Getting Naked on the Internet: What does the law say?

Telemedicine and Cyber Security

The Health Information Portability and Accountability Act (HIPAA) is a federal law that protects the privacy of your personal health information (PHI). HIPAA includes several rules and provisions that set guidelines and requirements for the administration and enforcement of HIPAA. The relevant ones for the exchange of PHI in the digital cyberspace are the Privacy Rule1, the Security Rule2, and the aptly named Health Information Technology for Economic and Clinical Health (HITECH) Act3.

Telemedicine is a burgeoning field of medicine that incorporates digital technology such as electronic health records (EHR), information sharing, and videoconferencing to enhance the interaction between physicians and their patients, and ultimately, improve the delivery of healthcare. Having been a plastic surgeon for several years now, I’m all too familiar with meeting people at social events, and immediately getting bombarded with intrusive and unusual questions and requests as soon as my chosen profession is ousted. Sure, it’s unlikely that a woman will disrobe and expose herself in front of me and my wife at a friend’s dinner party, but get us into an online “private” videoconference call, and who knows what body parts will make an abrupt entrance into the conversation. Physicians must approach with caution, says American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) President Stephen S. Park, M.D. in a recent article4. But, for me and most physicians I know, I feel like the cat is already out of the bag. Considering the amount of texts, emails, online chats, phone conversations over internet and satellite lines, and selfies of both pre- and post-op patients I’ve been privy to, I’m sure I’ve already broken too many laws, and completely disregarded the good doctor’s advice. The truth is, though, that we’ve only begun to scratch the surface.

Telemedicine may involve the electronic exchange of PHI which is protected under HIPAA law. Security considerations with telemedicine involve making sure unauthorized third parties cannot eavesdrop on or record a videoconferencing session where sensitive PHI is transmitted seamlessly, and unfortunately, innocently. Recently, a monumental data breach at one of the nation’s largest insurance providers has spurred a bipartisan political effort to reexamine HIPAA as it relates to telemedicine, possibly adding costly and cumbersome requirements to encrypt EHR data5. Additionally, a recent report done by BitSight Technologies, a cyber security risk analysis and management firm, found that healthcare and pharmaceutical companies ranked the lowest among the four industry categories studied6. Suffice it to say, people are taking heed of this emerging new threat.

The aforementioned laws, rules, and regulations guide the generation, maintenance, and implementation of telemedicine HIPAA compliance. We must be cautioned, though, that HIPAA compliance does not necessarily equate to actual cyber security, and that simply meeting standards set forth in these regulations may not be enough. As more public attention and scrutiny rise to the forefront of media exposure, look for the healthcare industry to take the cyber security threat much more seriously.

Daniel Kaufman, MD
Discreet Plastic Surgery

Bibliography
1. http://www.hhs.gov/ocr/privacy/hipaa/administrative/privacyrule/
2. http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/
3. http://www.healthit.gov/policy-researchers-implementers/health-it-legislation-and-regulations
4. http://cosmeticsurgerytimes.modernmedicine.com/cosmetic-surgery-times/news/cosmetic-virtual-consult
5. http://medicaleconomics.modernmedicine.com/medical-economics/news/senate-review-hipaa-security-medical-records-light-anthem-breach
6. http://info.bitsighttech.com/bitsight-insights-industry-security-ratings-vol-4-rc

Protecting Your Medical Spas (And Your Own) Reputation Online

Medical Spa MD has been threatened with lawsuits on more than one occasion for something that someone posted in the forums.

If you're running a laser clinic or medical spa you'll have some unhappy patients from time to time as well.. and very soon every one of your patients will have a Facebook page, Twitter stream, or personal blog that provides a public platform for them to voice their displeasure.

In fact, more than 85% of your potential clients who are looking for a medical spa or elective plastic surgery proceedure are doing research online. And it's not just kids. People between 35 and 60 are the fastest growing group online. If you're not the most prominant voice, you're loosing patients, revenue, and reputation.

There have been a number of medical spas and physicians who have literally gone out of business because they were unable to manage their reputation online when it was attacked. (Look at American Laser Clinics reputation.) Trying to 'fix it' with underhand tactics can make it worse.

And there's nothing you can do about it.

Here's a story on CNN about a student who created a Facbook page about a teacher:

A former Florida high school student who was suspended by her principal after she set up a Facebook page to criticize her teacher is protected constitutionally under the First Amendment, a federal magistrate ruled.

U.S. Magistrate Barry Garber's ruling, in a case viewed as important by Internet watchers, denied the principal's motion to dismiss the case and allows a lawsuit by the student to move forward.

