I’ve been thinking about how we use social media.  How can we characterize what we do?  I have always used Charlene Li and Josh Bernoff’s Social Technographics ladder for thinking about the various levels of social media participation.  I want to make it simpler for use in teaching others about social media.

Perhaps there could be as few as 4 levels of involvement:

Creation.  This is the creation and publication of original ideas – text, video, images.  Social conversation centers around ideas.  Few people make the stuff that others talk about.

Curation.  Curation is the collection of other people’s ideas.  This could be a collection of links or a blog post that cites some great work.  Curation usually happens at some kind of dedicated spot.  Selective sharing even on a real-time platform is a type of curation.  Most of us curate but we don’t think about it that way.

Conversation.  This is the dialog about ideas.  From written or recorded commentary to a simple retweet, input about things represents the start a conversation.  Conversation, or the ability to respond to what other people create is the defining element of web 2.0.  

Observation.  This is the consumption of ideas or conversation about those ideas.  It seems that most of us watch.  Historically, observation was the core element in web 1.0

These categories represent a subjective continuum and most of what we do is some combination of each.  Sometimes I make stuff, other times I talk about other’s ideas.  I’m definitely a curator.  The vast majority of my social time is spent listening.

What’s so striking to me about the Forrester ladder:  It all starts with somebody’s creation.  It’s been said many times before: Ideas and their embodiment represent a type of currency in the attention economy.  Good, original ideas create powerful conversation.  The power of the collection and discussion of those ideas shouldn’t be underestimated, however.

Perhaps a simple sequence could be: Listen, talk, collect, and create.

This eliminates 3 levels from the original ladder and may be simpler to describe to a physician audience.  What am I missing?

 

This is a general narrative of Pediatric Grand Rounds that I delivered at Texas Children’s Hospital on December 2nd, 2011.  I have included select graphics that were used during the presentation. 

I want to thank Dr. Mark Ward for inviting me to speak here at Pediatric Grand Rounds.  The dilemmas and concerns surrounding physicians and social media need more discussion.

By way of background you could say that I’m here by accident.  In 2006 I wrote a book for parents on reflux disease and milk allergy.  At the time it was suggested that I start a blog to promote the book.  I created a site, Parenting Solved, to offer practical commentary on issues of child health.  I grew the site between 2006 and 2009 and during that time learned the value of a personal platform as a means of reaching the world.

Out of sheer curiosity I began experimenting with Twitter in 2008.  In 2009 I noticed a sharp increase in social media use by physicians.  With this increased adoption, basic questions began to arise such as, “What do you do when a patient contacts you on Facebook?”  I launched 33 charts, a site dedicated to the issues facing doctors at the intersection of medicine and social media.  The site grew and evolved as a community for matters involving doctors, social media and emerging technology.  I’ve been fortunate to have the opportunity to help a number of organizations with their strategy and policy surrounding doctors and social media.  I’m hoping to share with you a little of what I have learned.

In academic presentations there’s always presumed authority on the part of the speaker.  But I’ll disclose that I’m not an ethicist.  This may offer a distinct advantage to the audience: I look at these problems from a very basic and practical level.

I’ll open with a little background on social health and how it’s redefining the role of the physician.  I’ll then transition into some of the challenges and questions that physicians face including transparency, boundaries of the doctor/patient relationship and the moral obligation to participate.  There are so many questions evolving surrounding new media and doctors but I’m unable to discuss all of them.  Hopefully this grand rounds will serve as a jumping off point for a discussion that will continue at Texas Children’s Hospital, Baylor College of Medicine and beyond.

Hopefully I won’t overpower you.  This graphic from David Armano illustrates how we can go to extremes and overstate the value of social media.  Many of us begin in an unhealthy place of thinking this is a fad.   We’re skeptical then we check it out.  There’s the potential to get too wrapped up with it but hopefully we convert toward a healthier place and recognize its real value.  I showed this to my wife who suggested that I’m somewhere between a zealot and humble servant.  But I’ll let you decide.

The physician redefined

This is a remarkable time to be in medicine.  We’re in the midst of a communication revolution not seen since the time of the printing press.  The world is changing around us.  What we do 50 years from now will be unrecognizable to today’s generation of doctors.  What it means to be a doctor is changing very quickly.  This includes the way we communicate.  I see 3 forces acting to redefine the physician.

Technology – The first force pulling on us is technology.  Much of what we once did with our hands is now done for us.  Advances in diagnostic imaging and genomics are  leaving us as purveyors and interpreters of information. Times have changed:  We once could only treat symptoms and diseases.  In the 21st century we will move toward personalizing and preventing disease.  Clayton Christiansen in his book Innovator’s Prescription describes this as a transition from intuitive to precision medicine.

Third party – Another force shaping doctors is third party control.  Care is increasingly under administrative/centralized control through managed care, evidence based guidelines and the collection of big data.  And given the seemingly unlimited availability of diagnostic options that I just described, 3rd party input would almost seem to be a necessity.

