Understanding Your Online Reputation As A Physician

By Jeffrey Segal, M.D., J.D. and Michael J. Sacopulos, J.D.

The observation that social media is experiencing explosive growth is hardly novel. Moreover, social media is significantly influencing the medical profession. 

CNN Money.com reported that Facebook passed the milestone of half a billion signed on users half a year into 2010.  The professional and legal ramifications from the rapid growth of social media touch almost every aspect of physicians practicing today.  One of the most challenging of these ramifications is a physician’s online reputation.

Pew Internet and American Life Project recently released numbers that document just how important the source of information regarding medicine and physicians the internet has become.  Sixty-one percent (61%) of American adults look on-line for health information. Forty-nine percent (49%) of Internet users report researching a specific disease or medical problem on the Internet.  Forty-seven percent (47%) report seeking information about their physician or other healthcare professionals from on-line sources. 

Finally, five percent (5%) of “E-Patients” have posted a review online of a doctor. It is these very reviews from a small subset which form the basis of a physician’s reputation on-line.

Most physicians equate a tainted online reputation with a direct loss of business.  The analysis is simple; the worse the online reputation, the fewer the patients.  There are certainly many examples to support this reasoning. 

Dr. Linda Morrison, a physician practicing in Indiana, experienced first hand the harm that arises from an online reputational attack. In July of 2000, Dr. Morrison noticed that an anonymous individual was posting defamatory statements about her via the internet. Dr. Morrison received e-mails from this individual under a pseudonym “Surfycity45” that, among other things, made threats against her medical license.  The attacks continued into the fall of 2000. Dr. Morrison ultimately learned that “Surfycity45” had been circulating defamatory comments about her while simultaneously encouraging others to do the same. “Surfycity45” worked hard to organize a cyber mob with Dr. Morrison as its target.  

Dr. Morrison, via counsel, attempted to enjoin Defendant American Online, Inc. from the continued posting of the defamatory statements about her by the anonymous subscriber.  For a variety of legal reasons, the United States Northern District Court of Indiana ruled against the injunction.  Although Dr. Morrison alleged that “Surfycity45” statements were false, defamatory, and had resulted in damage to her professional reputation as a physician, she was unable to have these remarks removed from the Internet in a timely fashion. The damage was done.  

The implications of a physician's online reputation now extends beyond patients. At least twenty seven (27) states have a recognized cause of action for negligently credentialing a physician. Given this liability, credentialing committees will likely perform detailed background checks using all available search tools, including social network sites.

It is not just patients and credentialing committees which are scrutinizing physicians’ online reputations.  In any  medical malpractice action, physicians should assume that the plaintiff’s attorney will checking the doctor’s online reputation. Geoffrey Vance, a thirty eight (38) year old partner at McDermott, Will and Emry, makes use of social networking sites to gather facts about the opposing side for trials.  “I make it a practice to use as many sources as I can to come up with and to find information about the other side” Vance said.  “We used to run Lexus Nexus; we still do that.  We always look at cases, and now we use the internet – Google, and social networking sites.”

Mr. Vance is not alone.  Paul Kiesel, a lawyer in Los Angeles County, admits to using social media not only to investigate the opposing side, but also to help select jurors.  “Last month I had fifty (50) jurors, and as the Court Clerk read out the names, I had two (2) people in the courtroom and the third person back at the office, with all three (3) of them doing research.”

Lawyers are not the only actors in a courtroom who are using social media at trial.  Courts across the country are grappling with the serious problem of “Internet-tainted” jurors.  In case after case, judges and lawyers have discovered that jurors are doing independent research via cell phone during trials.  Last year in Arkansas, a state court judge allowed a 12.6 million dollar verdict to stand even though a juror sent eight (8) messages via Twitter from his cell phone.