"We have constitutional values that will always need to be redefined due to changes in technology and society," said Ryan Calo, an attorney with Stanford Law School's Center for Internet and Society.

"The fact that students communicate on a semi-public platform creates new constitutional issues and the courts are sorting them out," Calo said.

Katherine Evans, now 19 and attending college, was suspended in 2007 from Pembroke Pines Charter High School after she used her home computer to create a Facebook page titled, "Ms. Sarah Phelps is the worst teacher I've ever met."

In his order, Garber found that the student had a constitutional right to express her views on the social networking site.

"Evans' speech falls under the wide umbrella of protected speech," he wrote. "It was an opinion of a student about a teacher, that was published off-campus ... was not lewd, vulgar, threatening, or advocating illegal or dangerous behavior."

Matthew Bavaro, an attorney with the American Civil Liberties Union who is representing Evans, was pleased with the ruling.

"The First Amendment provides protection for free speech regardless of the forum, being the Internet, the living room or a restaurant," he told CNN.

So, while there's nothing you can do to prevent an unhappy patient from broadcasting their displeasure, there is a way to keep that unhappyness from being the first thing that comes up when someone searches on your name or the name of your medical spa or clinic. That's to be the dominant 'voice' that's heard when someone is looking for information about you, your practice, or your services.

So what can you do to protect your personal and medical reputation?

In effect, you need to have a bigger microphone. That means that means that you're going to need to do some heavy lifting online to make absolutely sure that when someone is searching for information on your medical spa, dermatology practice, or plastic surgery clinic, the information that they find is about your practice, not negative comments from disgruntled patients.

And since this is such a problem for every medical practice and physician, we've been looking to help address this need. We're about to launch two new Medical Spa MD Select Partners to help.

The first, Freelance MD, is a creative agency specializing in marketing and advertising outsource services for medical spas and plastic surgeons. The second will be announced later this week.

Freelance MD will be hosing a free webinar on social media marketing this week. (You can see details and register in the previous post.)  If you're not an expert at using search engine marketing, social media, special events and local PR, you'll want to sign up and learn how it's done.

Realself.com

Tom Seery of realself.com and I had a fairly long discussion a few days ago about both Realself.com and Medical Spa MD's approaches to the marketplace and strategic directions.

Of course one of the topics we touched on was realself.com's decision to remove all physicians from the site that were not board certified plastic surgeons or dermatologists.

Tom didn't get into much detail on this point other than to say it was a long story and that keeping only board ceritified plastic surgeons and derms was the decison they'd made, and they're going to stick to it.

While I don't really have a decision staked out on this I made the point that physicians get good at what the do a lot of. If I were a Botox patient I'd much rather have a non-core doc with a lot of experience shoot me up than a fantastic plastic surgeon who almost never does it. (Truth be told, I can't see the flaw in that logic.)

I can understand realself.com's decision on a purely business decision. Realself.com's looking for some level of credentials to make sure that the laymen who are the real target market of the site are getting at least some level of 'trained' physician.

Realself.com is great for patients who are researching treatments. The consumer-centric focus differs from our physician-centric community but there's some small overlap.

One of the thoughts I opined to Tom was that I could see it would be challenging for new physicians who were just coming on to the site to be motivated to contribute with the way their ranking system works. If you're answering a lot of questions you get greater visibility and promotion internally on the site. While it stimulates some docs to write a lot of answers, it's hard to see how any new physicians could come up with the number of answers to gain some placement. Tom says they're going to launch some new initiatives that will 'promote' new physicians. (This might anger some docs who have spent endless hours writing answer about Botox or liposuction.)

Anyone here have an opinion about realself.com?

Ageless Elane: Markeing your medical spa blog.

Ageless Remedies Medical Skincare & Apothecary has started a blog called Ageless Elane.

'Elane' has left a few comments on Medical Spa MD and she's added a back-link to her blog. That's exactly the right way to begin to build your profile and help your local patients find you on the web.

I'd suggest that Elane enable comments on the blog though. While it's very common to be concerned about unhappy patients ruining your site, spam and flaming is something you have control over and it's much better to have interaction with your patients that your perspective patients can see.

If you're adding carefully thought out comments that add real value, please go ahead and link back to your site if you'd like. While we're a 'spam magnet' and have to constantly remove thousands of spam comments, we're happy to help our Members with a little 'Google Juice'.

Better yet, submit a guest post on Medical Spa MD and realize the good karma and good life that comes along with helping other Medspa MD Members... and the tens of thousands of patients who visit this blog every month.

NY Times & Medical Spa MD

There's an interesting article in the Times about housing listings in manhattan that are being commented on. There's a direct correlation between that story and Medical Spa MD's community commenting on laser clinics, med spas and laser treatments.