Health 2.0.  Patients themselves are changing and they are, in turn, influencing us. Perhaps the most influential force in the modern redefinition of the physician is the health 2.0 movement.  Health 2.0 is the use of social applications and other web-based tools to facilitate collaboration among patients and between doctors and patients.

For the better part of modern civilization our role as physician has centered around privileged access to information and knowledge.  But the web has created a type of disintermediation.  Patients can do more on their own.  They can access information and make certain judgments.  They can share information and adjust what they’re doing based on the input of others.   And the physician encounter is evolving as a more narrowly defined element in an individual’s quest to understand their condition and get better.  This health 2.0 element is fueled by social media.

So in effect, what we see are a variety of social and technological forces conspiring to redefine the physician.  I believe that how we react professionally to these forces over the next generation will help shape who we become.

A short history of social health

So how did it come to this?  How is it that patients who were once entirely dependent upon us began to become so independent dependent?  I created this visual to briefly illustrate the course of social health over the past 10-15 years.

• Long ago – Throughout most of modern civilization and up until about a decade ago, patients did what they were told.  They would show up in our office, we’d tell them what to do and they were on their way.
• The 90′s – Then came the Internet.  Patients acquired access to information, initially through static sites and hyperlinks, then in the mid-90’s through search.
• Turn of the century – Technology then allowed us to talk back and have dialog.  Social networks appeared and patients started getting together.
• Now – Information finds patients (and doctors).  And this is all through social media.

What’s important here is that long ago patients went looking for information; now health information finds them through their social networks.  You may hear the term web 1.0 used – this refers to this period when we passively read.  The shift to web 2.0 happened when we went from reading to active participation.

What is social media?

It’s interesting how things have changed.  Two years ago I had to spend a lot of time defining social media.  Most of us live with it and so it requires a lot less effort on my part.  While you’ll never get two people to firmly agree on the definition of social media, think of it as content made by you using mobile or web technologies that facilitates interaction.

This graphic from David Armano illustrates how information flow has evolved from a one-way broadcast to a network of conversations.

When I grew up in Boston as a child we had two sources of information:  Walter Cronkhite and the Boston Globe (the big green “1″).  Each morning the Globe editors decided what my family needed to know and sent it to us.  Each evening Walter Cronkhite would decide what we should hear and we would hear it.  We’d listen and that was it.  From the time of the printing press, this is how the world worked.  Broadcaster and audience.  As suggested by journalist A.J. Liebling, it was freedom of the press … for those who owned one.

Then we saw the appearance of social applications that allowed us to publish our own ideas.  A society once entirely dependent upon the mainstream media for their information has in the span of a decade or so developed the capacity to create its own communication channels.  The audience has become the broadcaster.  For physicians this has created tremendous opportunity as well as some pitfalls.

Physicians and social media

So physicians have used these tools just like everyone else and it seems we’ve been slow to adopt.  But good information about physician use is hard to come by.  This independent study, Doctors, Patients and Social Media released by Quantia this fall is one of the most comprehensive and it revealed these use statistics:

• Facebook: professional use 15%; personal 61%
• YouTube: professional use 8%; personal 31%
• Twitter: professional use 3%: personal 9%.  Note that this is personal use of Twitter is consistent with use in the US which is around 8%.

While doctors may be using these tools we really don’t have reliable information regarding what they’re doing.  This October 2010 survey by the American College of Surgeons demonstrates nicely one of the weaknesses we see with statistics surrounding social media use by doctors: meaningful use.  While they found that 22% of surgeons “use Twitter,” further analysis shows that half of these doctors rarely use it.  We don’t have good information surrounding precisely how physicians are using these tools.

Speaking of surgeons, let me digress and tell you about one of our own in the world of medical education: Dr. Mary Brandt.  Mary maintains a blog, Wellness Rounds, focused on wellness for trainees.  From recipes to advice on personal balance, this site offers sensible advice for frenetic medical students.  As important as the content she delivers is the view offered inside the leadership of Baylor College of Medicine.  If you search Baylor College of Medicine on Google you’ll find Mary’s site on page one.  Pre-medical students searching Baylor College of Medicine will, of course, find the requisite information on the medical school’s site.  But her blog offers students a first-hand look at the administration’s commitment to the well-being of its students.

We shouldn’t underestimate the value of this kind of presence.  This is where the next generation lives.  And to be competitive as a medical school we have to live in their space.

My view of physician social activity

This diagram illustrates how I see the social world of physicians.  When I think about doctors and the social spaces they occupy I think about two general areas:

1. Facilitated networks:  These are doctor-only networks like Sermo, Physician Connect, and Doximity.  These are applications designed to facilitate professional discussion.
2. Doctors in the wild.  Then there is what doctors do in public places like Twitter, Facebook and YouTube.

The personal use of tools like Twitter and Facebook are precisely what you might expect.  Soft professional dialog is the dialog about medicine but not direct patient-related dialog (health care reform, medicine in the news, etc).

