Saturday, August 26, 2006

Comments of a Newcomer

Off and on I have been a member of Toastmasters. I found myself teaching at the university level and not a very good teacher. This was interesting because I spent a lot of my time teaching. When I looked around I didn’t find many of my colleagues very good at teaching either. This was around about the time Canadian universities adopted the University of Kentucky's Teaching Improvement Project System, (TIPS) which actually set about training medical faculty to teach better. So I wasn’t the only person who noticed the problem. Before the TIPS program, medical faculty had generally followed the See One, Do One, Teach One model of medical education.

As I have been moving around a lot, I found ToastMasters a useful way to get to know people in new communities while building skills. There are many good aspects of Toastmasters clubs. They provide a supportive group of people providing helpful suggestions, a chance to practice different approaches with a non-medical audience and some excellent training materials. There is also a sort of group think that varies depending on the club. This is recognized by ToastMasters as a common phenomenon relating probably to the forming of group norms. So one of the things ToastMasters encourages is for newcomers to give comments. They encourage members to listen carefully to newcomer comments. Such comments may not usually be couched in the best possible way but are honest reactions that are invariable useful. The listeners job is to extract the kernel of truth in the comment.

In this tradition, as a newcomer to the medical blogosphere, I have a couple of newcomer observations to share. I think it is a wonderful thing to have a medical blogosphere. I stumbled on it quite by chance. Somebody posted a short notice about Tundra Medicine Dreams blog on the Listserve of the Society of Rural Physicians of Canada. It was the first blog I visited, I loved it and still do. If you have ever lived and worked in aboriginal communities in the north, Tundra Medicine Dreams along with the TV shows, Northern Exposure and North of 50, are going to be on your list of life time favourites. In no time at all I wanted to do my own blog.

I haven’t been around the blogosphere much, hardly at all compared to most of you. I discover new spots regularly that amaze. Moof does something about domestic violence and mentions a previous site and the history of how sexual abuse is recognized and dealt with comes tumbling down. There is a wealth of material on here for case studies. Flea, a pediatrician, handles a quandary of a child who receives the wrong vaccine in the best possible way and loses a family from his practice.

Now I am no blog expert when it comes to either content or process, except in the sense that X is the unknown quantity and spirt is a drip under pressure. I can’t even add to my Blog Roll without major template problems that last for weeks. So I offer my comments as a raw and green newcomer, one who really doesn’t yet understand all the group norms.

I have noticed that medical bloggers who by their own admission say frank, critical or sarcastic things seem surprised, Mexican Medical Student here and Barbados Butterfly here, that some readers react negatively. Some even create a whole reactive blog about a negative comment. This may be followed by reassuring noises from their loyal readers saying what a wonderful person they are, etc. So one gets the impression, intended or not, that one is not supposed to make anything less than laudatory comments at all. These are two blogs that interest me, so maybe that makes me more sensitive.

It’s true for all of us that we don’t hear negative feedback well, if at all, unless it is couched as a suggestion for change. But this approach to dissent is not conducive to the kind of creative civil society dialogue, as espoused by Jane Jacobs, that we need to encourage these days. I even caught myself trashing the look of a web site of an anti-evolutionist because of the black background which makes it unreadable.

As my father would say, "That, Borneo Breezes, is a lazy person's argument!"

For people to change, we need to cultivate a diversity of opinion. There are lots of different, strongly-held opinions about almost everything as the recent blogs at Parallel Universe and other places about male circumcision make glowingly apparent. Blogs provide a good place to have such discussion, hear dissenting opinions and respond to them. They are even a good place to rant and listen to other people rant, especially if they are humorous. I didn’t think about this when I started to blog, but I can see now that the discussion that blogs sometimes generate through their comments is perhaps as important as the piece. This in fact makes it better than newspapers, my current fetish.

Moof has done a great job on stimulating discussion about euthanasia. More is needed along this line. And we have all got to develop a thicker skin. We are not talking to just our friends who agree with us or even our friends who don’t agree with us, we are opening it up for everybody. Obviously there need to be some ground rules, indeed it looks to me like some have already started.

