@DrVes
@DrVes
@DrVes
@DrVes
the meaning of the video is not clear and those individuals often lose faith in the medical system. There have been cases where patients have refused care by a residency trainee after seeing their Facebook profile with images that don’t seem suitable for their doctor.
As important as this is, academics requires junior faculty members to quickly become known on a national stage. Annual meetings are a great way to do this, but they only occur, well, annually. Social media allows me to meet people throughout the year and develop connections that I would never have the opportunity to create.
Anonymity definitely has its place, but total anonymity? Apparently, not if you want to matter.
When it comes to health care and communications technology, in some ways, we are still trying to figure out what's right and what's wrong, and where to draw the line. It's an important discussion that's not to be taken for granted.
In an era of increasing information overload, the filter is a necessary and valuable tool and we’re only at the beginning of the technology curve. In the context of health, filters are critical to improving the effectiveness of the rising class of e-patients.
I networked with other bloggers, went to blogging conferences (after at first scoffing at them--who would go to a blogging conference??? Lame. I've realized, since, how much I love eating my words, or at least, embracing being lame.). I am not sure when my affinity for using parentheses developed.
I have seen and read countless articles, ideas, and opinions that I wouldn't have found without Twitter. Yes, it takes a little time to find good people to follow, and it then takes a little time to actually follow them. But the pay-off in new ideas and inspired thinking is marvelous - far better than the same amount of time on Facebook
Sadly, a crank has silenced another skeptic.
Many of you may know EpiRen, which is the Twitter and blog handle (and sometimes commenting handle here) of René Najera. René is an epidemiologist employed by the state public health department of health of an East Coast state and has been a force for reality- and science-based discussions of medicine, in particular vaccines. In fact, he’s come out as a strong defender of vaccines against anti-vaccine lies.
Unfortunately, EpiRen is no more, at least online; that is, if he wants to keep his job.
As related to my by Liz Ditz, A Public Servant, Blogging and Tweeting Under His Own Name, Has Been Silenced By His Employers:
Last weekend, Mr. Najera had a heated exchange with a pharmaceuticals “entrepreneur”, Mr. X– I put that in quotes as Mr. X. made some claims that don’t stand up. Mr. X also made a series of ad hominem attacks on Jen Gunter MD, to which Mr. Najera responded.
Rather than responding to Mr. Najera, Mr. X escalated in a particularly virulent way. Mr. X sent a series of emails–complaining about Mr. Najera’s opinions, complaining about Mr. Najera’s defense of vaccination, and threatening legal action–to a great many people senior to Mr. Najera in his department — starting with Mr. Najera’s immediate superior. Mr. X was able to do so because Mr. Najera was blogging under his own name, named the state in which he worked, and because the name René Najera is rather uncommon — especially in a small, East Coast state.
The result was, unfortunately, predictable. René was ordered by his superiors to cease all blogging, Twittering, and other social network activity related to public health. Having just last year been the subject of an e-mail and telephone campaign to try to get my university to fire me for my online activities, I completely sympathize with what René went through. Government and corporate organizations can be completely obtuse about the Internet, blogosphere, and the new social media, and, quite frankly, what one does in one’s own time should in general not be so restricted. That I’m fortunate enough to work for a university that values free speech for its faculty (the dean herself called me to assure me of this) does not mean that others are that fortunate.
It turns out that the person responsible for silencing René showed up in the comments of Liz’s post. Not only was this person gloating, but he immediately started threatening other anonymous/pseudonymous commenters who started criticizing his actions and whose opinions that he didn’t like. Here is his comment reposted in its entirety, with no editing:
i am mr. x; first, i am not anti-vax; second, i didn’t want epiren to stop posting, but rather to take down the defamatory blog; third, i am not done going after every individual who defames me.
you think you are safe, but all i have to do is file a john doe – or hire a cyber investigator. these courses of action cost less than $10,000 each; which means every person who is afraid of the light can be exposed.
i will not tolerate harassment, defamation, or any such action by any of you. i am very aware of all of you, and have the capital and the will to go after each and every one of you ONLY IF you defame or slander me.
i am self employed if you count owning 11 pharmaceutical companies with cum gross sales over 1/2 billion.
His very next comment continued his threats:
and just so we are clear. the next person on the list is anarchic teapot. i’ve already hired two firms to track him down.
I encourage my readers to peruse the comment thread there to see the rest of his comments. They degenerate from there, down to a poorly written, spelling error laden threatening letter to Liz. Sadly, this is a very typical reaction of someone who can’t win a debate based on science, facts, and logic. I know, as I’ve experienced these sorts of threats several times over the last six years. Indeed, the identity and goals of this particular crank are utterly unimportant, as his he. For purposes of this post, he serves only as a conveniently timed example of what can be the consequences of blogging under one’s own name. This pathetic bully is simply a convenient villain whose actions demonstrate far more clearly than words why a blogger might wish to blog under a pseudonym.
A favorite tactic of cranks trying to silence bloggers is what this particular bully did to succeed in silencing René: Start a campaign of e-mail complaints to the blogger’s superiors and coworkers at his place of employment. The first time that happened to me was in 2005, when a man named William P. O’Neill of the Canadian Cancer Research Group sent threatening e-mails to my department chair, my cancer center director, my division chief, and me. Fortunately, no one really cared (seriously, his complaint was simply that I happened to like Peter Bowditch’s criticisms of various purveyors of pseudoscience), and soon afterward every time he sent me a threat I would tell him that I was forwarding it to my aforementioned bosses. And I did. Particularly satisfying was how my then-chairman told me this guy was obviously a bully and to ignore him. Last summer, Jake Crosby over at the anti-vaccine crank blog Age of Autism wrote a post trying to paint me as hopelessly in the thrall of big pharma, and as a result AoA minions, flacks, and shills began an e-mail campaign to the board of directors of my university trying to get me fired. Fortunately that went nowhere, but it did cause me serious agita, particularly when the dean called me about it–at least it caused me agita until I realized that it was a call of support.
Oddly enough, not long after this kerfuffle erupted, our cyberbully took down his blog, Twitter account, and YouTube channel. Interestingly, though, he also appears to have eliminated access to his full name on his LinkedIn account. Personally, I find this puzzling, but maybe this man does have some shame after all.
Many of my readers know that the issue of pseudonymous blogging at ScienceBlogs has come to the forefront again. What certain corporate types appear not to understand is that the problem with combatting pseudoscience is that cranks don’t play fair on social media. When they start losing or when criticism starts to sting, many will just slink away. However, there is a significant minority who are bullies. This significant minority will try its best to silence skeptics and supporters of science using any and all online tactics. One favored tactic is frivolous lawsuits, examples of which I’ve documented here time and time again.
So why am I writing this? My purpose is simple. I want to use this unfortunate recent event and my own experience as an example to demonstrate that there are valid reasons why people choose to blog, Twitter, and comment using pseudonyms, and those reasons usually do not involve hiding from responsibility for their words. All too often, they involve wanting to take reasonable precautions against people like William P. O’Neill, Jake Crosby, and EpiRen’s tormenter. As another commenter, Corinna Becker, put it:
I completely understand the reasoning behind why people would use a pseudonym, to protect oneself and one’s family from potentially harmful situations as has been played out with EpiRen, to far worse and more dangerous threats. I myself am in a position where I can afford to use my real name, and value the transparency for my readers, but completely understand the reason why some level of anonymity is needed for people.
In a way, Mr. X has provided us a great example of the risk and benefits of anonymity when blogging. So thank you, Mr. X, for being willing to step up to the job. However, I find it a great shame and a disgust that you would target such a valuable source to the global community at large.
