Why Do We Twitter, ETC?

Why do we blog and text and Twitter and Facebook and email and everything else?

Ever since the first caveman picked up a rock and began grinding things on the wall, we have had the desire to communicate. I have been thinking about this alot, since my husband does not appreciate the current lines of communication. When I send a text or email to someone, he sneers. It seems I should pick up the phone and hear their voice, not settle for the "written" word transmitted electronically.

Last week I went to see the new stage version of Mary Poppins. I do understand that this is not a historical piece, but it did get me thinking about communication in the Victorian era. Pre-telephone people wrote notes. The rich had messengers to deliver these notes when needed. There were multiple mail deliveries each day. Mass media was the spoken voice or newspapers. When events occurred, paperboys hit the streets with special editions to get the word out. Those who could not read or afford the paper had to settle for what the boys yelled or what others told them.

The telegraph allowed our thoughts to be transmitted over longer distances, but the telephone was the next big change for personal communications. Remember the movie Meet Me In St. Louis? The family is excited and shocked that a boy is calling the older sister, Rose, long-distance. There is discussion about a possible proposal and whether or not one should marry a boy who would propose via an "invention." Sounds like my husband's attitude to email, text messages, and the whole social web!

Mass communications also changed through the 20th century, with the spoken word replacing text for immediate dissemination of news. TV and radio replaced the paperboy and the special edition. Newspapers became a once or twice a day publication. Now we are watching many of these papers die as the internet becomes the source of indepth news that they once provided. We can still get our immediate needs met with TV or radio, but we often go online when we want more than can be broadcast.

Personal communications have also changed, moving back to the written word. Fax machines first allowed us to send printed pages quickly, but soon we were emailing and texting information without ever printing it.

So in this brief, rather unresearched history of communications we have come around to written communications again. Some will last, like posts online, and others will evaporate into the ether as soon as the text screen is cleared.

So what will I tell my husband after this mental exercise? Things change - get over it! Some thoughts still require a face to face meeting (I put proposals, break-ups, and really bad diagnoses that I share with patients in this category). Because email and texts do leave a trail, some private conversations should be done face to face or by phone. Otherwise, I believe that anything I can say I can write. Or tweet.

Singing like a bird in spring

Earlier this week I wrote about Twitter. I admitted that I found some interesting twists, but I couldn't figure out why so many people love it. And I mean LOVE it, if they are really tweeting at the times on their messages. Last night my loving spouse, who doesn't really understand the power of text messaging, asked me to explain the Twitter thing. I finally admitted that I was still trying to sort out what was truly useful.

One of the people I follow is blackberryman. Through his posts I came to one on the use of microblogging in education. It's sort of vague, but does give me food for thought.

I'm looking for specific examples of uses of Twitter or other microblogs in education, particular graduate or medical school teaching. Leave a comment or a link to your site. Or tweet me!

Spring: Thoughts of airports...

Spring. The weather is warmer, the birds are singing, and it's time to start traveling! For those of you not in academic medicine, the year has a distinct rhythm. Very few meetings seem to happen between mid-November and March. I believe this is because of family holidays and bad weather during these months. Once spring hits, it's open season on meetings.

It's not just the chance to present science and eat out with your peers. No, committees, study sections, advisory groups, and specialty interest groups all seem to want to fly somewhere they are not. It is like some sort of weird, non-migratory behavior. We generally avoid blizzards this time of year, but thunderstorms can still ground planes and thwart the best planned travel. It pays to travel with entertainment - books, movies, and other toys can make 9 hours at O'Hare seem like 9 hours, not 18! I know, I've done it a few times.

For those of us who log a bit of air travel each year, the airport time can be the worst part. There are signs all over the airport about the 3-1-1 rule: carry-on liquids need to be 3 oz max, you put them in a 1 quart ziplock bag, and each passenger gets 1 bag. If you want more information about this, click on the picture- it will take you to the TSA website with more than you every could want to know! 3-1-1 has been the case since September 2006. Even so, there are still people in line who try to carry on big bottles of stuff. DON'T BE ONE OF THESE PEOPLE. YOU JUST LOOK DUMB.

A number of airlines now charge for checked bags. I believe this is a mistake; I would charge for any carry-on that won't fit under the seat, and give that second carry-on bag as a bonus to my frequent fliers. After all, stowing carry-on luggage is the biggest bottleneck in boarding the plane. When I rule the world things will be different, but in the meantime this does not mean that ANYTHING can be carried onto the plane to avoid these fees! I've seen people trying to put king-size bedding sets in the overhead compartment. It's insane!

Finally, watch where you're going in the airport. I am amazed at how many people just seem to have no clue that someone is in front of/beside/behind them. Try to be polite and considerate; someone will be delighted with your attitude. Especially at O'Hare.

That's enough rambling and ranting for one day. Feel free to say hello if you see me in the Red Carpet Club at O'Hare or Denver or one of the other places I go this year. I will have my nose buried in a really good book.

Follow you, follow me...

I admit that I joined Twitter not having a clue what it was all about. For approximately a month now I have been tweeting, trying to figure it out.

My first followers were an SEO and other techies. I signed up to follow them, and I have learned a lot from what they post. They are currently at SXSW, a social networking conference in Austin (thank you Google for that information), and I've gotten ideas about how I can use this tool in various aspects of my life.

