Medical Black Humor, that is Neither Funny nor Appropriate.

19 09 2011

Last week, I happened to see this Facebook post of the The Medical Registrar where she offends a GP, Anne Marie Cunningham*, who wrote a critical post about black medical humor at her blog “Wishful Thinking in Medical Education”. I couldn’t resist placing a likewise “funny” comment in this hostile environment where everyone seemed to agree (till then) and try to beat each other in levels of wittiness (“most naive child like GP ever” – “literally the most boring blog I have ever read”,  “someone hasn’t met many midwives in that ivory tower there.”, ~ insulting for a trout etc.):

“Makes no comment, other than anyone who uses terms like “humourless old trout” for a GP who raises a relevant point at her blog is an arrogant jerk and an unempathetic bastard, until proven otherwise…  No, seriously, from a patient’s viewpoint terms like “labia ward” are indeed derogatory and should be avoided on open social media platforms.”

I was angered, because it is so easy to attack someone personally instead of discussing the issues raised.

Perhaps you first want to read the post of Anne Marie yourself (and please pay attention to the comments too).

Social media, black humour and professionals…

Anne Marie mainly discusses her feelings after she came across a discussion between several male doctors on Twitter using slang like ‘labia ward’ and ‘birthing sheds’ for birth wards, “cabbage patch” to refer to the intensive care and madwives for midwives (midwitches is another one). She discussed it with the doctors in question, but only one of them admitted he had perhaps misjudged sending the tweet. After consulting other professionals privately, she writes a post on her blog without revealing the identity of the doctors involved. She also puts it in a wider context by referring to  the medical literature on professionalism and black humour quoting Berk (and others):

“Simply put, derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves. Those individuals who are the most vulnerable and powerless in the clinical environment – students, patients and patients’ families – have become the targets of the abuse. Such humour is indefensible, whether the target is within hearing range or not; it cannot be justified as a socially acceptable release valve or as a coping mechanism for stress and exhaustion.”

The doctors involved do not make any effort to explain what motivated them. But two female anesthetic registrars frankly comment to the post of Anne Marie (one of them having created the term “labia ward”, thereby disproving that this term is misogynic per se). Both explain that using such slang terms isn’t about insulting anyone and that they are still professionals caring for patients:

 It is about coping, and still caring, without either going insane or crying at work (try to avoid that – wait until I’m at home). Because we can’t fall apart. We have to be able to come out of resus, where we’ve just been unable to save a baby from cotdeath, and cope with being shouted and sworn at be someone cross at being kept waiting to be seen about a cut finger. To our patients we must be cool, calm professionals. But to our friends, and colleagues, we will joke about things that others would recoil from in horror. Because it beats rocking backwards and forwards in the country.

[Just a detail, but “Labia ward” is a simple play on words to portray that not all women in the “Labor Ward” are involved in labor. However, this too is misnomer.  Labia have little to do with severe pre-eclampsia, intra-uterine death or a late termination of pregnancy]

To a certain extent medical slang is understandable, but it should stay behind the doors of the ward or at least not be said in a context that could offend colleagues and patients or their carers. And that is the entire issue. The discussion here was on Twitter, which is an open platform. Tweets are not private and can be read by other doctors, midwives, the NHS and patients. Or as e-Patient Dave expresses so eloquently:

I say, one is responsible for one’s public statements. Cussing to one’s buddies on a tram is not the same as cussing in a corner booth at the pub. If you want to use venting vocabulary in a circle, use email with CC’s, or a Google+ Circle.
One may claim – ONCE – ignorance, as in, “Oh, others could see that??” It must, I say, then be accompanied by an earnest “Oh crap!!” Beyond that, it’s as rude as cussing in a streetcorner crowd.

Furthermore, it seemed the tweet served no other goal as to be satirical, sardonic, sarcastic and subversive (words in the bio of the anesthetist concerned). And sarcasm isn’t limited to this one or two tweets. Just the other day he was insulting to a medical student saying among other things:“I haven’t got anything against you. I don’t even know you. I can’t decide whether it’s paranoia, or narcissism, you have”. 