For all too many bloggers, the consequence of not taking such reasonable precautions is to meet the fate of EpiRen.
ADDENDUM: P.Z. Myers has weighed in.
ADDENDUM #2: Elswhere, our litigious bully still doesn’t get it:
oh, i think it’s too late for Rene. Unfortunately, you all have made such a stink that I am not sure he’s going to last long.
in fact, I think the only thing that would save him would be for someone to sue him and his employer and force his employer to defend him and retract the whole thing.
if anyone’s got any suggestions, let me know. I’m on your side. This unjustice against Rene has got to end, and NOW!
I’ve heard that a few academic medical centers, the identities which I will keep anonymous, are advising incoming medical residents to stay off social media. Meaning, they have to close their blogs, and shutter their Twitter or Facebook accounts.
As hospitals and doctors try to best use social media, and prevent damage from its improper use, taking the extreme measure of forbidding doctors in training from utilizing social is heavy handed, short-sighted, and, in the long run, will set doctors back in the increasingly influential online space.
I can understand that, from a hospital’s standpoint, the damage that a single person can bring to an institution is considerable. Consider the recent episode where a Rhode Island physician’s Facebook posting brought the hospital national infamy.
And in JAMA, there has been a study documenting that a small minority, 3%, of physician Tweets were inappropriate, with another paper showing a larger number of medical students engaging social media unprofessionally.
But utilizing social media properly gives physicians a powerful voice, and can help them build a positive, influential online persona. When these residents graduate, patients will be looking for them online. Physicians need to control their own digital footprint, rather than a third-party or a for-profit entity.
And prominent physicians in the social space, like Bryan Vartabedian, Wendy Sue Swanson, and Vineet Arora, give their respective institutions a physician-branded credibility that’s essential for trustworthiness online.
Casting social media in a negative light will only stunt physician adoption of blogs, Twitter, and Facebook. While hospitals probably see this as an negligible trade-off in order to protect their reputations, it’s outrageously selfish, and will make doctors even more tentative online. This puts them at a disadvantage at a time when patients expect more of their health care to involve the web, and, perhaps in the future, social media.
Instead of an outright ban, academic institutions need to bring their culture into the 21st century, develop reasonable social media policies, and educate their staff. It’s sad that social media is seen as a threat, while the considerable benefits of proper physician social media use can bring are ignored.
I’m often asked by hospital administrators, “How can my hospital be more visible in the social media space?” I explain that doctors need to lead the effort, not PR or marketing. Support doctors 110% in your social media efforts, and everyone will reap the rewards that will bring.
It’s unfortunate that some are taking the opposite tack. Banning physician involvement strikes me as poor strategy which will set these institutions back in the long run.
Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, and LinkedIn.
By 2010, 60% of adults in the UK were using the internet every day or almost every day, and this figure continues to increase.1 Although the use of the internet is becoming increasingly common in areas such as e-commerce and social networking, health systems continue to lag in their use of such technology to communicate with patients.2 The conflicting opinions expressed in the World Report by Sharmila Devi (April 2, p 1141)3 only extend the confusion around the use of social networking for communication with patients. We need a more pragmatic approach to the introduction of new technologies. As well as seeking to produce new evidence, we should be using current evidence on how social networking might be used to improve communication with patients.An alternative approach could involve considering the use of social networking in terms of wider clinical behaviour. Would you consider searching for additional information on your patient if the internet did not make it easy to do so with one click? Would you socialise with patients out of choice in a personal capacity? Would you feel threatened by your patients talking in the waiting room about their differing treatments? Most clinicians would feel confident in answering these questions.
Concerns about the effect of new technology on the doctor—patient relationship were probably being expressed when telephones were first introduced more than 100 years ago. Rather than viewing new technology as a threat, we should use the opportunities it offers to improve the efficiency and effectiveness of health systems and to improve people's knowledge of their health and illnesses.
We declare that we have no conflicts of interest.
Sharmila Devi1 airs the ethical dilemmas surrounding the use of social networking sites by health professionals. Last year we formed a group of representatives from the Australian Medical Association, the New Zealand Medical Association, and the Australian and New Zealand Medical Students' Associations, and produced guidelines on the use of social media by medical professionals.2Our guidelines explore the issues that social media present for doctors, such as confidentiality and doctor—patient boundaries. Rather than prescriptive advice, we present scenarios and discuss the potential ethical and practical implications to educate readers. Unlike our American counterparts, we have not explicitly advocated the formal reporting of unprofessional online behaviour; instead we encourage medical practitioners to notify colleagues discreetly themselves.
Looking ahead, we believe that more research is required, particularly into the changing relationship between health-care providers and patients, as social media acquires a more prominent role in society, and into potential uses for social media in the delivery of health care. Although change is inevitable, maintenance of professional and ethical standards is essential to protect health professionals and patients. We will update our guidelines as more evidence emerges, and look forward to what transpires from other groups working in this area.
We declare that we have no conflicts of interest.
Mayo Clinic offers intensive 2-day "Social Media Residency" training for a fee http://t.co/HUXqN6D
— Ves Dimov, M.D. (@DrVes)
Doctors and the Old TwitterJune 18, 2011
There’s a temptation to think of Twitter as it once was. As recently as 3 years ago there were very few physicians using Twitter. Early physician adopters enjoyed a tighter experience than today. Everyone followed everyone and actually finding another doctor was cause for celebration. It was a cocktail party – less a tool as much as a place to goof off. It was easier in many respects.
But Twitter seems to be evolving from a curious toy to a more focused space of sharing among the like-minded. I see new docs play out this broader evolution of Twitter: near obsessive early preoccupation gives way to the question of how it can actually work for them. Experimentation with relationships gives way to connections that are more likely to give us what we really need.
We’ve hit a point where many physicians on Twitter are looking beyond the cocktail party. There are simply too many of us. As a consequence of nothing other than our numbers, we’re increasingly divergent. Values, interests, and motivations vary – we gravitate to the like-minded. In some respects Twitter’s evolving practicality is a good thing. But it comes with a cost. I don’t know how and if it can be countered.
As much as Twitter is different now compared to 3 years ago, don’t get used to it. Things never stay the same.
Pharma emerging markets: what about Latin America and social media usage of pharma companies?Posted 8th June 2011 in Articles, General | Register to comment
Valentina Jaramillo
Investigacion Clinica Latam
Continued from “Pharma emerging markets: what is Latin America’s place within R&D?”
Recently we have seen a lot of movement around the FDA and its policies for the Pharma industry in the use of Social Media. Whether we agree or disagree or think their guidelines could be better at least it is a start.
“Are the regulatory agencies in Latin-American waiting for a final draft of FDA policies so they can implement them?”
I’ve done some research to see where Latin America stands on this area and sadly we are far behind. There are no specific regulations yet for what pharma can or cannot do using social media in the different countries of the region. There’s not much activity of the pharma industry in this territory either. Does it have to do with a corporate policy to handle Europe and the US first and then see how Latin-American can catch up? Is it because we (Latin-Americans) are scared to step up and start using social media within the pharma industry thus making the regulatory agencies in the region reluctant to create any guidelines yet? Are the regulatory agencies in Latin-American waiting for a final draft of FDA policies so they can implement them?
These and many more questions come to mind when I think about the use of social media by pharma companies in Latin-American. There are several interesting projects being carried out by pharma companies using social media in Europe and the US, for example we have Johnson & Johnson, Psoriasis 360 by Jansen-Cilag, Novartis collaboration with PatientsLikeMe and many more. However we don´t see the same in Latin America. Meanwhile, the community of doctors and patients using social media in the region is growing every day, so is pharma missing an opportunity?
