A Year of Blogging Dangerously

Well, folks, time flies. Today marks the first anniversary of the launch of Wachter’s World. I’ve learned a lot in a year. For example, a year ago, I thought you became a Russia expert by reading books and newspapers, not by trans-waterway osmosis.

Anyway, I thought I’d use the occasion of the anniversary to recount some of the blog’s statistics and accomplishments, and to talk a bit about where we might be going in the year to come. I recognize that this comes in the midst of the Wall Street meltdown, the VP debate, and more, but an anniversary is an anniversary, so here goes.

First, a few basic stats. I’ve posted a total of 76 times in the past year, a bit better than one every 5 days. The average post is about 1,300 words, which means I’ve written approximately 100,000 words. By way of contrast, my book Understanding Patient Safety runs about 72,000 words, and the average Harry Potter book clocks in at about 150,000.

My most commonly used tag is “Hospital Care” – I’ve tagged 54 posts (71%) with it. But we’ve covered a broad array of topics, as judged by the 10 most popular tags (number of posts with those tags):

  • Hospital care (54)

  • Health policy (44)
  • 
Patient safety/medical errors (38)

  • Quality measurement (35)

  • Medical education/academia (31)

  • Media/press coverage (26)
  • 
Information technology (25)

  • Transparency and reporting (24)
  • 
Hospitalists/Hospital medicine (22)

  • Quality improvement (22)

Want more stats? The site is averaging about 500-600 views a day – that’s an underestimate of the overall readership since hundreds of people subscribe to e-mails that provide the full text. (Parenthetical note: we are probably going to change those full text e-mails to shorter e-mail alerts that prompt you to click over to the site – sorry folks, but it is useful for us to know how many people are actually visiting the website).

Excluding these e-mail-only readers, the average posting has been viewed 1,841 times, up about 50% from the traffic during the first several months. All told, there have been 139,916 views of the site since the launch. There are 1,159 registered users (folks only need to register to get e-mail alerts or post comments), and we are averaging about 3,200 unique visitors per month (one IP address visiting 10 times counts as one unique visitor). About 25% of visits are from outside the U.S. – for some reason, we’re huge in Turkey.

The most popular post, by far, was the one on the different treatment received by docs and nurses caught snooping in Britney Spear’s chart: it was viewed 8,734 times! The next most popular post is more than 3,000 behind: surprisingly, it is a pretty wonky post on an arcane topic, the Yin and Yang of quality measurement, which has been viewed just over 5,400 times. Just goes to show that I’m not very good at predicting which posts will catch a wave.

Remember that commercial where the 20-somethings launch a website and watch the visit counter begin to spin at warp speed, first 10 views, then 100, then 1000. We saw that kind of velocity on one post: when I was the first out of the box to report on the resignation of UCSF dean David Kessler… that puppy looked like one of those National Debt calculators for its first few hours. Just think what it would have looked like if I could have gotten Tina Fey to play Kessler.

You’ve been terrific with your comments: there have been 266 of them since launch, averaging 3.5 per post. They have been interesting and respectful – I’ve only needed to delete a handful on account of “bad words” or insensitivity. The winning comment-getter: my post on the insanity of resuscitating 90-year-olds with poor protoplasm received 15 comments. Of course, the most avid commentator is the now-famous “menoalittle”, who has posted 25 comments. No, I don’t know who this is in real life (in fact, I’d estimate that I personally know only about 20% of the comment writers).

My proudest moment: when we led the national effort to overturn the federal government’s wrongheaded decision to suspend the Michigan ICU checklist study. That topic got my juices flowing – and yours too – the four posts (such as this) received a total of 24 comments. I don’t think we’re responsible for Peter Pronovost’s Genius award (announced by the MacArthur Foundation last week), but I do plan to hit him up for a loan.

It is fun to look back and see how closely I hewed to what I intended. In my first post, called “Why a blog?” and published on October 3, 2007, I wrote this:

So I suspect I’ll be blogging a couple of times per week. I’ll really try not to waste your time or just blog for blogging’s sake. Most of my postings will represent my thoughts, though I welcome your comments and hope we can generate a lively dialogue. At times, I’ll act as a curator, bringing items that I think you’ll be interested in to your attention. But even then, I’ll try to place the pieces in context, not simply becoming a library or another daily update of the literature or news cluttering your In-Box.

Not a bad description of the blog, don’t you think?

