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.

 

I woke up this morning to a couple of DMs from physicians alerting me to the Twitter thread seen below (tweets read bottom to top).  Is it unprofessional?  Decide for yourself.

Whether you change details or not, the use of the social space at the comical expense of those we’re called to treat is irresponsible.  While the detailed depiction of the patient’s problem is bad enough, the suggestion that you would have somehow ‘fixed’ the situation long before 36 hours is reprehensible.  This is something I’d expect from a frat house, not a treating physician.  Of course this level of dialog could only be sustained by someone hiding conveniently behind the cloak of anonymity.  Case in point for putting your name and maskless face behind everything you say.

Concerning doctors and public dialog, if the crowd doesn’t look after things, someone else will.  But I shouldn’t complain.  This sort of stuff gives me fodder for my next presentation.

What say you?

Comments to this post without a proper name and link to a digital property (Blog, Facebook, Twitter, etc) that identifies you as a palpable human being will be deleted.

Comments are now closed.  There are an amazing variety of views below as well as a number of ongoing conversations throughout the infosphere.

 

It seems for many doctors Twitter activity is an outpost connected to some other online place.  48% of physicians on Twitter link to their blog according to Katherine Chretien’s recent study published in JAMA.  Doctors apparently understand that different types of information flow better in different channels.

If you had asked me I would have estimated that this Twitter-blog association was much lower.  Of course I like to believe that I understand the social doctor better than I actually do.  And this is why we need original research like Katherine Chretien’s.

Image via Art Designer

 

When perusing my Twitter feed this morning I stumbled on this post directed to me.  Patients reaching me in public social spaces is becoming a regular thing.  I’ve discussed this in the past but I think it bears repeating.

So here’s what I did:

I understood mom’s needs.  Patients resort to ‘nontraditional’ means of communication when the traditional channels fail to meet their needs.  Recognize that these patients (or parents in my case) are simply advocating for themselves.  My specialty struggles with a shortage of physicians.  So we’re dependent upon phone triage to sort out the really sick from the less-than-sick.  It’s an imperfect system and consequently parents find themselves having to speak up when the gravity of their child’s condition hasn’t been properly appreciated.

I took the conversation offline. I don’t discuss patient problems in places where others can see.  So my first order of business in this case was to get the conversation to a place where it can be private.  I called mom, found out what was going on and rearranged her appointment to a time appropriate to the child’s problem.

I dicsussed why public dialog of health related issues may not be a good idea. Of course it’s the right of any patient to discuss their issues anywhere they like.  The difference is that once you engage in a relationship with a doctor you then have to consider the interests, needs of concerns of the treating physician.  And I’m not comfortable with public discussion of patient-specific issues, even if okay with the patient.

The biggest concern stems from the fact that platforms like Twitter severely limit the extent of the dialog.  Details get lost and its hard to tell if the patient really understands what you’re saying.  Then there’s the issue of documentation.  My peers and colleagues need to see what happened between us.  Twitter and Epic don’t talk.

And many patients aren’t aware that direct @ messages and DMs are not private.  Many people can access this information.  Depending upon the nature of the problem patients may not want this information released into the public space.

In this case specifically, the mother was not aware that her message was public.  We discussed this at length and she was excited that this case and her tweet could be used as an example.

I documented the encounter.  I created a phone note and documented the nature of encounter including the fact that the parent had initiated public contact.  I also note that I discussed the issues with public dialog and brought the patient up to speed on how I prefer to be reached.

Again, all of this is done in a way that respects the intent and needs of the patient.

Interestingly this is exactly what I do when I bump into someone in the grocery store or cocktail party who wants to talk personal issues.  Beyond something really simple I encourage that we pick it up in a place where I can give them the attention that they deserve and where all of it can be documented in the medical record.

If you’re a socially active doctor, what do you do when patients make public contact with specific health-related issues?

 

This week marked the start of my third year on Twitter.  When I announced this a couple of people have asked me to elaborate on how I use Twitter.  Specifically, how do I use it to bring in information that works for me.

I don’t know what’s right or wrong but I do know what’s logical and realistic for me.

Here are a few thoughts:

I use Twitter as an inbound tool.  My ratio of listening to posting approximates 500:1.  Listen more, talk less.  I try to share back only what I find remarkable.  If you follow me I’ll try to respect your attention.

I try to follow people who are smarter than me.  I’m only as smart as the information I take in so I recruit good people to bring me the information I need.  Those I follow create my human signal.  They’re my curators.