“…the community of doctors and patients using social media in the region is growing every day, so is pharma missing an opportunity?”
Latin America is one of the more social regions in the world, according to Comscore in January 2011, 88% of internet users in the region use social media, six of the fifteen principal markets of Facebook are located in Latin-American. Brazil, Venezuela and Argentina are in the top seven countries with the highest Twitter usage. These numbers suggest that pharma companies might be interested in engaging in social media in this region. However, it appears to not be the case, or if it is it is happening it is happening very quietly and goes unnoticed which is the opposite of how social media should work.
This post is a call to attention to the pharma industry to start using social media in Latin America in a sensitive but proactive way because in my personal opinion there are great things to accomplish if pharmasdecides to engage in this way. This is also a call to attention to Latin-American’s regulatory agencies to make them aware of what is to come I hope pharma industries in Latin-American take a stand in the use of social media so that we can start answering all the questions raised.
The next piece in this series can be viewed here.
About the authors:
Valentina Jaramillo DVM is co-founder of Investigacion Clinica Latam. She is also founder and moderator of the twitter hashtag #hcsmla. She can be contacted at vale.jaramillo@gmail.com.
Do you think it’s time for Latin-American pharma to engage with social media?
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60% of responding deans of medical schools reported that medical students had posted unprofessional content online, including: violations of patient confidentiality; use of profanity in reference to specific persons or faculties; discriminatory language; depiction of intoxication; sexually suggestive material; and pictures with illicit substance
Will physicians without an online presence go the way of the horse and buggy? (photo courtesy of searchpictures.net)
Recently, I came across a provocative article by Dr. Kevin Pho of KevinMD.com. The article states that physicians without a presence on the various social media platforms, such as Twitter, Facebook, and blogs, risk irrelevancy. Dr. Pho represents the leading physician authority on healthcare social media and when he makes such a bold and public statement regarding the importance of online engagement for physicians, people take notice.
The Doctor-Patient Communication Disconnect
In another piece, written by Dr. Pho, he cites a study that reported 50 percent of patients do not understand what their physician communicated to them in the course of an office visit. Not surprisingly, over 75 percent of patients visiting the emergency room do not comprehend the diagnoses and instructions their care provider team gives to them. Reasons for this may include health illiteracy, duress, distractions, or time constraints that prevent the patients from asking questions. Regardless of the reason, this communication disconnect does not serve either the patient or doctor well.
The Internet Stands in the Gap
The number of Americans who use the Internet as a health information resource is steadily rising. People would rather surf the Web for answers to their health and medical questions than brave the frustration and inconvenience of a doctor’s office visit. This presents a real and present issue, since a considerable number of sites provide faulty or downright dangerous information. Still, people Google their symptoms and often act based on the information gleaned from the search results.
Most physicians encourage their patients to become engaged in their own healthcare by becoming informed, or health literate. One way patients can do this is to use the Internet as an education tool. The problem arises when patients unilaterally act on this information without the input of their healthcare provider.
Physicians can use the Internet, by building an online presence, to engage in meaningful ways with patients and help determine whether information these patients have found is credible.
Social Media Can Make a Great Physician Even Better
According to Nicola Ziady, an expert on interactive marketing and social media in healthcare at Case Western Reserve University, Dr. Pho is right when he says doctors avoid involvement in social media at their own peril. She says that the rapidly growing movement toward mobile health and the use of electronic medical and health records will cause those refusing to embrace technology in a meaningful way, to quickly fall behind. In a recent article on her Web site, Ziady cites a May 2011 study called Taking the Pulse in which researchers found that 7 percent of U.S. physicians communicate with patients using video conferencing. The study, conducted by Manhattan Research, surveyed 2,000 physicians about their use of technology within their practices, including their use of electronic health records, e-prescribing, and patient communications.
Ziady believes that physician blogs provide a safe, controlled opportunity for physicians to publicize their opinions and engage with patients. Blogs can include video, guest contributions, and links to other sites of note. Ziady has this to say about incorporating video into a blog, ’Video chat is a great way for physicians to communicate with patients.’Beyond Blogs
Twitter and Facebook also offer a great way for doctors to strengthen their relationships with patients. These platforms do not offer the controlled environment of a blog or website; their real-time format requires that participating physicians pay careful attention to professional guidelines and avoiding HIPPA concerns. Ziady points out that doctors can visit the guidelines on the CDC and NIH Web sites relating to proper professional behavior for healthcare professionals participating in social media. Her experience with these sites is that they are very conservative, regarding social media, and offer amazing support for doctors wanting to create a professional online presence.
Will Social Media Have the Final Word?
Doctors without an online presence do indeed risk becoming irrelevant in regards to the networking platforms available on the Internet; physicians who still reject cultivating a presence, whatever the reason, should talk to a trusted friend, mentor, or colleague to get a fresh perspective on their reasoning and concerns about the consequences of remaining out of this popular communication platform. Becoming irrelevant because you don’t have a social media presence doesn’t mean you’re not a good physician in the traditional sense, but maybe it’s your rigid tradition that holds you back from being a great one.
Author Note about Nicola Ziady: Nicola Ziady has over a decade of experience building marketing strategy and solutions in academic medicine and healthcare environments. Read her compelling articles and strategy advice on her website. Ziady’s knowledge and experience will keep regular readers informed and ahead of the game when it comes to social media healthcare.
@beRt_MD right. v important to know. all tweets are dated and timed, some have locations too. rules are not tricky but you have to know them
— Ves Dimov, M.D. (@DrVes)
Warning… this is not going to be a mind blowing post … but this a message that bears repeating. This is also a message that should resonate loud and clear with providers, institutions or members of the healthcare enterprise world who are ruminating over the upsides — and potential downsides of a wide reaching, multiple digital property~ *social media* presence.
Physicians, Healthcare and Social Media…
As Ted Eytan found out when he questioned the (anonymous) physicians on Sermo — many physicians are simply not interested in establishing an online social media presence. Why … most state (??with some naiveté??) that “risk” is the overwhelming variable they’re concerned with. Yet, I imagine some of these very same physicians are the same ones with static Web (-)0.5 type platforms who state that they “are the best”, the premiere practice”, utilize state of the art modalities, etc. There’s probably more risk involved in their promotional language then a venture along well trodden social media circles where we have *established* and have discussed on multiple occassions what many of the risks entail and how to avoid the landmines that exist .
Many physicians also state that they are not interested in healthcare related social media endeavors because they do not feel that there is a pot of gold at the end of the healthcare-social media rainbow.
Social Media Use in an Active Healthcare Practice…
If the past two week scales or even maintains the level of new patients (7-10%)[addendum 1/26/2012: now averaging 12-15%] entering my office because of my social media presence AND the information presented on my website … then I can emphatically state that the ROI of your time, resources and the presentation of your content in a transparent, meaningful, evidence based (if possible) manner — will pay off quite well for your practice. Perhaps even far more important than that (and a more difficult to measure ROI), the patients will be entering your office far better prepared, far better informed, and far more comfortable. That means they will already have a reasonable understanding of what they might be suffering from, they will be far more comfortable with you because they have seen your videos and are comfortable with your demeanor and presentation —and all this, in the end makes your *job* in the office far more engaging, more productive and more efficient.
So, to recap …. When your blog or website presents meaningful content without the commercialized hype sooooo many marketers are pushing you to use — patients will …
1. Find you ( because of your digital property exposure)
2. Like you (if they don’t like your videos or content, they’re not coming to your office)
3. Probably *trust* you more than a doc they found in the phone book
4. Interact in the office with you in a far more efficient manner since they already have digested the content you presented to them online — which you can re-visit right then and there to reinforce what you have just told them.