My second comment is about the need for a medical meta-blog. A meta-analysis is an analysis of epidemiology studies about a topic. A meta-conversation is a discussion about a conversation. A medical meta-blog would be a blog about the medical blogs. Grand Rounds may have been started with something like this in mind, but the recent ones I have seen, seem to be descriptions about a weekly array of what’s available. Now, it is a very useful service, a great boon to medical blogging and bloggers and a wonderful way to initiate non-bloggers into the medical blogophere. A medical metablog would do some critical analysis by topic or issue or category of blogs. If it was by one of the medical bloggers, it might have to be anonymous because of the problem noted above about critical comments. It could be anonymously rotated. I could see a pithy review being syndicated to newspapers. It might help break through the glass ceiling of the internet. There could be money in this idea for someone. What do you think?



Blogger Moof said...

A medical metablog would do some critical analysis by topic or issue or category of blogs.

That is an amazing idea. Excellent! And I agree!

How would you go about doing this, hosting it on Blogger for anonymity and allowing a variety of medical bloggers to sign on and take turns editing? How would it be moderated?

I hope you'll consider submitting this post to Grand Rounds in order to garner a large viewing. Our blogging community is lacking exactly what you've described.

Thank you, by the way, for your kind words. I hope you don't mind, I'm going to link to your post and quote a bit of what you've said.

8:42 AM  
Blogger scan man said...

BB, Great post.
I agree with your point about medical bloggers 'who by their own admission say frank, critical or sarcastic things' seeming surprised and getting angry that some readers react negatively.

Why is it that your blog allows only those with a Blogger account to comment? I had to use my defunct Blogger ID to post this comment and to use some newly learned tricks in html to get my actual blog link on my name here scan man

12:25 AM  
Blogger TheTundraPA said...

I agree with Moof, submit this post to Grand Rounds for a larger viewing audience. These ideas deserve consideration.

You bring out a very important point; often the discussion generated by a post is more important than the post itself, and is one of the main benefits of blogging over reading newspapers. Critical comments are often not well received, but then critical comments are often not well phrased, either. You have obviously given a lot of thought to this, and your argument is very well stated.

I wonder what effect a metablog would have. If it encourages better writing and clearer thought, I am all for it. Ultimately, each blog is a soapbox for the blogger who writes it, and readers can vote with their feet--or their mouse. Anyone who doesn't like a particular blog certainly doesn't have to read it. The cream will rise to the top. The metablogger-of-the-week could be just as subject to personal bias as the host of Ground Rounds, since there are no standards for good blogging comparable to standards for good medical studies. In my mind, blog writing is either good or it isn't; and anything that encourages good writing and clear thinking is to be encouraged. Would the anonymous metablogger simply point out the "best" blog post on a given topic for the week? If so, then we may all aspire to produce our best writing in order to get the Blog-of-the-week-for-subject-X award. But how does someone apply critical analysis to something for which there is no standard other than personal preference?

I do not mean to deconstruct the idea; it is simply not clear to me how it would work. Perhaps you could post a "metablog" illustration to give us an example?

1:27 AM  
Blogger D.P. said...

Hmmmmm, great idea. I agree with Moof--you should submit this post to Grand Rounds. GR'ers tend to bounce ideas around and come up with some good solutions.


9:20 AM  
Blogger Borneo Breezes said...

Moof- I woke up thinking this wasn't such a good idea and found you had already launched it--so nicely too. Thank you.
Your questions are great and I haven't the answers. I don't even know about spiders and compacters and trackbacks but the post went into Grand Rounds. Probably we need to brainstorm a bit first.

In a metanalysis you stipulate the criteria, what is excluded and why and importance is assessed on a weighing of the number of participants in the study in combination with the validity and generalizability mainly. Without such criteria a report would not be research, just opinion. In metablogs there is probably a place for both opinion overview pieces and more rigorous analysis with criteria. We can define metablog however we want.

You are providing an overview of medical blogging, stimulating wonderful thoughtful dialogue and nuturing the network on your blog.

Scan man-
Thanks for commenting. I don't know how to make comments open to everyone but would like to.

TundraPA -
Great deconstruction! One of the ways to look at something new is from the consumer and/or potential consumer--what would they use or want. At dinner with some malarial researchers on the weekend, I mentioned I had begun blogging and they laughed and said, "like journaling on the web?"

