Introduction

A blog or weblog (derived from web+log) is a web based publication consisting primarily of periodic articles (normally, but not always, in reverse chronological order). By definition: it is a chronologically organized website updated by an individual (or a group of individuals) with entries/posts. Each entry typically contains the main body, a date/time stamp, and title. The contents of each blog differ, depending on the interests and style of the author.

Background

Historically, the term ‘‘weblog’‘ may have been coined by Jorn Barger (http://en.wikipedia.org/wiki/Jorn_Barger) in December 1997. The shorter version, ‘‘blog,’‘ was coined by Peter Merholz, who, in April or May of 1999, broke the word weblog into the phrase ‘‘we blog’‘ in the sidebar of his weblog. This was interpreted as a short form of the noun and also as a verb to blog, meaning ‘‘to edit one’s weblog or a post to one’s weblog.’‘ As of March 2003, the Oxford English Dictionary included the terms weblog, weblogging, and weblogger in their dictionary. Although the foundations of today’s blogs were being laid since the inception of the web, most of the people who were creating blogs at that time were tech savvy-people. They were primarily computer programmers and web designers; people who had knowledge of how the Internet worked and were conversant with HTML. Outside their jobs they would create their blogs, participating in these small communities with fellow ‘‘techies.’‘ Because of the skills and understanding required to create blogs, they were not nearly as widespread as they are today.

It was not until software like Blogger came along in 1999 that blogging was really brought to the masses. Because of Blogger it was no longer necessary to understand the technical side of web publishing; now anyone with an Internet connection could publish a blog. Enter the era of push button publishing; anyone with a connection to the Internet who can understand basics of personal computing could publish their own blog. Software like Blogger, Type Pad, and others helped blogs grow exponentially. Finally in 2003, Google’s purchase of Prya Labs, the company that created the Blogger software, brought even more attention to the world of Blogging.

Difference Between Weblogs And Websites

Before pointing out the differences, let’s begin by mentioning the 3 things that blogs and websites have in common: (1) both are ways to publish information and other data online, (2) both can be started and kept by any individual who is inclined to do so, and (3) both have URLs that anyone with an Internet connection can access. However, the similarities end there.

The main difference between the 2 is that blogs tend to be a lot more dynamic than websites. Blogs are updated on a regular basis with posts or entries that usually contain date/time stamps. Websites, on the other hand, are designed to be static. So, there is no need to update regularly and/or to add the date/time of update. Also, websites are updated with pages rather than posts or entries. Various blog hosts that make online publishing easy. Once setup, one just needs to write an entry (and/or post an image), click on a button (like ‘‘publish this entry’‘) and the blog will be updated. Knowledge of HTML and FTP is not required. Another point of difference is the development of communities. Although websites may maintain community- based tools like message boards and guestbooks, blogs encourage community building much more than websites, allowing others to make comments, tag entries of interest, and other features.

Different Weblog Software And Systems

Some of the most common questions asked by individuals contemplating a weblog are: How do you choose the right platform? Where is the best place to blog?

Blogging platforms are best categorized as follows:

• hosted weblog providers;

• stand-alone weblog software; and

• remote weblog systems.

Concept Of Healthcare Blogging

Blogging software has enabled people with limited knowledge of the Internet to publish their thoughts online and participate in a global conversation. Medical field or healthcare is also not immune to this global phenomenon. As of now there are only a few hundred physician blogs, but the number is growing. An aggregator of medical weblogs, www.medlogs.com lists a few popular medical blogs, include ‘‘CodeBlueBlog,’‘ ‘‘SoloDoc,’‘ ‘‘Trust Me, I’m a Doctor,’‘ and ‘‘Grunt Doc.’‘ Medical blogs generally fall into 2 categories. One type is written by a healthcare professional (such as a physician) about his or her life experiences or other personal thoughts. A more recent but unique trend is the blog that deals with actual patient cases. This latter blog allows other physicians to submit cases to the blog. Physicians can then offer comments or help with the case. Although not yet tested, this format could theoretically improve patient care by allowing the primary doctor to get feedback by other experts in the field. In the words of a physician blogger (From Bloggercon III Medblogger Session Transcription http:// www.enochchoi.com/thoughts/archives/001237.html) ‘‘We have a passion to share our story, we’re writing to express something that people will identify with and be able to take to heart, a way to leverage our knowledge and share, a way to help other physicians or patients to derive value. Do one Teach one, as in academic medicine, a culture of sharing and teaching. You can write from your own experience to share your own experience as a patient, referring specifically about the physicians and nurses by name, giving feedback to the bloggersphere about those providers, building a database of knowledge about them that can facilitate change.’‘

