Discussing On-Line Profiles - A New Addition To The Well-Child Exam

Through social networking sites, teens can now hangout with their friends without leaving their homes. But unlike sitting in a friend's basement, you're not always sure who else is there. There are unseen risks involved with virtual communities. Depending on the settings of one's web profile, personal information, photos, etc. may be open to anyone who wants to see them. Teens may be more lax about what they share on-line. They may say and do things on-line that they would shy away from in person. Teens may also feel pressured by their virtual community to post comments or pictures that may be inappropriate or illicit unwanted attention.

With how common these sites have become in everyday adolescent life, it would be wise for us as pediatricians to begin to include them in the teenage well-child exam. On-line activity and its risks can easily be worked into the "activities" part of a HEADSS exam. Incorporating it into the HEADSS exam can open the door to discussing the risks involved with putting personal information on-line as well as how to protect one's self and maintain one's privacy.

A recent study published in January's Archives of Adolescent and Pediatric Medicine has shown that adolescents may be open to advice regarding how and what they display about themselves on-line. In this study, a physician using MySpace sent an email to 18- to-20 year olds who displayed risky behavior in their on-line profiles. She informed them that the information they were sharing was open for anyone to see and advised that they take steps to maintain their privacy. 42% of the interventional group versus about 30% of the control group (P=0.7) made some sort of protective change whether it was reducing references to sex and substance use or changing their web profile setting to private.

These results were based on an unsolicited email from an unknown physician. It is likely that advise from one's own pediatrician with whom they have had a relationship for many years would be much more influential. Although there are many things to cover at the teenage well-child visit, given how much time teenagers spend on-line and in these virtual communities it is incumbent upon us to find the time and make the effort to discuss the risks involved.

By
Corinn Cross, MD, FAAP
COCM Website and Blog Editorial Advisory Group Member

The Nation's Doctor

As Surgeon General, from 1998-2002, Dr. David Satcher described his role as the “Nation’s Doctor”. In 2007, he testified before Congress stating in part, “I believe that it is the responsibility of the Surgeon General to communicate directly with the American people….” (Committee on Oversight and Government Reform The Surgeon General’s Vital Mission: Challenges for the Future Testimony by David Satcher, M.D., Ph.D. July 10, 2007.) Surgeon General nominee, Sanjay Gupta has already proven that he can communicate with the American people. The prevailing argument however, is that it takes more than a reporter to be the Surgeon General. His first challenge will be Congressional approval. After approval, Dr. Gupta will likely spend the majority of his time winning the support of those who believe he is not qualified.

Only two of the last eleven Surgeon Generals are easily remembered: C. Everett Koop and Joycelyn Elders. C. Everett Koop was Surgeon General from 1982-1989. He is a Pediatric Surgeon and continues to make television appearances. He was very public during his service and fit the stereotype of what most Americans associate with wisdom and experience. The Surgeon General warning labels and C. Everett Koop are synonymous in the minds of Americans who witnessed the obscure office become a very public platform. The second memorable Surgeon General is Jocelyn Elders who was Surgeon General from 1993-1994. She is a Pediatric Endocrinologist and created a media firestorm with comments about masturbation. Her firing began a rift in the perception of what the Surgeon General should promote. Public health advocates and political conservatives do not always agree on what message the Country should hear.

These two examples demonstrate contrasting communication styles and media experience. Media knowledge is a vital skill for an effective Surgeon General. It is this role as the “Nation’s Doctor” and his ability to communicate that illuminates the choice of Dr. Gupta for Surgeon General. Dr. Gupta is a neurosurgeon who has already become a trusted source of information for millions. However, he may not have the support of many in the scientific community or the Public Health Corps, which he would oversee. As with many institutions, experience is the currency that pays the dues. Other physicians also look at the choice as a threat to public health and primary care because he is a sub-specialist without a Public Health degree. The past eleven Surgeon Generals have had specialties to include neonatology, family medicine, nephrology and veterinarian medicine. The current acting Surgeon General Dr. Steven Galson specializes in Preventative Medicine and Occupational Health. Dr. Gupta’s credentials as an expert in neurosurgery confirm his ability to practice medicine. His success in public health would depend on taking full advantage of the vast resources at his disposal. If Dr. Gupta utilizes the scientific and medical advise of experts to analyze the evidence and then, uses his skills as a communicator to direct the National health goals he has the potential to be one of the best remembered Surgeon Generals in a generation. Imagine 15 year-olds talking at lunch, “Dr. Gupta said, ‘Ephedra can kill you.”