What are the plans going forward?  We’ll make some technical enhancements to the site, which will make it easier to post pictures and videos, and to host reader polls. The site crashed a couple of times over the year and we’re working to make it 100% stable. And yes, we are exploring the possibility of advertising.  I don’t love the idea either, but my good friends at Wiley do put a lot of time and energy into the technical aspects of the site, and – to be honest – I spend between 4 and 6 hours a week on it. So it does seem reasonable to try to capture some revenue. Please be assured that I won’t agree to host ads it unless we can do it tastefully, unobtrusively, and there is an editorial/advertising firewall (i.e., I learn the identity of the advertiser at the same time you do). My guess is that it will happen at some point, but I’m not in any rush (I’ve already rejected a few proposals). If we do ultimately choose to pull the trigger, I’ll comfort myself (or rationalize) that I’ll be in the company of the New York Times, the New England Journal, even NPR.

As the tagging data shows, I’ve tended to focus on issues in hospital medicine, with a particular interest in those related to quality and patient safety. I’ve spent a bit more time on IT than I expected, and on the crisis in primary care. I plan to continue writing on the things the most interest me, particularly when they influence our care of patients or the way we teach our trainees. I’ve been very pleased by the number of e-mails and calls I get asking me to look at an article or consider commenting on an issue – I do so about half the time, so keep those cards and letters coming.

Let me take a moment to thank the good folks at Wiley for all their help, particularly Lisa Dionne, Vickie Thaw, Geoffrey Giordano, Kieran Thomas, and Gary Spencer. My friends at the Society of Hospital Medicine have more than held up their part of the bargain when I asked them to partner with me on this: to host the site professionally, to promote it relentlessly, and to laugh at my jokes without ever dictating my content. I’m particularly grateful to Larry Wellikson and Todd Von Deak at SHM. Thanks too to the other healthcare bloggers who have picked up or commented on my posts, including KevinMD, Paul Levy, Avery Comarow, Jim Sabin, Maggie Mahan, and Matthew Holt. It is a very nice “community,” and I’m grateful to be part of it.

Most of all, thank you all for reading and being active participants. I’ve written half-a-dozen books and a couple of hundred articles, but nothing I’ve ever done has gotten as much thoughtful and prompt feedback – from patients, docs, nurses, reporters, policymakers, old friends, and more – as this. It is uniquely fulfilling. 

As one final note, you may recall the real reason I launched this blog: to try to convince my teenage kids that I was cool. One year ago, I wrote this:

…I’ll do my best to make it fun, interesting to read, and a bit contrarian and controversial. But never boring or wishy-washy. 

At least, that’s my goal. My 16-year-old son (who I hoped would be impressed by “My Dad, The Blogger”), saw the title “Wachter’s World”, rolled his eyes, and snorted, “I have an idea for your subtitle. How about “Just Like Wayne’s World… Only Nerdier!”



In this world of perpetual change and disruption, perhaps you’ll be pleased to hear that my kids still don’t think I’m cool. Some things never change. And thank goodness for that.

Thanks for reading. I’d keep writing if you weren’t out there, but it wouldn’t be nearly as much fun.

6 Responses to “A Year of Blogging Dangerously”

  1. DZA October 3, 2008 at 8:53 am #

    Happy Blogday from the East Coast…

  2. menoalittle October 3, 2008 at 4:08 pm #

    Bob,

    Congratulations

    Best regards,

    Meno

  3. watchley October 3, 2008 at 4:24 pm #

    Well done Bob. Your commentary on issues regarding quality, patient safety and technology and the replies from readers have been right on the mark. Sometimes our health care system rushes in on the lastest fad without thinking about the evidence or the consequences . Your blog helps to present a balance view. Keep up the superb work.

  4. Jerod October 3, 2008 at 6:23 pm #

    Kudos Bob, for a job well done over this past year. Wachter’s World is my antidote for this crazy world of health care.

    And, so you don’t feel alone, my two college kids don’t think I am cool either…..but more concerning is the fact that they remind me regularly that they get to choose my nursing home.

  5. jfsucher October 17, 2008 at 12:26 pm #

    Maybe a little advertising that your blog exists! :) I don’t remember how I found it… just tripped over it one day on an internet search for something. However, I am very impressed by the quality of this blog (technical and literary). Its probably the only one I have found worth returning to.

    Good job. Best wishes.

  6. chadialraies November 9, 2008 at 5:08 am #

    Nice and helpful work.

    Chadi Alraies
    Cleveland Clinic, Cleveland, Ohio

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