Inspired by the great fitness blogs recommended at Zen Habits, I began thinking about my own fitness goals for 2010. Swim from Alcatraz Island to San Francisco? Run the San Diego Rock And Roll Marathon? Qualify for the CRASH-B rowing championships? Or simply, just walk more?

I'll be the first to admit it: I get lazy sometimes. But as I read the blogs over at Zen Habits, it struck me that many fitness enthusiasts are already leveraging social media to help them meet their fitness goals for 2010. Here are a few ideas to help you get started:

1. Own It

The first step to any lasting change is to identify your goal. Announce your goals to your friends on Facebook, or join one of the fitness discussion boards to share your daily victories. (If you're feeling overly ambitious, check out Crossfit.com.) Announcing your goals in public forums forces you to take ownership and accountability for your goals. Moreover, you'll be inspired by the encouragement of your online community. For a bold example of this strategy, check out ProBlogger Darren Rowse's Fat Chart. 

2. Tweet It

Others have already written about how Twitter can be used to help you lose weight. @DrKal's post at TwiTip, "10 Ways To Use Twitter for Weight Loss," is helpful. Why not use Twitter tools like TWYE (Tweet What You Eat) to keep journals of diet and exercise? 

3. Wager It

Put a contract on yourself: wager that you'll lose the weight by making a commitment contract at StickK.com. Here's how it works: you set a goal, make a wager that you'll meet the goal by a specified time period, select a referee, then go for it. If you don't meet your goal by the specified time, your money will go to a charity of your choice. A simple but powerful concept: don't underestimate how much a little wager can nudge you toward your goals.

Own it, tweet it, or wager it: it's your move.

It's no surprise: the use of social media among physicians is expanding. In fact, some studies suggest that as many as 90% of physicians are using the internet to gather information about pharmaceuticals, biotech, and medical device information.

But despite this increase, few physicians are truly leveraging the power of social media. If you're like most, you've probably tinkered with Twitter for a few weeks, then written it off as a diversion. Or maybe you started a new blog and found that you underestimated the time and energy to maintain, much less blog, about your topic. 

Here's what I've learned: Don't give up on social media quite yet. Why? Because, like most things in medicine, there's a learning curve to using social media properly. Moreover, the true potential for social media to enhance your work as a physician is far from being realized. The problem is that most physicians simply don't know where to start. Here, then, is my list of the top 5 tools you can use to get started. 

Top 5 Social Media Tools for Physicians

1. Facebook Practice Page

Most casual Facebook users aren't aware of the marketing tools under the hood of Facebook. Among the most powerful is the ability to create a page for your medical practice. Use those features to create a fan page for your practice and ask you friends and colleagues to link to that page using the "become a fan" button.  Use the page for general updates and news about your practice. One excellent use of the Facebook Fan Page is Dr. Maggie Yu's Sherwood Medical Practice.

2. Google Reader for Medical Articles and News

An indispensible tool to my morning routine, the Google Reader allows me to scan hundreds of blog posts and medical news articles in the time it takes me to brew my first cup of morning coffee. I find feeds using the search function within the reader. Although not a social media tool per se, you can harness the power of social media by commenting on articles and inviting others to do so using the comment and note buttons at the bottom of each article in the reader. For more information on getting started with Google reader, watch my video, "How to Read 1,000 Medical Articles in Under 10 Minutes"

3. You Tube Channel for Patient Education Library

For months I had written off YouTube as a diversion to my daily routine rather than as an asset until I discovered that other physicians were already using YouTube to compile videos libraries of patient education materials.  Think of the top 3 questions you answer every single day and make a 1-3 minute video clip of your answer.  (I recommend using the Mino Flip video camera for hassle free video recording). Then upload these videos by creating a Channel site on YouTube.  Then announce your video library of FAQs with printed information in your waiting room, or better yet, on your Facebook Fan Page.