We are not talking about restriction of “free speech” here. Doctors just have to think twice before they say something, anything on Twitter and Facebook, especially when they are presenting themselves as MD.  Not only because it can be offensive to colleagues and patients, but also because they have a role model function for younger doctors and medical students.

Isolated tweets of one or two doctors using slang is not the biggest problem, in my opinion. What I found far more worrying, was the arrogant and insulting comment at Facebook and the massive support it got from other doctors and medical students. Apparently there are many “I-like-to-exhibit-my-dark-humor-skills-and-don’t-give-a-shit-what-you think-doctors” at Facebook (and Twitter) and they have a large like-minded medical audience: the “medical registrar page alone has 19,000 (!) “fans”.

Sadly there is a total lack of reflection and reason in many of the comments. What to think of:

“wow, really. The quasi-academic language and touchy-feely social social science bullshit aside, this woman makes very few points, valid or otherwise. Much like these pages, if you’re offended, fuck off and don’t follow them on Twitter, and cabbage patch to refer to ITU is probably one of the kinder phrases I’ve heard…”

and

“Oh my god. Didnt realise there were so many easily offended, left winging, fun sponging, life sucking, anti- fun, humourless people out there. Get a grip people. Are you telling me you never laughed at the revue’s at your medical schools?”

and

“It may be my view and my view alone but the people who complain about such exchanges, on the whole, tend to be the most insincere, narcissistic and odious little fuckers around with almost NO genuine empathy for the patient and the sole desire to make themselves look like the good guy rather than to serve anyone else.”

It seems these doctors and their fans don’t seem to possess the communicative and emphatic skills one would hope them to have.

One might object that it is *just* Facebook or that “#twitter is supposed to be fun, people!” (dr Fiona) 

I wouldn’t agree for 3 reasons:

  • Doctors are not teenagers anymore and need to act as grown-ups (or better: as professionals)
  • There is no reason to believe that people who make it their habit to offend others online behave very differently IRL
  • Seeing Twitter as “just for fun” is an underestimation of the real power of Twitter

Note: *It is purely coincidental that the previous post also involved Anne Marie.

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#FollowFriday #FF @DrJenGunter: EBM Sex Health Expert Wielding the Lasso of Truth

19 08 2011

If you’re on Twitter you probably seen the #FF or #FollowFriday phenomenon. FollowFriday is a way to recommend people on Twitter to others. For at least 2 reasons: to acknowledge your favorite tweople and to make it easier for your followers to find new interesting people.

However, some #FollowFriday tweet-series are more like a weekly spam. Almost 2 years ago I blogged about the misuse of FF-recommendations and I gave some suggestions to do #FollowFriday the right way: not by sheer mentioning many people in numerous  tweets, but by recommending one or a few people a time, and explaining why this person is so awesome to follow.

Twitter Lists are also useful tools for recommending people (see post). You could construct lists of your favorite Twitter people for others to follow. I have created a general FollowFridays list, where I list all the people I have recommended in a #FF-tweet and/or post.

In this post I would like to take up the tradition of highlighting the #FF favs at my blog. .

This FollowFriday I recommend:  

Jennifer Gunter

Jennifer Gunter (@DrJenGunter at Twitter), is a beautiful lady, but she shouldn’t be tackled without gloves, for she is a true defender of evidence-based medicine and wields the lasso of truth.

Her specialty is OB/GYN. She is a sex health expert. No surprise, many tweets are related to this topic, some very serious, some with a humorous undertone. And there can be just fun (re)tweets, like:

LOL -> “@BackpackingDad: New Word: Fungry. Full-hungry. “I just ate a ton of nachos, but hot damn am I fungry for those Buffalo wings!””

Dr Jen Gunter has a blog Dr. Jen Gunther (wielding the lasso of truth). 

Again we find the same spectrum of posts, mostly in the field of ob/gyn. You need not be an ob/gyn nor an EBM expert to enjoy them. Jen’s posts are written in plain language, suitable for anyone to understand (including patients).

Some titles:

In addition, There are also hilarious posts like “Cosmo’s sex position of the day proves they know nothing about good sex or women“,where she criticizes Cosmo for tweeting impossible sex positions (“If you’re over 40, I dare you to even GET into that position! “), which she thinks were created by one of the following:

A) a computer who has never had sex and is not programmed to understand how the female body bends.
B) a computer programmer who has never has sex and has no understanding of how the female body bends.
C) a Yogi master/Olympic athlete.