Physicians’ online reputations are being examined with increasing frequency at crucial moments in their professional career.  It is no longer  prudent for a physician to fail to monitor his or her online reputation. “Physicians should carefully monitor their online reputation. I have seen examples of ex-spouses, past employees, and competitors all posing as disgruntled patients in an online effort to damage a physician’s reputation. This is a real threat that is not going away,” says Rivera.

Whether physicians work through organizations such as Medical Justice or Search Engine Optimization companies or go it alone, they need to guard their online reputations. In the words of Benjamin Franklin “It takes many good deeds to build a good reputation, and only one bad one to lose it.”

About: Jeffrey Segal, MD, JD, is a neurosurgeon, is the founder and CEO of Medical Justice Services and has been a speaker at the Medical Fusion Conference.

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Freelance MD: 7,000 Unique Readers In Month 2

Freelance MD has passed 7,000 unique monthly readers in just two months.

I thought we may have a slower month in January after our first 30 days of astonishing growth, but I was wrong. Here's a screenshot showing how quickly Freelance MD is growing traffic, from 4,100 readers in December 2010 to 7,100+ in January 2011. That 70% month over month is a staggering jump.

At some point I'll be expecting this growth curve to flatten out since we're a pretty small niche -  physicians interested in getting more control of their careers and lifestyle -

• We've added a physician jobs area that we're looking to grow. We'll be adding non-clinical jobs in the very near future.
• We continue to be sticky. This indicator—even more than the growth curve—is something to get excited about since it denotes that readers are heavily engaged.
• We continue to add new members across our network. From our LinkedIn Group to our physician members on this site. (You can join Freelance MD for free and get access to our members only areas and downloads.)
• We've got a number of new Select Partner applicatants that would like to be part of our community. With partners like Health 2.0, ExpedMed, and the Medical Fusion Conference, we're tapping in to a number of other communities and events that we can add value to.
• We're in the process of adding a number of new reports and downloads for our members and the should be up shortly.
• We've added a number of new physician authors over the last month and there are others who should be up and running in the next few weeks.

There'a more than a little going on behind the scenes as we continue to build this community as a trusted resource for docs. Please let us know how we're doing, give us suggestions, or just vent if there's information that you want but can't find. Leave us a comment.

Update on Feb 1, 9:46 AM by Jeff, Freelance MD

The final number for January was 7,260 unique visitors. ; )

Inside Infant-Parent Mental Health Care

By Claudia M. Gold MD

Inside Infant-Parent Mental Health Care

Three-month-old Jenna sleeps peacefully in her mother’s lap. The cards seem stacked against her. Cara at 17 is struggling to finish high school. She has been diagnosed in the past with bipolar disorder, but currently is receiving no treatment. Her primary care doctor, who referred her to me, has been prescribing an anti-anxiety medication as a temporizing measure. Cara has been playing phone tag for over a month with the therapist at the community mental health center, whom she needs to see in order to get an appointment with a psychiatrist.

Cara is scheduled as my patient in my behavioral pediatric practice. I put anxiety as the diagnosis on the billing form. But in truth the aim of my work with this mother-infant pair is to protect her daughter’s developing brain from the well-documented ill effects of maternal mental illness on child development.

Cara talks in a rambling manner about a range of subjects- her older sister at 20 pregnant with her second child, but neglectful of the first, her father who abandoned the family when she was two. She is particularly focused on her difficult relationship with James’ father, Ed.  She tells of his drug use, his recent arrest for stealing, his neediness and his inability to accept his role as father.

An infant’s brain makes as many as 1.8 million neural connections per second. The way in which these connections are formed is highly influenced by human relationships. As Cara responds to Jenna’ face and voice, is attuned with her rhythms and needs, both physical and emotional, she is literally growing her brain.

Important research has shown that when a mother can think about her baby’s mind and attribute meaning to his behavior, she helps him to develop a secure sense of himself and of his relationship with her. This security helps him to regulate himself in the face of difficult emotions. As he grows older he will have the capacity to think clearly and flexibly and manage himself in a complex social environment.