I find people to follow from the people I follow.  Smart people attract and talk about other smart people.  Lather, rinse, repeat.

I constantly test and sample.  I’m always trying people out to see how they fit.  I’ll follow people, find that they’re noisy and unfollow.  Another may represent an amazing addition.  Like dating you’ll only know what you like and don’t like by trying it out.

Follow me if I help you.  Whether those I follow are following me is irrelevant.  It doesn’t influence how good their feed may be.  And you should only follow me if I offer something of value to your stream.  The sooner we all get over this issue of obligate refollowing the sooner we’ll see Twitter change from an instument of narcissism to one that make our lives truly more productive.

I keep an A-List on Tweetdeck.  I frequently scan my core feed so long as I’m not writing, seeing patients or with my family.  I also keep an A-list.  This is my concentrated core of people who at this point in time are of special interest to me.  When I first follow someone I think may bring important information I put them on my A-list.  My A-list consists of no more than 3-4 dozen people so I can be away from my computer and still catch their feed hours later.  This ultrapurified feed changes week to week.

I talk to lots of people I don’t follow.  There are plenty of people I meet and talk to who I don’t follow.  Sometimes I wind up following them once I learn what they’re about.

There’s more to life than medicine.  I explore different verticals.  My most creative ideas come from non-medical people.  At social media meetings I’m most interested in hearing what’s going on outside of the health world.  It’s my chance to hear a different perspective.  I listen to smart folk in marketing and communication.  I listen to creatives.  I’ve got motivational types and daddies.  Smart, successful writers help me understand how I need to be functioning to be successful.  I’ve got a few funny people.  And there are some old friends I’ll never let go of no matter how noisy they get.

I don’t fight interest migration.  Your interests, motivations, and needs will change over time and what you do with Twitter should reflect that.  You should allow your feed to be plastic enough to match those changing needs.  Don’t be afraid to declare that you’re moving on and changing direction.

What’s important to take home is that you need to shape Twitter the way you need it to work for you.  I’ve heard it too often: “I’m overwhelmed.  I’m feel like I’m feeding from a fire hose.  Help me. Good God, someone help me.  I’m a victim.”

Help yourself and stop listening to all that nonsense in your feed.  Forget decorum, hurt feelings and the habits of the almighty gurus.  Fashion Twitter to work for you, not overwhelm you.

One last thing:  Twitter is changing, I’m constantly evolving, and my view of this transient little medium may likely be different in a year.  So don’t quote me.

• If you liked this you might like… To Unfollow is Human

 

Someone recently asked me how I choose my followers on Twitter.  When I offer an opinion on how I use Twitter, keep in mind that I don’t represent a hospital, business or Fortune 500 brand.  What you do as a marketing professional on Twitter may be very different from what I do as a free-range physician.

I follow:

1)  People who bring me information I can use.  Twitter has evolved as my human signal.  If something’s important my stream will let me know about it.  I try to keep it pure.  I avoid noisy folk.

2)  People with whom I have some kind of meaningful relationship. I’ll follow and connect with my closest contacts if they take to Twitter.  Even here, however, I’m selective.

When I think of Twitter I think inbound rather than outbound.  I put almost all of my attention on who I follow and very little attention on who follows me.  I do more listening than talking.  We need more of that.

Is that selfish?  Not at all.  It’s how I use the tool.  I do share and create but its disproportionate to what I consume.  With regard to my outbound stuff, I like to think that I create value by sharing links that are remarkably good.  Socially I think more horizontal than my peers in social health.  So I often pull in content from other silos in the infosphere.  I offer dry, sarcastic humor if I’m in a mood.

I find the reciprocal follow to be nonsense.  When I follow someone I want their content; there’s no expectation that they have to be interested in me.

As I evolve, how I communicate evolves.  So this is all subject to change.

 

Yesterday some of us participated in the flagship physician Tweetchat (MDChat).  Or better, I tried to participate between finishing up some calls and choking down a bean burrito.

When the idea was initially proposed to me I committed only to supporting its initiation with the occasional role of host.  I’m simply overcommitted but wanted to support Phil Baumann and those who were willing to try to break new ground.

So I lurked, chewed, and pondered.

Doctors or not, everyone knows I’ve been a pretty lukewarm proponent of the tweetchat.  I think they’re noisy, difficult to follow, and too abbreviated for constructive dialog.  As early adopters I think we tend to put the novelty of the medium above its practicality.