4. Twitter for Connecting with Colleagues

I know. You've tried it and you still don't get how Twitter can  make you a better physician.  Look at it this way: Twitter is like a big cocktail party with lots of conversations in the room. When you show up to a cocktail party, you don't just walk up to a group of colleagues and start talking about your practice; you listen, you participate in the ongoing conversation, and when asked, you provide information about yourself. Too many physicians use twitter like a megaphone at a cocktail party: "ATTENTION: New Study Finds Most Antidepressants Minimally Helpful"--some bewildered glances, but mostly ignored. My point is that there are rules for social engagement on Twitter, and if you don't follow these rules, you're likely to be ignored. Used correctly, it can be an extremely effective tool for finding colleagues for collaboration and consultation.  For some ideas on other ways physicians are using Twitter, check out Dr. Shock's blog article, "Twitter, Doctors, Hospitals and Medical Education"

5. Practice Blog

Again, this is a tool many physicians, including myself, have tinkered with and eventually abandoned. While there are a number of ways a blog can be used to market your practice, I'd encourage you instead to see the blog as an opportunity to engage others on controversial happenings related to your field. One of my favorite blogs in this vein is The Carlat Psychiatry Blog.  Notice that Dr. Carlat isn't promoting his practice, nor is providing straightforward news on updates in psychopharmacology. Instead, he writes candidly about controversial topics for a general audience.  How can you slant your blog from a medical information site to a blog with remarkable content? 

You might notice that I did NOT include having a practice website on this list. Most practice websites are static brochure sites that provide information about a practice or service; in order for a physician website to function as a social media site, it needs to be a place where people gather to exchange information. Ideally, you want your remarkable blog and business information on the same site. For a an excellent example, check out Philippa Kennealy's The Entrepreneurial MD.

I'd welcome your comments on any tools that you use that I haven't mentioned.

• National Center for Complementary and Alternative Medicine

• ConsumerLab.com

Think about this question for a moment: "Why are you on Twitter right now?"

 To grow your business? To keep updated on the latest breaking news? To problem solve? To share?

If you're not sure why you're on Twitter this very moment, then it's likely that you could become a more efficient user by remembering the lessons from Stephen Covey's The 7 Habits of Highly Effective People. To get the most out of Twitter, keep these habits in mind:

• Habit 1: Be Proactive

• Habit 2: Begin With The End In Mind

• Habit 3: Put First Things First

• Habit 4: Think Win/Win

• Habit 5: Seek First to Understand, Then to be Understood

• Habit 6: Synergize

• Habit 7: Sharpen The Saw

Finally, it's worth remembering that the Twitter phenomenon won't be around forever. Remember MySpace? After all is said and done, today's Twitter will become yesterday's MySpace. When you look back and reflect on the time you spent on Twitter, will you have a specific, measurable Return On Investment?

Michael Lara, MD practices near San Francisco, California. He writes frequently on the intersection of culture and medicine. 
   

And yet, within this financial turmoil, there remains a subset of patients who seem to be tolerated this economic storm quite well--Yes, they've lost money just like everyone else.  No, they're not among the super wealthy.  What's their secret for remaining calm?

The secret, quite simply, is that they've chosen NOT to jump on what's been referred to as the hedonic treadmill.  Briefly, hedonic treadmill hypothesis compares the pursuit of happiness to a person on a treadmill who has to keep working just to stay in the same place.  The hedonic treadmill hypothesis comes from field of positive psychology. It refers to the observation that people tend to remain at a relatively stable level of happiness despite a change in fortune.

Patients in distress have little interest in hearing the hedonic treadmill hypothesis of positive psychology.  Instead, I've learned to use the power of story to convey the essence of this concept.  Here's one version of the story that I keep in my library of healing stories:

A boat docked in a tiny Mexican village. An American tourist complimented the Mexican fisherman on the quality of his fish and asked how long it took him to catch them.

~Tao Te Ching, 66

It's unlikely that Lao-tzu, the author of Tao, had Twitter on his mind when he penned these words more than 2,000 years ago, but his writings remain remarkably prescient.  In my re-reading of the Tao, I came across several passages that are no less relevant in today's world of Twitter. Here are the top 5 lessons I've gleaned from the Tao and their relevance to Twitter: 

1. Imagine the Possibilities

The Tao is like a well:
used but never used up.
It is like the eternal void:
filled with infinite possibilities
~Tao Te Ching, 4

Anyone who's spent time on Twitter can attest to this.  We've all felt exhilirated, overwhelmed, even manic, at the boundless possibilities of Twitter once we "get it". What possibilities for your business or enterprise do you dare to imagine?

