of their buddies from the golden age there. They claim it’s because Twitter operates even faster than the blogosphere.

As a writer, though, I’m onto the system’s real appeal: brevity…Twitter’s character limit puts everyone back on equal footing. It lets amateurs quit agonizing over their writing and cut to the chase. @WiredReader: Kill yr blog. 2004 over. Google won’t find you. Too much cruft from HuffPo, NYT. Commenters are tards. C u on Facebook?

“Commenters are ‘tards?” What an asshole. Other than spam, I’ve deleted probably only 2 comments in three years. Granted, I’m not high-traffic, but a sweeping generalization like this deserves to be called out. Commenters, along with the writer(s) is what builds a blog community. Bloggers who don’t allow comments had better be book-selling authors who’d understandably have too many comments to manage without staff, or they’re egomaniacal blowhards who don’t want to have to open what they say up for conversation. Sure, I’d reserve the right to limit conversation on a post, but not the site.

As for amateurs being limited on Twitter to 140 characters, I have two things to say: 1) “amateurs” don’t give a shit about 140 characters; they’ll just send 4-5 tweets until their overly-long paragraph (like this one ) gets typed. If they don’t “get it” in the blogging world, they aren’t going to “get it” in the micro-blogging world. 2) Brevity and thoughtfulness together in language is always a beautiful thing, but let’s face it: 99% of the time, Twitter isn’t about wordsmithing in a 140-character limit, it’s about writing about the dilemma you’re facing between what to have for dinner or how much sleep you didn’t get the night before.

And if Paul’s hypocrisy wasn’t already evident, check out the entirety of the hypothetical tweet that is the last sentence. That’s no amateur writing “C u on Facebook?”, that’s a real pro.

A professional asshat.

Anybody who’s anybody in the medical blogosphere knows that Dr. Ramona Bates, besides being a plastic surgeon, is a master quilter of the first order. It’s also no secret that she’s a great person and supports so many bloggers with kind words and commentary.  However, her kindness totally went to the next level when she offered to make my daughter a “crazy quilt” from leftover fabric that had fun animals, bright colors, etc. that would be great for kids to relate.  

Here is the gallery where the quilt pictures are (plus some more from the same few days). I got an account on SmugMug a couple of months back because that’s where I really felt my “good” photos should live because I’d have control over the design, layout, etc. unlike Flickr. That said, I’m still moving stuff over slowly (read: barely) but feel free to bookmark the main gallery and check back as photos will be populating regularly. 

Ramona sent a nice card with the package, but one thing that stuck out was that she wanted the quilt to actually be used, not (I assume) tacked on a wall–or worse yet, left in a drawer. To that end I made a small video of my daughter with the new quilt that very evening. It’s nothing fancy, the lighting was off (it was almost bedtime, so only indoor light) and I overlooked correcting for WB or gain in the camera, but that’s not the point–the point was to show Ramona that her gift was received with the same care and affection with which it was sent, used immediately and often, and treasured forever.

Thanks Ramona!

I am not kidding. Elmo. For the last 6 months or so I’ve seen more Elmo than anything other single type of programming–period. It’s the side effect of the strange psychological mind-meld that furry creature can achieve with the 2-year-old age group.

However, a few moments of Sesame Street are actually cool and clearly have some “inside jokes” aimed at the older kids/grown-ups watching it with the little ones.** This one is perfect for the theme of today, featuring the sexy, sassy, singular Tina Fey as the Skipper of this bunch o’ scalawags! It’s about 13 minutes and has some “annoying” Elmo moments of course, but it’s all worth it for Tina and the smart-alecky muppet shipmates. I’m hosting here instead of YouTube in case of “copyright” violations (not with PBS, per se, but with hot-ticket celeb media lawyer types WRT Tina Fey)–enjoy!

And on a similar note, Change of Shift, the illustrious nursing blog carnival is hosted this week by Emily McGee, aka crzegrl, and of course also has the pirate theme built right in. She’s got multimedia content to go with all the awesome posts there, so check that out too!

In closing, yes, I know I’m posting this the day AFTER but the video encode (it’s my own personal rip from the TV, not commercial) and some other things didn’t allow me to get it in before the end of yesterday. But it’s never too late to honor pirates, right?! (and yes, I didn’t talk like a pirate, but I’m just trying to get this late post up before it gets later. Don’t make me walk the plank!)