5. Dramatically improve your patient satisfaction scores … (data available on request
)
Why Should Physicians Engage in Social Media…
In the end… my presence online is to support the spread of meaningful, trustworthy, evidence based (when available), actionable information and guidance to patients and consumers from around the world. I am personally not looking at my engagement from an ROI perspective… I continue to feel that physicians have a moral obligation to fill Google’s servers with quality content to drown out the commercialized nonsense that exists online today … but for those of you in search of bringing patients in your door — the message here is clear. It works… it’s happening … and it’s the message, social media is only the medium — and the risk is manageable.
Related posts:
Last weekend, I was on a panel for internal medicine residents at the American College of Physicians Council of Associates forum in San Diego. I was invited by Erin Dunnigan and Baligh Yehia, the Co-Chairs of the Council, a position that I have also held earlier in my career. The topic – was about the debate on social media use among medical trainees and whether it was professional. Fortunately, I was lucky enough to do it with my rock star colleague Darilyn Moyer, the program director at Temple, who also moderated last years panel on Mean Girls in Medicine with me.
The Temple chief resident, Brooke Worster, started us off by asking the much debated anathema in medical education – what is professionalism – and if it is in the digital domain, it’s even harder to describe. Then she proceeded to show some videos of medical students that you could say exercise some creativity – from the harmlessly funny to incredibly poor taste and ranging from schools such as UT Southwestern to my own alma mater Washington University in St. Louis.
The questions from the residents were spot on and here were some of the Q&A that followed:
Medical trainees are people too – shouldn’t they able to express themselves in ways using colorful medical humor either in a show or their profile?
The objection is not for class shows and parodies – those have existed since the very first class medical show that took place at the University of Michigan and called the Galen’s Smoker (this year’s name- “Spleen Girls”). The issue is more complicated with public consumption of materials never meant to be seen by a public audience. Then, when a video is seen by a patient, an employer, or another interested stakeholder, alumni, philanthropists, those that donate their body to science (to name a few), the meaning of the video is not clear and those individuals often lose faith in the medical system. There have been cases where patients have refused care by a residency trainee after seeing their Facebook profile with images that don’t seem suitable for their doctor. So, while medical trainees deserve the right to blow off some steam and exercise creativity, it should not compromise their ability to see patients or work in the future.
Shouldn’t we just trust students and residents to police themselves on social media?
The answer here is that while most students are capable of policing themselves, a breach of professionalism on the internet is like a NEVER event – especially if it relates to patient information or trainee information that could result in harm. So, opting for a putting out fires approach will not be effective and it’s important for medical educators to teach students and residents about responsible use of social media. The good news is that the more one uses social media, the more likely they are to be able to draw that line in the sand. Our research shows that superusers, or more frequent users, are more likely to oppose regulation but are also more likely to believe that they are responsible for portraying a professional image. So, by teaching people to use it appropriately, we may actually prevent violations and breaches.
Should schools screen social media as part of its application process?
Interestingly, some students and faculty in the audience advocated for ‘second chances’ and redemption if a student had a inappropriate picture posted since Facebook privacy settings are initially confusing and a student could be misguided initially. But, let’s face it… screening applications for admission to medical school or residency is hard and takes time. People are looking for ANY red flag to set downgrade your application compared to others. Don’t give them a reason. Medicine is not unlike any other industry in which candidates are interviewed to see if they can get the job done and also represent that organization appropriately. If a video is posted that showcases a student in a tasteless parody with your school logo or name in the background, a hospital or residency is not going to want to take that risk with you.
What can medical schools do to protect themselves?
Well, for starters, schools can have a social media policy that highlight that do’s and don’ts in this area. Unfortunately, in a recent study by @kind4kids and @MotherinMedicine, most schools do not so we have room for improvement. The second thing is that schools can also deliver education, not only on the negatives – or how NOT to use social media, but they can also encourage and role model proper use of social media through disseminating course materials, student press, recruitment and admissions, or communicating with their students. A recent post on a new student blog actually has a Poll this week asking students if they would want to receive information via social media and the majority say yes.
What can students do to ensure that their digital image is safe?
This question actually came from a student that has the same problem as me – a person with another name who happens to be garnering attention for the wrong reasons – in my case, it’s someone with my same name who is an ophthalmologist and has been accused of blinding patients and has many negative patient testimonials. So, what can I do – well I initially started on LinkedIn to try to distinguish myself from this person and I also took control of my own digital footprint using a Google Profile to highlight who I am and the links on the web that I want people to see. (You’ll notice my Facebook profile is NOT on my Google Profile).
The same old adage about Vegas applies here- whatever happens on social media stays on social media. Therefore, just like the national dialogue on health information technology, its important for medical educators and trainees to engage in a constructive dialogue and establish policies that both set standards and teach others how to meaningfully use social media.
–Vineet Arora, MD
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I have the distinct honor of wrapping up the online prelude for the SGIM Social Media Workshop “From Twitter to Tenure”. So far we have heard from Alex Smith (@AlexSmithMD) from GeriPal, Vinny Arora (@FutureDocs) from Futuredocs, Bob Centor (@medrants) from DB’s Medical Rants, and Kathy Chretien (@MotherinMed) from Mother’s in Medicine.The previous posts all describe how social media can advance an academic career. Rather than restate many of the same points, I’ll just summarize many of the themes brought up by these clinicians, while highlighting my own personal story.
1. Learning to write: The most important lesson blogging has taught me is that telling a good story is hard, and that I need a lot of practice to become a better writer. That’s why I love blogging as it forces me to write. As opposed to writing for an academic journal, which often takes more than a year from concept to publication, blogging gives me the opportunity to practice my skills on a weekly basis while receiving immediate feedback from my community of peers. This same point is echoed in both Kathy Chretien and Bob Centor’s posts, with Bob stating it very nicely in the following quote:"The most important old lesson is that one must write to become a better writer. Blogging made writing a habit."2. Building national connections: On a day to day basis we all spend most of our time in our local community. As important as this is, academics requires junior faculty members to quickly become known on a national stage. Annual meetings are a great way to do this, but they only occur, well, annually. Social media allows me to meet people throughout the year and develop connections that I would never have the opportunity to create.3. Amplifying your voice: the reason that Alex and I initially started GeriPal was that we wanted a place to express our opinions for everyone to see. We found that the more we wrote the more people read. As Bob Centor wrote in his blog post, this helped us build a brand and also gave us some street cred. For instance, writing on topics that were important to me has led to several interviews with the New York Times.
4. Helping others: As Vinny Arora wrote in her post, blogging has also led me to be an advocate for social media through giving abstracts and workshops on this topic. I was a co-presenter at two AAHPM workshops on using social media to promote palliative care. How did I meet my other presenters including @ctSinclair? You guessed it – blogging. I have also been asked to be part of the AAHPM External Awareness committee thanks to my online presence. Lastly, I get to meet folks like Bob, Vinny, and Kathy at 4:30 today when we give our SGIM ‘Twitter to Tenure’ talk (none of which I’ve actually met in person yet!)
These are just some of the reasons on how social media can advance your career as a health care provider. If you want to learn more, check out the full posts from Alex, Bob, Vinny, and Kathy at:
Sunday - Alex Smith (@AlexSmithMD) on GeriPal
by: Eric Widera
We’ve recently seen a lot of concern in the popular press and the medical literature about the behavior of medical students and physicians on social media sites. Concern that students and physicians may act unethically online is justified, but we need to be precise in our conversations.