With that said, chats can be fun.  It’s a situation where I feel comfortable while at once restless.  Kind of like at a medical staff meeting where the agenda doesn’t hold me quite as much as just being among my friends.

At the end of the day I might agree with Dr. Anonymous that the average physician new to social media might not find a twitter chat as the best way to spend a precious hour.  For me that hour represents the better part of a blog post which, over the course of a month, will influence hundreds of readers and live forever.

But I suspect that there will always be those among us looking for companionship over content.  And it’s hard to argue with that.

 

I can’t say I understand it when major brands choose to represent themselves as logos on Twitter.  Case in point is Sharpie.  For the past couple of years I have been a huge fan of Sharpie Susan, the twitter persona of the Sharpie brand.  Sharpie Susan was spunky and quirky, occasionally noisy, at times unpredictable, but definitely fun.  She not only talked about which rock stars were using customized Sharpies but occasionally chimed in on what her daughters were up to.

Yesterday I noticed she was gone.  The account had been replaced by a Sharpie logo and the name changed simply to ‘Sharpie’.  When I inquired I received back a tweet informing me “I’m just Sharpie now, like Cher or Madonna.”  I thought to myself, “that was supposed to be cute but it really wasn’t.”

Give me Sharpie Susan.  I don’t talk to no stinkin’ logo.

I understand that none of this is health related but it’s a small lesson in how this all works.  Ultimately this social stuff comes down to human-to-human dialog.  Sure there’s risk when an individual represents a brand.  We all know that.  The human element is unpredictable.

Logo avatars on the other hand are safe and clean.  Sterile.  They also happen to be worthless when it comes to the conversation I seek.

If you want me to listen, give me someone I can talk to.

What say you?

 

Last night Susannah Fox put up the Bat Signal.  It seems she’s been charged with addressing the American College of Surgeons next month and she’s looking for some creative input from the medical social community.  Not surprising, really.  Interest in social media among physician groups is growing fast.

I thought it might be worth sharing a few random thoughts on the care and handling of the physician audience.

Doctors think in 1.0

Remember that the average physician is naïve when it comes to social media and its role in health.  Most physicians see e-patients strictly as consumers.  The concept of true socialization and active involvement by patients and physicians will likely be foreign to your audience.

With that said, you’ll get more mileage with a thorough, basic discussion of what this is all about and why it will change healthcare more than you will with a detailed how-to-do-it dialog.

A doctor is a doctor

Don’t sweat the audience.  While you could probably come up with some tailored, specific examples for surgeons or OBs, the core social issues for physicians are not specialty-specific at the introductory level.  In social terms, a doctor’s a doctor.

Raise your expectations

Based on their anemic adoption we sometimes think that doctors are resistant to the idea of social media.   I remember speaking this summer to one of the local medical societies in West Texas.  The audience was much older than I had expected and as I waited I prepared myself for resistance to what I had to say.  But, in fact, the opposite happened.  This audience of older generation physicians saw social as a way to potentially bring medicine back to its focus on connecting with patients.  Who knew?

Even if slow to adopt, physicians are intrigued and increasingly interested in social media’s potential.  We’re a malleable group.

Manage their expectations

It should be understood that we haven’t figured out where and how doctors should make social work for them.  Let’s face it, it’s time consuming and the applications that measurably impact care are few and far between.  The power lies in the potential that comes once we have the entire physician population in the loop.

And be careful of selling the fantasy:  While it makes great fodder for the media, selling “live tweets from the OR” as the saving grace of the next medical generation won’t win over any physician audience.

What keeps doctors up at night

As you think about your physician audience, consider why none of them have blogs or are found on Twitter:  1) Physicians naturally have issues with transparency 2) they haven’t got time and 3) they have concerns over liability and privacy.

But transparency is generational.  Time you can’t fix.  And issues surrounding patient engagement in the public forum are educational.

This patient contact issue and the theoretical potential for liability is a huge preoccupation.  I’ve found that a lot of physicians believe that their social entree obligates them to discuss patient issues in public.  I always convey my bias (possibly a slowly evolving standard):  discussion of patient-specific issues in public forums is off limits; discussion of patient non-specific issues is encouraged. Any attempt at patient-initiated discussion of specific medical issues immediately goes offline and onto the EMR for issues of record, liability and safety.

Doctor-patient dialog surrounding individual care should be limited to HIPAA compliant networks that integrate with the EMR.  I like to cite HelloHealth as an early example of this model.  The screen grabs always wow the crowd.