Sometimes the topic is blogging. Jen is a fierce proponent of medical blogging. She sees it as a way to “promote” yourself as a doctor, to learn from your readers and to “contribute credible content drowns out garbage medical information” (true) and as an ideal platform to deliver content to your patients and like-minded medical professionals. (great idea)

Read more at:

You can follow Jen at her Twitter-account (http://twitter.com/#!/DrJenGunter) and/or you can follow my lists. She is on:  ebm-cochrane-sceptics and the followfridays list.

Of course you can also take a subscription to her blog http://drjengunter.wordpress.com/

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Lanyrd, the Social Conference Directory

24 11 2010

I’m a blogger who usually needs quite some time to write blog posts. However, I just learned about a new tool that I need not describe in detail. Firstly, because Heidi Allen just described the tool in a blog post here. Secondly, because the tool is so intuitive and easy.

I’m talking about Lanyrd, a directory of geeky events, technical conferences and social meetings.

It is really so simple and effective. Please follow me.

You go to http://lanyrd.com/, connect via OAuth to Twitter and before you can count to 3, Lanyrd shows you the conferences your friends on Twitter are going to as a speaker (blue border) or an attendee. You can also see friends who keep track of the conference (vague).

Unfortunately purely scientific or medical conferences are not included, but who knows what Lanyrd is up to.

You can track the conferences by subscribing in iCal / Outlook. It is also easy to add conferences.

I might go to Medicine 2.0, but I didn’t make up my mind yet. If I click on the link I see the following page:

You can click on “Attend” or on “Track” if this applies. Furthermore you get an overview of the conference: the location, the link to the website, the Twitter account, the hashtag used in tweets (#med2) and of the speakers.

Oh …. there are none yet, so I added a few.

It is easy to do, people who have never logged into the site can also be added. However, if helps to know the exact twitter name, if many people on Twitter share the same name (else you have to check all the profiles generated with Twitter search).

Lanyrd is the baby of the recently married couple Simon Willison and Natalie Downe. And as it goes with babies, they grow up.

What can we expect the next few years?

Simon in the Guardian:

“We have lots of exciting plans for Lanyrd’s future. One of the things we’re very keen on is gathering information on past conferences – speaker slides, videos, audio recordings and write-ups. In five years’ time, we hope we’ll have the best collection of conference coverage possible.”

Credits to Heidi Allen (@dreamingspires) and Anne Marie Cunningham (@amcunningham) who discussed Lanyrd on Twitter. As said, Heidi wrote a post on Lanyrd, and Anne Marie wrote a short blogpost at Wishful Thinking in Medical Education on the need to find list of upcoming medical or health conferences- and the hashtags that would be used to cover them on twitter. The Solution as it appeared was Lanyrd (at least for some of the conferences).





Reclaim your Privacy on Facebook using a Simple Bookmarklet

20 05 2010

Of all social networking sites, Facebook causes the greatest privacy concerns. Certainly since it has changed its privacy options over time.

In the beginning, Facebook restricted the visibility of a user’s personal information to just their friends and their “network”, but the default privacy settings have become much more permissive, as you can see in the video below.
This short video is based on a visualization made by Matt McKeon and gives only an impression of a work-in-progress
(for up to date info check the original animation at http://mattmckeon.com/facebook-privacy/).

The reason? According Facebook founder Mark Zuckerberg the controversial new default and permanent settings just reflect the way the world has changed, becoming more public and less private (see ReadWriteWeb).

“Default” is the key to the problems. You have to opt out to protect your privacy. However to fully protect your privacy on Facebook, you have to navigate through 50 settings with more than 170 options (see great charts at the NY Times!). Facebook’s privacy policy is longer than the American constitution!!!

Shocked by the results of the ACLU’s Facebook Quiz (see Mashable), I already changed my privacy settings last summer. Doing a simple quiz on Facebook meant everything on your profile (whether you use privacy settings or not), is available to the quiz. Even more worrying, when your friends do a quiz, everything on your profile is made available to the developers as well.

Since the default privacy settings have changed, my settings needed to be adapted again. But where were the leaks in the 170 options?