According to Kevin of http://www.kevinmd.com healthblogs essentially boil down into several basic forms. On one end, there is “link-blogging”, where the blog simply links to interesting reading. Examples are his own blog, as well as instapundit (http://www.instapundit.com) , fark.com (http://www.fark.com), and kottke.org http://www.kottke.org). On the other extreme, there are blogs with long, thoughtful entries expressing analysis, creative writing, or stories. Respectful insolence (http://scienceblogs.com/insolence), intueri (http://intueri.org), and health care renewal fall into this category. There are also hybrid blogs that combine link-blogging with more lengthy entries, such as freaknomics (http://freaknomics.blogs.nytimes.com) and the blog at medpage today (http://medpagetoday/blogs )

My Experience With Health Blogging

A blog (http://www.sumerdoc.blogspot.com/; or http://www.indianradiology.com/) was used to post interesting cases from routine practice along with any interesting abstracts from day-to-day work (Fig. 1).

Figure 1

Fig-1) Author’s Blog

Sometimes, to interest readers, a few cases were put up as image quizzes and have seen a tremendous response. As a physician, blogging created an opportunity to share my experiences with colleagues, medical students, and patients. For a radiologist in particular, as radiology is an image-based science, a blog is a satisfying endeavor in that you can share your experiences and interesting cases with others instantaneously instead of going through the complex and time-consuming process of getting them published in a journal. Agreed it cannot and will not ever replace the peer reviewed journals but definitely gives one an outlet for interesting cases. In a sense, blogs function like peer-review journals do in the academic world, but there’s a key difference. The distribution of articles in academic journals is largely controlled by a publishing cartel that charges exorbitant amounts for subscriptions, which are subsidized by the institutions that can afford them. Think of blogging as a socialist model for information exchange.

Blogs can be tailored for patients (www.radiologyinformation.blogspot.com). This site is to inform patients about their diagnostic procedures. In this effort, I used the following free web sites: http://www.blogger.com/ (for building the blog), http://www.hello.com/ (for posting images), and www.photobucket.com (for uploading images). The success of this project can be measured by the fact that in the last full year of ‘‘rad-blogging,’‘ more than 3lakh visitors came to the site from all over the world, with thousands of queries from patients, colleagues, and many interested students.

Gains out of this project are multiple. First and foremost as the readers on the blog were from a diverse background it created an awareness about the subject among nonradiologists. An unexpected group of regular readers turned out to be medical students, who were preparing for various examinations and used the blog to find answers to their examination queries. A long standing outcome of this endeavor may be popularizing the subject among medical student and increasing awareness about the subject among nonradiologists. This blog is regularly updated, the usual frequency of blogging being thrice a week. This is the main difference between a website and a blog. Updating promotes a more regular readership as compared with websites. Future thoughts for progression of this blog are creation of a ‘‘Radiology Book Review’‘ section. This section would review radiology books on various modalities and would include a combination of both popular books and new books so that readers are kept updated about radiology books. Another thought for expanding the blog is a section on ‘‘Radiology-gadgets’‘—giving information to the readers from various manufacturing companies.