My opinion is that the same standards apply to social media as apply to the general behavior of medical students and physicians. What constitutes “professional behavior” is an ongoing debate, with broad consensus and legal backing around certain issues like patient confidentiality, but with much controversy on issues like dress, comportment in public and criticism of the profession.
My fear is that broad policies for behavior on social media risk overreaching. Discussion of a general social media policy can easily start with an issue like patient confidentiality and stretch to cover issues where less consensus exists.
Let’s debate policies that address particular professional concerns like patient confidentiality or public behavior. This approach will force us to be precise in our definition of “unprofessional conduct” and avoid conflating issues under a banner of “online professionalism.”
Bryan Vartabedian, also known as @doctor_V is one of the sharpest thinkers on the crossroads of medicine and social media. His blog - 33 charts – is inspiring, ground breaking and thought provoking all at the same time. Through his Twitter presence, whith more than 5,800 followers, Bryan demonstrates that medical authority does not necessarily have to derive from peer reviewed publications. In this interview, he shares some of his wisdom with the MedCrunch community. Enjoy!
MedCrunch: How did you get started on blogging?
Bryan: In 2006 I was writing a book on irritable babies. At the time, it was suggested that if you were an author, you had to have a blog. And so I started my first blog “Parenting Solved” with the selfish intent of selling books. I remember when the blog was just a few months old, Nestlé and Gerber merged and I published a short piece on the future of baby food. I didn’t think much of it but the post was picked up by one of the major financial feeds in Europe and my traffic skyrocketed. Industry professionals called and wanted to talk. I was shocked. It was then that I realized the power of this platform. It was then that I realized this was more than a gimmick for selling books. But I ultimately became a bit burned out writing for parents. In 2009 I began to see more doctors coming into the social media space and so I thought this might be an interesting topic for a blog. And that’s when I started my blog 33 charts. My goal was to create some dialogue around the issues that doctors were facing in social media.
MedCrunch: Where do you want to take 33 charts?
Bryan: That’s a good question since I blog strictly out of passion at this point. Just like MedCrunch, I haven’t been obsessed with traffic – I don’t have a publishing model necessarily. I am reaching a point where I am trying to figure out social media and digital communication might fit with my academic career. So I really don’t have a good answer for that; It’s a subject for internal debate.
MedCrunch: How important is a clinical background for bloggers in our field you think?
Bryan: For doctors who think and write about social media I think it offers a lot of credibility when you actually work as a physician. I’m always suspicious of doctors who blog about healthcare, who haven’t had some experience seeing patients. You can do it but I think this is more difficult.
MedCrunch: Are you involved in the healthcare startup scene at all?
Bryan: I have received calls from health care/social startups looking for medical leadership. Right now I work in an academic division that supports my exploration of this area so I have to say that I’m pretty happy. However, I’m always looking at opportunities to grow.
MedCrunch: In your opinion, what makes a good writer? How much is hard work, how much is talent and what do you do to become even better at writing?
Bryan: Well, that’s a tough question. Clearly there are people with a natural capacity to put their thoughts into words. Despite that, I suspect that hard work and consistent writing make you successful. In blogging the tricky thing is finding a voice that’s unique – a style that defines you and sets you apart. And that only comes through experimentation. On 33 charts I’ve tried to adopt a minimalist voice that gets immediately to the point and appeals to the attention span of the average reader. Also, I try to ask and answer very basic questions that aren’t addressed elsewhere. I try to see things from a slightly unique angle and I think people like that.
MedCrunch: Great! How often do you write? Do you write daily? And how much do you write per day in terms of minutes or hours?
Bryan: I write for about 2 hours a day, usually very early in the morning and after my children have gone to bed. I write typically five out of seven days. Most of what I type never sees the light of day, however. Writing with full-time clinical responsibilities and a family presents some real challenges.
MedCrunch: And how many hours a day do you spend on sites or streams like Twitter?
Bryan: You know it’s interesting – I always have TweetDeck open so it’s hard to tell how much time I spend on Twitter exactly. Twitter is interesting because it’s become my primary feed for information. Most internet material that I read comes straight from people who I follow on Twitter. And I try to follow people who are much smarter than myself. I don’t like the ‘you follow me, I follow you’ approach that some people advocate. I think hard about how to make Twitter work for me as a serious tool for information management.
MedCrunch: Do you think that Twitter can also be a distraction? There are studies that claim that too much social media consumption actually makes us less happy. What do you think?
Bryan: Yes, Twitter can be a dangerous distraction. But this is true for email and all the other inputs in my life. For physicians over the next generation, our greatest challenge will be information overload. I like Seth Godin’s take on the story. He advocates the importance of ‘shipping’ – that is, the final act of making things. We can talk, we can theorize, we can plan, we can network, but it’s ultimately what we product that counts. And while my inputs are important in this line of work, my ability to ship is directly related to my ability to work without interruption. I think it requires discipline and space to cultivate creativity.
MedCrunch: What would you recommend to colleagues who also wanted to have a large Twitter following like you do?
Bryan: You know it’s interesting because I haven’t really made any effort to get a large following on Twitter. And as I said just a moment ago, Twitter has really become an inbound tool for me. In fact I spend a lot of time on Twitter but I don’t actually say very much. I spend an enormous amount of time watching my feed, looking at what’s inbound from really smart people and following those links. I try to retweet things that I believe are truly valuable which in turn creates value for my followers.
MedCrunch: Is there any career or success advice you would like to give to young colleagues who are just starting their clinical careers?
Bryan: Well I guess it depends how you define success? Perhaps one of the biggest problems I see in American medical trainees is that we try to push physicians down fixed, predetermined paths. For example, in American fellowship training you’re encouraged to do bench research as part of your fellowship training. Yet there are so many other interesting aspects of medicine. When I think about my passion for writing and communication, I feel that early on I should have integrated this into my ultimate career destination as a physician. So I would encourage young trainees to follow their passion and love and try to integrate that into what you ultimately do as a physician, even when it doesn’t fit the mold.
MedCrunch: So in terms of productivity, are there any apps you could recommend to our readers?
Bryan: I’m becoming increasingly dependent upon Evernote.
MedCrunch: What do you use it for?
Bryan: Well, whenever I have any idea with regards to writing or speaking, Evernote is where it’s captured. It’s on my iPhone and synchronizes nicely with my desktop, so it’s always there when I need it. Very few of the ideas that I have come while sitting at a computer. Also, recently I have started to put my Kindle highlights into Evernote (read Bryan’s post about how he accomplishes it here). That way I always remember the most essential points about a book that I have read. It’s pretty neat!
MedCrunch: One last question. You recently wrote a book review about a book called Enchantment by Guy Kawasaki. In this book, Guy claims that you should have a mantra for yourself. A short statement that explains what you or your company are about. In Guy’s case it’s ‘empowering people’. Do you also have one?
Bryan: I have no mantra. But I’m thinking I need one. I guess ‘defining the intersection of social media and medicine’ is where I’d start. But I can probably do better than that. I’ll get back to you.
MedCrunch: Great. Thank you so much for your time!
Dr.Vartabedian currently serves as an Assistant Professor of Pediatrics at Baylor College of Medicine in Houston,Texas and attending physician at Texas Children’s Hospital.
Dr.Vartabedian was born and raised in Boston, Massachusetts. He holds a bachelors degree from the University of Massachusetts at Amherst and a medical degree from the University of Massachusetts Medical School. Dr.Vartabedian completed his pediatric residency and fellowship in pediatric gastroenterology and nutrition at Baylor College of Medicine/Texas Children’s Hospital in Houston. He is certified by the American Board of Pediatrics in both general pediatrics and pediatric gastroenterology and nutrition.