The Office of the Surgeon General may be poised for the spotlight and focus America’s medical needs toward the best care practices. Or it may become another distraction from important issues. We may see how ready for change everyone is and how an effective communicator can make a difference.

by
Jeff Hutchinson, MD, FAAP, FSAM
COCM Website and Blog Editorial Advisory Committee Member

Social Media Sites and Inauguration Coverage: A Glimpse Into Communication of Today and The Future

This week's Inauguration will not easily be forgotten. From the earliest moments to the First Couple's First Dance, it was a day filled with hope, memorable "tissue" moments, though-provoking music and words, and images of a gracious passing of the Presidential torch of power that will be carried with all of us for a very long time.

In addition to the usual TV coverage, a surprising twist to my day was how much more enhanced the experience became for me due to the power of my social media involvement on Twitter and Facebook. As the Inaugural events were unfolding, simultaneously, my virtual community of friends and colleagues were posting their impressions and images real-time from all 4 corners the United States. We even shared what we were snacking on! No longer sitting alone with our thoughts, we became a rich community of voices sharing our thoughts and impressions real-time.In the blink of an eye, a virtual living room of spectators for the biggest historical moment in most of our lives emerged.

And, we were not alone! JuJu Chang from ABC News had a flipcamera and her iPhone at the Inauguration. She not only posted videos on her ABC News blog but updated to Twitter and Facebook throughout the day. It was a cool way to give views another way to experience the Inauguration besides the more traditional TV coverage ABC was also doing, which was excellent.

We have yet to really tap into the full power of these communication tools but if Tuesday was any indication, a door has been opened that we have only just begun to walk through. It will be interesting to see how we all end up using social media in our media and communication lives and to learn from each other's experiences. We are likely to find we will only be bound by the limits of our own individual creativeness.

There was a true sense of unity and community this week that was visible and palpable on the Mall, parade route, the many evening balls, and in all our communities on and off line. While I had a bit of Inaugural media coverage brain burnout the following day, I woke up that morning hopeful about the future and looking forward to exploring more the power of the world of social networking.

Image: First Dance (FoxNews)

Republished with permission from Dr. Gwenn Is In

Question Of The Month: Getting Ideas for Media Work

Media Question #2:

If you do media work such as write a column, article, blog, do TV or radio show, where to you get your headlines or ideas?

A: Headlines: national or local

B: current AAP journal articles and themes

C: the producers or editors give them to me

D: what I see in my practice

E: other – please specify

Here are this month's responses:

"Most of my topics for articles either come from the AAP / journal searches that I find interesting or from the reporters themselves. While I find the stories that I do from the articles I find to be more interesting and satisfying, I don't have a lot of time to pitch story ideas. Thus, I also respond to reporter's ideas more often than I would like."

"A and D: I get my headlines from the NY Times or Chicago Tribune. Patients are the best source of questions and usually answers. It adds the personal touch to the discussion."

"As my blog is for Residents and our local EMS providers, I tend to stick with topics related to what we are seeing in the ED. The saying about things "happening in 3's" is very true where I work! I often incorporate hot topics or seasonal items into the discussion."

"I do a local cable TV interview show called "School Health news' I get my ideas from my knowledge of school Health' and Current AAP Policies."

"All of the above. I read other blogs, columns; listen to talk radio. Then I research and write my editorials or columns. My essays are from my practice."

If you'd like to contribute your answer to this question, email me!! gsokeeffe@aap.net or cocmeditor@pediatricsnow.com

GENERATIONAL GAP OR INFORMATIONAL GAP?

Today's blog is by COCM member Mark Rosenberg M.D., F.A.A.P., from Children's HealthCare Associates in Chicago, Illinois, who writes:

"As recently as two generations ago, when a new parent needed advice on the care and raising of their newborn, the trusted source of information was a grandparent or other close relative. Now the ‘trusted’ source of information is the internet and the various information services available on line. While we owe a great deal to the information revolution on the internet including rapid access to information including libraries of journals that would have required a trip to the university library, there is much to be wary of. Information may be posted by literally anyone, who then becomes an instant expert.

A case in point of the information revolution is recent access to information on vaccines; particularly the celebrity endorsed alternative approaches to immunizing infants. Despite numerous medical studies and epidemiologic research in the safety of vaccines, as well as a track record of reduction in vaccine preventable disease, members of the public have chosen to accept anecdotal stories of alleged harm caused by vaccines. The result has been lower rates of immunization in many areas of the country and the potential for susceptibility to diseases that most pediatricians and emergency departments rarely see including invasive pneumococcal disease and Haemophilus meningitis.

