Med Rants, Medpundit and Rangel MD were the first medical blogs I recall. Med Rants was the first blog to link to me, that I know of. Retired Doc was also an early supporter (thanks guys!).
In order to justify blogging in my own mind I had to find a niche, something not too many other medical bloggers were doing. Many medical blogs were news aggregators. I didn't want to do that because I believed then, as I do now, that scientific advances in medicine shouldn't be treated as “news” in the ordinary sense. Then there were the bloggers who related personal stories from their practices. There was plenty of that out there, and it was not where I felt I could make a unique contribution. Then there were the consumer information blogs, far too many for me to feel like starting a new one. Finally I realized that there was only a handful of blogs doing what really interested me---hardcore clinical blogging directed towards medical professionals in practice and training. That would be my focus, especially in the area of hospital medicine.
Before long I realized that public policy issues increasingly caught my blogging attention. That has seen a precipitous increase in this the most interesting political season in my memory. Despite that, the main focus remains clinical.
From the first I felt it very important to define my audience. I knew I couldn't write clinical content with any nuance or precision for professionals and consumers at the same time. It takes a special talent to do both. I realize that decision has cost me significantly in terms of blog traffic.
I will keep this endeavor going as long as it's still fun. Y'all will have to put up with me a while longer.