2. Know When Enough is Enough

Fill your bowl to the brim
and it will spill.
Keep sharpening your knife
and it will blunt.
Chase after money and security
and your heart will never unclench.
Care about people's approval
and you will be their prisoner.
~Tao Te Ching, 9

Quite simply, we need to know when enough is enough. When we've self-promoted enough. When we've tweeted enough. When we've attracted enough followers. Do you know when you've had or done enough?

3. Build Your Following One Tweet At A Time

He who stands on tiptoe
doesn't stand firm.
He who rushes ahead
doesn't go far.
He who tries to shine
dims his own light....
If you want to accord with the Tao,
just do your job, then let go.
~Tao Te Ching, 24

We all know stars in the universe of Twitter, but we've also seen meteoric falls out of twitterverse. Avoid schemes that promise you immediate surges in followers. Build a following tweet by tweet, day by day, and establish a solid following.  Do your work, then stand back.

4. Do Unto Others....

Without opening your door,
you can open your heart to the world.
Without looking out your window,
You can see the essence of the Tao.
~Tao Te Ching, 47

 As I write these words in the pre-dawn darkness of my office nestled among the California redwoods, I am receiving Direct Messages from all over the world--New York City, Finland, England. No, I'm not psychic. I'm on Twitter. Return the courtesy by responding promptly to Direct Messages and the world will show up at your doorstep. 

5. Start Small, but Think Big

Are you beginning to see what I mean about Lao-Tzu's prescience? From a series of small messages less than 140 characters in length,  I have build a slow but steady following, nurtured ideas for blog posts, and have attracted new patients to my medical practice. Not through expensive advertising campaigns or glossy marketing campaigns or media blasts. I've built my tribe 140 characters at a time. Imagine what you can accomplish with a series of small acts--140 characters at a time....

Michael Lara, MD is a physician in private practice near San Francisco, California.  He writes frequently about the intersection of medicine and technology. 

Twitter and The Art of Seduction

Se-duce: transitive verb: Late Latin seducere, from Latin, to lead away, from se- apart + ducere to lead

The only way to get rid of temptation is to yield to it
~Oscar Wilde

Have you ever stayed awake at night wondering why you spend so much time twittering?

Have you ever vowed to tweet less, only to jump out of bed  the next morning and check your replies, direct messages and…admit it…your follow count?

When you realize how much time you’ve procrastinated, you promise to tweet less.  You withhold your tweets for a few hours…a day…maybe even a week.

But then it happens: the next morning, you yield to temptation and you’re back on Twitter again. 

What’s going on here?

The answer? Seduction. 

Twitter enacts the phases of seduction as outlined in Robert Greene’s book, The Art of Seduction. As Greene points out, we're seduced in four phases.

Here’s my take on how Twitter seduces us:

• Phase One: Separation: Stirring Interest and Desire

• Phase Two: Lead Astray—Creating Pleasure and Confusion

• Phase Three: The Precipice—Deepening the Effect Through Extreme Measures

• Phase Four: Moving In For The Kill

And as you stand there, drink in hand, mingling with new faces at your next Tweetup , it dawns on you: You’re been seduced by Twitter.

 Let the games begin. 

Valley Fever

I.

“So, basically, before I tell you my story,  I need to know if you are Indian.”

The patient, Rajeev as I shall call him, is a 29-year old Indian engineer who comes to my psychopharmacology clinic at the insistence of his wife for, as she had informed me over the phone a week earlier, “unmanageable instability.” Rajeev, dressed Silicon Valley Casual--a custom-fitted dress shirt with silver cufflinks, a dark blue sports jacket and slacks, black Salvatorre Ferragamo loafers-- sits at the edge of the couch in my office, gazing intently at me as he awaits an answer. 

“Well,” he gestures impatiently, “I suppose it does not matter.”