I then figured out how to make my tweets update my status on Facebook. This accomplishment led to the stream of "Pascale is..." posts that have increased the breadth of my followers. One night I posted that I was sitting down to enjoy a great old flick on Turner Classic Movies (TCM). Next thing I know, TCManiacs is following me. I signed on as a follower, and found out that all sorts of interesting sites and the daily theme and schedule are posted. What a great idea! As a classic film buff, this service alone makes me happy to be one of the tweeple!

Of course, as I look at what I post, I realize how mundane most of it is. As a physician-scientist many of my friends and family members think my professional life is exciting. Not true! Most of it comes out like, "finished at first hospital; now time for second institution." Or today's question: "Is anyone in Omaha still peeing?*" Yet people read these and sign up to follow. Makes me worry about some of them, cause I wouldn't generally follow the stuff I am writing.

Which makes me wonder why I'm writing it. In part, it's because I am still feeling my way through microblogging. Part of me still doen't entirely "get it," so I just keep plugging away. On the other hand, I've gotten a feel for some utility in just about a month, so maybe someday I will understand the rest of it!

Last week, there was a newstory in the tweets of one of my followees. A guy had been arrested, and he was described by his job titles followed by "He has 1,800 followers on Twitter." Is this a new factoid for our bios? Is it good to have 1,800 souls hanging on your every 140 character utterance?

One thing I did learn quickly was NOT to have every tweet SMS'd to my Blackberry. Instead, I pull up my feed periodically and read it when I feel like it. Otherwise I think I would go mad. I mean, do I really want to know that Bell, Book, and Candle was on this afternoon while I was working? When I can't do anything productive with the information?

If you have any other good uses of Twitter, please comment! I'm still learning about this phenomenon. In the meantime, remember that I am a Professor of Pediatrics with 15 followers on Twitter! (I finally made double digits this week!)

*I am a pediatric nephrologist, so this is a highly relevant professional question.

Happy World Kidney Day!

May all your golden dreams come true...

Required Reading on Health Care Reform

As a physician, there are many out there who would assume that I want to keep our current US health care "system." They couldn't be more wrong. Daily I experience the waste and inequities of our state of affairs, and I am appalled.

Required reading is this week's cover story from Time Magazine. A health care reporter, Karen Tumulty, describes the hell her brother went through when he was diagnosed with chronic kidney disease, even with an experienced medical reporter in the family to work through the system (or lack thereof). This story is not an isolated incident; this happens to thousand of working Americans every day! It is especially tragic to me when a parent has to change jobs and their children with pre-existing conditions cannot be covered by a new policy.

From my professional perspective, the waste involved with multiple payors is incredible. At our institution we have many people whose job is to figure out what is covered for each patient and to what level. Some patients have multiple sources of coverage. While this sounds like a good thing, what usually happens is that no payor wants to cover anything. When I see the number of people employed just to figure out this transaction, I can't help thinking about how many people could be covered with the funding for these bureaucratic expenses.

Another frustration is the nit-picking that goes on for trivial expenses. One recently discharged patient needed a medication she had previously taken as a pill in patch form. She had been admitted several times because she would vomit the pill and her health issues would decompensate. I had to spend 45 minutes in voice mail hell to get the switch approved. The cost of one admission would cover the difference between pill and patch forms for a long, long time. I can't imaging being a patient, someone not familiar with the system, and trying to jump through these hoops. I'm afraid I would just give up - and many patients do, to the detriment of their health.

The job of the insurance companies is to make money for investors, just like any publicly traded corporation. Spending money on healthcare reduces profits, even if it makes you, the insured person, better. If patients truly had choice, they would pick companies that covered them better over time and others would go out of business. The choice is not in the hands of patients but their employers who are looking at the needs of the group and the business, not the individuals. We need a drastially different approach to healthcare in this country. It's time, America.

Condition update

I blogged a while back about my cat, Denver, who has chronic kidney disease. We noticed that he had "the dwindles(1)" and was losing some weight. I made his annual checkup appointment, fearing that they would tell me his kidneys were worse. Could euthanasia be far away?

Of course, our burrowing cat (see photo) has stable kidney function. So what was the problem? Turns out he had developed hyperthyroidism, another common geriatric cat problem. We started medications and he is doing great. He has gained almost a pound in the month since his treatment began.

Of course, there is also humor in this turn of events. While I am a pediatric nephrologist, my husband is an endocrinologist. The cat has managed to develop medical issues dealing with both our specialties, just to show he doen't play favorites.

He will be celebrating World Kidney Day by using the litterbox and indulging in catnip.

(1)This is sophisticated medical terminology; do not attempt to use this wording outside of a professional setting...

Birth and Kidneys

Another month is upon us. Time flies whether you're having fun or not!

The second issue of my "child," ASN Kidney News, is at the printer. The whole process of starting this magazine is sort of like giving birth every other month without the benefit of drugs. It is a labor of love, though, much like childbirth. It has been fun to explore issues and updates outside of my usual scientific and clinical relm. The March issue will feature dialysis issues. For those of you who don't practice nephrology, the folks at Medicare (which pays for most dialysis treatments in the US) have come up with new "conditions for coverage" which must be met if we want to be reimbursed for providing treatments. The stated purpose of these new changes is to improve patient care and outcomes. The secondary purpose seems to be killing more trees to generate all the required paperwork. So far, my life hasn't been affected too much (and it is all about me).

On a more uplifting note, World Kidney Day is coming up (see logo above). WKD started to educate everyone about the rising risk of kidney disease. This year it falls on my birthday, so I feel it will be a truly magical occasion. Go kidneys!