I see professional dialog as the conversation surrounding specific studies, education and doctor-to-doctor sharing/collaboration.Professional dialog is the thinnest slice of the public dialog.  Doctor-patient interactions appear limited to education and general health information.  You’ll find little, if any, patient-specific dialog between doctors and patients.  You’ll notice that among most doctors in the wild, there is a clear overlap in personal and professional dialog.

This diagram hopefully illustrates one of the biggest challenges facing this generation of doctors: the definition of professional boundaries.  Maintaining our image used to be pretty easy.  We kept a certain demeanor in the hospital and in the exam room and that was all we had to worry about.  And physicians were seen one way.  We were always encouraged to keep a deep and clearly defined ‘therapeutic distance’ from our patients.  Messaging about doctors came from the AMA or the public relations office of the local hospital.  Pictures, quotes and words were carefully chosen.  Even the media played a role in defining the image of what constitutes ‘doctor-like’ appearance and conduct.

But the democratization of media has made each physician an independent publisher.  We’re hearing from doctors with all kinds of opinions, ideas and agendas.  Just a decade ago few physicians had a voice – now every physician is potentially a broadcaster or journalist.  While this should be seen as cause for celebration it has lead others to have concern.

Technology leads the human process

This graphic illustrates the challenge that comes with such rapid change.  What we see is that technology is now way ahead of the doctors, the law and any dialog surrounding ethics.  This discrepancy between progress and it’s human follow through creates gaps that we’re not prepared to deal with.  This will be a recurring theme.  Our current systems are modified at a 20th century pace.

John Halamka, a physician and CIO at Harvard Medical School, wrote last week that “technology is easy, policy and processes are the hard part.”

Patient Privacy and Professionalism

With respect to social media, I see two challenges facing our profession: patient privacy and professionalism. There are others we could identify but I think that these two occupy the minds of those watching doctors in public.

• Privacy is relatively easy.
• Professionalism is remarkably difficult.

I’ve noticed that health institutions tend to focus on patient privacy almost at the exclusion of professionalism.  The privacy issue is pretty straightforward: Avoid patient-related subject matter in public dialog.  Period.

Why should we avoid discussing our patients in public?

1. These are public places.  While the world ponders ‘how to handle doctors and their social tools’, it’s important to understand that tools for communication don’t change the standards of patient privacy.  And privacy concerns are not new.  But I don’t want to appear cavalier – real time communication carries with it new challenges never before faced by doctors.  The role of new media physician publisher comes with new responsibilities.  We just have to remind ourselves that these places are very much public.
2. Documentation is tricky.  Documentation of dialog on fragmented communication channels is difficult to impossible.
3. De-identification is difficult.  Proper de-identification of patient information is difficult.  It’s also important to understand that what’s de-identified today may well not be de-identified in 5 years.  Computers with access to big public data will be likely to be able to make connections between disparate pieces of information.

Here’s an example of just how difficult de-identification can be.  This spring a doctor in Rhode Island recounted a patient experience and believed she had de-identified the patient.  Apparently it wasn’t neutralized quite enough and the family members of the patient were able to identify this as a loved one.  She was disciplined by the Rhode Island State Board and lost her privileges at the involved hospital.  Again, avoiding the discussion altogether would have kept this doc from the professional pain she experienced.  More importantly she would upheld the implicit agreement that her encounter was strictly between her and the patient.

So we work to be HIPAA compliant.  Then we’re off the hook then, right?  Maybe not.  Consider that I’m on service and see a really interesting new case of neonatal hemochromatosis in the NICU.  So I decide to share on Twitter: “Just saw an amazing new case of neonatal hemochromatosis.  Not sure the little fella’s going to make it.”

Anyone see any problems with this?

We can argue that this doesn’t violate HIPAA and is, in turn, safe.  But what if this patient happens to follow me and makes the connection that it’s her baby that’s being discussed.  I suspect that a lot of patients would have a problem with this.  Potentially this sort of ambient documentation represents a breach of trust.  Call it a HIPAA-compliant breach of trust.  Physicians must think beyond HIPAA in their public dialog.  Our obligation to the relationship we share with our patients goes beyond legislation.

When patients reach out

So what should you do when a patient reaches out to you?  Recently a patient reached out on Twitter with a medication question.  I had apparently seen the patient the day before and they couldn’t recall how to dose the suppository I had prescribed.  This is a pretty rare occurrence for me but it has happened a few times.  And admittedly this happens far more often at the grocery store than it does on line.

So how should you handle it?  Here’s a mini-protocol that I initiate when patients reach out:

1. Take the dialog off-line.  The first thing I do is take the dialog off-line.  I’ll message back and tell them that I can’t respond here but would love to chat.
2. Address their concern.  I then try to take care of their problem.  It’s important to understand for a digital native mother, outreach on Facebook isn’t some kind of novelty.  To everyone in this audience it is, but not to her.  This isn’t a fad.  It’s one of the world’s leading communication platforms.
3. Discuss PHI.  After I address their issue, I’ll discuss why I can’t discuss protected health information in public places.  Then I remind them about the potential downside to the public disclosure of medical details.
4. Create a phone note.  Finally, I put it all in a phone note.  And very importantly I document that it was the patient that initiated the public contact.

