Medium high

So it's been three years since I sang the praises of Tumblr, and about two years since I last logged in. Much like the iPad was a "in between" device whose appeal plateaued as smartphones get bigger and laptops get more nimble, for me Tumblr was always stuck between short Tweets and real sit-down-and-think writing. And both Twitter and real writing are taking up more of my mindshare.

I've been writing and blogging a bunch (not here, of course) over at EPMonthly. Specifically I'm enjoying the weekly Crash Cart, commenting on new EM stories with Bill Sullivan and Mark Plaster. The fodder is chosen by the EPMonthly staff (lately Matt McGahen has been on fire), we try to keep the writing incisive but informative, and the whole thing is fun and rewarding.

Elsewhere on the web, my circle of Twitter contacts and sources has been great lately. And whenever I feel Twitter is grating, I just tweak my lists, add some fresh voices, and it all gets better again.

So for me Tumblr never took off, despite its strengths. The aggregator was spiffy, and I really liked how Tumblr allowed me to elegantly collect posts on certain topics, But I never was able to engage with the various Tumblr communities - posting and sharing things to Tumblr was like decorating a snazzy room that no one visited.

Still, I'm still drawn to the idea of reinvigorating my web presence. Which brings me to Medium, the popular writing platform that's trying hard to not be a blogging platform. Each article is beautiful; a pleasant experience to read and write. But they've deliberately made it hard to aggregate content or set up a 'presence' for yourself (in the mobile app, for instance, you can't view your own writing, or even search for it).

For a while I waited to make the leap to Medium; I just figured more features were on the way. Only now do I kind of understand what Ev & co have been up to: Medium can't be gamed - it will only show you quality writing. Yeah, it's recommendations are based on your interests and the kind of people you follow. But you can't leverage your page design or tags or posting frequency or social connections to increase the visibility of your writing. You just have to write well. It's as if they decided everything else - the blogrolls and hashtags and carnivals and follower counts - has all been a distraction.

So I'm going to give Medium a shot, sharing some pieces from EPMonthly and here that could use a little fresh air.

To be continued...

Order Sets & the Art of Medicine

When I was part of Jeff Neilson's illustrious Informatics Research panel at SAEM in Dallas this past spring (we were recently invited back for San Diego next year) I spoke on the topic of simple clinical decision support projects, particularly evidence-based order sets. I also talked about incorporating clinical calculators into orders, so trainees could enter discrete patient data into the EHR and see if the test they were considering was appropriate.

These are feasible research projects that can have measurable impacts in utilization or even care, don't require big budgets, and can be done in a resident-friendly timeframe. 

There was a question from the audience. Someone wanted to know if order sets and clinical calculators were antithetical to the idea of resident education - that organizing tests and meds by complaint, and building calculators into the EHR, made it too easy to be a doctor. Might we consider abandoning order sets and focusing on memorizing doses and appropriate indications for tests? By focusing on these things, were we failing to train doctors in the Art of Medicine? 

I was surprised by the question. Perhaps it's because I'm in a bubble - surrounded by colleagues who know as much (or more) than me about patient safety, bedside teaching, EHR usability, and evidence-based guidelines for care. 

I don't remember exactly how I responded. I said something about how order sets and clinical calculators are here to stay, unquestionably reduce errors, improve efficiency and encourage appropriate resource utilization (when implemented well) and the only challenge remaining is making them as current and easy-to-use as possible. 

That was a start, but I should have also pointed the audience member to the Checklist Manifesto, which covers the evidence, obstacles and psychology behind getting doctors to put their ego aside, be humble and make sure everything worth doing is getting done. After all, there was probably a time where pilots complained about losing the artistry of flying, but the public cared about their planes not crashing. Similarly, in an era where we are trying to get 100% compliance on core measures, when we're asked to do more, and see more, with less time and less support, it's imperative we make the EHR work for us as best it can. 

The Art of Medicine may have once involved regaling patients and staff with feats of memory; now it seems more appropriately about forming a fast rapport with patients, and explaining Bayesian algorithms for risk stratification. Let computers do what they're good at - lists and calculators - and let doctors have meaningful conversations with patients. This seems like the new state of the Art.