As a Fellow of the American Academy of Pediatrics and a member of the AAP’s Council on Communications and Media, he is frequently quoted by media on issues of pediatric and digestive health. Dr.Vartabedian has served as the national media spokesperson for companies such as Playtex and Biogaia.
Dr.Vartabedian has an interest in the evolving role of social media in health care. Since 2006 he has been active in the health blogosphere and currently writes the syndicated blog, 33 Charts. As an active speaker, Dr.Vartabedian has addressed the American Medical Association, the American Telemedicine Association and the Texas Medical Association on the issue of MDs in thesocialmediaspace. HeservesontheadvisoryboardfortheinauguralHealthTrackatthe 2011 SXSW interactive festival in Austin,Texas.
As a freelance writer, Dr.Vartabedian has written for a number of national publications including Parenting and American Baby. He is the author of Colic Solved – The Essential Guide to Infant Reflux and the Care of Your Crying, Difficult-to-Soothe Baby (Ballantine/Random House 2007) and First Foods (St. Martin’s Press 2001). He is a contributing author to The Real Life of a Pediatrician edited by Perri Klass (Kaplan 2009).
He is married and the father of an twelve-year-old son and a seven-year-old daughter. Dr. Vartabedian lives in The Woodlands,Texas.
Google "anonymity medical blogs" and you will find many takes on this. Some anonymous med-bloggers advocate the value of sharing real-life stories, but to me that comes loaded with layers (like nachos) of conflicts of interests. We all have the right to be anonymous, but is it always a good idea to do it just because we can (like nachos)?The 100% anonymous comments that people leave all over the web tend to vary in quality. I'm talking about ones that really say "Anonymous" next to them. Some blab without thinking too hard, and I can't deny that I sometimes enjoy rebutting them within my limits of decency. Other times, they add really insightful feedback and I wish I could address them properly to carry on the conversation. I still take such comments knowing that I can always just delete an occasional bad apple.
- Why do you want to be anonymous?
- Who does it protect? And from what?
- Does it promote or hinder dialogue?
- Does being anonymous affect one's behavior?
- Should anonymous people be regarded differently?
- Should being a healthcare professional tie us to a common standard of blog-ethics?
Many on Twitter or blogs stay pseudonymous. Some of these people have advanced their online presence such that they meet anthropological, sociological, and psychological criteria of a productive community member. They often have extensive online networks and a reputation built on participation. With these people I tend to be a bit more cordial because they stake their feelings and commitments to what happens around them. You can collaborate with them. But again, this falls in the grayscale.Recently at TEDx Maastricht, Simon Sinek spoke about trust. He said a mom looking for a babysitter is much more likely to trust the 14-year old neighbor with zero experience, but not the adult with lots of childcare experience who just moved in next door. That's human community. So, does anonymity work against participants who discuss health, policy, ethics, etc? Let's shamelessly cite myself on Twitter:
Dr. Akerkar asked a great question, which I believe was rhetorical. Although the vast majority of people mean well, I also think those who stay 100% anonymous tend to:Anonymity definitely has its place, but total anonymity? Apparently, not if you want to matter.
- worry about their online identity due to some lack of knowledge,
- be casual passers-by who don't want to stay engaged in the conversation,
- not want to take credit for their own comments,
- or they might be just new and are trying to get their feet wet before jumping in (some evolve to be "pseudonymous" or start using real names).
- Of course I'm generalizing, I can think of several exceptions.
5/30 Addendum - great posts for alternative perspectives:
"My guidelines for blogging about clinical medicine" (5/25) by ShadowFax on blog: Movin'Meat (similarities between our two posts are pure coincidence... I guess we both like xkcd)
"Anonymity, Pseudonymity, Privacy, Online Discussions, Deleting Posted Material, & Tempest in a Tweet-cup" (5/27) by @lizditz
Doctors Shouldn’t be Socially AnonymousSeptember 22, 2010
I don’t think doctors should be socially anonymous. We need to be seen.
Here’s why going underground isn’t good policy for physicians:
Anonymity makes you say stupid things. When you’re shouting from the crowd it’s easy to talk smack. Come up to the podium, clear your throat and say something intelligent. You’re a physician, not a hooligan.
It’s 2010 – anonymity died a long time ago. You think anonymity offers shelter? You’re funny, you are. Anonymity is a myth. You can create a cockamamie pseudonym but you can’t hide. And if I don’t find you the plaintiff attorneys will. They found Flea.
Being a weanie is no excuse. Just as you’re unlikely to consult a lawyer before speaking at a cocktail party, commenting as Dr. You is unlikely to kill you or land you in court. Just a couple of pointers: Don’t talk about patients, help people out and be nice. Trust me, I’m a doctor.
We need you, dammit. There are like 12 doctors in the free world with regular blogs. And all the rest are either working or peeking from under their desks hopin’ this social stuff all goes the way of the hula hoop. If we all just spoke up we could change the world. As for me, I’m typing as fast as I can and I’m tired of doing it alone.
Anonymity soils credibility. We need to be out there helping to keep check on the nonsense circulating in the infosphere. I think it was Dr. Val Jones who once said that the Internet needs lifeguards. Of course patients can swim. No one needs to be rescued but there’s nothing wrong with a few strategically placed lifeguards to blow the whistle every now and again (mind you, these aren’t paternalistic lifeguards but lifeguards seeking a partnership with empowered, engaged swimmers).
“I’m not a doctor but I play one on the internet.” In the end, no one trusts a lifeguard in a ski mask. Unless we know who you are, you don’t count. If you’re anonymous I have to assume you’re actually a disgruntled medical assistant with an axe to grind. Show your face and create a digital footprint that we can all see. Look at me. Look at my blog. Cross-check me with Texas Children’s Hospital, Baylor College of Medicine the quarter million other ventures I’ve been engaged with. I’m real. Those links are real.
Go and be real so that your voice can be credible.
What am I missing here?
This is a rough transcript of a brief presentation given to the American Gastroenterological Association/Digestive Disease Week.
I want to thank the AGA/Digestive Diseases Week for inviting me on this panel of speakers. It’s exciting to see the AGA recognize the need for professional education in social media. I’ve been on Twitter since 2008 when there were few doctors even familiar with the concept of social media. Watching it evolve I’ve been forced to confront some of the real issues facing doctors in the social space. Hopefully over the next 20 minutes or so I’ll impart some of my hard-earned wisdom.
I have to fully disclose that the title of this presentation (Teens who Tweet) suggested that I was just going to talk about teens. But if we look at this data from the Pew Internet and American Life Project we see that teens don’t tweet. In fact, Twitter adoption among teens appears to be almost half of what we see with young adults. Why is that? Two reasons: 1) Teens see Twitter as a middle-age platform 2) and it never reached early critical mass with teens. What do teens do socially? Text and Facebook. And teens are interesting because while they may be active socially, they’re less inclined to bring their diseases along with them. So as a physician you are unlikely to be approached by a teen with health related issues. I care for lots of teens and it has yet to happen. And digital professionalism is independent of your patient’s age.
I want to give you a couple of examples of patient contact on social media. 2-3 months ago I was friended on Facebook by a woman in my community. I couldn’t recall who she was so I messaged back and asked how I knew her. She replied that we didn’t know one another. She had read my book, Colic Solved, and had a remarkably irritable 6 week old baby who was only taking 12-14 oz/day and wanted my help. So what do I do? Is my response subject to discovery in a court of law? Could I receive disciplinary action from my hospital for engaging in a non-secure fashion? Would my response be an action reportable to the Texas State Board of Medical Examiners. Or, do I have an ethical obligation to this mother who has presented her baby to me in this way? So what would you do?? I did what I would do in any other situation, independent of the communication medium: I did the right thing. I got the mom’s number, called her and arranged to see her the following morning.