Luckily there is a very simple bookmarklet Reclaim Privacy that can check and fix your profile in 2 minutes (see Mashable.com) It is very easy.

1. First go to Reclaim Privacy and drag the bookmarklet to your web browser bookmarks bar
(in the example I dragged the bookmarklet into Chrome’s bookmarks (upper arrow)

2. Go to your Facebook privacy settings and then click that bookmark (Scan for Privacy, see arrow) once you are on Facebook.

3. You will see a series of privacy scans that inspect your privacy settings and warn you about settings that might be unexpectedly public.
In my case my friends could still accidentally share my personal information. This is indicated by a red sign: “insecure.

4. So I clicked “prevent friends from sharing your data”, and in seconds this was the result:

5. I tweaked the contact information a bit (caution) by changing my contact settings, but I still would allow everyone to add me as a friend (I still have to approve, don’t I?)

Piece of cake!





Silly Saturday 23 # Twitter Cartoons

15 05 2010

Like my previous Silly Saturday/Friday Foolery this a post in the style of “A Picture is Worth a 1000 Words”.

It also fits in with my last post: “A Quantitave Study suggests that Twitter is not Primarily a Social Networking Site”

[1] As a matter of fact the first cartoon is from the presentation of Haewoon Kwak et al that I reviewed in that post, although they used it in a different context.

What do you think when you see this cartoon (by Ian D. Marsden)?

My first impression is that someone twitters instead of helping people out when there is a riot, accident, terrorist attack etc., but its meaning is positive: “During the Iranian election unrest Twitter was used as a powerful tool to get news out of the country”

[2] Twitter as it is seen by many…

A bit of self-mockery is always sound. Although of course my Twitter behavior is quite unlike that depicted above.

[3] But I do recognize the behavior of Twitter sheep like these (and I don’t mean the lonely sheep but the ‘sheepish followers of celebrities). Brilliant cartoon by Gerald the Sheep (Ben Gallagher)

[4] Noise to Signal also posts some excellent Twitter-cartoons (and Facebook, i-pad etc). The Cartoon below (from RobCottingham) is from the post: “Mommy, where do hashtags come from?” Do you know where # come from?

Here a real-world example of the confusion hashtags (#) can cause…

"There are 3 hashtags in use, which one is the real one?" http://twitter.com/Dymphie/status/13776462934

That is it for now.

And also from Ramona 🙂  ….Glad I’m not a lonely sheep)…

Credits:

  1. Cartoon: Iranian Election Demonstrations and Twitter » Iranian Elections and Twitter by Ian D. Marsden on Marsden Cartoons
  2. Twitter Sheep : Gerald-sheep at bengallagher.com
  3. “Mommy, where do hashtags come from?” from Noise to Signal (Rob Cottingham)




A Quantitave Study suggests that Twitter is not Primarily a Social Networking Site

13 05 2010

A lot can be said about Twitter, Facebook, Linkedin and other social media. What is the best, the most useful, the most popular the most social (and has the least privacy-issues, hehe Facebook)?

You know I love Twitter. Twitter is a social networking and microblogging service that enables its users to send and read messages known as tweets. The tweets don’t exceed 140 characters, so your message must be very concise. For me Twitter is a very rich source of information and a useful networking site. But it is hard to explain that to others.

Some Most people think that individuals who twitter are just parroting others (hé this is called retweeting, guys!) or are just egocentric bores (“I eat cornflakes for dinner”).

Well, a recent quantitative study by a group of researchers at Korea’s Advanced Institute of Science and Technology suggest that they might just be right. … Or at least their data suggest Twitter may be less of a social site and more of a news site.

According to Haewoon Kwak et al this is the first quantitative Twitter study ever.

The researchers crawled the entire Twitter site and obtained 41.7 million user profiles, 1.47 billion social relations, 4,262 trending topics, and 106 million tweets. They looked at the follower-following topology, looked at the ranking by number of followers and by PageRank, analyzed the retweets and the tweets of top trending topics.

You can read the main conclusions in the power presentation below and their abstract for Proceedings of the 19th International World Wide Web (WWW) Conference, April 26-30, 2010, Raleigh NC (USA). Below the abstract you can also find links to two download files, enabling you to reanalyze the data
Going Social Now and ReadWriteWeb also give a nice overview.

