Wednesday, July 27, 2011

How to get started with Twitter (QUICKLY)

I've outlined 10 quick steps to getting started, in video and text. Play the video while looking at the text?

1. Sign in at
    *Your username will become your identifying "handle." I recommend going professional. I'm @astupple.

2. Click the drop-down at the upper right, choose "settings," and attend to "tweet privacy."
    *Before you share content, decide if you want it public.

3. Click "profile" and upload a picture.
    *Better to use a photo of your cat than nothing- otherwise people will think you're a spammer.

4. From the homepage, click "who to follow" and enter "@astupple," "@westr," and "@kentbottles."
    *You can sample our "feeds" by clicking on the links.

5. "Twitter clients" are programs, apps, and extensions that interface with twitter better than the website.
    *I recommend the web browser extension "chromed bird" for google chrome. Fast. So fast and easy.
    *Others love "tweetdeck" and "hootsuite" as desktop programs to use instead of the twitter website.
    *For your phone, I like the "echofon" app, but tweetdeck and hootsuite apps are great too.
6. Know this: Only those who follow you will see your tweets EXCEPT...
    *If you include a handle, @JohnDoe, in the tweet, then John Doe will see it even if he doesn't follow you.
    *If you include a hashtag, #thebeatles, then anyone following or searching #thebeatles can see it.
    *If someone searches your for terms that you used in your tweet, they MIGHT see it.

7. Q few quick terms:
    *Tweet- Any time you send a message via twitter.
    *Retweet- You resend a message that someone else tweeted, the originator notices (and appreciates it)
    *Reply- A tweet that starts with someone's handle, it's viewable by your followers who follow that person.
    *Direct Message (DM's)- Private message someone by entering "d astupple Blah blah blah..."

8. When including links, shorten them with services like or
    *The twitter clients usually do this automatically, you'll get a sense of how to condense links quickly.

9. If you want to see crazy, sign in to Sundays at 9PM and enter "HCSM."
    *I dare you. (It's the H.ealth C.are S.ocial M.edia weekly tweetchat and it's FUN.)

10. Finally, I'd follow @tweetsmarter to get LOTS of great tips on Twitter use and everything else.
    *The Twitter Guidebook answers questions like "What is a hashtag?" and others far better than me.

Happy tweeting!

Tuesday, July 26, 2011

Twitter is a vastly rich medium that's worth your time.

It's 10 minutes, and it's all been said before, but I hope this video is worth your time.

Summarized below are three reasons (among many more) to give Twitter a shot.

1. Taking
You don't have to give in order to receive. By following people without ever delivering a keystroke, you can quickly consume information that is relevant to your interests. Like surgery? Follow Atul Gawnde (@Atul_Gawande). Curious about the latest in neurology? Check out @NeurologyNow. Interested in healthcare policy? Follow @GarySchwitzer. Thirst for everything? @KevinMD and @KentBottles.

2. Giving
If you want to create content, there are gradations of involvement. You can innocuously resend what you thought was interesting (called retweeting), or post websites that interest you, along with short descriptors. More boldly, you can share experiences, make statements and judgements, or use Twitter to broadcast your own creations (warning- you might find yourself creating a blog and posting videos about how awesome you think it all is). See how medical student Allison Greco unifies blog and Twitter at and on Twitter as @GrecoA3, or gastroenterologist Bryan Vartabedian at, @Doctor_V.

3. Networking
While conventional circumstances narrow who we get to know in this world, Twitter offers a great way to connect with people we don't know but who otherwise share our interests, our quirky insights, idiosyncratic hangups, or outrageous perspective. If nothing else, consider establishing a Twitter account before attending your next conference, whereby you'll more easily meet attendees with your motivation. And, it's not just for connecting with those across the country, but also for meeting local people and maintaining relationships you've already started. I know @Peds_ID_doc pretty well, and gain much clinical insight, considering I'm rarely physically in his presence on the floors.

Caution: Don't say anything that would would bother you were it printed in the newspaper. Envision each tweet on a billboard outside your hospital. In the digital world, it's hard to know where the walls are that enclose your statements, and depending on your personality, it's easy to lose yourself, or to outright forget yourself, and say something boneheaded (or worse).

Monday, July 25, 2011

Aphorisms and The Black Swan and Twitter

The most compelling aspect of Nicholas Nassim Taleb's book The Black Swan was his dissection of the narrative fallacy. We continually concoct explanatory stories to comfort ourselves in the face of an irreducibly complex world. Crucially, stories compel not only by their truth, but by their very nature as stories. (Taleb cites those fantastic split-brain experiments where intelligent patients, faced with their own obviously contradictory behavior, will fabricate wild explanations without hesitation or doubt.)

