10th Anniversary of Dr. Smith’s ECG Blog: First Post was November 7, 2008

This was the first post 10 years ago today:

ST depression: is it ischemia? No, hypokalemia.

A bit of history:
K. Wang formerly sent out a paper ECG through interoffice mail called “The EKG of the Week.”  When he left Hennepin to go to the University of Minnesota, I decided to start sending out the “EKG of the Week” by email to any residents and faculty in our department who wanted it.  Scott Joing, the founder of our department educational site www.hqmeded.com suggested that it would be easier just to blog it and send out the link to the blog. 
It sounded like a good idea.  He set it up and called it “Dr. Smith’s ECG Blog.”  I am not much of a techie myself, so would not have thought of it. 
Soon after, I noticed that there were viewers from outside Hennepin, there were comments, and the numbers went up.  This was a complete surprise, and totally unplanned.  
By December 2010, Scott Weingart gave the blog high marks on EmCrit, and viewership exploded, so that by May 2011, there were about 30,000 pageviews per day.
Viewership really exploded with the use of Facebook.  Now whenever I post, I promote on FB and get at least 20,000 views there, and up to 85,000, and most of the traffic to the blog comes from FB.  I also promote on Twitter, but get far less traffic from there.
There are now 945 published posts.  I have 249 drafts in various stages of writing, many (if not most) abandoned because I just can’t get them into a form which has a distinct message.
There are over 13,000,000 pageviews on the blog now.  There were 40,000,000 views on Google image search when they stopped counting 2 years ago.  There are 55,000 Facebook followers and 14,000 on Twitter.  I never expected any of this!
Why did the blog catch on? What made it different from the multitude of other ECG sites or textbooks?
I believe there are several factors:
1. It is free FOAMed.
2. It is always in clinical context: how does this ECG help to manage this patient?
3. I have developed unique ways of diagnosing ischemia and acute coronary occlusion which were, and still are, not well known, and I can illustrate these here on the blog.
4. Every ECG finding has many different manifestations, and this wide variety can be displayed online.  Every de Winter’s T-wave looks different.  Every subtle occlusion looks different.  These many morphologies could only be displayed online, never in a book, as there is not enough space in a book.  
5. Similarly, ECGs are dynamic; they evolve.  Books show only one, or sometimes 2 sequential ECGs.  I can post a half dozen or more to show this evolution.

Now Pendell Meyers and Ken Grauer are adding a lot of insight to the blog.

We are going to keep it going!  Thanks for reading!!

Steve Smith

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