Rajeev sits up, cranes his neck to one side, and stretches his arms forward to adjust his shirt sleeves--gestures a conductor might make in the hushed moments before the music begins. 

“Basically, I came here to California from India after graduating at the top of my class from the best university in New Delhi--I was, you should know, the top student out of 347 students. From there I went to Stanford for a PhD in triple E,  Electrical Engineering and Economics, and from my dissertation, which I completed in 3 years, I published 45 papers and started three different companies and you should know that I have five patents to my name and  have been featured in Fortune and have had stories written about me in the Wall Street Journal and New York Times and ... you are not Indian, right?...No, well then you maybe you would not understand  my problem... after all, you are not Indian... Basically, I have been having panic attacks and these intense mood swings because I'm afraid that I will not fulfill my destiny as the Vedic astrologers in Bangalore have predicted; it is my destiny, you should know...quite simply....to change the world.”

 And with that, Rajeev sits back into the couch, crosses his arms, thrusts out his legs and contemplates the tips of his Ferragamos as he wags them impatiently. A few moments later he glances expectantly at his wife, Sanjita, who sits beside him on the couch.

 An attractive green-eyed Indian woman in beige slacks and a white designer blouse, Sanjita, remains silent and continues to gaze deferentially at the carpet in my office.  Her silence is broken by the bright tinkling of her bracelets as she raises her hand to her mouth to clear her throat. We collude, sharing in the knowledge that, were it not for her phone call a week earlier to request an urgent consultation, Rajeev would not be here in my office today.  While her husband’s frenetic narrative and body language are, I believe, an easy read to my psychiatric/detective eye, Sanjita remains elusive--her minimalist facial expressions and body language neither confirm nor deny the truth of her husband’s account.  Nevertheless, I suspect that Rajeev’s impetuous temperament, fast-paced talking, restlessness, and grandiose delusions are suggestive of one and only one condition, and in the silence that ensues I furtively scribble my working diagnosis: Bipolar disorder 

Bipolar disorder, or manic-depression as it was once termed, affects more than two million Americans every year.  In its classic manifestation, symptoms can include any of the following: increased activity and restlessness; extreme irritability; racing thoughts; distractability (often mistaken for attention deficit); a decreased need for sleep; poor judgment; spending sprees; substance abuse (especially of alcohol and cocaine); and, tragically, denial that anything is wrong.  “How could anything be wrong”, patients often protest, “I’m more productive than ever!” Experts in the field concur that the two million figure is a gross underestimate of the actual prevalence of bipolar disorder, as this figure does not include sub-syndromal manifestations at the softer end of the bipolar spectrum.  Researchers in the field have identified as many as six different subtypes of bipolarity and place the actual prevalence closer to seven million, more than seven times the population of San Francisco. It also turns out that, contrary to what most Americans believe,“mood swings” are not the most characteristic feature of bipolar disorder.  Instead, the disorder reveals itself in an insidious crescendo of  sleepless nights and eighteen-hour work days, in an obsessive quest for perfectionism at any price, of high stakes risk-taking and fast-talking--characteristics, some might say, of any successful entrepreneur.  Many times, anxiety and panic attacks, not mood swings,  are the harbingers of an impending manic episode. It is not until this behavior spirals out of control and threatens to sabotage million-dollar deals or undo marriages that they come to me, as Rajeev has, seeking reprieve to a life interrupted.

II.

For the last ten years I have practiced psychiatry in the Silicon Valley and have witnessed the emotional aftermath of the internet bust in 2001.  Prior to the bust, I have had the privilege of working with the nouveau riche as they struggled to embrace their new found glory; the privilege of listening to their stories of how they struggled, persevered, and finally reached their promised land of venture capital funding; the privilege of sharing a sliver of their American Dream. As I psychiatrist, I was trained to remain indifferent to the personal fortunes of my patients, but after dozens had recounted their victories, I could not help but feel a tinge of envy.  Although I was born and raised in quite a different valley, I too longed for my own slice of the American Dream. 