However, stories often fail (even the best inevitably fail at the hands of unpredictable, rare, black swan events), and we rewrite our stories and hang on until they fail again.

But these stories do have kernels of insight and nuggets of experiential wisdom. How do we pluck out the insight?

Enter the aphorism, short statements that focus on the insight and dispense with the time-consuming and misleading narrative. Nietzsche authored many of my favorites:

"A casual stroll through the lunatic asylum shows that faith does not prove anything."

"Admiration for a quality or an art can be so strong that it deters us from striving to possess it."

Are Twitter, status updates, and the sound bites of social media digital aphorisms, dispensing with the narrative and going straight for the insight?

Saturday, July 16, 2011

The Race Is On: To the victor go the spoils (of 21st century medicine)

In the past, the medical profession was aware of groundbreaking technologies and applications well in advance of patients. Their first experience with EKG’s and genetic testing was mediated by their doctor from the beginning. Today however, patients can get their hands on mountains of genetic data through the mail at the price of a fancy meal. As these tools are made ever cheaper and more sophisticated, as inexpensive and inobtrusive devices are networked with smartphones and mobile health apps, and as patients increasingly adopt these tools in an effort to define themselves as empowered members of the doctor-patient relationship, the traditional medical world will be trying to catch-up. Today’s doctors will have to learn how to adopt these advances into their practice on their own, and it’s hard to think of a better time to start than now. The challenge of a patient armed with a dossier of Google searches pales in comparison to an empowered patient who has the motivation and time to enlist several features of 21st century medicine: direct-to-consumer genomics, mobile health apps, personalized medicine, social media tools, personalized health records, and more.

While the current medical education curriculum still labors under an educationally conservative structure, medical students might paradoxically see great opportunity. Today’s medical students are largely digital natives who, importantly, have not been shaped by what has been described as a bygone era of medicine. They are uniquely suited to learning about these breakthroughs, experimenting with the devices and tools, and innovating their application. In the teaching hospital, the medical student can familiarize his or her superiors with the tools while gaining insight into effective uses. Thereafter, medical graduates so informed would be highly sought after to shape the clinical and commercial future of these initiatives. There is a wealth of opportunities for the student who buys a BodyMedia armband and talks about it with clinical faculty while on the wards, or, by comparing their experiences interviewing patients in the clinic with the dialog at, becomes proficient at distinguishing what patients want to know from what is helpful to know. Precisely because medical schools struggle to incorporate this material into a curriculum means that students who take the initiative to become proficient in 21st century medicine stand to be particularly valuable to many stakeholders in the healthcare field.

Wednesday, July 13, 2011

Why the FitBit is FanTastic.


Being healthier means a lot of different things, but one commonality to almost any health improvement is that, at some point, it will be hurt a little to run a mile, forego an ice cream, or down some cabbage. And that's why the FitBit is the best health tracking tool there is:

It's painless.

You put this tiny clip on your person and then forget it's there. It can go a week between charges, all the while recording your steps and calculating your total calories burned. And when you're within 15 feet of your computer, it uploads your data wirelessly (provided the hub is attached by USB). And. That's. It.

Even the fee schedule for the fitbit is painless. The device costs $100, and the basic web analytics are free--if you want, you can upgrade to more web features for a fee. Again, painless.* I've been using it for 7 months and haven't had a day go unmeasured.

This is a point too easily lost: people don't necessarily want more features, they want less pain. (David Pogue engagingly demonstrates this truth here.) The makers of health apps and health games and tracking tools and health devices need to understand that most people want less tasks to do, and less to think about, rather than more. (See my post about apportioning our cognitive resources.)

Bells and whistles often become work, and living healthy is already a full time job.

*Compare FitBit to the BodyMedia armband. It's accuracy is unparalleled, and it's able to measure your calories burned even while watching TV and sleeping. The web profile is flashy, and there's a great smartphone app that enables you to watch your data in real time. And... it's a little painful. 

The armband is bulky (how do you wear it at work?), you have to take it off and physically plug it into your computer every day, and there's an unavoidable monthly fee. It's painful.

Note: I have no affiliation with FitBit and no axe to grind with BodyMedia. 

Dirk Nowitzki gave me mad props today, and it was awesome.

My Nike+GPS app had a message for me at the end of my run today, and it was from Dirk Nowitzki: "Hey, this is Dirk Nowitzki, and I just wanted to give you mad props for making it out there today."

I couldn't be much more of a cynic, and I HATE patronizing flattery, and what could be more baldly obvious than that a corporate behemoth was shamelessly using a celebrity to make me feel good about buying and using its products? By all rights, I should be sick.

But if I don't get bummed some canned words of encouragement at the end of a run, I'm a little bummed.

