How can you make sure future program directors find only the best “you” online? Follow these suggestions when using social media services such as Facebook, Twitter and blogs:

- Consider carefully what you’re posting
- Avoid posting patient stories
- Periodically search yourself
- Check the photos in which you’re “tagged”
- Define funny - Humor can be hard to interpret
- Choose your friends carefully
- Restrict your privacy settings

Eli Pariser: Beware online "filter bubbles", TEDtalksDirector, May 2, 2011: As web companies strive to tailor their services (including news and search results) to our personal tastes, there's a dangerous unintended consequence: We get trapped in a "filter bubble" and don't get exposed to information that could challenge or broaden our worldview. Eli Pariser argues powerfully that this will ultimately prove to be bad for us and bad for democracy.

Similarly, you don't want Twitter to replace your RSS reader - always get to the original source. When you see a medical news item on Reuters or WebMD, don't stop there - always go to the original journal article. More often that not you will find that the results reported in the original article are a quite a bit more nuanced and less certain than the layman language, SEO-optimized headline that you first encountered. Always go to the source. If you write a blog, always link to the source.

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

From The Lancet:

Hard work is required: “Genius is one per cent inspiration, ninety-nine per cent perspiration” - Thomas Edison

Late in life, Charles Darwin made the same point in a letter to his son: “I have been speculating last night what makes a man a discoverer of undiscovered things, and a most perplexing problem it is.—Many men who are very clever,—much cleverer than the discoverers—never originate anything. As far as I can conjecture, the art consists in habitually searching for causes or meaning of everything which occurs.” Darwin was a relentless student of nature from 1828 until the few weeks in late 1838 when he suddenly perceived the mechanism of evolution by natural selection.

There can be no doubt that geniuses have worked habitually and continually. Darwin produced 160 published papers, in addition to celebrated books and a vast correspondence. Albert Einstein had 240 publications, Sigmund Freud 330, Henri Poincaré 500 papers and 30 books; Edison was the owner of 1093 patents, lodging an average of one patent every 2 weeks of his adult life. In the arts, J S Bach on average composed 20 pages of finished music per day, while Pablo Picasso created more than 20,000 works.

Experience is essential: “Where observation is concerned, chance favours only the prepared mind” - Louis Pasteur

The 10-year rule states that a person must persevere with learning and practising a craft or discipline for about 10 years before he or she can make a breakthrough. The initial scientific evidence for the rule came from studies in the 1960s and 1970s of chess-players, who take 10 years and more to become masters of the game. Then it was found to apply to Olympic swimmers and concert pianists.

Hardly any genius in history—not even Leonardo da Vinci—seems to have short-cut the long and gradual path to creative breakthroughs.

References

Perspiration, inspiration, and the 10-year rule. The Lancet, Volume 376, Issue 9751, Pages 1458 - 1459, 30 October 2010.

Twitter comments:

@equijada: the ability to infer disparate ideas into one is the 1%. The rest is just salty water. 10-yrs, 10,000 hrs -> playing w/ observations

According to a report from the IMS Institute for Healthcare Informatics, the top 10 most-prescribed drugs in the U.S. are:

- hydrocodone (combined with acetaminophen)
- simvastatin
- lisinopril
- levothyroxine sodium
- amlodipine besylate
- omeprazole
- azithromycin
- amoxicillin
- metformin
- hydrochlorothiazide

The top 10 best-selling drugs are:

- Lipitor, $7.2 billion
- Nexium, 6.3 billion
- Plavix
- Advair Diskus, $4.7 billion
- Abilify
- Seroquel
- Singulair, $4.1 billion (it will be generic in 2012)
- Crestor
- Actos
- Epogen

References:
The 10 Most Prescribed Drugs. WebMD.

AlJazeeraEnglish: Hundreds of children in southern Sudan have died from a mysterious illness that they have called the "nodding disease". The mentally and physically disabling disease, which has no cure yet and affects only children, first emerged in Sudan in 1980s.

"We have no clue as what is causing this. It's like a detective novel and a murder mystery, because it's fatal," says a tropical disease specialist from UNICEF.

Bizarrely, the seizures occur when the sufferers start to eat, or when it is particularly cold. When a bowl of sorghum is placed in front of Susannah, the "nodding" begins almost immediately, and stop when she has finished eating.

Some villagers say the disease is a curse, others blame the country's long civil war and suspect that government forces have been dropping chemical weapons.

