Why and How I Blog

KevinMD wrote his take on a number of issues last week, including the demise of several popular medblogs:

Blogging and practicing medicine often don't go hand in hand. Most of the media coverage borders on negative, focusing on patient privacy issues. Hospital administrations have shut down physician blogs. Furthermore, practicing medicine is exhausting, leaving blogging at the bottom of the priority list.

We are fortunate that new voices have emerged as these blogs have closed down. That's important. Physicians are often left out of the healthcare debate, despite the fact that we will play a pivotal role in any type of reform....

The blogging medium is an ideal way physicians can make our voices matter. It's in our best interest to keep the medical blogging phenomenon strong.

I don't think I could have put it better than Kevin. The more I read of medical blogs, the more I learn about the nuances of healthcare policy and administration. Blogs serve a vital role in disseminating physicians' perspectives to policymakers and journalists. They also provide a basis for physicians to share information among themselves. It is in our best interest to keep medical blogging going.

This post is a how-to of sorts for doctor-bloggers who are wondering how to keep their blogs going when they are already working 60-80 hours per week and trying to be good parents and friends as well. I'll present my own approach to posting on this blog, how I developed this approach, and why I think it will help doctor-bloggers to use some or all of this approach in their own blogs. Read on.

In the world of medblogosphere 2.0, I am a new blogger, but a long, long time ago (actually 2002-2004) I wrote a blog called At the Still Point of the Turning World. It was a blog about my life as a resident and all the things I did in my spare time, which was actually quite a lot. I met a lot of people through the blog and found it to be a great outlet for creative energies and everyday frustrations. And then I let it lapse.

Why did I let that happen? So many reasons. Here's a few:

1. As I made transitions in my life, I didn't know how to take the blog with me. For example, Still Point was very much identified with my residency and that stage of my life. When I got a job in Rural and moved, I didn't know how to represent my new life on the blog. Sounds ridiculous, but it was true.
2. The process of maintaining a blog was really tedious and I got sick of keeping up with it. Way back in the early Pleistocene era, when I was writing Still Point, commenting systems were in their infancy, there was practically no control over comment spam, and it was really hard to keep a blog template looking clean and interesting (i.e. editing sidebars) without knowing a fair amount of HTML. As for including photos, hosting services didn't let you post photos on your blog from their servers, so I had to FTP everything myself over to an Earthlink account, which was incredibly time-consuming and annoying. Things are so much easier now, it is almost a pleasure to keep up with blog maintenance.
3. As I got swept up into my new life, my posting became more and more sporadic and I fell prey to the "it's-been-so-long-I'll-have-to-apologize-for-not-posting" malaise that seems to afflict so many bloggers. Pretty soon, this malaise gives way to resentment (the "who-do-these-people-think-they-are?-Do-they-think-I-OWE-them-a-blog-post-or-something?" phenomenon) and then the idea of posting to the blog becomes so laden with guilt and annoyance that it is easy to let the whole thing go.
4. Of course, as always, TIME became a limiting factor. When you're trying to make a living and maintain a decent standard of personal hygiene, posting regularly to a blog seems completely out of reach.

After the ignominious end of Still Point, I was hesitant to start blogging again. I was worried that yet another medical blog would not be well received, and I didn't want to crash and burn again from the time commitment of blogging. I thought about what I would write about, how often I would post, and what I wanted to get out of blogging. In other words, I developed a crude editorial plan for Rural Doctoring before I ever launched the blog. I found a number of blogging websites that were helpful in defining these goals, especially the justly famous ProBlogger, which I admire not for its success in monetizing its blog, but for its commonsense advice to bloggers on building and maintaining a good site.

My editorial plan consisted of a few broad principles:

• A focus on rural healthcare with specific examples of how current healthcare policies are played out in small towns.
• A literary rather than a journalistic tone to posts.
• Daily posts, of which at least 3-4 per week would be original content rather than reporting content written elsewhere.
• Priority on meeting my own goals: to improve my writing discipline and style, to integrate the act of writing into my working life, and to explore topics and themes that might one day be the foundation of a book of my own.