The tiny fraction I know about Dirk NowitzkiI is that he's well regarded as a dedicated player and a stand-up guy. When I imagine Mr. Nowitzki sitting in a sound booth somewhere recording his stock accolades, I'm pretty sure he is, in no small degree, genuinely happy for me. I bet he's happy to be encouraging legions of minor athletes out there, and genuinely wants us to keep at it. And it works.

Imagine if it was stock commentary from my doctor?

Sunday, July 10, 2011

Getting Played: 3 design thoughts for improving buy-in for mobile health apps.

Just because it's a game doesn't mean it's fun.* With angry birds, you simply fire up the app and start poking at the screen, but in health games you have to do something you'd rather not- eat a vegetable or run a mile or climb some stairs. To overcome this....

It would be simple.
In any game, there's a gap between input of time, energy, and focus, and the output of points earned, leveling up, or saving the princess. While some games thrive on a wide gap that's filled with a rich story line, engaging graphics, or intricate maneuvers, my health app would have a strict minimum of futzing around. This is because, by the time I reach for the health app icon, I've already crossed much of my gap, and I'm ready for my reward. Now.

It would be social.
Yes, social is all the rage, and rightly so. A less obvious feature of the value of social is that it enables healthy people to encourage close friends and family to be healthy, without precipitating an intervention. Motivating loved ones to eat better and exercise is tricky if you don't want to bring anxiety, guilt, and tension into a relationship. A social game is a perfect way for healthy people to casually encourage others, as well to stay motivated themselves.

It would include your doctor.
A family doc I worked with had some success with his own personal diet brochure. It was especially successful because he had personally lost much weight with it. What if he could point patients to a social game app that he himself played too? Consider the ramifications: The doctor's advice about eating better and exercising doesn't end at the office door. The app is good branding for the physician's practice. Buy-in soars because the virtual presence of patients' doctor connects healthy lifestyle choices with significant disease. Hospitals can adopt it as well, and there are lots of hospitals with lots of money. Local businesses can support it too by advertising their healthy offerings of food, gyms, or exercise equipment. I dare say this is only scratching the surface....

*Check out Jane McGonigal's TEDTalk on solving problems, including obesity, with games.

Wednesday, July 6, 2011

On Surgery, etc.: Revenge of the Nerds

I laughed out loud. Several times. This is, objectively, really funny. About why docs are slow to social media.

On Surgery, etc.: Revenge of the Nerds

Monday, July 4, 2011

A Phalanx of Mobile Apps: Just What the Doctor Ordered

                                                                                                                     "The Cavalry Charge" -Frederick Remington 

"Civilization advances by extending the number of important operations which we can perform without thinking about them. Operations of thought are like cavalry charges in a battle — they are strictly limited in number, they require fresh horses, and must only be made at decisive moments." - Alfred North Whitehead An Introduction to Mathematics

There's a simple reason the phrase "there's an app for that" has become so trite so quickly: it's a useful expression. But I think the utility of the expression, beyond Apple's branding brilliance, comes from a deeper place: it's primal. 

Using an app in place of a thoughtful operation is, to borrow Whitehead's phrase, like mounting a cavalry charge, but without having to refresh the neural horses. 

Since our brains are finite, capable of only so many cavalry charges a day, progress is two-pronged. It both increases the number of cavalry charges, and continuously promotes the brain to the vanguard. The more apps come along, the more operations are completed, and the more the brain is liberated from mundane operations and promoted to the forefront of what really counts in our day. Crucially, I don't see apps as dumbing us down, but rather, as smartening us up to perform previously unreachable operations of thought.

Today, when I'm faced with the need to operate thought, a little voice asks if "there's an app for that"? It's really not a modern question, but a primitive reflex rustling about in the wisdom of Whitehead's statement. Humans have always sought tools to solve problems that buy us more time to solve more problems (that buy us more time to solve more problems, รก la Ray Kurzweil). We corralled herds of mammoth off cliffs to save the time and effort of hunting them one-by-one. There's no real difference when we use the Chipotle app to save the time and effort of waiting in line. 

Much has been made of the impact of apps on healthcare (See Kent Bottles's post for a trove of examples). But I believe the biggest impact has yet to be richly explored, and that is the  the quantified self movement. 

Briefly: consider that monitoring the effects of our behavior clearly benefits our health (See Thomas Goetz's The Decision Tree blog for examples). The trouble is, we behave all day long, and continuously monitoring our the effects of our behavior would use up a lot of cavalry charges. Given that chronic disease is the costliest aspect of healthcare, and that lifestyle choices such as diet, exercise, and smoking are key contributors to such chronic conditions as congestive heart failure, diabetes, and chronic obstructive pulmonary disease, then a phalanx of mobile apps might be just what the doctor ordered.