"Yah," I said, "but the potential is enormous. There are specialist's providing regular updates on the literature in their specific area. Couldn't you use that?"

And then they were all ears. And that is only one aspect. To encourage my MPH students to access some of the discussion in blogs, I suggested a couple of sites. A better way, in retrospect, if I knew more about the blogosphere, would be a mini guide to what was available in public health with comments.

There are also real gems hidden in the archives of the medical blogs that could benefit from wider sharing. So as you can see, I am all over the place at this point.

7:22 PM  
Blogger Borneo Breezes said...

DP -
Welcome. Thanks for commenting here. I am looking forward to some more bouncing around.

7:28 PM  
Blogger Barbados Butterfly said...

Excellent post - I find your comments most interesting.

I would like to remark that I am not surprised when I receive negative comments. Life is a constant stream of feedback, some negative and some positive. Blogging entails descriptions of opinions, responses or actions which people can choose to disagree with or agree with.

The impression I have gained during my time in the blogosphere is that it is perfectly acceptable to make non-laudatory comments. However, the blog belongs to the blogger. The excellent blog of Bitch PhD has a disclaimer I quite like:

"Comments are great; offensive comments get deleted."

I quite like this policy. As the owner of my blog I have the right to decide what is offensive and what is not. When someone posted a comment "You are a bitch" on my blog, I deleted it. And posted about it, because I wanted to. I find it interesting that the negative and offensive comments have always come from anonymous people. None of the anonymous commenters have engaged in further dialogue about their viewpoints; I am not sure if this is because of my approach toward them or because anonymous people who type "you are a bitch" in the comments sections of blogs struggle to engage in intellectual dialogue. Perhaps it is both.

I welcome negative comments on my blog. But I prefer that the authors be brave enough to put a name (even just a first name, or a pseudonym) to their comments. Otherwise the message they wish to convey will likely be lost in the ether. And constructive comments are always more welcome than unconstructive ones.

I guess I could, as you have, set my blog so that it does not allow anonymous comments. I did that for 24 hours in response to a "you are a bitch" comment, but relented immediately after a frequent commenter emailed me and elegantly explained why I should allow anonymous comments.

I look forward to reading more from you!

2:04 AM  
Blogger Giskin said...

Hello there, Borneo Breezes. What an interesting post. I think that the Medical Blog Network sort of aspires to be a kind of metablog, with featured posts and commentary, but I'm not convinced it's going to be successful. When Grand Rounds is 'edited' for quality control, people do get upset if their posts are excluded -- after all, what's absolute drivvel to one person is another's insightful analysis. I think the blogosphere resists being regulated and enjoys the anarchic aspect.

10:09 AM  
Anonymous NUNG said...

Thank you.
An intelligent post from Kuching.

10:50 AM  
Blogger Barbados Butterfly said...

Oops, correction: the disclaimer is "obnoxious comments get deleted", not "offensive comments get deleted" :)

1:16 PM  
Blogger keagirl said...

I think it's really poor etiquette to insult someone on their own blog. Sure, you can disagree and write a polite dissenting comment, but to call people names and write viciously rude comments is really uncalled for. Opinions, negative or otherwise, are welcome, but let's all keep it on a civil level.

People have to realize that blogs are written mostly for amusement (or at least the blogs I read) and the occasional profound musing and should be treated as such.

10:37 PM  
Blogger Borneo Breezes said...

Barbados Butterfly-

Thanks for dropping by and entering into dialogue. I didn't intend to single out any blogger and regret I did.

Bloggers are in control of their blog. As such it is a power relationship and when things get "edgy" or close to feelings or topics about which readers feel strongly, they may overreact.

We used to say in working in small communities that the only honest feedback we got was when someone was in the ER drunk, so we had better listen, even if it was overstated.

To me the fact that there are few non-laudatory comments and most negative comments are anonymous suggest people do feel constrained. After making a few comments and being greeted by silence, I felt so constrained.

Verbal abuse, of course, is something different and not to be tolerated.

Nung -

I am just discovering there is a blogging network here. Thanks for dropping by.

Thanks, I will check out the Medical Blog Network.

12:32 AM  
Blogger Barbados Butterfly said...