Once I'd defined these principles, broad and overly simple as they were, I developed the following process of finding ideas for blog posts and posting finished pieces on this blog. I'm still refining this process, but I can say that its major components are:

• Keeping a list of ideas for blog posts
• Identifying chunks of time in which to write blog posts
• Maintaining momentum for writing blog posts

The process begins in a Circus Ponies notebook. I like this application because it gives me a lot of options for organizing lists, files, drafts in one big file that looks like a notebook, with different page styles and dividers, etc. I think you can do the same thing on Microsoft Word, but I started with Circus Ponies and I'm happy with it. Here's a screenshot of the table of contents for Rural Doctoring's editorial notebook:

This is the table of contents for the notebook. I've got dividers for sections devoted to lists of post ideas, post series (such as the MEconomics series) and what I like to call "columns" or recurring posts such as the Birth Stories and Cases I try to put up on a weekly basis. (I whited out some lines because there's a few ideas I've got cooking that I haven't decided to run with yet and I didn't want everyone to wonder what happened to them if they never get written.)

The structure of the RD editorial notebooks helps me keep all the post ideas that might otherwise get lost on the backs of grocery receipts, the bottom of sticky notes, or misprinted pages salvaged from the laser printer at work. I shove all these ephemera into my tote bag and enter them into the editorial notebook. This way, when I do have a block of time in which to write, I don't have to face the time-sucking horror of not knowing what to write about.

Sometimes an idea begins as a one-liner and takes on a life of its own. For example, before I launched RD, I had an idea to write about "personal finance for doctors, my own case study." Well, when I started making notes on this idea, it turned into a big outline divided into seven distinct parts:

This is the current version of the MEconomics outline. I've been working on it on and off for about six weeks. At first, there were the main topic headings, then all the little details, and when I think a section is sufficiently well-outlined for me to write from it, I write the post.

In addition to the advantages of keeping all post ideas together, using Circus Ponies' outlining functions also helps me get some writing done even when time is tight. Having a prepared outline means I can sit down and write a single paragraph based on the outline, and know where I left off when I return to the post later. This way, even if I only have half an hour, I can write a few paragraphs and keep the post flow moving. If I had to sit down and come up with a good post from scratch every time, I would probably never write any because I'd be waiting around for a four-hour block of time to get the work done. Since I don't have very many four-hour blocks (and when I do, at least two of those hours are devoted to napping), I have to use outlines.

Which brings me to the concept of series of posts. This is a technique recommended by Darren Rowse at ProBlogger. Darren uses it to build a sense of anticipation about a blog, but I find it useful for a few other reasons:

• Developing a series of blog posts compels me to break up a huge post into digestible units. I have to admit, I am the most verbose person I know. One of my colleagues responded to a long email I wrote with the comment "my GAWD you're wordy." This is obviously a personality flaw but at least I share it with James Joyce, Charles Dickens, and a number of other fine writers. Anyway, it seems I'm incapable of writing a post of any substance in less than several thousand words. One solution would be to impose stricter editorial filters. I'm working on this. The second is to divide a big topic into subtopics. Hence, post series.
• Committing myself to a series of posts builds momentum into my writing schedule. Once I decided to post once a day, I had to come up with seven posts a week. If I had to dream up seven distinct subjects every week to post about, this blog would have lasted about five minutes. However, post series help me fill in upcoming weeks and gives me concrete goals to meet instead of the dreaded "get some writing done."

To keep track of post series, I use Google Calendar to keep an editorial schedule handy:

Click here for a full sized version.

Here you see the MEconomics series (Personal Finance on the calendar) is scheduled every Monday, and will soon be overtaken by a new series later in the month. I also have a shorter series starting this week. By mapping out the progress of a post series on a calendar, I can plan in advance how much writing I have to get done. The beauty of Google Calendar is that you can overlay one calendar over another. Here's the RD editorial calendar (orange) overlaid with my work schedule (purple):

Click here for a full-sized version.

On the combined schedule I've added a few notations reflecting how I look ahead and identify blocks of time in which to write. I don't actually schedule these blocks down to the minute, because my life is too unpredictable with OB call, cats, and a bazillion changes happening within my hospitalist group. At least I can eyeball this calendar and determine when I can tackle a big project and when I should set my sights a bit lower. I can also use light days to write a few extra posts so I can slip them in when needed.