“What’s happening now is the numbers aren’t enough,” Ms. Doherty said, referring to the information published by StreetEasy. “People are asking questions they can’t ask their broker, and they’re really interested in the qualitative perspective, in getting opinions of people.”

There is certainly no shortage of opinions to be found online. Drawing on reams of publicly available data on sales prices, comparable listings, creditors’ liens and even mortgage amounts (in the case of condominiums), commenters debate what an apartment is worth and how much a seller might be desperate enough to accept. They also pinpoint flaws ranging from imminent construction of a garbage facility nearby to crimes of linoleum.

For their part, sellers and their brokers are seething over what they perceive as a lack of accountability, hidden or misanthropic motives, and the fact that defending one’s property — even correcting a factual error — can prolong or aggravate its turn under the collective microscope. Sellers also object to being typecast as Marie Antoinette in the French Revolution-style discourse.

That accusation is not exactly refuted by the commenters themselves.

“All of us who were renters have endured a fair amount of ridicule from owners for our caution,” said Michael Waxenberg, 46, an information technology director and renter who is shopping for a three-bedroom apartment on the Upper West Side. “There is an element of vindication in what’s happening now — maybe we were right in trying to play it safe.

Medical Spa MD has now been around for almost 4 years and has the largest community of nonsurgical cosmetic medical practitioners that I'm aware of. The laser companies have noticed and there are some that already interact on the site. There are others who monitor Medical Spa MD but are sitting on the fence since they don't want to put themselves in a situation where they become a target. Nasty comments on the web live forever.

The number of times that Medical Spa MD has been contacted by named individuals and laser companies with requests to edit or remove comments has grown considerably. (I have yet to hear from any laser company or individual that they feel that Medical Spa MD has not been fair with them.) There are growing pains with any community and Medical Spa MD has had it's share. In looking at how to best address companies and individuals legitimate concerns there are some potential changes we're looking at. I'm not interested in Medical Spa MD becomming an attack site for individuals with a grudge. (If I wanted that we wouldn't remove the comments we do.)

As Medical Spa MD moves forward we're adding increasing capabilites and functionaily, from the ability to buy Botox, Restylane and Perlane in bulk or with group purchasing power, to offering targeted SEO & SEM for your web site, to building out a companion site that targets potential patients for your cosmetic practice. All of these additions are scheduled to be up within the next 30 days.

That being said, Medical Spa MD should continue to grow as the most trusted cosmetic physician community on the web... even if there are some changes needed.

7 Ways To Engage Med Spa or Plastic Surgery Patients On Your Site.

First, if you're not blogging for your medical spa,  laser clinic or plastic surgery practice you're probably still using a rotary-dial telephone. Start.

Your patients are busy, and in order to gain and keep readership on your site you need to provide your existing and potential patients with information that makes their lives better, easier, and less stressful. Laser clinic or cosmetic surgery websites face the temptation of turning every post into a dry marketing appeal. It’s up to you as the physician or clinic owner to overcome that obstacle and provide your med spa patients information about your services in a quick and easily digestible way.

So the question is... How do you do that? Here are seven ways you can engage readers of your med spa or plastic surgery blog and keep them coming back.

1. Offer Real Medical Advice

You've got real medical experience, share it. (Yes, you do have to be careful so you don't get sued but post a clear disclaimer and be smart about your 'opinion'.) If you like Thermage or Fraxel, say it. The very best way to gain loyal readers is by sharing your knowledge and giving them practical information they can use to make decisions. You can give your readers an instant benefit by avoiding abstract ideas and providing specific tips, advice and tools they can use right away.

2. Talk to Your Existing Patients

You’re already ahead of the game with this one, because your existing plastic surgery or med spa patients already have a connection to you, otherwise they wouldn’t be reading your blog. Better yet, impressing them leads to greater word of mouth referral. Get to know them by keeping an eye on comments (allow comments on your blog and don't delete them unless they're way over the line), watching for trackbacks and listening to feedback in other forums. All of this input can be material you can use to make your posts resonate with your individual readers.

3. Share Personal Stories

Business is business and personal is personal, right? Not anymore. Today there is an increasing amount of overlap between the two, and people want to know a little more about the person behind the med spa, laser clinic or plastic surgery center, beyond a cv and medical marketing speak. So give a little of yourself to create a stronger relationship with your readers. Women (and our market is women) want to know that they can trust you. If all you ever post is your latest laser hair removal ad, you're just not as trustworthy as a the plastic surgeon who loves his kids and has a dog.