And if you can discuss an ethical dilemma or two you’ll have the academic elements of your audience drooling.  Bring towels.

Physicians have an obligation to be in the online space

Maybe I get away with it because I wear a stethoscope, but I always tell doctors that they have an obligation to participate in the dialog.  I always use autism and vaccines as the example.  The search engines in this regard are ruled by a loud, vocal minority linking vaccines and autism.  Consider that the American Academy of Pediatrics has 60,000 pediatricians.  If each of them were involved in the creation of some kind of content with reliable information, we would rule the search enginges.  Powerful stuff.  Always has an impact.

Think mobile

It’s estimated that some 81% of physicians will own a smart phone next year and mobile may be the segue into soft social adoption for many MDs.  Touch mobile and win your physician audience.

Tweet by example

One of the most powerful take home messages I pass to physician audiences is to study other doctors who are in the space.  Spend time watching and listening before taking the leap into the public forum.  I encourage people to look at what other doctors are doing and see how it applies to their setting.

Remind them to cultivate their digital footprint

I look at my role with physician audiences as one where I seek to motivate and empower.  And that’s when I feel rewarded. The idea that they can potentially control their digital footprint has huge value.  Ask the audience to do a vanity search and remind them that their reputation is under the control of sites like Healthgrades.  Remind them that they themselves are actually in control what people see when they are searched.

I encourage them to get started with a LinkedIn profile for one thing.  It’s soft social and a nice entrée into an online identity.

I’m not Joe MD

In a strange way I have to warn you to be careful of my advice.  Docs like myself and Howard Luks and others see the world through a very different lens than the average internist or general surgeon in middle America (who I refer to as Joe MD).  When thinking about our approach to the digitally naive physician we have to be careful about how we apply what we know about those of us who have already arrived.  Keep it basic and remember where they’re at.

Finally, I should say that Susannah Fox’s willingness to reach out to the physician community is a testimony to her understanding of how this social stuff is all supposed to work.  Even when we don’t know exactly how to approach something, there’s always someone who does.

I could go on all day.  What else would you add?

 

Lately there’s been talk of a tweetchat for doctors.  The issue has surfaced on Twitter over the past couple of weeks.  The idea is out there – the genie’s out of the bottle.  There will be a tweetchat for physicians.

But I’m not sure we need it.

We may want to think about why we need a Twitter discussion group and what we’d like to get out of it.

I look at tweetchats like I look at medical meetings:  I go to see old friends in one place.  Most of what’s discussed was public long before the meeting.  The most interesting stuff happens in the hallway.  With that said I still go to medical meetings.  But it’s usually to cultivate relationships.  And tweetchats do accomplish that.

I like to participate in tweetchats to see who shows up.  I like to look at how people behave, how they meet the challenge of open-ended questions in the limits of 140 characters.  It’s really interesting to watch those who think they have the answers.  I like to see who actually takes the process so seriously that they can’t crack a joke and have a little fun (this tells me the most).

But I have to ask: Is what happens during a tweetchat parallel broadcasting or conversation?  I might suggest that the nature of the medium facilitates parallel broadcasting.  You have to admit that it’s hard to make substantive commentary in 140 characters with 20 people simultaneously answering.  The process devolves into a battle of one-liners where the effort is to keep up rather than absorb and learn.  Sub-dialogs evolve that, while interesting, distract from the core topic.

Mitch Joel at Six Pixels of Separation wrote and interesting post last week suggesting that despite how we may think of ourselves and our digital world, real conversation may be going out of style.  We’re devolving into a community of broadcasters.  It’s worth a read and may have some corollary to this discussion about twitter meetings.

The thing is that while there may be measureable benefits from tweetchats we have to decide whether this represents the best use of time for physicians (or anyone for that matter) who’s social involvement is primarily limited by the clock.  I struggle to maintain a balance of commitments to my family, my patients and the development of new ideas.  One hour is one core idea that never gets shared on this blog.  But everyone’s different.  And for me the frustrations of Twitter as a discussion platform outweigh the benefits in many cases.

We shouldn’t confuse the importance of getting doctors together with the importance of getting doctors together for dialog on Twitter.  Let’s not forget the dynamic conversation that can happen around blogs when everyone participates.  This week we saw KevinMD take a step to organize dialog within LinkedIn.

Tweetchat for doctors will have its day.  When it starts I’ll be there.  But look for me in the hallway.