On line parent groups provide another source of information to parents, not unlike the backyard fence that my parents used to chat with neighbors, except that the sources of information are unseen and anonymous. These groups have become sources of health information as well as information about specific physicians. Once one of the physicians in my group acceded to parents’ requests to provide an alternative immunization schedule, she was subsequently identified as the physician to go to, despite not seeking out that role. Word of mouth[on line version] has changed her image and practice. A similar source of information is the blog, an online discussion group frequently within a media source web site. This use of the parent to parent information exchange may have the perception of official sanction when conducted by an ‘official’ media source, such as a newspaper or magazine.

For pediatricians, the challenge is to adapt to the new informational age by convincing families to use validated sources of information and rebuild the confidence in physicians as reliable health care providers. Beyond accurate information medical groups must maintain credibility without conflicts of interest in our relationships with the pharmaceutical industry and vaccine manufacturers. Grandparents play a role in discussing their past experience with vaccine preventable disease. Families need to hear our strong voices as advocates for the health of their children."

Do you have a blog post you want to share with COCM members on media issues? Email me at gsokeeffe@aap.net.

Preparing For A Media Appearance

When you get a call from the media for an interview, how do you prepare? What goes through your mind?

COCM member Dr. Vandana Bhide, an internist and pediatrician in solo practice in St. Augustine, Florida, was called by the media recently about a situation in her community and shared with us her media lessons learned. She writes:

"Recently, I was interviewed by the CBS affiliate in Jacksonville, Florida to on a story about a local 14-year old girl who almost died of alcohol intoxication after attending an underage party. Here are some things I learned from my media experience:

1) Research, Research, Research. Even though I have spoken at town hall meetings and other forums for the public regarding the medical effects of alcohol on children (I am on the board of a local substance abuse counseling center which also runs a number of in-school alcohol and other drug abuse prevention and intervention programs), I felt so much more confident and calm when I had some time (OK, 30 minutes, tops, but better than no time at all) reviewing the important points I wanted to make about the topic. Even though only 10 seconds of it got on the air, it made for a more interesting 10 seconds!

2) Expect the Unexpected. When the reporter called me to meet for the interview, she asked me to meet her at the “Real Jail” (as opposed to the pretend jail???) After unsuccessful attempts at trying to find “Real Jail” under the “Points of Interest” section of my GPS and then also failing to find this location on Mapquest, I finally resorted to the old-fashioned technique of asking a policeman for directions. I finally figured out that the reporter was referring to the adult jail, not the juvenile detention center. When I saw the segment air, I realized that the reason the team was reporting at the jail was that three people had been arrested in conjunction with the underage party.

3) Be Humble. I gave the interview at 5 PM on a Saturday, and the segment was scheduled to air on the 6 o’clock news. I was told that the piece would probably be bumped off the 10 o’ clock news because of the approaching thunderstorm. You may think that your “expert” opinion is important, but maybe it isn’t in the big scheme of television news. Lesson learned: Weather is Important. Especially on the Atlantic Coast of Florida. Especially during hurricane season. Especially during a perfect golf weekend. I guess there wasn’t any breaking weather news because the segment did indeed air again on the 10 o’ clock news.

4) Generate interesting questions and answers. The only question the reporter asked me was, “Should parents speak to their children about alcohol?” The answer seems obvious, and yet studies show that the vast majority of parents don’t speak to their kids about the importance of refraining from alcohol and drugs. So I tried to avoid answering with a brief yes/no question and instead explored what are the barriers to parents and kids having this discussion.

5) Speak in English. Seems obvious, doesn’t it? But how many of us have been guilty at some time or the other of speaking in medicalese? Do television viewers understand that “the toxic effects of alcohol include bradycardia and other arrythmias, respiratory depression, hypotension and death by aspiration?” If the explanation is not easily understood, you may find your segment on the cutting room floor!"

COCM Members In The News

Here's some of the latest media appearances of COCM members:

• Ari Brown (Star Ledger: Autism)

• Deborah Mulligan (Star Ledger: Dry Drowning)

• Deborah Mulligan (Washington Post: Dry Drowning)

• Linda Reid Chassiakos (Editorial Daily News)

• Linda Reid Chassiakos (Editorial Daily News)

• Gwenn O'Keeffe, MD: Dr. Anonymous Radio Show

• Gwenn O'Keeffe, MD: Vicky and Jen's Radio Show

• Jo Ann Rohyans, MD was on CBS affiliate Ohio (WBNS-TV) on Tuesday, July 8 discussing HPV

• Robert Mendelson, MD discussed HPV for "Scribe" a monthly publication for the Medical Society of Metropolitan Portland in early July

• Richard Baltz, MD, Newborn Colic, Newsweek

• Thad Woodward, MD hosts for Line One - Your Health Connection, KSKA, Anchorage, Alaska