4. Go Non-Surgical Again

Throw in an occasional post that’s not exactly med spa or plastic surgery related. If it bombs, it bombs and you know to go a different route next time. But if it is successful, you can insert some comic relief, mindless banter and maybe even a personal story as listed above to give your patients a brief change of pace. Talk about how expensive Botox is. How Thermage charges for every tip you burn. How you worry about providing the best patient care.

5. Keep It Short and Sweet

You could probably write some very long posts when you’re discussing your latest business endeavor or what it took to build out your med spa or plastic surgery practice. If that much information is necessary, split it up into a multi-part series. Use lists, subheads and images to break up heavy content whenever possible.

6. Share The Conversation With Your Patients

Ask directed and specific questions at the end of your posts to encourage reader commentary. For every few posts where you provide advice, throw in a post that asks for the answer. Involving your readers will give them an opportunity to take an active role in your blog. Ask them if they'd like a membership as part of your offering. Talk about your patient referral perks. Ask who they think provides the best patient care. Ask if they can help your med spa provide better care...

7. Give Potential Patients What They Want

Carefully read the comments provided by your existing and potential patients. They are invaluable because they allow you to tailor your posts to the information your readers are asking you to provide. Acknowledge the comments, answer the questions, and address the requests and you’re on your way to building great relationships with your readers.

8. Bonus: Protect Your Med Spa or Plastic Surgery Practice

OK I said seven ways. Here's a bonus.

Of course I'm not a lawyer... (see how I carfully did that) but your medical opinions are your own. Keep a clearly defined page that states that the content of your site is not to be used as medical advice and shouldn't be acted on without consulting a physician. There are any number of medical blogs that write about specific cases with this kind of disclaimer in place.

If you've got a med spa, laser clinic or plastic surgery blog, how do you work it?

Older Plastic Surgery & Laser Clinic Patients Are Online

It's no longer the case that teens are the ones flooding Facebook and Twitter. (You can follow Medical Spa MD on both Medspa MD on Facebook and Medical Spa MDs Twitter feed.)

The chat below shows the details of the Baby Boomers rush to embrace social networks. In the last week at least three people have told me of a parent that has 'discoverd Facebook'. It's no longer the case that you can just have a web site and sit back to be found. The web is maturing and big business. The rush of Baby Boomers to embrace Facbook, Twitter and social networking in general is indicative of this move.

According to the study referenced below, Baby Boomers...

• Increased reading blogs and listening to podcasts by 67 percent year over year; nearly 80 times faster than Gen Y (1 percent)
• Posted a 59 percent increase in using social networking sites—more than 30 times faster than Gen Y (2 percent)
• Increased watching/posting videos on the Internet by 35 percent—while Gen Y usage decreased slightly (-2 percent)
• Accelerated playing video games on the go via mobile devices by 52 percent— 20 times faster than Gen Y (2 percent)
• Increased listening to music on an iPod or other portable music player by 49 percent—more than four times faster than Gen Y (12 percent)

Meanwhile, Gen Y...

• Participation slipped in virtual worlds from 23 percent to 19 percent
• Consumed no more video online than they did last year
• Clogged and contributed to wikis less (it's down from 35 to 33 percent)

Additional data from the latest Accenture report is summarized here from TWICE.

For medical spas, plastic surgeons and dermatologist, this represents a change in the way you'll need search engine marketing in order to get in front of your potential patient population. Yellow pages, newspaper... gone. Search, blogs, social networks allow you to harness technology and get it in front of your potential patinets; woment 35-60.

Antiaging

Anti-Aging Medicine: An Overview is a general article about anti-aging medicine that includes a bibliography.

Is human aging still mysterious enough to be left only to scientists? [unknown]

Scientific Legitimacy of the Term "Anti-Aging" is a letter to the editor of the Journal of Anti-Aging Medicine.

Ethics of Anti-Aging Medicine Questioned [by Professor David J. Demko, Phd]

Anti-Aging Case Study # 011102 is a typical case study of a well-executed and comprehensive anti-aging program.

Anti-Aging Nutrition Secrets [CNN.com]

Articles about Caloric Restriction with Adequate Nutrition (CRAN)

Calorie Restriction Eat Less, Eat Better, Live Longer [by Roy L. Walford, M.D.]

Deprenyl: A Universal Anti-Aging Strategy? [Smart Drug News]

Dietary Restriction and Aging in Rhesus Monkeys [Life Extension Magazine]

The Five Proven Secrets to Longevity - The first online Anti-Aging book from the American Academy of Anti-Aging Research. You are welcome to browse through the various synopses available.

Graying baby boomers fuel new 'anti-aging' market [Post-Gazette]

Hormone Replacement Therapy [by Elmer M. Cranton, M.D.]