In the 1960s and ‘70s my family lived in the outskirts of Chino Valley, located about 40 miles east of Los Angeles.  While long known by locals for its quaint dairy farms and fragrant walnut groves, Chino was at that time beginning a process of gentrification that would eventually supplant the dairies and walnut groves with housing developments for the Hispanic laborers who worked the fields. My family lived in one of the first housing developments, the 13th Street Housing Project, comprised of clusters of cinder-block housing units stuccoed over in pale pink.   It was here, among the undulating, redolent hills of the valley and under the watchful eye of Cousin Bruno, that I began my journey into psychiatry and the mysteries of bipolar disorder.

“No, no, Cuz. You have to jump back as high as you can, and when you feel yourself coming down to earth, then you shoot. Don’t wait ‘til you’re already down. And shoot the ball above your head, not from your chest, ‘cause then you look like a chavala, a sissie.”

We are on the basketball court at Gird Elementary and Bruno is sharing with me the secrets of his fade away jump shot. Bruno is twelve-years old, three years my senior, and is recognized among the 6th and 7th graders as the best outside shooter in town.  Slender, with a slight muscular build, the apple of his biceps flexes as he executes a perfect shot.  As he stands there in the schoolyard with his t-shirt sleeves rolled above his shoulders, black pompadour hair slicked back and one hip jutting forward, he resembles a younger, slightly darker-skinned version of James Dean.

“See, you have to keep on top of your game... keep it tight.”

And Bruno had kept on top of his other games. Two years prior, just after his 10th birthday, his picture appeared on the front page of our local paper, The Chino Champion, with the title, “Local Talent Sweeps Chess Tournament”.   Bruno sits poised before the the chess board,  nibbling contemplatively on the fingernail of his pinky.  Surrounded by a sea of privileged well-to-do spectators who lived on the other side of the railroad tracks, his is the only brown face in the photo. Later he would confide in me his secret to taking the tournament, “King’s Indian Defense--pendejo.”

And, if excellence in games of physical and mental strategy weren’t enough, Bruno was universally praised by his math teachers for the high marks he attained in algebra.  To this day I can still picture the cryptic pages of equations he would post on Grandmother’s refrigerator, especially the thick scrawl of red ink-- “Great Job, Bruno!” Several years later, in his 9th and final year of public education, Bruno dated the Junior Prom Queen of Chino High, the daughter of a wealthy Dutch family of dairy owners.  She would go on later that year, rumor had it,  to make a guest appearance on the Brady Bunch as Greg Brady’s girlfriend. Only decades later would I understand the pattern behind Bruno’s victories, only later would I recognize the pattern behind his thrill-seeking, fast-paced, no regrets way of life, the pattern behind his sleepless nights spent prowling the streets in search of something, anything, that would lull the incessant rumblings of his unquiet mind.

 III.

“Basically what you have prescribed has worked. I am 70% better I would say ... maybe 75%”

Rajeev is back in my office, alone this time,  for his one week follow-up visit.  He appears calmer, more relaxed, as he takes his seat.  A triumphant smile flickers across his face.  “Sanjita agrees.  We are not arguing as much.”

After the initial consultation, I had diagnosed Rajeev with Bipolar Disorder, Type I, and had prescribed a combination of an antipsychotic, risperidone, and a sedative-hypnotic, clonazepam.  The pharmacologic armamentarium for the treatment of bipolar disorder, though far from perfect, has progressed in the last decade; gone are the days where our options were limited to older antipsychotic medications, lithium, or valproate--all medications whose side effects (involuntary muscle movements, tremors, kidney and liver toxicity) were in some instances worse than the symptoms they were intended to treat. Today, no less than ten medications are indicated by the Food and Drug Administration for the treatment of Bipolar Disorder.  They include all of the next generation antipsychotics (now relabelled as “mood stabilizers”), a new class of anticonvulsant drugs that include lamotrigine (a mood stabilizer with antidepressant properties), time release versions of valproate and carbamazepine (less toxic and easier to dose than their parent drugs), and in a reincarnation of an old concept, combination capsules that mix an antidepressant with an antipsychotic (Symbyax=fluoxetine + olanzapine). Yet despite these advances, there remains one vexing fact in the management of bipolar disorder: more than sixty-percent of patients do not adhere to their medications.  Patients, the experts believe, eventually yearn for the creative highs of their hypomanias, a time when symptoms are just below the threshold of chaos, a time of effortless flow and peak performance.

