Bloggers' Grand Rounds: The evolution of medicine's netroots

The short history of the rapid growth of medical blogging can be seen through the progression of Nicholas Genes, MD, PhD.

In 2002, Dr. Genes discovered blogs -- online diaries -- for the first time. The next year, he started Blogborygmi, chronicling his life as a University of Massachusetts Medical School student. The following year, he started a "carnival," organizing the small cadre of medical bloggers to host a weekly Grand Rounds featuring links to the best of what their niches had to offer. Dr. Genes figured there were about 50 blogs written by clinicians, with at least a dozen written by physicians.

During the last few years the number of clinician-written blogs has grown at least tenfold, boosting the popularity of Grand Rounds, which recently passed its 100th edition and has spawned specialty-specific offshoots.

And Dr. Genes isn't even out of residency yet.

The state of medical blogging has "never been better," said Allen Roberts, MD, a Fort Worth, Texas, emergency physician who has been blogging as "Gruntdoc" since 2002. "When I started, there were probably about 10 medical bloggers. We knew who each other were online. [Now] every time there's a Grand Rounds, there's more medical bloggers I never heard of."

Nobody knows exactly how many medical blogs there are, but it appears that those written by clinicians are the tip of the iceberg. Approximately 120,000 American adult Internet users are blogging about a specific health problem or illness, said Fard Johnmar, founder of Envision Solutions LLC. The New York-based health care marketing communications consultancy recently conducted what it calls the first global survey of health care bloggers with The Medical Blog Network.

Johnmar's estimate reflects a survey released in June 2006 by the Pew Internet and American Life Project, that found that 8% of Internet users, or 12 million American adults, are blogging in general, with 1% of them blogging about health.

The growth of medical blogs is reflected in the evolution of Grand Rounds itself, which now receives 50-plus submissions, double or triple the number it received during its early days, according to regular readers. A blogger hosting Grand Rounds, which is read by clinicians and patients alike, can expect his or her daily site traffic to increase five to 10 times its normal daily rate.

It's important to Dr. Genes, a second-year emergency medicine resident at Mount Sinai Hospital in New York, that Grand Rounds be accessible, because he wants to show the public that "there are great stories, there are great debates and a lot of opinions about current health news."

How it works

Grand Rounds itself is not a permanent Web site. Instead, individual bloggers volunteer to host each week's edition. The hosts often are bloggers who are frequent submitters. Michael Hebert, MD, an internist and pediatrician in McComb, Miss., submitted posts to Grand Rounds over the first six months of 2006, and was invited by Dr. Genes to host on Oct. 31. Dr. Hebert happily accepted. "In a way I felt obligated because I had submitted to Grand Rounds many times before and benefited from it," he said.

As the host, the blogger can pick a topic for the week or highlight the most interesting links to articles and blog posts submitted by bloggers and other readers. Each new edition is posted at 7 a.m. EST on Tuesdays, and includes the name of the next week's host, so readers can submit links.

Part of the appeal of Grand Rounds comes from the individual styles of the hosts. Dr. Hebert, for example, used the Halloween timing to embed his links into "The Intern," a parody of Edgar Allan Poe's "The Raven."

Rita Schwab, a medical staff consultant, posted her week's hosting on the blog operated by MSSPNexus msspnexus.blogs.com/mspblog/. She imagined a conversation with "Star Trek" physician Jim McCoy, including his imagined response to a research paper from the American Alliance for Medical Cannabis stating that pot can be used to treat diabetes: " 'What?' Dr. McCoy said, clearly astounded. 'I can't believe it. I wouldn't consider smoking marijuana! Well, there was that one time when I was in medical school, but I didn't like it and didn't inhale.' "

Tony Chen, director of new business development at Evanston (Ill.) Northwestern Healthcare, wrote his Aug. 15, 2006, Grand Rounds on his blog (link) as a long, chatty letter to his then-2-month-old son. "One day, when he is old enough, I hope he'll read this and learn about how health care used to be way back in 2006," Chen wrote.

R.W. Donnell, MD, an internist and hospitalist in Rogers, Ark., declared his style to be "stream-of-consciousness" as a way to "liven up" the list of 66 links he ended up providing on Nov. 28, 2006, at his blog (link).

He also was inspired by the style of presentation of the traditional academic event that inspired the Grand Rounds blogging name:

"It's trendy nowadays at traditional academic Grand Rounds for the speaker to disclose any potential conflicts of interest. Here are mine. ... A Zithromax clock, a hand-me-down from National Nurses Day, graces one wall of my office. I have attended about four drug company lunches in the past year.

"Although underappreciated, nonfinancial conflicts, perceived or real, are just as important as the financial kind. We all have them. I, for example, am a) a Christian, b) a member of the vast right wing conspiracy and c) a staunch adherent to the principles of science. (Note that a is not inexorably linked to b or in opposition to c)."

Two days later, Dr. Donnell posted that he was astounded at the response to Grand Rounds.

"I confess -- I underappreciated Grand Rounds," he wrote. "Neglected to read it. Neglected to link to it. ... What changed my attitude more than anything was the exposure to what's 'out there.' The medical blogosphere is bigger and deeper than I knew."

Genes-is of an idea

From the start, Dr. Genes wanted to ensure Grand Rounds was a place both clinicians and nonclinicians would appreciate. "The idea is to introduce the wider world to the growing medical blogosphere -- the doctors, nurses, students, administrators, EMTs, techs, and patients who blog," Dr. Genes wrote on his site on Sept. 21, 2004. He hosted the first Grand Rounds a week later.

"What I wanted to avoid was a lot of jargon" so Grand Rounds wouldn't become an inside-baseball fest for doctors that would limit it to a niche audience, said Dr. Genes, a die-hard Red Sox fan.

As of the end of 2006, there have been 118 editions of Grand Rounds. On Dec. 26, 2006, Dr. Genes hosted Grand Rounds for the first time since he kicked off the effort.

Grand Rounds has grown so popular that some bloggers have recently begun calling for it to stop listing every submission. Some complain that 50 or 70 posts are too many to wade through. Others complain about the quality or commercial nature of some posts.

"What people are asking is: Should we reduce the number of posts we highlight and highlight the best of the best, which is kind of what Grand Rounds is supposed to be in the first place ... or be more inclusive and include everybody who wants to come in?" Johnmar said.

Some bloggers wanted to include specific others, launching grand rounds for specific specialties, including radiology and pediatrics.

"Although Grand Rounds is kind of the granddaddy, you're getting these splinter carnivals coming off [as it has grown]," Johnmar said. "What that tells you is that people are very appreciative of Grand Rounds but they want more focus on topics that they care about that are closer to them."

While Dr. Genes is not involved in the offshoots, he is often cited as the inspiration. Joe Paduda, a Madison, Conn.-based consultant who created Health Wonk Review, a biweekly compendium of health policy links, said, "Nick Genes' Grand Rounds has done such an excellent job covering the medical blogger community it inspired us to try to do the same on the policy side (plus Nick has already done most of the heavy lifting figuring out this type of thing so we didn't have to do too much work)." Paduda writes on Managed Care Matters (link).

Offline, Dr. Genes is looking to practice as an emergency medicine physician, possibly subspecializing in critical care, ultrasound or toxicology, he said.

But he'll stay involved with Grand Rounds. "As long as there are hosts who are willing to select and compile submissions and publish creative editions, it'll still be worth reading."