A couple of things are worth noting here.  This father who sent the suppository tweet didn’t know that everyone who follows the two of us can see his @message.  He didn’t understand what was private and what wasn’t.  This is something that I’ve seen pretty regularly: Patients often don’t understand the privacy settings of common social media applications.

It also makes sense to have a communication policy that lays out the expectations for how your office would like to communicate with patients.

Here’s a situation I once faced:  One day I was friended on Facebook by a woman from my community.  I didn’t know who she was so I messaged back and asked how we knew one another.  She responded that we didn’t know one another but she had read my book and she had a 9-week-old screaming baby whose intake was limited to 12 oz.

So what do you do?  Keep in mind that this is a public, non-protected medium.  The hospital compliance officer is looking over my shoulder.  The Texas State Board prohibits care without the maintenance of a proper medical record.  I chose to call her and see her in the office the next day.  Fortunately this kind of contact is pretty rare.  But since I had responded to her request I was engaged and felt the obligation to help out.

When patients talk about you

You can’t talk about patients but can they talk about you?  Absolutely.  With the rise of physician-specific review sites patients have a forum for commenting on everything from the front-end staff to your dress.  But as it turns out, physician review sites are typically polarized between those that either love or hate the doctor-in-question.  Consequently physician review sites have not evolved as the tool that the empowered patient had hoped.

Negative comments can arise, however.  It’s important to keep in mind that as a doctor you have no control over what people say about you.  But what you can control is the content that you create.  If you create nothing you are entirely at the mercy of what’s created or said about you on your behalf.  You have to look at yourself as being responsible for the creation of a positive digital footprint.  This is one argument for participating in social media a positive, meaningful way.

The doctor discussed in this post on 33 charts chose to sue a patient who published what she considered to be an unfair comment.  The result was that the story was picked up by every major news outlet and the world then wanted to see what had been said.  So while this doctor was trying to get rid of some negative commentary, the end result was a digital trail strewn with news stories about how she handles criticism.  She even made Grand Rounds this morning at Texas Children’s Hospital.  This is an example of what’s been called the Streisand effect.  Sometimes our best efforts to eliminate something from the web have the opposite effect.

Professionalism

The issue of defining professionalism in the digital world has been difficult because professional conduct is subjective.  Definitions vary across generations and cultures and ultimately the question of professionalism will need to be defined within the community or network of the participating doctor.  This discussion is part of a broader debate surrounding personal boundaries and transparency.  How transparent is too transparent?  And what does my professional, social and IRL community expect of me?

It’s an important question since institutions charged with monitoring physician conduct must make this judgment.  But at the end of the day it’s important to keep in mind that social media is just another public space.  For the individual physician the solution is simple: always remember that the world and, more important, your community is watching.

Can we separate our personal and professional lives?

Many have advocated for ‘dual citizenship’ online – a separation of our personal and professional lives.  But I think that it’s difficult to achieve.  We have to be careful believing that what we say and what we create will be contained to a limited audience.  In an environment where anything can be screen grabbed and shared, the use of what we create is at the whim of the person who consumes it.  I assume that online dialog on any platform has the potential to be seen by everyone’s eyes.

Regarding patients and Facebook, I try to restrict Facebook to people I would normally have for dinner.

Deviant Doctors on Twitter

The risk of talking about ethical dilemmas in social media comes with the potential appearance that the wheels are falling off the wagon.  So are doctors really that bad?  Is this discussion about professionalism overrated and do we know anything about what doctors are doing?  Our knowledge about physician conduct is limited but this study by Kathy Chretien at George Washington offered some interesting insight into how frequently physicians engage in questionable conduct on Twitter.

She studied 5,156 tweets from physicians and found that 144 contained what was deemed unprofessional content.  It’s interesting to note that 92% of the doctors responsible for what was judged as potential disclosure of PHI used their full names in their Twitter bios.

As a side note, Kathy is an example of an academic physician who is adding to our professional body of knowledge while serving as stellar example of a physician voice in social media.  You can follow her on Twitter at @MotherinMed.  Her blog, Mothers in Medicine, offers up fresh writing from young female physicians.

In the context of Kathy Chretien’s study is Dr. Wendy Sue Swanson’s observation that ‘We are way worse in the elevator than we are online.’  Wendy, a blogger for Seattle Children’s Hospital, also serves as a brilliant example of how an original voice can leverage the power of social media for positive messaging.  If you are interested in understanding how pediatricians can harness the power of social media be sure to read Wendy’s writing and watch her videos.

Is anonymity the answer?

So perhaps the doctors in this study who potentially disclosed PHI would have been safe had they just used a pseudonym?  But true anonymity is a relic of the digital past.  Just about anyone can be identified.  And while it’s been argued that anonymity allows a safe outlet for the persecuted, it just as easily creates a situation where a physician entrusted with the private affairs of a patient is accountable to no one.   The issue of anonymity and the individual rights of those who are truly oppressed remains an unsettled issue.

