• 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?

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.

The world won't drag you down. Only you can drag yourself down.

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.

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.

"Teaching by specialists is fraught with difficulties on a family medicine course: although they may be experts in their own field, many specialists may never in their careers have had exposure to family medicine. So it is difficult for them to appreciate that family doctors deal primarily with patients and their symptoms rather than with diseases. The gulf between what is taught and what needs to be learned seems difficult to bridge."

A nice entry at the BMJ blogs.

And it was silly. Time was being wasted, mistakes were being made, information was no doubt lost (I have no evidence it was). So people are working to make these things work better. But change always brings pushback, and change always brings unexpected complications and inefficiencies. And the conservative folk who opposed the change always have a valid argument that it was a bad idea, even if the change is mostly for the better.

This last year I've watched Michigan adopt a new electronic records system called MiChart, and I've heard nothing but grumbles. I watched our own family physician, talking smooth doc-talk to my wife's complaint of a sore throat, slowly turn to a mumbling grump because he couldn't find the right pull-down menu on the user interface to just order the damn strep test.

I assume as people grow into a EHR system, they with bristle. Every new software is confusing and ugly and irritating. And certainly the federal government's push to get everyone on compatible EHR systems makes it feel worse.

What I can't assume is that EHRs will prove better than pushing carts of paper around. But they have to, right? Mayo's been doing EHRs for a while now, and managing good records is pretty much what made them famous: efficient information facilitates good care.

Anyhow, I found this article in my news feed and it got me thinking about this again. Students are being trained in an EHR setting and will no doubt be more comfortable with this stuff than my paper-head family physician will ever be.

There's a lesson in here somewhere.

The profession has a stake in raising a competent and admirable next generation. Why shouldn't they help pay it? Cheers to the AMA on this one.

There's a pretty cool, pretty simple study showing how endoscopic training on a gaze-down display leads to superior performance than training on a gaze-up display. It is surprising how many medical devices and techniques I've encountered assume the doctor or nurse is able to manipulate something while looking at a display screen somewhere else. Even video gamers address the screen head-on. Why, when the stakes are so much higher, do we like doctors to crane their necks?

At Michigan we don't have a special Med Ed building, though we do have a "Learning Resource Center" and a "Clinical Simulation Center" housed in different parts of the hospital/bioscience complex.

How big of a deal is it for a medical school, embedded in a big university hospital to have a dedicated building for medical education? Is it worth $75 million?

The options, as I see them, are:

1. More teachers or teacher hours
   
2. More efficient curricula
   

What am I missing? Teaching takes time and content. Which gives us better leverage over education efficiency? It's an empirical question.

Gov. Otter should set up 5 state-sponsored residency slots in Idaho to match.

From the paper:

But fundamentally, very few physicians have formal CS training. We are therefore hamstrung in implementing IT solutions. We are unqualified to participate in designing and developing transformative applications. We are poorly equipped to apply the intellectual rigor of CS in research and clinical problem solving.

The solution?

To overcome this problem, one solution is to incorporate a formal, medicine-specific [computer science] curriculum as the third pillar of medical education.

The argument?

But [computer science] and medicine revolve around the same core processes: the gathering, storage, and interpretation of data.

...and...

As a pillar of medical education, [computer science] benefits medical students and physicians in two discrete domains: critical thinking and lifelong learning. The optimal time for this training is during the preclinical years of medical school.

I can't even begin to describe how wrong I think this is. Train medical students to be doctors. They don't have to be chemists. They don't have to be physicists. They don't have to be anatomists, zoologists, or even biologists. They certainly don't have to be computer scientists any more than they have to be psychologists, sociologists, dieticians, anthropologists, or population geneticists.

Medicine is not a science: it is a discipline. Doctors are not scientists: they are doctors.