You can see I also allow myself some light post "columns," such as the Weekly Wrap and the Rural Sights posts I use over the weekends when traffic tends to be lighter and I tend to be more tired and overcommitted. Even though the Wrap is a bit redundant with Grand Rounds, I like to write it because it helps me remember posts that stimulated my own post ideas. There are so many awesome medblogs out there that the Wrap is really fun to write every week. Similarly, I like the Rural Sights column because it usually involves one of the wacky photos I take in and around Rural and, I hope, gives a certain flavor to my descriptions of life up here. Other columns include the Birth Stories and Cases that I can often write in advance and post when needed.

So that's my approach to writing blog posts. Of course, there's a lot of time I haven't factored into this discussion, such as time spent keeping up with what other bloggers are writing, medical news, and maintaining the site in general. But what ultimately lies at the foundation of a good blog is good content, and I hope medical bloggers keep writing good content well into the future.

Comments

[DrCris]

Wow, I think this is a great post, that raises interesting issues.

I think it is important for doctors to blog, in the same way that it is important to meet up at conferences - we are our own peer support group.

I like your planning examples, but I find myself working slightly differently. I try to blog about what it affecting me at the time. So I make a series when I am trying to figure out something. I save my drafts in MarsEdit and keep a log of them that way, but I also keep track of post ideas in Omnifocus.

Your planning is very impressive, and it obviously keeps you on track, which is great.

[buckeye surgeon]

Wow! Impressive blogging regimen! After reading about your intense preparations, I sort of feel like the guy who shows up to a fancy black tie cocktail party with flip flops and sixer of busch light. hats off to you.

[Vijay]

I read this on the day it was published and was too intimidated to comment here. So I just 'liked' it on StumbleUpon & left a comment on your friendfeed. Ditto everything that Enrico said. And your organisational skills (?obsessiveness) are scary. There is no doubt about it.

[Theresa]

Hi Bruce, thanks for stopping by:

As I mentioned in the post and to Enrico, I'm not intentionally creating essays but I am naturally verbose and everything turns into an essay.

I think I will try to adopt a haiku-like minimalism in future posts (fingers crossed).

[Bruce]

Thanks for your commitment to active writing. I believe that regular posts make a "newer" blog more compelling. I have found that the internal drive to created essays has dropped over the past year and my posts are less frequent than they were. I love your enthusiasm!

[sm]

Hi Ruraldoc,

Love your blog. also love all the voices that have so much to say that needs to be said. What about a group blog..that should take the pressure off the need to post on everything. I really want to see panda bear back,surgeon's blog etc etc.

[Theresa]

Excellent points, Enrico. It is true that going from outline to post is one of those "and then a miracle occurs" type of processes. I think being chronically sleep-deprived actually helps me get the writing done, because it removes a few layers of inhibition.

I don't edit a lot because one of the things I like about blogs is the off-the-cuff nature of the writing. Of course, I like a post to cool off before I publish it, in case I have written something totally offensive or thoughtless--I can usually catch these after letting the post cool for a while.

Goodness knows, I'm not going for perfection. But blogging daily has been a good practice for me and helps fertilize my mind (already full of...oh well you get the idea) for future writing. That's the best reward of blogging.

[enrico]

I certainly respect you as a fellow wordy colleague. ;) You do take the cake on organization, though. While such meticulousness is rather amazing, bordering on scary, I hope it's not energy that you find unmaintainable. After all, it's just a blog, not a journal article you're writing. (although one could argue peer-review does play a psychological role in performance)

The single biggest problem I have is the inability to stop the self-editing process. I often force myself to push out a post at what I consider 90% complete even knowing people will be reading it as I make minor adjustments, because if I waiting until the asymptotic 100%, it'd languish in the drafts folder, never to see the light of day. You didn't address the writing process, per se, beyond outlining. For some of us, the translation from an outline (however complete) to a finished post is far from a single-step process. And for even more of us, the process of creating an workable outline would eat up the time willing to commit to a post in the first place.

We all blog for different reasons and have different expectations for ourselves. Some might be trying to achieve blogging "excellence" and recognition for its own reward. Some are more inclined towards an online journal and community. The latter is a reason the "microblogging" phenomenon via Twitter, etc. has been so explosive. In the end, I think era of the monolithic blog posts and "big ideas" from individuals will continue to diminish from individual blogs to corporate, monetizable collectives leaving personal sites personal. That's just my take on where I see things going. Both are necessary and enrich the medblogosphere in the their own way.

[Nick]

Thanks for creating this blog and keeping it so interesting and informative.