Effects of human growth hormone in men over 60 years old [The New England Journal of Medicine]

Lifespan Project Launched [by Richard Weindruch and Stephen R. Spindler]

MIT researchers uncover new information about anti-ageing gene [MIT News]

News and Views from the library of the American Academy of Anti-Aging Research.

Anti-Aging Research Brief [American Academy of Anti-Aging Research]

Science Edges Closer to Fountain of Youth [Chicago Tribune]

The Serious Search for an Anti-Aging Pill [Scientific American Magazine]

Top Ten Life Extension Drugs [Life Extension Foundation]

Longevity Report has a host of articles.

From the excellent anti-aging blog of Cambridge biogerontologist Dr. Aubrey de Grey

Patient Gagging & Your Plastic Surgeon?

Medical Spa MD hosts anonymous comments. I made the decision to allow that after some careful thought when I first launched the site. (Of course, almost all comments on the web are anonymous.)

There are both benifits and drawbacks to anonynimity. With the number of cease and desist letters I've received I'm aware that not everyone is happy when they're pilloried in public by namless commenters. Here's a story from the AP on doctors who are asking patients to sign what amounts to a gag order befor they'll treat them.

The anonymous comment on the Web site RateMDs.com was unsparing: "Very unhelpful, arrogant," it said of a doctor. "Did not listen and cut me off, seemed much too happy to have power (and abuse it!) over suffering people." Such reviews are becoming more common as consumer ratings services like Zagat's and Angie's List expand beyond restaurants and plumbers to medical care, and some doctors are fighting back.

They're asking patients to agree to what amounts to a gag order that bars them from posting negative comments online.

"Consumers and patients are hungry for good information" about doctors, but Internet reviews provide just the opposite, contends Dr. Jeffrey Segal, a North Carolina neurosurgeon who has made a business of helping doctors monitor and prevent online criticism.

Some sites "are little more than tabloid journalism without much interest in constructively improving practices," and their sniping comments can unfairly ruin a doctor's reputation, Segal said.

Segal said such postings say nothing about what should really matter to patients — a doctor's medical skills — and privacy laws and medical ethics prevent leave doctors powerless to do anything it.

His company, Medical Justice, is based in Greensboro, N.C. For a fee, it provides doctors with a standardized waiver agreement. Patients who sign agree not to post online comments about the doctor, "his expertise and/or treatment."

"Published comments on Web pages, blogs and/or mass correspondence, however well intended, could severely damage physician's practice," according to suggested wording the company provides.

Segal's company advises doctors to have all patients sign the agreements. If a new patient refuses, the doctor might suggest finding another doctor. Segal said he knows of no cases where longtime patients have been turned away for not signing the waivers.

Doctors are notified when a negative rating appears on a Web site, and, if the author's name is known, physicians can use the signed waivers to get the sites to remove offending opinion.

RateMd's postings are anonymous, and the site's operators say they do not know their users' identities. The operators also won't remove negative comments.

Angie's List's operators know the identities of users and warn them when they register that the site will share names with doctors if asked.

Since Segal's company began offering its service two years ago, nearly 2,000 doctors have signed up. In several instances, he said, doctors have used signed waivers to get sites to remove negative comments.

John Swapceinski, co-founder of RateMDs.com, said that in recent months, six doctors have asked him to remove negative online comments based on patients' signed waivers. He has refused.

"They're basically forcing the patients to choose between health care and their First Amendment rights, and I really find that repulsive," Swapceinski said.

He said he's planning to post a "Wall of Shame" listing names of doctors who use patient waivers.

Read the entire article here

So... where to come down? The right to criticize and protect yourself, or additional protections for individuals who may be the recipient of negative comments.

Sona, Solana, Dermacare, medical spa frachises and consultants, RealSelf.com, Cutera, Thermage, Lumenis... these companies have taken some heavy hits around here from disgruntled docs. Would you want unhappy patient to have a high profile forum like this one that they could use to damage your reputation and business?

Why every physician should be blogging.

The  Independent Urologist has an excellent post on why you should be blogging as a doctor..

By blogging actively and transparently--in your own name--you can influence the dialogue that already exists and turn it in your own favor. Your blog should be compelling, honest, and well written, and if it meets those criteria, people will find it and link to it. The more posts, the more links, and the higher the google organic ranking. Plus, it's fun, and you'll make friends.

All of your posts should be linked to your own website, if you have one, and--this is key--you must blog in your own name and be proud of what you write.

This way, you can influence the conversation that takes place in cyberspace that is about you.