It’s interesting to note that anonymity among physicians was more common in the early days of the medical blogosphere (early 2000’s).  In fact, the first facilitated network for physicians in the United States, Sermo, launched in October 2006 and allowed anonymous profiles and continues to in 2011.  Anonymous profiles in facilitated networks for physicians are otherwise unheard of today.

The risks of anonymous physician opinion are best illustrated in the case of Dr. Rob Lindeman, a Boston-based pediatrician who maintained a very active blog in the mid-2000’s.  He was a fantastic writer with sharp opinions that offered insight into the mind of a working pediatrician.  He wrote under the name of Flea, after the famed Red Hot Chili Peppers rocker.  He went to trial to defend a case in 2007 and chose to blog his opinion on the personal habits of the female plaintiff attorney.  He was identified and confronted during the trial.  The case made every major newspaper in the free world and now serves as a cautionary tale for good judgment and the risks of presumed anonymity.

So what’s the problem with anonymity?

1. It’s an illusion.  While it was once possible to maintain true anonymity, anyone can be uncovered.
2. It creates a false sense of security.
3. It creates the mindset for saying things that your normally wouldn’t (and probably shouldn’t) say.  I have always believed that if you can’t stand behind what you have to say perhaps you should stay seated.  I think this probably stands as solid advice for physicians in the new world of social media.

Digital natives in the medical world

We’re facing a new problem in professional medical education:  The appearance of digital natives in medicine.  We are witnessing the matriculation of residents who have been raised with real-time communication.  And in a world of health privacy legislation, institutional accountability and analog attendings, there have been growing pains.

The way to train the next generation is not to prohibit the media but rather to teach how we can live with it as professionals.

I saw the writing on the wall earlier this spring and called Lee Aase at the Mayo Clinic Center for Social Media and suggested that we put together a video for incoming medical residents on the issue of digital professionalism.  So I gathered Victor Montori from the Mayo Clinic, Wendy Swanson from Seattle Children’s, and Kathy Chretien and we put this together and launched it on the first of July.  It’s simple but the idea was to give young trainees a little advice from a group of socially docs and generate some dialog about this important issue.

The video enjoyed wonderful visibility and met its goal of creating chatter.  The Wall Street Journal Health Blog covered the story.  Of note, this is a good example of how you can use social media to leverage the mainstream media.  We are planning to re-release this video in a more polished form for the 2012 academic year.

Are physicians morally obligated to participate in social dialog?

I first raised this question in 2009 and it generated a lot of dialog.  I’ll submit to you that as physicians we are obligated to create, curate and talk.  I like to raise the example of vaccines and autism.  When a frightened young mother searches ‘vaccines’ and ‘autism’ she finds exactly what you’d expect:  The shrill from a loud minority that has done its best to turn back two generations of effort to eliminate dangerous infectious diseases in children.  Consider that there are 60,000 pediatricians in the American Academy of Pediatricians.  If just once a year each one of these 60,000 pediatricians wrote, commented on or recorded some piece of information dispelling a vaccine myth we would rule the search engines.

It’s interesting that as physicians are the first to criticize what patients read but we’re the last to create it.  Public education is part of our charge.  We have an obligation to do better.

Texas Children’s Hospital’s Medicine | Milestones | Miracles is doing its part to create the content that parents should read.  Since its launch last year Michael Reina and Chris Ferris in marketing have done a tremendous job cultivating a world-class center of dialog for those invested in child health.  Each one of you in this audience can use this remarkable platform to harness and share the wealth of information that you have within you.  This post by Rachel Cunningham represents how we all should be creating the stories surrounding vaccine preventable disease.

While there’s more that can be said you might take home these four tips for safe engagement:

1. Avoid patient specific issues
2. Don’t be anonymous.
3. Remember that everyone’s watching.
4. Be nice.

Risk and opportunity

I’ll finish by sharing an observation: Almost universally when speaking to physicians and health care administrators, social media is seen from the perspective of risk and fear.  Almost never is it viewed from the position of opportunity.  While clearly we need to mitigate the risks involved in public dialog we need to recognize it as a remarkable opportunity.  Medicine and the world around us is changing very quickly.  How we respond to these changes will define our profession over the next generation.

Links to Amazon represent affiliate links. Dr. Vartabedian has an advisory relationship with Doximity.