Nurse Ratched’s Place is the home of this week’s Grand Rounds, the best collection of recent posts from the medical blogosphere.  I loved the use of retro (I mean retro) photos showing how far medicine has come and how quackery still hasn’t changed much.  (my magentic bracelet hasn’t come in now that I think about it… heh)

Go check it out! Oh and happy ‘Diez y seis de septiembre‘, Mexican indepdendence day.  Unlike cinco de mayo which is all but ignored unless you live in Puebla, this holiday is the most important for the nation–their 4th of July, if you will. But it’s hard to make a beer/liquor campaign here in the US with such a long name.  Still, some people try like this group in Austin try to do it anyway and keep the true tradition alive.  I’m going to go do my part to celebrate *cough* *cough* later this afternoon on the other side of the border and hope Dept. of Homeland Security is gullible kind enough to let me back in.

Welcome to my first video blog posting!  I thought this would be appropriate to welcome myself back to my own blog (nobody else was gonna throw me a party) by giving you, my readers–now worthy of a medal of loyalty at this point–a little somethin’ somethin’ extra for your patience.  Here it is, or rather, here I am in moving pictures:

That was fun! I was honest when I said I did it in one take, believe it or not. I’m a pretty nim quick-witted person, and I actually thought of the whole “effect”/”transition” thing as I was talking up to that point. I filmed the “extra” scene separately, of course, but the rest of it was one take. The “goodies” were added in post, of course, and if it didn’t work I simply would have re-recorded another, less-silly take to replace this. I think it was a success!

I really, really have to give a shout out to Dr. Anonymous who pioneered so much multimedia for us medbloggers and who does his own video blogs about his radio show (before and after) as well as his own personal topics. Emily McGee, aka crzegrl, is also a pioneering medical vblogger whom I’ve admired greatly for putting herself out there and talking about her job and life in informative, silly, and touching ways.  Lastly, Vijay aka Scanman, had a brief foray into this area, but I think he dropped it in favor of audio ‘casts. It’s all good–I think anything we do to reach out to readers and each other in new and different ways just makes our social and professional networks that much stronger and more fulfilling.  Cheers to all of you, and now me, too!

As I mentioned in the spot above, a lot will be coming soon of a personal, and at times, difficult nature. I know I need to finish my personal illness story, and believe me when I say it has the highest priority.  After a week or so when I’m far more “caught up” with posting my narratives (I’m not going to inundate the blog all at once) I think you’ll understand where I’m coming from. I think you’ll also see that if after all that I’m still around, then I’m not going anywhere!  On to more posts, and thank you, thank you, thank you for caring enough to still be around–you’re the best!

Who better than Gruntdoc, one of the medblogosphere’s oldest (and I mean that as in “stately” and “learned” hehe) and most respected bloggers, to host the 200th anniversary edition of Grand Rounds! Is it flashy? Is it full of Web 2.0, AJAX-y, or Flash animation goodness?  Hell no, cuz that’s just not the way Gruntdoc rolls. Short, sweet and to the point–we need editions like these just as much as the envelope-pushing ones, and if I do say so myself, completely apropos for the nostalgia of the first ever 6-peat host.

Congrats from a fellow proud Texan!

I know I haven’ t been good about posting GR updates, but there’s no time like the present with The Blog That Ate Manhattan (TBTAM)’s Seinfeld edition of this week’s best of the medical blogosphere. Check it out!

Went out to a park the other day to shoot some wildlife. Uploaded a pic to Flickr, and now I’m seeing how it embeds in the blog. Heeeeere goes:

I could delete this if it works, but I should probably leave it up just ’cause. There aren’t any other pics in my photostream yet, but that will change soon.

Ok, onto the next post…

(Update: Ugh…how do I get the text NOT to float on the right? Small potatoes for now…how do I get the pic to specifically link to the “Large” version on Flickr? Perhaps that’s a blogging software limitation. I’ll try it by hand. And why am I typing “out loud” for testing purposes? Probably to show that even though I may not post every week day, I still think about it. )