So while SM hold great promise for personal branding, education, public health, this case illustrates challenges beginning to face doctors in this new mode of interaction. And just because patients will occasionally approach us in the grocery store or at a restaurant doesn’t mean we stop buying groceries. Similarly, these social media experiences will happen and it isn’t an excuse not to engage.
Looks dangerous, huh? Actually not really if you keep your wits about you and exercise common sense. While there are a hundred ways we can keep ourselves safe on public social platforms, I’ve boiled it down to 4 that will help keep you out of trouble.
- Never discuss patient-specific issues.
- Never be anonymous.
- Remember everyone’s watching
- Be nice
I’m going to drill down on the first two in the next couple of slides. The last two are important but I’m not going to expand. Just remember number three: everyone is watching and what happens on Twitter stays on Twitter, literally. Everything is part of your digital footprint and everyone can see it: your boss, your patients, your soon-to-be ex-wife’s attorney. Now while that’s at once funny and scary, you should look at all this from an opportunity perspective, not a risk perspective.
So why should we never discuss patient-specific issues? Basically everyone’s listening. And while the patient may offer implied consent by initiating the dialog, not all patients understand the implications of disclosing personal health information. And even if they do understand, it isn’t something that I’m comfortable with. Keep in mind, too, that on Facebook or Twitter are difficult if not impossible to properly document.
We need to think beyond HIPAA. Very often we measure the safety of our actions against HIPAA. But remember that HIPAA is a legal dictate. As physicians we always have to think of the commitment to our patients beyond what the law requires. Just because a story may be HIPAA compliant doesn’t necessarily mean that it’s appropriate for public dialog. For example, if I see a baby with neonatal hemochromatosis in the NICU and decide to mention on Twitter that ‘today I saw an interesting case of neonatal hemochromatosis,’ this may not disclose personal information. Yet if the mother of that baby were to read my feed it would potentially represent a breach of our trust.
You may think to yourself, ‘I’ll just change the details of my patient encounters and write about them.‘ You can do this but you have to be extremel careful. Last week a doctor in Rhode Island chose to share a patient encounter on Facebook after she de-identified details of the encounter. Apparently the case wasn’t de-identified quite enough and a family member identified the scenario. She was fined and lost her privileges.
You may think to yourself, ‘I’ll create an alternate persona. No one will know who I am.’ But anonymity creates a false sense of security and lowers the threshold for you to say things that you might not otherwise say. The fact that my boss, chairman, patients and mother-in-law see what I write keeps me safe. And there’s no such thing as anonymity in 2011. You can be tracked.
Here’s how anonymity can get you in trouble: In the mid-2000′s there was a famed medical blogger who wrote under the name of Flea – his personality was based on the rocker from the Red Hot Chile Peppers. He was very powerful with thousands of readers. He wrote very edgy, provocative content. But behind this avatar was a mild-mannered Harvard trained pediatrician. During a medical malpractice trial in 2007 felt it would be appropriate to write about the trial and specifically the personal habits of the female plaintiff attorney. Someone made the connection, clued in the plaintiff team and during a moment that made history he was asked ‘are you Flea?‘ The case settled immediately. Read a very interesting interview with Robert Lindeman, the doctor behind Flea.
So what should you do when a patient contacts you? This Tweet came through on a Saturday morning when I was at my son’s baseball game (“DrV, this is X’s Dad. We forgot, do we give one suppository or two”). It came from the father of a child with proctitis who I had seen with 15 other patients on a Friday. So what would you do? Can you ignore it? Again, what’s the right thing to do?
So here’s what I do when patients try to reach me in a public social space:
- Take the issue offline. I simply contact the patient by phone to discuss the issue is a more private environment.
- Address their problem. Understand that they have a need to be met.
- Educate the family. I let them know about the personal pitfalls of public disclosure of health information. I then tell them that I can get in trouble. Every time this has happened families understand entirely. And through all this understand that for many of your young patients Facebook and other real-time platforms are the way they communicate. It’s interesting that the father who messaged me about he suppository didn’t know that his tweet was public. He didn’t understand Twitter messaging.
- Open a phone note and document the encounter. I always make it clear that the dialog was initiated by the patient.
Because of this you may want to initiate a communication policy for your practice or clinic. Given all of the available channels for social dialog you need to define how and under what circumstances each channel will be used.
I might leave you with the suggestion that we as physicians have the ethical obligation to be involved with the creation of content and dialog in the health infosphere. And as providers we have to start looking at this from an opportunity perspective rather than risk. We have the capacity to collectively harness the most powerful communication medium since the printing press. We can influence ideas about health. We can change the way we’re viewed. We can be publisher and reviewer. It’s where the patients are and its where we should be as physicians.
The link to Colic Solved is an affiliate link.
Tagged as: AGA, DDW, Ethics, Social media, Twitter
For the Twitter to Tenure workshop, I considered how social media enhanced my career. I will argue that social media (in my case especially blogging) has had a major impact on my academic productivity.
I started blogging in May 2002. My initial entries focused primarily on finding news stories, linking to them and giving some commentary. Tweeting satisfies the first two activities today. Over time, I moved more to commentaries (short essay pieces).
In 2002, I had a mild form of writer’s block. I wrote, but dreaded it. I started blogging to escape writer’s block and improve as a writer. These two goals quickly satisfied, blogging transformed my method of exploring ideas.
Over the next several years, I would write about this rare sore throat complication. Several patients and parents of patients began commenting and emailing me. Through one I actually talked with the parents of two teenagers who died of Lemierre syndrome.
The blog entries and interactions with patients and parents led to my consideration of Fusobacterium necrophorum as a missing bacterial pharyngitis. Thus, because of a blog I started following this literature carefully.
That new research passion influenced a new series of pharyngitis articles that I have written:
1. Singh S, Dolan J, Centor R. Optimal Management of Adults with Pharyngitis – A Multi-criteria Decision Analysis. BMC Medical Informatics and Decision Making 2006; 6(14).
2. Centor RM, Cohen SJ. Pharyngitis Management – Focusing on Where We Agree (Editorial). Arch Intern Med. 2006;166:1345-1346.
3. Centor RM, Allison JJ, Cohen SJ. Pharyngitis Management: Defining the Controversy. JGIM. 2007;22:127-130.
4. Shah M, Centor RM, Jennings MS. Severe Acute Pharyngitis by Group C Streptococcus. JGIM. 2007;22:272-274.
5. Centor RM. When is throat culture indicated for an adult with pharyngitis? Clinical Consultation Answers to a reader’s question on Throat cultures for pharyngitis. The Journal of Respiratory Diseases. 2008;29(8):313.
6. Gupta N, Lovvorn J, Centor RM. Peritonsilar abscess requiring intensive care unit admission caused by group C and G Streptococcus: a case report. Cases Journal 2009; 2:6808.
7. Centor RM. Expand the pharyngitis paradigm for adolescents and young adults. Ann Intern Med. 2009 151(11):812-5.
8. Centor RM. Role of Non-group A Streptococci in Acute Pharyngitis. J Am Board Fam Med. 2010 May-Jun;23(3):423.
9. Centor RM, Geiger P, Waites K. Fusobacterium necrophorum Bacteremic Tonsillitis: 2 cases and a review of the literature. Anaerobe. 2010 Dec;16(6):626-8.