Issues, Controversies, Problems

Although patients frequently share personal details on the Web through support sites such as www.breastcancer.org or through diaries chronicling their own battle with illness, this is usually in the spirit of shared experiences rather than true patient consultation. Such generic advice offered on general medical Web sites is relatively protected from legal challenges; however, advice given on a named physician’s or practice’s Web site or blog would be much more liable to constitute a duty of care, particularly in response to a patient’s specific query. Also, there is a very real risk of other users posting their ‘‘advice’‘ on a physician’s blog, which the unsuspecting or ‘‘net-naıve’‘ patient may read as the physicians advice. Unsavory comments or dangerous advice placed by unwelcome visitors may appear uncensored on the blog, for which the physician is personally responsible. Even though the sites created at blogger.com permit the ‘‘owner’‘ of the site to edit and delete such unsavory or dangerous comments, the comments in question remain as blogger’s property until deleted. Blogging may well become the default means by which unofficial communications take place on the Internet. Blogs of this nature can be positive sources of information for patient, teacher, and student and may become “an easy method of information exchange and opinion building” in at least this one field. However, there remains the substantial concern among the medical community regarding the quality of many blogs, which may discredit them as a worthwhile source of information for many medical professionals and students. Harty-Golder also points out that regardless of quality, HIPAA privacy regulations may limit the usefulness of a blog by restricting what type of information can be presented in the blog and how much detail about a particular case may be revealed. Fears of lawsuits may prevent blogging from catching on in the medical field to the degree it has caught on in other fields. Blogs may replace newsletters and newspapers in years to come, but this reflects the content of those publications (ie, reportage framed and intermingled with subjective opinion). Such ‘‘reporting’‘ can never replace objective peer review in the sphere of science.

Future Direction

Micro-blogging is the new buzz word and is defined in Wikipedia as “a form of blogging that allows users to write brief text updates (usually 140 characters) and publish them, either to be viewed by anyone or by a restricted group which can be chosen by the user. These messages can be submitted by a variety of means, including text messaging, instant messaging, email, MP3 or the Web”. Micro-blogging allows writing brief text updates on the go, and sharing them with friends and interested observers. Popular examples of micro-blogging services include Twitter (http://twitter.com/), Tumblr (http://www.tumblr.com/) and Jaiku (http://jaiku.com/). The status feature of social-networking services such as Facebook (http://www.facebook.com/) provides another example of micro-blogging. The content of a micro-blog differs from a traditional blog due in that it is typically more topical, smaller in file size (e.g. text, audio or video).

Conclusion

This new tool of blogging enables sharing knowledge simply and fast. There are various packages available mostly free or at a low cost to individual users. Templates offer simple customization of the design without knowing HTML or requiring any other programming skills. This is particularly useful in medicine and the blog format provides a unique and powerful opportunity to bring medicine, “behind-the-scenes”, to light. Web 2.0 is not about big publishing houses or static information websites it's a dynamic, interactive and pulsating system wherein ordinary people like you and me can convey things and get responses. It is remarkably easy to begin today. You can edit, contribute and work on any article you'd like at wikipedia or blogs instantly. No software to learn or download, and there's no requirements for membership to become an editor. This is only a beginning of democratization of knowledge in the field of radiology and healthcare in general and surely the future looks exciting.

To put it in one line, Blogs are by the people, and for the people. The true democracy in medicine lies in web 2.0 tools such as blogs.

Additional Reading Section

• Alavi, Nasrin. We Are Iran: The Persian Blogs, Soft Skull Press, New York, 2005. ISBN 1-933368-05-5.

• Blood, Rebecca. “Weblogs: A History and Perspective” “Rebecca's Pocket”.

• Bruns, Axel, and Joanne Jacobs, eds. Uses of Blogs, Peter Lang, New York, 2006. ISBN 0-8204-8124-6.

• Kline, David; Burstein, Dan. Blog!: How the Newest Media Revolution is Changing Politics, Business, and Culture, Squibnocket Partners, L.L.C., 2005. ISBN 1-59315-141-1.

• Michael Gorman. “Revenge of the Blog People!”. Library Journal.

• Ringmar, Erik. A Blogger's Manifesto: Free Speech and Censorship in the Age of the Internet (London: Anthem Press, 2007).

Key Terms & Definitions

Blog/weblog- it is a chronologically organized website updated by an individual (or a group of individuals) with entries/posts.

Web 2.0- web or internet information which is created by the users themselves.

Microblogging- a form of blogging that allows users to write brief text updates (usually 140 characters)

Wiki- wiki is a page or collection of Web pages designed to enable anyone who accesses it to contribute or modify content, using a simplified markup language