BB, I think it was useful to give examples of blogs demonstrating the points that you were making and I don't think you were singling anyone out in a negative fashion.

I agree with Keagirl that opinions are welcome but that they should be voiced in a civil fashion. In the blogosphere and in real life name-calling and vicious comments are unwelcome and do not promote thoughtful discussion.

Often I think comments are met with silence not because they are disagreed with, but because they are agreed with. Some bloggers have a policy of replying or responding to all comments, but most don't. I suspect that's because blogging (and comments) mean different things to different people.

Lastly, (sorry, I've only just noticed your earlier reply to Scan Man regarding comments) to make comments open to everyone go to 'Settings' in your Dashboard, then select 'Comments', then select 'Anyone' next to the question "Who can comment?". This will open your blog comments up to everyone. If you want to disable comment moderation scroll further down the same page and put 'No' next to "Enable Comment Moderation?"

Hope this helps.


12:40 AM  
Blogger Shinga said...

There was a recent call to ban a contributor from Paediatric Grand Rounds. This raised issues of how strong an editorial policy can be and whether different rules apply to different contributors. Can someone make a strong, unsubstantiated comment if they are part of the community or have some other form of pass, but not otherwise?

There was an interesting item about negative intelligence (the quality that prevails when intelligence is absent) and blogging: an internet way of self-knowledge. One of my favourite comments is that:
"Territoriality on newsgroups takes the form of flaming [info] or more particularly what I call negative intelligence. Over and over you can see the classical educational ideal of individual discovery being sadistically crushed. And learning to withstand this social pressure in newsgroups provides a fine, self-paced training-ground for withstanding the self-knowledge taboo in general.

Newsgroup flamers run the gamut from homeless psychos to celebrity PhDs."

I'm thinking about this issue a lot because I'm the host of the next PGR. When I did it last time, I included posts with which I disagreed because I thought that they were issues that were in the popular media and needed to be discussed. For that reason, I didn't even frame them with my opinion. Is this form of hosting too bland - and less acting as an editor, and more as the person who cobbles together an applique quilt of posts?

Regards - Shinga

3:34 AM  
Blogger healthpsych said...

I agree that, quite often, the more important dialogue takes part in the comments section. Negative feedback can be good when it's clearly articulated, constructive and not simply a personal attack.

To quote Barbados Butterfly's example, what benefit is added by calling someone a 'bitch'? BB recently created a post about someone who accused her of being 'arrogant.' I'm one of the people who replied to that post to say my perspective was different. I didn't take that to mean only 'nice' comments were welcome. To me, BB has the right to respond to such a comment, anonymously made.

Anonymity allows people to make personal comments. However, I still allow anonymous comments on my blog because sometimes people are simply more comfortable in stating their position that way.

Ah, but I'm rambling. I'll shut up now. :)

5:41 PM  
Blogger Dreaming again said...

regarding Toastmasters, I have considered going to that. I'm getting a book published, a devotional book.

As a way of promoting the book, I may be asked to go speak at women's groups and women's ministries in churches. I am terrible at public speaking. It might be a good thing for me to learn something about it. Maybe. Public speaking scares the fire out of me.

8:04 PM  
Anonymous EMR and HIPAA said...

I wonder if the people at Healia - A Health Search Engine would be interested in working on a meta-blog using their search technology.

The hard part is moderation of content. Google has created a Google Health Search Engine where they use what they call a Co-op to manage the quality of the content. This however requires a Large crowd of people to ensure that the content is of high quality. I'm not sure there are enough medical bloggers to do this yet.

11:35 PM  
Blogger Borneo Breezes said...

Shinga - Your comments are very thought provoking.
The role of editor is never easy. We lost the editor of JAMA a while ago because he wanted to stimulate thought and discussion about the view that oral sex was not regarded as sex and did it at the time of Monica Lewinsky and more recently CMAJ lost two editors because, it appears, the board of CMA wanted to control content.

The best comments and discussion about both these issues were in other medical journals, so I suppose we stumble along, hopefully improving. Luckily we have had some excellent examples of good editors.

Now this all sounds interesting but it is way beyond my skill set. (I didn't even know what you initials meant!) I sense you are right about the critical numbers tho'

11:04 PM  
Anonymous medifast coupons said...

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9:25 AM  

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