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Blogging and Tweeting as an Outlet

kathyniederKathy Nieder, MD began her career as a family medicine doctor in 1984. She became interested in social media as a tool for healthcare in 2011 and has been blogging at Family Practice 2.0 and actively using other sites, particularly Twitter, to stay abreast of the rapid changes in healthcare, both in patient care as well as policy and political issues. Dr. Nieder is an employed physician for a large healthcare system in Louisville, KY. She enjoys partnering with her patients and believes patients who are well-informed and take an active role in their own well-being make for healthier, more satisfied people who make better lifestyle choices.

I spoke with Dr. Nieder about what led her to blogging and social media, what changes she thinks need to happen in medicine, and what advice she has for future physician-bloggers.

V: When did you start writing on your blog, which you call Family Practice 2.0? What made you want to start blogging and writing?

Dr. Nieder: I think it was three years ago, when I had seen the blog of another a family practitioner. There was a lot of pent up emotion, and still is, in terms of the frustration of what was going on in primary care, and a blog seemed like a good outlet. It also seemed like a good place for patients to be able to see the other side of how I felt about what I did. Shortly after that, I found twitter, which is really something I do a lot of, and that further strengthened some of my ability to talk about how I felt about the changes going on in medicine. And through twitter in particular, I met a lot of really interesting people who are trying hard to change healthcare in a good way. Subsequently, I’ve been to a fair number of conferences where I’ve gotten to meet these people in real life. That’s just very exciting and thrilling in the sense that you kind of feel like you already know these people before you meet them. It helps a lot with the burnout that physicians are feeling to be able to meet people who are trying to make a difference in a good way in medicine. I found that my blog and my twitter activity were in some ways a lifeline.

V: With your blog you said patients can google you and find it. Have they talked to you about it after finding it?

Dr. Nieder: Yeah, they’ll come in and comment on a post. It’s interesting because my system is not particularly thrilled with my blog. I even at one point got a phone call from someone saying, “The CEO doesn’t like what you wrote on your blog.” When I asked, “Which entry was that?” he wasn’t clear on what it was. It was so interesting to get that response from someone who obviously hadn’t read it. The CEO and I ultimately got coffee a couple of times, and he was fine, but it was interesting that this led me down that path, if you will.

V: It seems that writing gives a certain sense of power to physicians to say what they think about what’s going on. It’s nice that you talk about a lot of the issues with “meaningful use” and with paperwork and the EHR, which are all things that people know are issues—but having a doctor narrate the day-to-day problems is really helpful. What do you think are the main issues that you see as a doctor that we need to address in healthcare, and what are the ones you choose to write about for the blog?

Dr. Nieder: I think the biggest one is this whole idea of patient engagement. Patient engagement often just ends up being “let’s get a portal, let’s make sure the portal works.” But the true patient engagement is making sure that the patients have access to what they need, and really good patient engagement should involve a partnership between the physician and patient. Those tools are not there, or if they’re there, they’re in some startup that’s not being utilized. It just seems like we keep talking about it, but nobody’s really truly on the patient level making it happen. The second thing is provider-physician engagement. We are disengaged in many places. My daughter is in medical school right now and I’m watching her go through this process, and I don’t see anything in the process that’s making that better. She’s learning the basics she needs, but she’s not getting some of the things to help her survive in this environment.

V: What do you think are the best strategies for combating burnout? What could medical schools and residency programs do to decrease burnout?

Dr. Nieder: I think a big part of where burnout starts is in medical school, where you don’t have time to do anything outside of yourself really, and any time you take to do that, you feel guilty because you’re taking it away from the time you should be studying. I know it’s not a healthy way for people to live, and it just persists into residency. We should be making certain that physicians take time off, so that they have that time to be more innovative and creative in their jobs. But many systems don’t give a damn about how creative, or how burnt out, or how tired their physicians are. So it comes back to the patient engagement part of it—you can’t be engaged with your patient if you’re burned out. And as a consequence, your patients can’t be engaged. Primary care physicians can’t save the system money if they’re not engaged.

V: Do you have any advice for physicians who want to start blogging or being creative?

Dr. Nieder: First, you can’t wait until the thunderbolt hits you, you just have to sit down and do the work. The second piece of advice would be to get on twitter and to follow some of the big thought leaders, that gives you more ideas about what your blog could be about. It also helps you to know what’s out there that may be more positive than what you’re experiencing.