What are their main conclusions:

  • Twitter is not very “social”
    • It is “I follow you”, not “lets become friends” and you don’t have to approve or follow back. Following thus means that you “just subscribe” to the tweets of that person.
    • Only 22.1% of the relationships are reciprocal, thus 77.9% of the relationships is one way, just one of two is following the other. Surprisingly, 67.6% of users on Twitter are not followed by any of the people they follow.
    • this low reciprocity is unlike all other human social networks.
  • For most tweople, Twitter is primarily a source of information, not a social networking or information dissemination platform.
    • The Majority of topics (54,3%) are headline topics
    • Few users reach a large audience directly.
    • The average path length between two people on Twitter is 4.12. This is much shorter than Stanley Milgram’s original experiment uncovering the “six degrees of separation” phenomena.
    • Any retweeted tweet is to reach an average of 1,000 users no matter what the number of followers is of the original tweet.
    • Once retweeted, a tweet gets retweeted almost instantly on next hops, signifying fast diffusion of information after the 1st retweet.

It is a beautiful study that highlights the topological characteristics of Twitter.

One word of caution. Twitter is analyzed as a whole. There are many subpopulations with their own kinetics and goals. So the majority of people may follow the news, and fans may follow a celebrity by the million, but there are (relatively) small niches on Twitter, like health and medicine (or science) that may not follow the same rules.
I daresay (guess) that more people in this niche follow each other and do use Twitter both as a source of information and as as  network for social communication.
But these small niches are outnumbered by others (news sites, CEOs, celebrities).
At least that is my hypothesis.

Who is going to test this??

Many different Twitter birds in a flock

Credits





#FollowFriday #FF Dutch @Nutrigenomics @Beatis @TheSofa @DrShock @digicmb

21 11 2009

Last week I announced that I would weekly update my FollowFriday Twitter list.

On the FollowFriday list are people I would like to recommend to you.

When you’re on Twitter you can follow my FF-list here:
http://twitter.com/laikas/followfridays-ff/

This week I would like to put several Dutch people in the limelight.

All these people have in common that they twitter mainly in English about scientific and/or library 2.0 subjects. And they are all nice.

@digicmb (medlib, geek, NL, **) and @DrShock (doctor, psychi, NL, **) were already on my #FF-list

@digicmb (Guus van den Brekel) was on Twitter long before I gave it a try. He knows a lot about Second Life, Web 2.0 Tools (especially all kinds of widgets and Netvibes)  and is always willing to share information. A must follow for librarians. His blog is http://digicmb.blogspot.com/. The Google Wave directory of helpful waves! is a recent post that I liked.

I already knew @DrShock as a blogger. DrShock is a Dutch psychiatrist working in a University hospital. His specialty in psychiatry is the treatment of depression. His blog (http://www.shockmd.com/) is regularly mentioned on this blog. It has a beautiful lay-out with a broad coverage of subjects. DrShock even regularly participates in the Medlibs Round and will be a future host of this Medical Librarian blog carnival as well.

Another Dutch psychiatrist, with a similarly well chosen name: @TheSofa. Georg Fritz is only recently on Twitter, but had interesting Tweets right from the start. He also started a posterous account: georgfritz’s posterous. I like the The November poem I by Thomas Hood, that starts like this: No sun–no moon!  No morn–no noon!  No dawn–no dusk–no proper time of day–  No sky–no earthly view–  No distance looking blue–….
No wonder people get depressed at this time of year.

Also very interesting are the tweets of @Nutrigenomics, Professor in Nutrigenomics, Wageningen University and Director of NL Nutrigenomics Centre. Main emphasis of tweets is on genetics, nutrition, science and health. The link at his Twitter account goes to the Nutrition, Metabolism Genomics Groupat the Wageningen University.

Last week I first ‘met’ @Beatis on Twitter. She is still not sure about the value of Twitter. I hope she will stay tweeting, because her tweets -that can be best described as (moderately) skeptic- are certainly valuable. She co-authors the (english-language) Anaximperator blog. The purpose of this blog is to warn against alternative medicine and alternative medicine for cancer in particular.

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