April 30, 2013
More social media
I've been playing with Twitter (@rbstansfield) as a work-related information channel. I follow medical education hashtags (#meded is used a lot, but also some conference-specific ones pop up occasionally). I have noticed a few things. These are in no particular order:
- At least 80% of of #meded tweets are about social media itself. Doctors and medical educations on Twitter seem primarily interested in promoting the use of Twitter for doctoring and medical educating. It almost seems like a joke with so many people talking about how great this tool is but very little evidence that anyone is actually using the tool for anything.
- There's a powerful skew to the tweets-per-user. I had to actually unfollow one prominent meded tweeter because my feed was almost homogenously him. I've since started following a lot more users so perhaps it wouldn't be so aversive now. But in general most tweets in my feed come from only a small percentage of the people I follow.
- There's little space to do more than just link. Any idea or argument with more than one logical step has to be planned carefully. The linguistic compression necessary to keep tweets short renders text unreadable after a while. Again, I'm sure I'll get the hang of it as I go.
- There's a bland kind of hyperbole in the community. And the hyperbole tends to be positive. Right now there's a tweet being re-tweeted in my feed: here it is. It's very typical of my Twitter feed content. It's a nod to a brief web article with a summary that sounds intriguing: how do med students use apps? Well if you follow the link you learn that most med students have smartphones with the iPhone being the most popular and that they spend a good amount time using "apps" on them but not so much around patients because they don't want to give the impression of being disengaged or callous. That's good, I guess, but it's hardly a description of how med students use apps. This tweet will bounce around a few people's feeds and occupy a few minds for a few minutes before evaporating. I doubt it will help anything or inspire anyone or change anyone's mind about anything. But it's quick and it's fast and there's an awful lot of it so in the aggregate it's probably having a bigger impact.
So that's where I am with Twitter. What am I missing?
April 25, 2013
Doctors on social media
I dislike the term "social media" because it lumps together things that have very distinct characteristics. Nonetheless, most "social media" has user-generated content, low barrier to entry, and high interactivity between users which makes it hard---even impossible---to control a conversation.
Given that, here are 10 reasonable guidelines for doctors who want to be doctors in the world of social media. I'd be curious to see how many of these turn out to be wise; especially the first one.
Empathy and compassion fatigue
Ezequiel Gleichgerrcht and Jean Decety have a new PLOS-One article about clinicians' empathy. It's a huge sample of practicing clinicians (N > 7,000). The most interesting finding to me is that clinical experience per se did not affect empathy, burnout or compassion fatigue; instead, disposition was related to these things. Clinicians who experience the negative aspects of being compassionate showed the most personal distress, which in turn was associated with burnout and secondary traumatic distress.
The world won't drag you down. Only you can drag yourself down.
April 24, 2013
Information is not data
A wise professor once reminded me that information is not data. Stacks of videotaped interviews are information. In order to analyze it you must first turn it into data by viewing and coding it and recording the codes in some analyzable form. That process is not analysis: it is coding. Once the coding is done and the information has been turned into data, the analysis can begin.
My graduate education was so steeped in that wisdom that I can hardly understand people who don't make that distinction when they talk about research, analysis, information, and data. If I send someone a summary table and they thank me for the "data" I am confused. When I ask for data and I get a list of means, I get irritated.
And when someone gives me an Excel spreadsheet that contains organized fonts and colors and column widths and combined cells and multiple lines of header information and rows of summary statistics for subgroups (indicated by cell borders) and so on, I begin to get downright angry. That spreadsheet may well contain all the information I need in order to extract the data, but the author has spent what is no doubt an aesthetically enjoyable time obscuring that information as much as possible.
Data are square. Data do not have curly flourishes. Data are not pretty or elegant or understandable at a glance. You should spend as much time formatting your data as you do drawing on your windows. Oh, you don't draw on your windows? Why not? Because you want an unobstructed view of the world? Ah yes. So you do understand.
Information is nice, but data are useful.
April 02, 2013
Fatigue vs. Handoffs
Shorter shifts in residency mean more frequent handoffs between people who are least skilled to do handoffs and the result is more medical errors.
And of course there's the sobering fact that post-residency docs will have seen very little continuity of care.
Basically we declared doctors should put more heart into their craft, then turned hospitals into assembly lines.