Can I possibly improve my blog? Maybe.

For kicks, I decided to look on PubMed to see if there was any research done on blogging. There is. Actual research done on how docs blog. Cool. But it's Saturday, so I'm only going to look at 2 of them.

First of all, did you know about Web 2.0?? I sure didn't but I've been using it like a mad person for years. Web 2.0 describes web sites that use technology beyond the static pages of earlier web sites.

This article makes a point I've been considering for a while - making my blog searchable in a way that will make it easier to match experiences I've had with my progress in my training and any applicable social aspects. They propose that bloggers use the usual tags they use (my favourite seems to be 'note to self''), they call these folksonomy - plus a diagnostic code from the ICD-11. The blogs that the researchers suggest these tags be used include WebMD, Kevin MD, and CasesBlog. My blog has little to do with these blogs - it's just me, I'm trying to learn more about myself as a physician not necessarily educate others (though I hope that's a happy bonus), and, for the most part, I hide my patients' true diagnosis. If I choose to follow the proposed system in this paper, which frankly isn't terrible, it makes it more difficult to hide my patients' identity. Unless, I use the ICD codes only for my rants on specific topics like suicide and HIV, and ignore the diagnoses of the cases I dissect. Which certainly is something worth looking at.  While I won't follow their algorithm to the letter, I will try to remember to tag liberally.

Another set of researchers looked specifically at learners' blogs. It's like they were looking over my shoulder. They found that learners used their blogs to reflect on their experiences. Their table 2 looks at the analysis of the blogs and what is covered and offers a few suggestions. My absolute favourite is the suggestion to share coping strategies with peers. Personally, I would have put it under "emotional distress" not "interaction with peers". I think that many learners are looking for other learners' blogs to find out how they deal with the big stuff in their lives - exams, residency matching, patient death... Having a fairly anonymous way of talking about things we are afraid of telling each other face to face would be helpful. There are many conversations taking place on twitter and in medical journals about burnout. It seems to me that using each other via the anonymity of Web 2.0 is one way to seek help without worrying about repercussions.

They also found that blogging learners were likely to preach the benefits both of collaborative learning and having a solid support system. Of course they do. Blogging learners rock.

Pinilla et al also makes some suggestions about how medical educators can use their students' blogs to enhance their learning. One suggestions is that the educators look for where their learners are having problems with exams, etc. This creeps me out. If I had any inkling that my teachers were looking at my blog I would have stopped writing. Or at least edited my posts to the point of ruining the point I was trying to make. Random, unknown educators would have been welcome to peruse, but not my own teachers. Looking at broad themes and concerns of the bloggers in general is a great idea. That it might even be an option makes me happy that I've stayed the Imposter.

So, to recap what I've learned:
1. Tag my blog liberally so that finding information in the future will be easy, both for me and for my readers.
2. Encourage the use of blogs as a way to share coping strategies.
3. Blogging learners rock.
4. Educators should not follow their own learners' blogs. It's creepy. But I'm all for qualitative research. Especially when it's done by someone else.

My online appearance is more important than my physical appearance

I had a great time today reading posts and comments on Twitter about physicians' appearances.

Things I've learned:
1. Some docs really like this article from 2005 (!!!!) on the importance of dressing well for your patients. Remember it can take up to 3 years to publish an article so this data is from 2003 at the latest. Think track suits and Queer Eye for the Straight Guy.

2. The BBC would really like doctors to generally judge everything about their outward selves. This article looks at "scruffy doctors", overweight doctors, and doctors who smoke. They also acknowledge that many patients are expecting the white coated doctor to be male. 

Which brings me to...

3. A separate discussion has been playing out today on Twitter about how young female physicians are perceived spurred by this blog entry. Female docs are often (VERY often) mistaken for nurses. Even after introducing themselves as Doctor SoandSo. I know I've blogged on this before but I can't find it. We are also assumed to be the assistant, the secretary. As an older than average resident, I was usually mistaken for the social worker or my pediatric patients' mother DESPITE wearing an ID badge and my stethoscope. One intelligent staff member asked me 6 times during my 2 month pediatric rotation to fill out the insurance forms for "my child". She was shocked every time that I was *still* a physician. I was once blocked from a code by the nurse who called me to it because she thought I was a family member (again, with stethoscope and badge). 

While I was on rotations in other hospitals, I would carry a small bag with my "pocket" stuff. Pens, a Drug Pocket, my phone. Most "professional" women's clothing prohibits actually using pockets if they do exist. This teeny satchel was usually the scape goat in my mis-identification. 

This is one of those issues that makes me a bit cranky. Have I told you yet about the preceptor who told me that it was perfectly reasonable to be mistaken for the social worker since "doctors don't have long curly hair, you can't expect to be taken seriously"? It makes me see red. 

If, in real life, I'm mistaken for another profession or not a professional at all, based on my hair and my satchel, what must the medical world think of me based on my online profile? 

Some argue that our online presence allows others to see our "true selves" (it's the basis for many relationships that start online). Social media (SoMe), plays a big part in my life. I'm in a tiny rural town, most of my friends are in different provinces. Without my online presence, I would be entirely isolated. My professional online presence is split between The Imposter and Dr. SoandSo. Maintaining my anonymity on this blog is important to my being able to use it as a sandbox for trying out ideas and ways of dealing with patients in a safe environment. As Dr. SoandSo, I have opinions on family medicine and its role among the specialties. As just me, I am on Facebook with my friends and family so I can watch my family grow up from a distance. 

I'm seeing guidelines and suggestions about how docs (and everyone else) should behave online. It's true, many docs are illiterate in the ways of SoMe, but I think that they are aware of how to behave in a crowded mall. The same rules we learned in kindergarten apply. 

1. Share everything. Post your references so others can also be as smart as you.
2. Play fair. Don't overload your online profile so that your friends aren't also visible. 
3. Don't hit people. Don't call them names. Maybe they have had a really bad day.
4. Clean up your own mess.  Untag any photos that you wouldn't want your mother to put into the family Christmas card. 
5. Don't take things that aren't yours. Credit any source that you use. You wouldn't want someone else prancing around in the sweater you took 3 years to make claiming they knitted it themselves. Our intellectual property is just as important. 
6. Say you're sorry when you hurt somebody. Apologise when you make a mistake and correct those mistakes.
7. Wash your hands before you eat. MRSA y'all. 
8. Live a balanced life - learn some and think some and draw and paint and sing and dance and play and work every day some. Your online friends are interested in the new bottle of wine you found just as much as they are the new journal article that you found so fascinating. Share. But please don't overshare. 

Truthfully, first impressions are just that. The patients who mistook me for a social worker trusted my ability to care for their medical needs. First impressions don't matter nearly as much as who we as health professionals truly are. How many times have you heard from your patients the story about the surgeon in his million dollar suit with no bedside manner? Could you possibly sleep well at night knowing that you had treated your patients in a way that would have put you in the corner during kindergarten? My online presence is as close as it comes to knowing the real Imposter and how she speaks with her patients. 

Dress respectfully for your patients but act respectfully (online and face to face) for yourself as much as them.