93% of those surveyed are infected with a parasitic worm which causes Onchocerciasis (also known as river blindness). However, the level of infection among children without "nodding" is 63%. The worm is carried by black flies which breed near fast-flowing rivers.

A team of CDC experts conducts a multifaceted investigation in northern Uganda. An Epidemic Intelligence Service Officer tells the story about Nodding Disease, a neurologic syndrome which is devastating to afflicted children.

References:
'Nodding disease' hits Sudan. BBC, 2003.

Adults have one of the two forms of glaucoma:

Mayo Clinic: Four million people in the U.S., 100 million worldwide, are infected with Hepatitis C. It's a virus you can get from blood transfusions given before 1990, shared needles, unclean tattoo needles and sometimes sex.

In many cases it leads to cirrhosis of the liver and eventually liver cancer. Standard treatment with interferon and ribavirin only cures about 45% of all patients. But thanks to two new medications, up to 70% of people with hepatitis C may be be cured. More than 40 medications are in development.

From the National Geographic Magazine:

Here are a few suggested approaches for social media use in medical education:

- Peer student groups can utilize a private blog to share clinical experiences

- Course/program directors and staff can use a wiki to manage course/program materials and centralize frequently used documents

- Longitudinal preceptors can use a microblog (e.g., Twitter) to share links to journal articles, medical news, and reminders

- Admissions personnel can use social networks during the application, interview, and acceptance processes to build a community before students ever set foot on campus

- A public affairs office could generate podcasts to share graduate news, campus information, celebrations, and research success stories

The Networked Teacher - Diagram, Flickr http://goo.gl/CVddi

References:
Saarinen C, Arora V, Fergusen B, Chretien K. Incorporating social media into medical education. Academic Internal Medicine Insight. 9(1):12-13, 19. Read the full-text PDF here.

Some tips from ProBlogger:

- Create Healthy Boundaries. For example, I have established a “no computer time” rule for myself where I don’t use the laptop (or my smart phone) between the time I get home from work and when we get the kids to bed. By setting up this boundary, I free my time and my mind to enjoy my children, play outside or help my wife out with dinner each evening.

- Communicate Your Reasons for Blogging. Why are you investing all this time and effort into blogging anyway? Take the time to tell your loved ones why your blog is important to you and how you see it as a benefit for your family.

- Sacrifice Personal Time, Not Family Time

- Seek Their Input

According to BMJ, Vermont moves closer to becoming first US state to provide “socialised medicine”.

Vermont is set to become the first US state to launch a single payer healthcare plan after a bill passed both houses of the state’s legislature.

The plan is expected to be signed by Governor who originally proposed the idea that would abolish most insurance plans and would instead provide healthcare to all residents through public funding - a “single payer” scheme and is fiercely opposed by many conservative politicians as “socialised medicine.”

Some doctors in Vermont are unhappy about the proposed changes. In an online poll of 600 doctors conducted by a state representative and an ObGyn doctor, 28% said that they will stop practising medicine in the state if the plan is adopted.

Comments from Twitter:

@a_singledrop (Emily Lu): Seriously?

@movinmeat: calling their bluff.

@gruntdoc (GruntDoc): States as exp labs.

@backpackerchick (Hartley): In another era, doctors ****** about Medicare and found themselves richer than ever when it was enacted! What's good for the doctor (profits) is not necessarily good for the patient!

@RN_ing (Mary v. Seattle RN): Change is difficult... to be expected, but continue to want #singlepayor.

@irfandhalla (Irfan Dhalla): Single payer turned out to be well liked by docs in Canada. Will same happen in Vermont?

What do you think? Feel free to comment below, or post on Twitter.

The University of Illinois Medical Center has installed a system called HyGreen (Hand Hygiene Recording and Reminding System) which acts as a reminder to health care workers before they ever enter a patient's room.

The provider begins by cleaning his hands, then placing them under a sensor that recognizes the cleaning, and transmits a signal to a badge the provider is wearing. When they walk into the patient's room, that badge transmits an "all clean" signal to a sensor above the bed.

If a caregiver walks into a room without washing their hands, the sensor won't get that all clean signal and the badge will start buzzing.

References:
Tech Ensures Your Doc Washed Their Hands. NBC Chicago.

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.

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).

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.

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.

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:

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

The Really Smart Phone: Researchers are harvesting a wealth of intimate detail from cellphone data, uncovering the hidden patterns of social lives, travels, risk of disease - even political views.

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

CNN: "I've got these stabbing pains" - Man complains about migraine, finds he has had a knife in his brain for 4 years.