“I need to know one thing, Dr. Lara.  Do these pills that I am taking, will they take away my ambition and drive to succeed?  I think I mentioned last time that my biggest fear is that I will not fulfill my destiny to change the world. And one other thing: As soon as I am back to 100%, I plan to stop these medications.”

Rajeev’s predicament is not uncommon.  Like many of my other bipolar patients, Rajeev really wants to know when he can discontinue his medications so that he can resume his demanding work schedule.  My immediate concern is that, despite taking antipsychotic medication, Rajeev persists in his grandiose delusions. Or so I thought.  It turns out that everything that Rajeev has said about appearing in Fortune magazine and The Wall Street Journal, about starting and selling companies--every word of it--is absolutely true. In the years I have treated bipolar disorder, or “Valley Fever” as I sometimes refer to it , I have come to appreciate the utility of the internet search engines in verifying the incredulous narratives of my patients. In Rajeev’s case, I did not learn of the veracity of his account until after I had given him my diagnosis and started him on medication for bipolar disorder; only later did I google him and discover the extent of his Silicon Valley stardom.

Rajeev’s case raises some interesting questions for psychiatrists who treat bipolar disorder: do we really want to medicate away hypomania, however prevalent? It is worth remembering that some of the most brilliant minds in history have suffered from the illness: Vincent Van Gogh, Lord Byron, Emily Dickinson, Edvard Munch, Robert Schumann, Jackson Pollock--the list goes on.  And in my own generation it turns out that entrepreneurs like Rajeev have disproportionately high rates of bipolar disorder compared to the general population.  The experts are divided on this issue: some argue that it is better to let patients “run warm” for a while (they will, after all, stop their medications, and besides, they make a hell of a lot of money when they are hot) while others argue that it is best to medicate  at the earliest symptoms--decreased sleep and increased irritability--invoking the kindling hypothesis, which maintains that with each excursion into mania, it becomes increasingly easier to cycle up into subsequent episodes.

IV.

I last met with Bruno during Thanksgiving of 2004.  Now in his mid 40s, he is but a shadow of the athlete that he once was. Gaunt and balding, he walks with a cane (the consequence of gunshot wound to the knee) and takes a seat across from me at my aunt’s kitchen table.  He is wasting at the temples and the sagging skin of his neck and arms are covered with faded tattoos in bleeding Gothic script.  For the last 24 years he has been locked up at Pelican Bay, California’s highest security prison, for various drug and gang-related offenses. 

“So, Cuz, what you up to?” I notice a rattling sound emanating from deep within his chest as he struggles to enunciate.

“You know, I told the vatos at Pelican Bay that I had a cousin who went to Harvard and Stanford, a cousin who was gonna be a doctor.  None of them believed me. Shit, half of them never even heard of Harvard or Stanford. Pinche pendejos. So what you up to?”

“I am a psychiatrist... a psychopharmacologist.”

Bruno cocks his head back in disbelief. “A psychiatrist? I thought you wanted to be a doctor?” The rattling in his chest becomes louder.

“Well, what I do is treat illness--mental illness-- with medications and talk therapy.”

“Oh, so you give drugs to people?”

“Yeah, that’s essentially what a psychiatrist does.”

“You give drugs to people to make them feel better?”

“Yeah, I guess so.  I suppose you could say I give drugs to people to make them feel better.”

“And you get paid to do this?”

“Yeah...”

“So let me get this straight: you get paid to give drugs to people to make them feel better?”

“Yes.”