Other posts from 33 charts that you may find interesting

• 6 Things I Never Talk About on Twitter – This was written some time ago but the principles still apply.
• Physician Conversation Agents – Is there an evolving role for the physician spokespersons on social media channels?
• Why Doctors Should Use LinkedIn - Commentary on why every doctor should have a LinkedIn profile.
• The 911 Blog Disclaimer - A tongue-in-cheek view of a common disclaimer found on physician blogs.
• iPhone Attribution Error - A new exam room issue facing this generation of physicians.
• How Would a Plaintiff Attorney Use Your Tweets? – The title says it all.
• The Disconnect - Some thoughts on the emotional detachment that physicians sometimes feel from their patients.
• Let the Patients Speak – Why physicians should not impose ‘gag orders’ on a patient’s right to comment on their experience in public.
• The Information Show of Force - My recollection of when parents first began appearing in my office with inkjet printouts.
• Doctors and the Future of Touch – A brief look at the future of the physical exam.
• Doctors and the Reality of Information Overload - Some advice on handling one of the greatest challenges to the next generation of doctors.
• The Digital Physician – A breakdown of the differences between the digital and analog physician.
• 6 Signs That Social Media is Not for You – A few signs indicating that it might not work for you.
• Doctors, Mosques and the Limits of Transparency – A brief example of why you might avoid social dialog about religious ideology.
• Who Will Police Physicians in Social Media – The title says it all.

 

I think perhaps our biggest challenge going forward is attention crash.  Too much input.  Too much noise.  We’re trying to listen to too much.  The problem is that as information explodes, we don’t scale.  Keeping our eye on everything simply isn’t sustainable.

Twitter gave many of us our first taste of real-time input.  We were told that ‘listening to everyone’ else was our way to be heard.  Twitter was the early 21st century’s party line.  A message roulette of sorts.  Facebook has had its lessons.  After too many connections we discovered just how difficult it can be to tell loose acquaintances that their stuff just isn’t that important to us.

I finally see people around me coming to the realization that they need filters.  They need a better signal.

I’ve been monkeying around with Google+ and I think it puts us a little closer to where we need be.  Google forces filtering on the side of the sender and the receiver.  After all, not all messages are appropriate for everyone in our broadcast area.  And not all inputs (or circles) are appropriate for us all the time.  G+ is more intentional and gives us the option for more control.  It offers a step towards controlling the noise.  I’m not sure that this is the place for me, but it’s definitely interesting.

How it’ll all shake out isn’t clear.  I suspect that the draw of tighter control won’t be enough to pull the average college student or mother of four away from Facebook.  Twitter isn’t going anywhere.  There’ll always be demand for the party line.  And I suspect that as the social world continues to fragment, the digital biosphere will segregate by species.  As these properties age and fall from grace, they will evolve to comprise some kind of social media long-tail.

Either way I think we’re all (along with our tools) getting closer to understanding that listening and broadcasting to 20,000 folks is not the most efficient means of getting and sharing information.  Maybe it’s the beginning of the end of an era.

 

Emerging social media platforms appear to come with a requisite social media guru kabuki dance.

The Platform appears.  The Platform bows to the gurus looking desperately to publicize that they’ve been bowed to. The guru teases the masses with what they can’t have. The masses get whipped into a frenzy.  Scarcity, of course, makes the heart grow fonder and the network potential stronger.  We supplicate before those above us on the social pyramid.  We’ve heard that they hold the key to The Platform.

As we wait, we dream of how good it will be.  We dream that this is The Platform that will make us more empowered, more connected, and more engaged than ever before.  This is the solution that will make us pure in heart, mind and digital signal.  And despite its rumored shortcomings we learn that the best is yet to come.  Our happiest, most hyperconnected life lies just beyond beta.

Then there’s the predictable arms race of guru hacks and how-to’s, do’s and dont’s, peppered with the vague assurance that this is really it.  This is what we’ve been waiting for.  Could it just be shiny object syndrome?  Of course. But what if it isn’t?

The Platform watches in quiet approval as the dance unfolds.

(In an unrelated matter, I happen to have some Google+ invites. Message me with your gmail address.  Addendum:  Gone just as quickly as I posted and it seems Google+ is again closed to new members.  But there are more invites where that came from.  Just check 33 charts every 5 minutes and follow/friend/fan/like/love/hug/1+ me on every one of my social properties.  All I’ll say is you have to see Google+ to believe it.)

 

My social life has been pretty simple.  I have always kept 33 charts as my home base with Twitter as my main outpost.  I flirt with Facebook.  All of it’s been manageable.

But consider that I now participate in a SocialCast stream with an emerging research project at the University of Cincinnati Medical School.  Doximity has a mobile product that’s about to pop and Sermo just released its new mobile application.

Enter Google+.  All this has me wondering, ‘how many places can you live?‘

I’ve become increasingly pragmatic in how I see these tools.  I find myself looking less for community and more for the right information amidst a a cacophony of independent broadcasters.  I’ve become preoccupied with fighting digital noise.  It seems I spend most of my time looking for the right signal.

If I’m alone it won’t be for long.  I think Google+ represents the first time the public has experienced real fragmentation.  It’s the first real challenge to social media’s first major players. It’s an experiment than we’ve ever seen and the results will tell us a lot about what people really need and want.  Social media will make its move beyond novelty to a place for real communication.