When I work with mother-baby pairs like Cara and Jenna, I focus on one simple thing. I listen to these mothers with the aim of helping them to reflect on their baby’s experience of the world and the meaning of their behavior. It never ceases to amaze me that with this singular focus, meaningful communication happens even in what appears to be chaotic and dismal circumstances.

As I listen to Cara’s rambling story, I know I need to help her start thinking about how all of this affects her relationship with Jenna. I use a technique I learned from leading researcher and clinician Peter Fonagy to help a person who is stuck in this kind of non-reflective thinking. I hold up my two hands. “Wait, I say. “I want you to help me understand how you think these problems with Ed connect with your relationship with Jenna.”

She pauses for a moment and then begins to cry. “When Jenna is so needy of me, it makes me think she’s just like her father, and I get so mad. Then I feel terrible for getting angry at her.” It’s a remarkable insight. But she isn’t done. She looks down at Jenna. “See how relaxed she is when I am calm. But when I get upset, she starts to cry.” Then she tells me of a time when she felt about to lose control, but somehow had managed to make Jenna laugh. “We were having a conversation,” she says joyfully, “even though she doesn’t say any words!”

It is a small moment in one 50-minute visit. I am confident, however, that with a string of moments like this, where Cara is fully present with her daughter, there is hope that she may break the cycle of intergenerational transmission of mental illness and help to grow a healthy brain.

About: Claudia M. Gold MD is a  pediatrician with a longstanding interest in addressing children's mental health issues in a preventive model. She blogs at http://www.claudiamgoldmd.blogspot.com/

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The Health 2.0 Spring Fling In San Diego

Health 2.0 has brand new updates for the Spring Fling Conference in San Diego on March 21-22, 2010.

Even though the spring conference is quickly approaching, at Health 2.0 we are always keeping our eyes out for something new and exciting to bring to our audience. We have recently added documentaries, panels, presentations, and speakers to the agenda. You can’t afford to miss this conference. You can register here.

Health 2.0 San Diego 2011

The Health 2.0 Spring Fling Conference will focus on three themes where Health 2.0 can make a difference: making health care cheaper; the evolution of research; and prevention, wellness, exercise and food. Surrounding these three themes we have an exciting line-up of demonstrations, panel discussions, documentaries, and speakers that will both intrigue and inspire our audience.

Here are some additions to the San Diego agenda:

We have a great morning session scheduled called The Future of Research! The emergence of user-generated content, and the rise of patient involvement in Health 2.0 is radically changing research in both discovery and clinical practice. This panel may have the most impressive line-up of people changing the research process ever assembled. It includes:

• Susan Love, the pioneering cancer surgeon behind the Army of Women clinical trial recruiting program.
• George Lundberg, the former JAMA & Medscape Editor who’s now at Cancer Commons
  shaking up medical research publishing.
• Gilles Frydman, of ACOR, the Founder of one of the oldest and most research savvy patient communities.
• Josh Sommer, the young patient activist who’s building the Chordoma Foundation to accelerate specific medical research.
• Paul Wallace, Kaiser Permanente’s lead on patient engagement and board member at the Society for Participatory Medicine.
• Deborah Estrin, Professor of Computer Science at UCLA who’s leading very different ethnographic hands-on research studies in the inner city.

Health 2.0 always shows the most cutting edge technology demonstrations. A few of the demos you’ll see in the panel on Prevention, Wellness, Exercise and Food include; Keas (Linsey Volckmann), Shopwell (Brian Witlin) and Fooducate (Hemi Weingarten).

Also just added to the list, Will Roesenzwieg, Physic Ventures, investor in food & wellness start-ups, Abbe Don, health maven at legendary design company IDEO, and Arnie Milstein, famed medical director of the Pacific Business Group on Health, and now leading the new Clinical Excellence Research Center at Stanford.

We’ll also be highlighting winners of the Health 2.0 Developer Challenge.

