If you pay attention to medical Twitter you’ll notice the creeping emergence long threads and clustered Tweets over the past few months. It’s long-form Twitter. This was evident during the discussion around the release of the CABANA trial – the study drew a strong response from cardiologists on Twitter who, despite the finding, were divided on the role of ablation in the treatment of atrial fibrillation (for the long skinny on CABANA, read Dr. John Mandrola’s take over on Medscape.)

Coping with CABANA

And it wasn’t just Twitter’s cardiology microcelebrities but everyday doctors who were otherwise less visible or less apt to weigh in (at least to my badly filtered eye). Jay Schloss, one of the Twitter cardiology commentariat, made the call that the discussion threads probably needed to be constrained to a couple of days. The dialog it seemed was so robust it just couldn’t be properly followed in this format.

Twitter as a place for threads, or chunk streams

Here Howard Luks, one of medicine’s great public translators of orthopedic information strings together a sequence of Tweets on the role of diagnostic imaging in middle aged folks. As Twitter demonstrates and describes, “A thread on Twitter is a series of connected Tweets from one person. With a thread you can provide additional context, an update, or an extended point by connecting multiple Tweets together.”And as Howard shows in this thread, clustered chunks can get real engagement. We’ve all seen this threading used more regularly over the past few months for editorial thinking.

(For the communication wonks here’s what Harvard Business Review said about communicating in chunks back in 2013.)

What’s facilitating the rise in long-form Twitter?

Why are we seeing this? Beyond the availability of threading functionality, my guesses are:

• 240 characters. 280 characters has created the space for more opinion. Stating your case in 140 characters was challenging for a lot of us. 240, for better or worse, makes it easier to make your point.
• Clustered Tweets. As Howard Luks did above, we can block together ideas in a sequence that can bee seen and shared together. What 280 characters can’t do, 2800 can.
• No other place to go. I can’t help but think that the itch to render an opinion leaves most public physicians without much of a place to connect. Facebook never quite took for health professional connection. And we have yet to see a successful ‘social network’ for doctors. Twitter remains the default platform for this kind of back-and-forth, not because it’s good for that but rather we have nowhere else to go.
• Critical mass of health professionals. But doctors have been on Twitter for over a decade. But social networks need a critical mass in order to bring value. My friends at the W2O Group and Creation, two of the premier companies that track physician conversations tell me that despite a general slowing of adoption over the past couple of year, the numbers of doctors on Twitter continue to rise.
• Rising comfort with public conversation. Beyond just numbers, perhaps more of us are willing to step up and speak out. Whether its comfort with public dialog or critical mass effect isn’t clear.

Social engagement like the days before social

Seeing some of the back and forth reminds me of the comment sections of blogs before social media existed. These comment threads went on for pages, it seemed. I remember refreshing these comments during down time between patients just to see what was new. It was the only place in the world where we could have a back and forth conversation (literally).

After Twitter and Facebook rose in popularity the conversation that was once limited to comments moved into social media.

The eclipse of physician conversation

But it was never really the same. What Twitter offered with its constrained format wasn’t enough. And offsetting comments from blogs to Facebook as many suggested would happen just never materialized. The doctors dispersed, the threads dissolved, and Twitter morphed into an information/broadcast stream more than an engagement medium.

And many physicians who had created the raw weblog material that facilitated comments abandoned blogging altogether for the new frontier of social.

Sure there was back-and-forth on Twitter but not like those blog conversations.

Are physicians looking for a unified platform?

If you look at what’s happening I can’t help but think that there is a latent demand for a place and space for professional dialog. Long-form Twitter is filling the bill for now but I’m not sure it’s built for speed.

Further, Twitter as an information and conversation stream remains a poor choice for the placement of enduring content – that is the stuff that we want people to search and find. A longer form idea will likely do better in the long run on a searchable WordPress site or Medium than in the transient stream of long-form Twitter. I’ve seen some brilliant stuff in 15 tweet sequences that, unless archived somewhere, will get swept away in the stream.

I opposed the move to 280 but I think it’s had some interesting consequences. It is facilitating more meaningful dialog despite the potential format difficulty that comes with volume.

Nonetheless, despite the riches of the internet, all this suggests that there is a clear latent demand for places and spaces for doctors to gather, debate and publish ideas.

Maybe it’s time to bring back my comments on 33 Charts.

Image via Samuel Zeller