“So tell me one thing: how is that any different from what I used to do on the corner of 13th back in the day? Shit, go figure...you go to Harvard and get paid and I go to Pelican Bay and get 24 years.  Well, I guess I taught you right, Cuz, you kept it tight and kept on top of your game after all”

 And in a way Bruno is right. The sad truth is that Bruno had everything Rajeev had, and more--intelligence, good looks, ambition, notoriety, beautiful girlfriends.  But, unlike Rajeev, Bruno had the misfortune of growing up in a time and a place that did not recognize manic depression, in a time and place where there were no psychiatrists, in a time and place where treatment choices were limited: to self-medicate or to self-destruct. The irony is that Bruno showed as much promise in his earlier years as my most accomplished executive patients; the irony is that Bruno, not my medical school professors, was my best psychopharmacology teacher; the irony is that Bruno, a jaded convict, was and still is capable of moments of unmatched tenderness as he shared with me secrets of the King’s Indian Defense and the fade away jump shot.

Rajeev and Bruno, at different times and in different places, were victorious despite their illness.  The essential difference is that Rajeev had access to the best chemicals medicine could offer to combat his illness. Bruno had neither the access nor the means and so, like any good entrepreneur, he invented his own. 

Will Twitter change the way physicians practice medicine?

Probably not.

Does Twitter have any practical uses in the late-adopting tribe that is modern medicine?

Maybe.

As an early-adopter with all things technical, I've found Twitter to be a useful adjunct to my private medical practice. Along the way, I've stumbled upon a few practical, time-saving techniques for integrating Twitter into an office-based medical practice.

Generally speaking, Twitter use falls under three categories:

As a Tool For Information Collection:

• Medical News Updates
• Job Openings
• CME opportunities

As A Tool for Information Sharing:

• Physician to Physician communication for general medical questions, curbside consults
• Live blogging from medical conferences

As a Tool for Communications Regarding Direct Patient Care:

• Physician-to-team member about non-urgent matters
• Office staff-to-patient about appointment reminders

I've also found that there are several scenarios where Twitter should NOT be used:

• To communicate directly with patients and their families

• To communicate with anyone regarding matters that require urgent or timely action

• To answer inquiries from anyone regarding details about patient care, even if from a recognized Twitter account.

Furthermore, under no circumstances should patients be referred to by name or other identifiable means, even via Direct Messages.

For Twitter to work as a viable tool in an office-based medical practice, everyone should have a basic understanding of how Twitter works.  Every team member, for example, should understand the difference between a Direct Message and the Public Timeline.  Our rule is to tweet only via Direct Messages, but assume that the tweet will be on the Public Timeline.

Another Twitter tenet is understanding how and when key team members integrate Twitter into their work day.  For example, key members of my teams and office staff know that I tweet from 5:00 am to 5:30 am and again from 7:00 pm-7:30 pm.  Team members also understand that some of my tweets are distributed throughout the day (I use TweetLater), so even though my tweets might be appearing during the workday, I'm not necessarily tweeting live.

There are, no doubt, other potential ways of integrating twitter into an office-based medical practice. 

Any other ideas? Please share them below.

The frenetic energy in the paintings of Jean-Michel Basquiat were often punctuated with the tag line he made famous: "SAMO" (Basquiat's acronym for Same Ol' S***).

Later this month Sanofi-Aventis will be launching their new drug Aplenzin, an extended release form of an older antidepressant Wellbutrin.  What's unique about Aplenzin?  Not counting the curious choice of dosage strengths (174mg, 348mg, 522 mg)....not much.

SAMO.

But the release of Aplenzin does highlight a recurring theme in the pharmaceutical industry: increasingly desperate attempts to extend patent lives of drugs.

In the last several years, "new" medications are brought to market that turn out to be variations on one of three basic themes:

1) Extended Release, Sustained Release, Controlled Release of ...
2) Isomer of....
3) Metabolite of...

(For an interesting take on these shenanigans, check out Malcolm Gladwell's article, "High Prices: How To Think About Prescription Drugs")

What is lacking in drug development is inquiry into new targets for drug development, not variations on the same theme. But there's promise on the horizon: witness the advent of nanotechnology for drug delivery for treating drug addiction, the very disorder that Basquiat succumbed to at the age of 27.

In the mean time, we can reflect on how remarkably prescient Basquiat was, speaking not about the pharmaceutical industry, but about his anti-establishment stance against "art school "artists:

"SAMO for the indirectly involved, the easily convinced, and the baffled..."

May your spirit live on, Baquiat.