Health 2.0 Developer ChallengeSan Francisco Bay Area Code-a-thon is January 29th at Google! This Code-a-thon is focused on making information easily accessible to individuals. All teams will have the chance to get their hands on newly opened API’s and both public and private healthcare data-sets. We’ll have technical talks from Roni Zeiger, Google, Sastry Nanduri, HealthTap, and Alex Tam, frog design. We are also happy to announce that the Lucile Packard Foundation has issued a challenge to benefit children with special health care needs.

Future Code-a-thons:

The Washington DC Code-a-thon will be on February 12th at Georgetown University’s Department of Health Systems Integration.

The Boston Code-a-thon will be on February 19th at the Microsoft New England Research & Development Center.

These events occur over the course of one day, bringing together developers, designers and raw data sets to build exciting new applications and tools for improving health care. Attendees quickly form teams and dive into the task of creatively designing new tools. Winning teams will get the chance to present their application in front of a distinguished group of judges at the Health 2.0 Spring Fling Confernce in San Diego, March 21-22, 2011. Registration is FREE!

Physician vs Weatherman

By James Barone MD

Why wouldn't any physician want to be a weatherman?

As I sit here this morning, two inches of snow are on the ground and the snow shows no sign of letting up. The forecast was “Snow showers with no accumulation.” Once again, the forecast was wrong.

Just how accurate are weather forecasts? A New York Times article described in detail a study that was done in Missouri. It showed that television meteorologists were remarkably bad at predicting the weather and the further out the forecast went, the worse they did.

A website called “Forecast Advisor” tracks the accuracy of forecasts for any area of the country. For New York City last year. The first screen shot shows three different forecasts for today. The first was posted yesterday and the other two are revisions. None are correct as it is snowing heavily right now. The second screen shot lists cumulative accuracy statistics for the New York City area. At first glance, the accuracy for last year looks pretty good. But here’s an interesting thought. According to the New York Times article if you predicted it would not rain every day, you were right 86% of the time.

The website Weather Report Card gave “D” grades to all five major weather services that it follows regarding both temperature and precipitation forecasts for yesterday, January 24, 2011.

Now contrast this with my current profession, general surgery. How would you feel about me if I told you I made the correct diagnosis of appendicitis 76% of the time last month? Or say I told you that you needed hernia surgery but my record of actually finding a hernia was 86%? I think I would very soon be out of business.

Not so the weathermen. It seems that they are immune to criticism or accountability. In fact, the Times report stated, “When station managers were asked about this [accountability], one said, ‘There’s not an evaluation of accuracy in hiring meteorologists. Presentation takes precedence over accuracy.’”

This is why I’d like to be reincarnated as a weatherman. You can be wrong as often as you like. And if you are, no one cares. In addition, you get to engage in witty banter with the news anchors and the sports guy. My really special reincarnation wish would be to come back as the guy who stands on the beach during a hurricane and tells you it’s raining hard as my hat blows away and billboards fly past. By the way, what do those guys do when there are no hurricanes? I want that job too.

About: James Barone MD has been a surgeon for almost 40 years and a surgical department chairman for over 23 of those years. He blogs at http://skepticalscalpel.blogspot.com/

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Writing Your First Book As A Physician

Looking to write your first book as a physician?

“A man should learn to detect and watch that gleam of light which flashes across his mind from within, more than the lustre of the firmament of bards and sages.” 

