Interview with the Founder of Clinical Cases and Images

Published on Medscape.com, 01/04/2006.

Dr. Dimov, the author of Clinical Cases and Images - Blog is interviewed by Nick Genes, the founder of Grand Rounds:

I've been asking some questions of the hosts for the "pre-rounds" column. These are very open-ended, think of it like a platform for you to explain your site, what you get out of blogging, and how it all came to be.

1. Your blog is different than other hosts of Grand Rounds -- it's a testament to the diversity of blogs, but I'm curious why you chose this format and not some kind of a traditional education site.

I was a chief resident at Case Western Reserve University (St.Vincent/St.Luke) Internal Medicine Residency Program and we needed a website to communicate ideas to the residents and to get feedback. Google's Blogger.com looked like the ideal choice - free and with a modifiable template.

The idea was to make a regular website using blogging software and to use it to address the questions of the residents. The website was "for the residents, by the residents". We answered questions from morning report and posted interesting cases. With Audioblogger, it only took a phone call to describe an interesting EKG which was posted on the web as an MP3 file within seconds. If somebody felt uncomfortable performing a certain procedure, for example, paracentesis, we would upload a step-by-step instructions with photos.

The residents loved the "blogspot" and this is how it all started. Traditional websites are static, blogs are "living organisms", you can see them growing and anybody can comment right there on the page.

The original website was organized in categories. Sometimes I had commentaries that did not fit in any section but I did not want to forget the next day. The blog started as a notebook to collect those ideas. I am much more organized now because of it. At least, I always know where to find things I've seen or I've read about: just click the search button of the blog.

2. I usually ask people what made them start blogging -- in your case, I'll change it to what made you start this educational website? Do you view it as a blog first or is the blog an adjunct to the case archives...

I just explained why I started the website above. Let me answer why I keep working on it. After we got the top positions on the search engines for "central line" and "arterial line" placement, I realized that the website was much more than a bulletin board for the residency program. The clinical cases in everyday practice are often very different from the textbook descriptions. "His CHF did not read the book", an experienced physician used to say. Clinical Cases and Images was created to bridge the gap between theory and practice. It is a case-based curriculum of clinical medicine. On the other hand, everybody needs some time to relax, and this is how Hit the Road (the travel website) was born.

With time, the project branched into several websites. All of them are separate sites but they are linked together by the blog. The ideas start on the blog and after they get a more structured form, they are transferred to the regular websites (which just use the blogging platform but are not blogs).

My projects include:

- Clinical Cases and Images. A Case-Based Curriculum of Clinical Medicine. This project is supported by physicians in the Section of Hospital Medicine at the Cleveland Clinic and the Case Western Reserve University (St. Vincent/St. Luke) Internal Medicine Residency Program. ClinicalCases.org was featured in BMJ.

- Procedure Skills collects slide shows with explanations of some common medical procedures like central line placement and thoracentesis. The procedure articles are referenced in Wikipedia, the world's largest online encyclopedia.

- Clinical Cases and Images - Blog. Casesblog features daily news, comments and ideas.

- Clinical Notes collects information which is not related to clinical cases but represents practice tools, for example, Sample Admission Notes for the Most Common Conditions and A Systematic Approach to Reading an EKG.

- Computers and Internet is a website that collects the information technology stories from Casesblog relevant to medical practice.

- Hit the Road - See America and the World features photos and descriptions of interesting places to visit around Cleveland, Ohio and around the world.

The blog is a blog first and the other project live a life of their own but everything is in a sense bundled together by the blog.

3. Who are your readers? Residents? Students? Attendings?

The readers come from all over the world (as it is the case with most blogs), the average is 350-550 visitors, 1200-1600 page views per day. Most of them seem to be patients or doctors looking for medical information on the search engines. I wrote about InstaWife's heart attack (with her permission) and Instapundit gave me 13,000 visitors in a day and a MSNBC.com link.

Recently my websites were featured in BMJ and its readers started visiting as well.

Many visitors come from the major U.S. medical centers, like Mayo, Harvard, Johns Hopkins, Cleveland Clinic, etc. We are in the process of integrating the Clinical Cases website within the Internal Medicine Residency Program at the Cleveland Clinic and the new medical school there.

4. It seems that, even when you get the urge to pontificate and share stuff, you still cite the literature. I am thinking of your happiness post and others. Do you ever just want to write? Opine? Maybe down the road?

I did not start writing just to express opinions. The goal is to share knowledge about a topic, based on clinical experience and literature, and to get feedback. On the blog, I sometimes comment on a news story but I always have in mind that despite my disclaimer (" All opinions expressed here are those of their authors and not of their employer"), I still represent my employer.

"Inflammable" posts and angry rants get a lot of links and comments but erode the credibility.

By the way, I like using mnemonics like the one in the happiness post you mentioned: the MOTORS of your life. I have made up more than 1,000 mnemonics and this is another part of the project that will be launched sometime next year.

5. What are some of your favorite posts? Ones that inspired good debate, challenging issues...

These are just a few examples:

How Do Doctors Use Google - Blogosphere Impact
The post about Google use by doctors got a lot of attention and links by the main blogs following the search industry. It was even referenced in a recent BMJ editorial.

Case Reports and HIPAA Rules
This post provides the basis of Clinical Cases and Images' very existence. If posting clinical cases for medical education were illegal, I would have to close the website.

Simply Fired - How NOT to Blog About Your Job. Especially If You Are a Doctor
People will blog no matter what. It is important for the employers to have some reasonable guidelines that employees can comply with. The poster child of a fired blogger is Mark Jen who got fired from Google after writing about the company on his blog ninetyninezeros.blogspot.com (the digits in a googol). It was fun to see Mark commenting on my blog.

Who Are the Medical Bloggers and Where to Find Them?
Kent Bottles did a great job of introducing medical bloggers to the readers who can now connect the writings with the voices.

Text-to-Speech Programs and Continuous Medical Education
CME and keeping up-to-date has to be fun, otherwise I will not feel like doing it. iPod is here to help. This story was also quoted in a BMJ editorial.

Make the Largest Encyclopedia in the World Better. I already did (I hope)
"Common sense is not so common", Voltaire used to say. Wikipedia with its "wisdom of crowds" often provides this common sense. If a link is not good, it just does not last long on Wikipedia.

"Women Don't Have Heart Attacks." So Wrong
The psychologist Dr. Helen (a.k.a. InstaWife) had a heart attack at 37. It took doctors weeks to diagnose it. This story was meant to raise the awareness so that we can decrease the chances of repeating the same mistake again.

Web 2.0 in Medicine
Web 2.0 is here to stay and we should use it to benefit our patients. This blog itself is small part of Web 2.0. You mentioned that I constantly cite the literature, well, I do have 12 references to this post :-)

Note:
The interview was used for the Pre-Rounds column of Medscape.com which features the hosts of Grand Rounds.

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