You really should blog or have your staff blog. If you don't know how, it's actually incredibly easy these days. I recommend the site that I use (Read my review of squarespace here.) It literally only takes about 3 minutes and you're ready to go. If you can use email or word, you can manage this system.

It's also good business. Linking your blog to that static site that you paid to have built might mean that someone can actually find out what you do and offer on the web. (I'm not kidding.) 80% of potential patients are using the internet to research major purchases. Blogging gives these potential patients an opportunity to find you and give you a point of contact and trust building.

Take a look at some of the physician blogs listed on the resource page. You really should be blogging. 

Med Spa Marketing with Google Alerts

Using Google Alerts to keep track of what is being said about you and your clinic or medspa on the net.

 
Want to know what people are saying about you and yours on the web? Use Google Alerts to set up notifications when bloggers write a post about the specific topic in question. This sends an automated email to your inbox every day or once a week as you choose.

If you're running a business then there are people mentioning you on the web in forums or blogs. Google alerts let you keep track of all this information in one place.

Alerts also have the benefit of allowing you to easily stay in touch with the latest posted information about Botox, Thermage, Sona Medspas, DermaDoc (wink) or whatever else you're interested in. I keep about 30 alerts and have them set to notify me weekly. (I find daily notifications unmanageable.)

The trick here is to specify very carefully exactly the information you're wanting to receive.  My alerts include keywords like: Jeff Barson, Medical Spas, Medspas, Medispas... You'll need to think slightly about possible wording if you're looking to get everything but Google will send you every reference that fits.

Review: Squarespace.com

You can find a list of other reviews I have completed and links to the products and resources I use to run my businesses in the Resources Section of this website.

Review: Squarespace.com - Dynamic web sites

Name: SquareSpace
URL: www.squarespace.com
Purpose: Dynamic web sites, blogs, content management for laymen. 

Let me start by saying that my personal experience to date with Squarespace has been 100% satisfactory. I have never had a complaint the system has always done what I wanted it to do. I’ve been blogging for the last four years and have switched all of my blogs from hosting systems like Wordpress or Blogger, and my static sites (I still have one) to squarespace.com.

Your web site is the most important part of your online presence. How it looks. How it acts. And more importantly, how easy it is to change, are of prime importance in making a decision on what kind of system to use.

What are your options?

 

Static Sites:

By far the most common choice are static sites. Of course it's not really by choice, they were simply the only available choice until recently. If you have a site, it's probably static, meaning that it's not easily updatable and you can't to it yourself unless your pretty technically inclined.

Pros: You already have one.
Cons: Hard to build. Expensive. Search engines hate them. No traffic.
Cost: Expensive to build and host.

Blogging Software:

Extremely uncommon for medical businesses in the current market. Wordpress , Blogger, Typepad... these were the first attempts at making dynamic sites that are easily updatable and they work as far as they go. Their somewhat technical and again you'll have to hire someone if you'd like to customize your site and offer more than a standard template. 

Pros: Relatively easy to set up. Inexpensive or free. Search engines love them if regularly updated.
Cons: Hard to customize. Limited function. Still need some tech savvy to implement.
Cost: Cheap. From little to free depending on configuration.

Dynamic Sites:

Squarespace.com is the next generation of content management systems that go far beyond what's previously been available. Squarespace has built a system that takes absolutely no knowledge of html, css, or other geek speak and it's built from the ground up for ease of use. If you can use Word, you can use squarespace.

Pros: Easiest to use and setup. Completely functional with advanced features like built in RSS feeds. You can try it for free.
Cons: None, if you don't mind the price tag.
Cost: About what a static site costs: From $7 to $25 a month.

The Bad.

I always like to get the bad news out of the way so here it is... I used to have here that I couldn't think of anything but I've since stumbled across some shortcomings. Here it is:

Squarespace is not open source so they don't have nearly as many members or or growth as Wordpress has. While it means that squarespace provides detailed support (which is excellent I might ad) it also means that they don't have nearly the footprint or developer time that Wordpress does. So, squarespace does not support at least one of the options that I would like to use on my blog. Text Link Ads uses server side scripts. Since squarespace is hosted, they don't allow you to install server side scripts and so I can't use one of methods I'd like to monetize my traffic. Text Link Ads doesn't offer a scripted solution yet so I'm SOL on this one.

I emailed Anthony about this and he responded that if they felt any platform gained enough of a foothold they would start supporting it. I would expect this negative to resolve itself and I certainly can't consider it as anything but a note but I thought I'd include it since I it is something I would like.

How I found Squarespace.

Back in 1999 I started to need web sites. So I learned how to write and code so I could build them the way I wanted.