So wrote Ralph Waldo Emerson in “Self-Reliance.” Those words published in 1841 have reached out to me over the past several decades and led to several publications:

• a song (later a book) about DNA: “the DOUBLE talking HELIX blues” (a Vertebral Disc, the flip side of which is “The Battle of Gross Anatomy”)
• a textbook on the interface between medicine and psychiatry: “Pediatrics, Neurology, and Psychiatry: Common Ground” (with N. Paul Rosman, M.D.)
• a diet book: “The Popcorn-Plus Diet” (featured in a People Magazine story)
• a book on depression in childhood: “Is Your Child Depressed?” (which I wrote because far more children and adolescents in my practice had headaches due to mood disorder than to the much-feared brain tumor)
• a song pertaining to sexual abuse: “Tell It Again” (which received airplay on National Public Radio)
• a book of original limericks: “For Better or Verse” (quite clean; reviewed favorably in limerick form in the St. Louis Post-Dispatch)
• a play based upon a Berton Rouché piece from the New Yorker: “Twisted: A Mind-Body Mystery” (which I presented in a solo dramatic reading in Boston, Chicago, St. Louis, and Heidelberg, Germany – the last in German), and most recently
• a book about a very important, largely unrecognized health problem: “Swallow Safely – How Swallowing Problems Threaten the Elderly and Others. A Caregiver’s Guide to Recognition, Treatment, and Prevention” (with my wife, Roya Sayadi, Ph.D., CCC-SLP, as first author). 

Was I an English major in college? No. Actually, I majored in music at Princeton, taking premedical courses on the side.

Do I have a background in theatre? Hardly. Not unless you count an unsuccessful tryout for “Frosty the Snowman” as a fifth-grader in Bloomington, Indiana.

Emerson’s words have been a further inspiration and goad. For he goes on to say (in the same essay): “In every work of genius we recognize our own rejected thoughts: they come back to us with a certain alienated majesty.”

That feeling does not sit well with me.  And I agree with Emerson that “The eye was placed where one ray should fall, that it might testify of that particular ray.”

Sometimes this ray is simply an awareness of my own ignorance.  Let me give you an example. It was years before I realized that (1) my wife, a speech-language pathologist, spent a large part of her practice dealing with swallowing problems and (2) she knew a heck of a lot more about swallowing than I, as a pediatric neurologist, ever did.  I figured — if I’m lacking this kind of information, there must be plenty others in the same boat.

Fifteen months later we were the proud parents of “SWALLOW SAFELY: How Swallowing Problems Threaten the Elderly and Others. A Caregiver’s Guide to Recognition, Treatment, and Prevention.” My wife is the first author. We have self-published the book and made it available for $14.95 through www.SwallowSafely.com, Amazon.com (including a Kindle version), and as an iBook. 

It has been received warmly by patients, family caregivers, professionals, and independent reviewers. A towering figure in the field of swallowing and its disorders, Dr. Jeri Logemann, a professor at Northwestern University and Medical School, felt that our book “will be very helpful to dysphagic patients, their families and all of us who love to eat.”

An independent reviewer, ForeWord Reviews, called the book “…a well-researched, informative guide for those caring for the elderly or the ill.” It concluded: “This book will save lives.”

The good news is that “SWALLOW SAFELY” is the first (and only) book for the general public that deals with this very important subject. The bad news is that, while many people these days know about the dangers of falling in the elderly, they may not realize that swallowing problems, too, account for tens of thousands of lives lost annually in this country. Deaths come about through choking, aspiration pneumonia, and malnutrition.

Now that the book has been written and published, we spend our time wrestling with the 800-lb. gorilla known as marketing. After all, books gathering dust in the garage or basement will not save lives or recoup our out-of-pocket expenses.

We’ve been active with the media, made presentations at public libraries, Parkinson’s disease support groups, and senior center meetings. My wife and I have greatly enjoyed doing this project together. We’ve had our challenges, but fewer than anticipated. But then again, our relationship survived — indeed, was fortified by — a two-year home remodeling project.

About: Joel Herskowitz, M.D., is a member of the Boston University School of Medicine faculty, a staff pediatric neurologist at Boston Medical Center. E-mail: herskowitzjoel@aol.com.

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Nonclinical Jobs For Doctors?

Not sure if a cashier is what most doctors are thinking when they're looking for nonclinical physician careers and opportunities.

(via A Cartoon Guide to Becoming a Doctor)