And pay no attention to social media’s most visible acolytes who predicted during G+’s first week that it would evolve as the dominant social place. Remember that they love everything shiny and new.  But when the dust settles we’ll see who’s in and how the platform really makes their lives better.

Despite how it may look, nobody can live everywhere.

 

There was a time when the information concerning patients could never reach the outside of a hospital.  Or at least it was difficult.  What was discussed on an overhead projector in a dark conference room never had the capacity to reach beyond our personal space.  New technology has created the ability for us to instantly share our work with the world.  This creates the potential for infringement on the relationship we share with our patients.

Enter the digital natives in medicine.  These young trainees have grown accustomed to the concept of real-time communication and transparency in dialog.  But fluency in social dialog and health privacy are often at odds.  As a result, residency coordinators are facing the issue of professional boundaries among physician trainees.  But how do we prepare the next generation of physicians?

I thought the issue could use some discussion.  So with the generous support of the Mayo Clinic Center for Social Media, myself and a few colleagues decided to pull together some advice for resident safety when using social media.  Victor Montori from the Mayo Clinic, Wendy Swanson from Seattle Children’s Hospital and Katherine Chretien from George Washington University enthusiastically jumped on the project and offered their expertise.

As I mention in the first minute of the clip, this isn’t meant to create rules but rather to get folks talking about how we should be handling ourselves in digital public.  Over the first week we’ve enjoyed 1,300 views and coverage from The Wall Street Journal and American Medical News.

Hopefully we’ll see this dialog carry on further in the weeks and months ahead.  There’s more where this came from so stay tuned.

 

This NCI Cancer Bulletin article on the use of social media at this week’s American Society of Clinical Oncology is worth reading.  It showcases how a major medical organization sees social media unfolding at a national meeting.  I’ll be following #ASCO11 closely where some sources predict the Tweet count could reach 10-15,000.

What caught my eye was discussion surrounding the speaker-imposed restriction of Twitter at scientific presentations.  Apparently some meetings such as the Biology of Genomes Conference at Cold Spring Harbor Laboratory, presenters have to grant permission to allow the use of Twitter (this apparently will not be the case at ASCO).

This is a quote from the meeting media policy at Cold Spring Harbor Laboratory

Often, during the course of a meeting, a scientist will present a discovery, method, or current project that is not yet complete or published. Therefore, to prevent the premature release of confidential information, we require all media attendees to obtain permission in advance from the relevant scientist prior to reporting any spoken or printed information gleaned from the meetings. Media attendees are encouraged to approach scientists out-of-session (e.g. during coffee breaks, poster sessions, wine and cheese parties, etc.) for informal discussions, formal interviews, and/or permission to report sensitive information at the appropriate time.

While It’s hard to be critical of Cold Spring Harbor Labs, this policy illustrates the disconnect between the past and the present.  The reference to the media ignores the obvious reality that we are the media.  Communication tools like phones have become tools for publication.  Or, as Jay Rosen has put it, we are ‘the people formerly known as the audience.’

Clearly scientists need to protect data prior to publication.  But a dated system of review that stops doctors from talking will hold us hostage to the constructs of the 20th century.  Until this is sorted out, citizen journalists need to be respectful of information and how it is used.  Recipients of that information need to understand the context of scientific dialog.  And we need to understand that legislating the use of a platform will not stop the conversation.

h/t to Brian McGowan (@CMEadvocate) for directing this story into my stream.  Image via Lazy Crazy.

 

You’ve got to excuse me.  I’ve got this thing with Twitter disclaimers.  I think we’re like lemmings in the way we copy snippets of blind reassurance into our bios.  I’ve suggested that the 911 blog disclaimer is a practical joke initiated by the legal community.

‘These tweets are my own,’ is the workhorse of disclaimers but I wonder what purpose it serves.  What’s interesting to me is that we rarely see similar disclaimers used in other forms of communication.  When I spoke at AGA last week I failed to begin with a slide reminding the audience that my comments were not the official position of Texas Children’s Hospital or Baylor College of Medicine.  At cocktail parties we don’t use ‘pre small talk’ qualifiers that identify us as non-spokespersons of our employers.  What reasonable person would really believe that my Twitter feed is the official feed for the delivery of my hospital’s public opinion?

And do we really need to announce that our shared links don’t represent endorsement?  Who in the free world really thinks that when I retweet a link or idea I’m formally endorsing the site on the receiving end?  When was the last time a shared link lead to identifiable damages from the lack of the endorsement disclaimer?

I can understand disclaimers about medical advice.  But we’re all waiting for that first big judgment against the ‘disclaimerless’ doctor brought to her knees by that loose tweet construed by the patient-victim as individual medical advice.  Rest assured that when it happens you’ll hear it here first.

Ultimately I think this use of language is about fear.  But I suspect that those interested in getting at us won’t be deterred by cut-and-paste disclaimers.  Perhaps it’s time to rethink the practical utility of the disclaimer.