As usual I conducted extensive due diligence before deciding to use squarespace. (As a guy the definition of horror is finding out later that there was a better choice I could have made.). I read forums and surfed around the web. I talked to my geek coder friends. I quickly came to realize that squarespace different from everything else available. It was clean, it was customizable, and most of all, it just worked perfectly and had everything I could want and nothing I didn't. The fact that they were charging actually made it an easier decision for me since it convinced me that they were going to make money and actually stay in business, making it easier to get help and service rather than have to research and do everything on my own with a 'free' service.

Now I'm inherently nervous about putting all of my eggs in one basket, so I started a new site in order to test squarespace and find out if it was as good as I hoped. 

To be honest I have very little confidence that squarespace would live up to my expectations. I've been more than pleasantly surprised. In fact, every site but one (Surface Medical Spas) has been built or switched to squarespace. Here's the list:

• Simple Curiosity? - Daily posts to tickle your thinking bone.
  
• Medical Spa MD: Information for physicians in retail medicine.
  
• Nimble Theory: My other business blog about technology startups & angel investing.
• Pony tail Club: My daughters blog about her riding academy and horses.
• Kid Agent: My sisters site as a child agent in Hollywood.
• Studio Salon Suites: A business site.
• Fight Club: A networking blog for entrepreneurs. (Since rolled into Nimble Theory)

There are some others that I've helped my friends set up as well but I don't own them.

Why choose Squarespace over a free blog site?

You can get a blog up and running for free as on Wordpress or Blogger. It's a valid solution and I've done just that in the past. (Squarespace also has a 30 day trial period that's free.) There are a number of things to take into account:

1.  I've found the 'free services' to be something of a misnomer since there is either:
   
   • Significant time involved that could better be spent elsewhere so you're, in effect, paying yourself 50cents an hour.
     
   • You end up having to pay someone to do it for you anyway.
2. Starting at $7 a month squarespace is a steal. In most cases if you're really running a site you're going to be responsible for hosting it anyway. (My virtual server for Surface Medical Spas runs about $49 a month.)
   
   
3. Since Squarespace is a paid service, they offer a host of support features and technical support. Since switching all of the blogs I run to Squarespace I've opened up around 35 support tickets. In every case the problem has been resolved and the tech support has been phenomenal with same day turnaround.
   
   
4. Squarespace comes with some really great features standard:
   
   • Search: Where Google's site search works great, Squarespace blows the doors off.
   • FAQ builder: If you've ever tried to build a FAQ (as I first did here: Medspa FAQ) The new FAQ feature stomps any other solution I've seen.
   • Drag & Drop: Moving stuff around on a whim.
   • RSS: No longer any need to configure your RSS feeds. It's already done.
   • SEO: Snap. Everything is valild and optimized so people can find you.
     
   • Build forms and capture information from your visitors. You've truly got to see this in action to believe it.
     
   • I could go on ad nauseum but here's the Squarespace feature set.

Building a dynamic business site that actually works the way it's supposed to.

If you're building a business site these day's it's easier than every. You no longer need to know HTML or CSS or any geek speak. However, and this is important, building a site that no one goes to is a waste of time. There are literally billions of web pages and your tiny spot on the web had better be easy to find.

Perhaps the biggest benefit of using Squarespace is the ease of use. While I'm writing this on the site, I've got spellcheck and the rest of the editing tools that everyone takes for granted. If my front desk needs to offer a special at a certain location, they just log in and do it... The don't have to call me, get the IT guys involved, or shed a tear. It's so easy that my daughters site at Pony Tail Club is run completely by my wife and daughter who have zero, zilch, nada, snake-eyes, by way of geek training. 

If that isn't the tipping point I don't know what is. 

Medical Blogs: Kevin MD calls it Black Wednesday.

Via Kevin MD: Grim news pervades the medical blogosphere today.

Fat Doctor has announced she is shutting down her blog:

Someone in my department printed out my blog and showed it to my boss. He tells me he didn't read it and won't interfere in what I do with my own time as long as I do a good job at work.

Flea's blog mysteriously vanished. Perhaps not coincidentally, he is in the midst of a malpractice trial.

Last year, Barbados Butterfly was forced to shut her blog after her hospital found out:

Thermage & Medspa MD: What's getting tightened now?

 Thermage actually likes Medical Spa MD enough to buy me a coffee.

Clint Carnell, The VP of Domestic Sales for Thermage and I met for coffee to talk about a number of things, some of which relate to this site. I'd had lunch with Clint previously. Evidently my Thermage rep Chris likes me more than my Botox rep. At least Chris sent me a big hunk of plastic.

Here's a list of parts of the discussion I feel I can divulge.