 

I received an email notifying me that 33 charts has been chosen as a selected site by Sermo.  While I haven’t exactly figured out what it means, I am thrilled.  Not because I need a hug but because Sermo may have realized that there are doctors like me talking outside of their network.  I always found it odd that the original social network for doctors was effectively absent from the dialog happening in the blogosphere and on Twitter.  Perhaps there’s a new marketing sheriff in town.

Either way, here’s why a network like Sermo should be working public spaces:

There are lots of doctors here. When Sermo launched Twitter wasn’t on the map.  But they’re here and doctors are having the social experience in public.  We’re your customers.  You should be behind every single one of us.

We’re talking about you.  Even the tightest professional vertical can’t survive without multiple channels of outreach.  Doctors and medcomm folks talk about Sermo.  Whether it’s earned or not, you remain on the radar, front and center.  And like any other business you need to listen, respond and be involved.  As a social business this should be obvious.

Doctors need a place to talk.  Sermo started ahead of the parade with the field of dreams belief that if you build it and they will come.  But doctors weren’t ready to talk.  But we’re here now and public dialog has evolved in the absence of any better place to collect.  I think we’re seeing a unique window of opportunity for those who want to build the leading platform for doctors.  Doctors are ready for community – many talking on Twitter would seize the opportunity to jump over to someplace like Sermo.  Sermo’s well-positioned to capture this market, but not without a little disruption.

You’re mentioned at medical meetings (but less frequently than before).  Interest and dialog about doctors and social has picked up dramatically.  Every major medical meeting in America has in the works a panel (if not a keynote) on the subject of social media.  As the biggest gorilla in the jungle, Sermo should be there.  I would think about a publically facing physician evangelist.  Think what Amber Naslund is to Radian6 or Scott Monty is to Ford Motor Company.  The absence of IRL physician representation is a lost opportunity with the passing of each meeting.

Doctors needs leadership. The physician world is desperate for leadership and support surrounding their entre into social media. From our struggle to define digital professionalism to the training of our next generation of doctors, there’s a rare opportunity to create an indelible mark on the hearts and minds of the medical community.  Everything done without Sermo’s name and support is a lost opportunity.

You’ve got competition.  While outreach will not make up for a product that doesn’t exactly meet a doctor’s needs, it will become increasingly important as real competition in this space heats up.  Keep your eyes peeled and sleep with sleep with a sidearm.  If you’re not careful the stealthy folks at Doximity might just take you down from behind.

Of course social outreach is a critical piece of your defense.

And while I’m flattered to be Sermo selected,  don’t look for your badge on 33 charts.  As you can see, I don’t do bells, lights and whistles.

 

If you haven’t registered for the Fourth World Congress on Social Media and Web 2.0/Medicine 2.0 at the Stanford University School of Medicine on Sept. 16-18, time is running out.  Early bird registration ends May 15th.

This is the first time the Medicine 2.0 congress will be held in the United States.  Look for data-driven studies of the latest projects applying Web 2.0 and mobile computing applications to health, patient care and biomedical research.  In addition to the research track, there will be practice and business tracks.  And it all takes place in the new $90 millon Li Ka Shing Center for Learning and Knowledge.  My pulse is quickening.

Medicine 2.0 is shaping up as a who’s who of social medicine.  Speakers include:

• Jennifer Aaker PhD, a professor at Stanford’s Graduate School of Business and author of The Dragonfly Effect.
• Lee Aase, head of The Mayo Clinic Center for Social Media.
• Charlie Cheever, co-founder of Quora and formerly with Facebook and Amazon.com
• Thomas Goetz, MPH, executive editor, Wired magazine; author of The Decision Tree.
• Abraham Verghese, MD, bestselling author and professor of medicine at Stanford.
• Susannah Fox, Pew Internet and American Life Project
• Jay Parkinson, Futurewell
• Berci Mesko, Webcina
• BJ Fogg, Director of the Stanford Persuasive Technology Lab
• David Peskovitz, BoingBoing
• Phil Pizzo, Dean, Stanford School of Medicine
• Sean Handel, EVP, Epocrates
• Alan Greene, HealthTap.
• LeRoy Heinrichs, Cofounder, Clinispace
• Denise Silber, Doctors 2.0
• Wendy Swanson, SeattleMamaDoc
• Amy Tenderich, Diabetesmine
• Paul Wicks, PatientsLikeMe
• Dan Zarella, Hubspot
• Howard Rheingold, Social media visionary, Stanford.
• Paul Costello, Director of Public Affairs, Stanford.
• Michael Conlon, VIVO Project PI.
• David Gaba, Immersive Learning Pioneer, Stanford

Hope to see everyone there.  I should be easy to spot. I’ll be the excited guy in the front row.

Medicine 2.0 is an annual conference that was convened in Toronto in 2008 and 2009, followed by last year’s event in Maastricht, Netherlands. Medicine 2.0 was started by Gunther Eysenbach MD, MPH, an associate professor of health policy, management and evaluation at the University of Toronto and editor and publisher of the Journal of Medical Internet Research. He is also a member of the scientific program committee for this year’s event.