• Thermage had some internal discussions about whether it was a good idea to approach or contribute to what amounts to a public forum (this blog) but they've decided to give it a trial run at least. I got the feeling that Clint and others at Thermage were willing to try something that's new in the marketplace on their feeling that I would be fair to them. (With the hammering that Dermacare and the other medical spa franchises
  have taken on this site I give Thermage a great deal of credit for that.) I think that out there. If you're a company and don't have a blog you're doing yourself a disservice. There's no better form of constant contact with your target market as long as you're not just publishing the same old lame press releases. There's a paradigm shift in marketing that changes the traditional way that's taught in schools and I think more highly of Thermage that they're willing to engage in it. It speaks highly of the brains running the company.

Chris Anderson has some feeling on business blogs; "the natural voice of the boss is fundamentally incompatible with the voice of the blogger, at least as regards their own company affairs.". But wait, there's still hope. Chris goes on to say "The best business blogs come from the employees, not the bosses. They have more time, and are less prone to marketing gobbledygook and gnomic platitudes. And those kind of blogs are on the rise, not the decline."

• Clint told me that a large number of Thermage's reps now read Medspa MD. I thought there was something going on when the Does Thermage Work Poll received 200 positive votes without any negative votes after it had been neck and neck for weeks. Surprise. Good work guys, but now the Cutera reps (they're here too) will probably start dropping that positive percentage. I'm going to have to block ISP's from tallying more than one vote. Perhaps I'll post a Thermage vs. Titan poll and let them battle it out.
  
  
• Thermage has been trying to track down the producers of the refurbished Thermage tips for a while. I gathered that the refurbished tip guys know this since they're changing PO boxes every couple of weeks. Thermage is going to post to this site their position that the study on reactivating or refurbishing Thermage tips is bogus and that the physician who is credited with authoring the paper doesn't exist. I'll be posting Thermages position on this as soon as they send it to me.
  
  
• Thermage is sitting on a number of new thermage tips until they're sure that all their efficacy problems are behind them. I can see that they don't want a repeat of Thermage's previous problems that caused a backlash among physicians. If they can crack the cellulite conundrum they'll be set.
  
  
• I queried Clint about Thermage and the competition from Cutera's Titan and/or Palomar's fractional IR treatment heads. He was reticent to say anything bad about competitors but it was obvious to me that Thermage really thinks that they've got this modality nailed down. I didn't detect any sweating which is good. The companies that focus on what the competition's doing inevitably wind up fighting the wrong battles. I expect to get hard and fast specifics from Thermage and compare the technology providers side by side. Perhaps a Palomar or Cutera rep will pass this up the food chain and we can get some info from them as well. Different strokes for different folks.
  
  
• Clint's smart and I liked him tremendously. Now that Thermage is a public company they face challenges that they didn't when they were private. If Clint is representative of Thermage's leadership I'm impressed.
  

Peer Review: The dirty little secret of medicine.

Via Rangle MD: The problem with peer review.

Chris Rangle is an Internist practicing in Texas. His blog at Rangle MD is one of the older physician blogs on the web. The block quote below is from a post of his on how peer review works in Americas hospitals.

The majority of the time physician concerns about quality and patient safety are properly addressed without the administration going after the whistleblower but increasingly the system put in place by the 1986 law is being used to silence the messenger. According to the Pittsburgh Post-Gazette a 2001 report by the University of Baltimore found a serious potential for abuse by the hospital peer review system.

The report found that whistleblower physicians who alienate hospital officials are vulnerable to having their admitting privileges taken away, with devastating effects on their practices. Because the federal Health Care Quality Improvement Act protects peer review panels if they are sued, it also can have the effect of protecting a malicious peer-review group motivated by spite, prejudice or a desire to cripple a competitor's practice, the authors said.

What's more is that these peer review committees tend to operate in their own little worlds being only loosely governed by the hospital's bylaws. They are not courts of law, the committee members usually have no experience with legal procedure, and a such there is the potential for them to become the closest thing to a legalized "Kangaroo Court" in this country as you can get. A physician reader let me know about his own devastating experiences with these committees.

"In these proceedings, it is a trial. But it is unlike any 'trial', you have ever imagined. It is a chapter out of 'Alice in Wonderland'. The emphasis is all on 'procedure'. There is NO due process. There are NO rules of evidence. Hearsay, opinion, rumors, innuendo, and outright lies are completely acceptable as testimony. Truth, facts, and evidence are irrelevant. All that matters is procedure. The board can decide that a physician improperly performed a hysterectomy on a MAN, and it cannot be challenged in court as long as 'proper procedure' was followed in making the determination. I am not kidding. If this were not so serious, it would be hilarious."