Other blog posts attracted the attention of editors. My public questioning of hospital medicine, as well as other blog posts led other articles.
10.Centor RM. Seek First to Understand. Philosophy, Ethics, and Humanities in Medicine. 2007; 2:29.
12.Centor RM. A Hospitalist Inpatient System Does Not Improve Patient Care Outcomes. Archives of Internal Medicine. 2008;168:12:1257-1258.
13.Centor RM. Rebuttal – A Hospitalist Inpatient System Does Not Improve Patient Care Outcomes. Archives of Internal Medicine. 2008;168(12):1257-1258.
14.McGinn T, Centor, R. Where Should Hospitalist Programs be Housed? J Gen Intern Med. 2008;23(8):1288-99.
15.Centor RM. A hospitalist inpatient system does not improve patient care outcomes.
Arch Intern Med. 2008 Jun 23;168(12):1257-8; discussion 1259-60.
16.Centor RM, Taylor BB. Do Hospitalists Improve Quality? Arch Intern Med. 2009; 169(15):1351-1352.
What have I learned from blogging?
The most important old lesson is that one must write to become a better writer. Blogging made writing a habit.
Expressing your thoughts in public (like the orators in Hyde Park) has allowed me to refine those thoughts. My blog’s readers have become intellectual partners.
Writing a blog, or tweeting, or having a facebook page, can help create a brand. Having a brand makes success in academics more likely.
So consider blogging, or tweeting or whatever new social media outlets arrive. You will have fun, and perhaps even advance your career.
The board said Monday that the 48-year-old physician wrote on Facebook about some of her clinical experiences at Westerly Hospital, without using patient names or intending to reveal patient information.
But, the board says, one patient's injuries were such that an unidentified third party was able to identify the person.
Yesterday some doctor anonymously tweeted about her patient's condition. She has a large following on Twitter. Some found it humorous, a few doctors found it offensive. One in particular, Dr. Vartabedian, posted what I think is a sensible comment on his blog at 33charts.com. Another physician disagreed on his own blog, scepticemia.com. Links point to respective articles.This debate is not about a witch hunt (scepticemia suggests it is) against those who tweet about their patients. When it comes to health care and communications technology, in some ways, we are still trying to figure out what's right and what's wrong, and where to draw the line. It's an important discussion that's not to be taken for granted. Similar issues are bound to come up again.
The following is an exchange between yours truly and the author of Scepticemia.com. Leave us your comments at the end, let us know what you think:
While some med students and Dr's are trying to get schools/hospitals to integrate social media into medical training, missteps like these give more ammo for the anti-HCSM crowd. The professional value and ethics of social media use in health care are fast-evolving, but still new. Just because we have new tools (Twitter, FaceBook, blogs) in an old trade (Medicine), that does not obviate existing ethical standards and common sense.
For those interested in a contrasting viewpoint – because there are always at least 2 ways to look at an issue – to my recent post about the potential effect of the ”filter bubble,” I am using this post to present the other side of filtering. Filtering – in layman’s terms – is the way by which companies like Google and Facebook (“gatekeepers”) determine what your search results will be, using algorithms that incorporate data from your prior search habits. Ian Eslick recently sent me a link to an article that explains the positive aspects of filtering. Eslick is a PhD candidate at MIT Media Laboratory and is studying how filters apply to healthcare information on the web. Here’s an excerpt from that article:
In an era of increasing information overload, the filter is a necessary and valuable tool and we’re only at the beginning of the technology curve. In the context of health, filters are critical to improving the effectiveness of the rising class of e-patients.
This is a fascinating topic that is not new, but that I have recently discovered. I certainly don’t claim to be an expert, which is why I am posting the MIT Media Lab’s perspective, as well.
Do any of you out there have thoughts on the topic? How about filtering as it relates to healthcare information? Did you know about the concept of the “filter bubble” or personalized search results or is this also the first you have heard of it? Do you see other pros and cons to it? Does this topic even matter to you?
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I'll soon be heading to the 2011 Society of General Internal Medicine's annual meeting. As prelude to a workshop called "Twitter to Tenure," I, and several fellow academicians are blogging about how social media has helped our academic careers. See bottom of post for the other posts in this series. And if you'll be at SGIM, please come and say hi!If I had known that starting a personal blog in 2006 would eventually result in such great things for my career, I would have started one a long time before that. The truth is, I was simply trying to capture the moments of new motherhood that I didn't want to forget. (Also, before 2006, I was like, what's a blog?) In the process, I unknowingly set wheels in motion that would eventually help shape my future personal and career pursuits. (Bonus!) This is what you call a win-win. Win-wins in life are the best.
Writing leading to...
In my early days of blogging, I posted feverishly, to my 3 readers, one of which was my husband. We're talking practically everyday (I sigh when I think about how much more time I had when there was only 1 child to contend with). In the process (of talking to those 3 people), I developed my writing voice. It became like nothing to write a post- I could whip one out in 5-10 minutes, honing my story-telling, organization and my writing got better. (Please do not use this previous sentence as an example.) Malcolm Gladwell talks about this 10,000 hours phenomenon to achieving excellence in anything--I haven't come close to that but blogging so frequently was a start.Writing opportunities...
An amazing thing happened in the midst of blogging feverishly (now over 3 readers): people found my blog and offered to pay me to write about parenting --humor writing. Paid! To write! This was a huge boon since it felt like I was an actual writer who could (occasionally) make people laugh. Meanwhile, the blogging (on multiple blogs now) continued, more hours under the belt. I networked with other bloggers, went to blogging conferences (after at first scoffing at them--who would go to a blogging conference??? Lame. I've realized, since, how much I love eating my words, or at least, embracing being lame.). I am not sure when my affinity for using parentheses developed.And medical education applications...
I now appreciated what blogs could offer (discussion, community, feedback, support, to name a few) and while studying adult learning theory and the theoretical underpinnings for reflection in medicine, started a reflective writing blog for internal medicine clerkship students. Students' writings blew me away as they wrote frankly (amazingly frankly) about professionalism, doctor-patient relationships, empathy, and the struggles and anxieties of being a medical student. This led to workshop presentations at conferences, a paper in an academic journal, and networking with some pretty awesome collaborators.And research....
Having had a blog where I occasionally mentioned issues that I saw in the hospital, as well as developing a (vaguely, on good days) humorous writing voice, I could appreciate the line that physician-bloggers had to manage between privacy, humor, disclosure, and professionalism. I became interested in the intersection of professionalism and physicians on social media and had an idea for a study on medical students and unprofessional online content. I also got involved with other forms of social media - Facebook and Twitter - and more ideas for studies came. This research has led to plenary talks, media interviews, grand rounds invitations, national conference workshops, and has defined a career path. Not to mention it's just fun to do these studies. Note: I would have never imagined I would be doing research when I was a resident! Thoughts of doing research in the past had always been accompanied by images of pain and suffering, like having a fork stuck in an eye.And staying up-to-date with news from my field...
I've become a Twitter convert, thanks to Twentors (sorry) like Vinny Arora, an amazing academic rock star and Star Tweeter (ST). It has become my go-to source for breaking news and keeping up with my areas of academic interest --medical education and social media in medicine. I do not follow anyone like Paris Hilton ("I'm sooo tired! Need a nap!"), and instead follow those who have similar interests (as me, not Paris--pretty sure our interests don't overlap) or provide interesting perspectives and links. See Vinny's post for more resources about how to use Twitter professionally.And Mothers in Medicine...
And of course, blogging led to the birth of Mothers in Medicine. Enough said.So, social media has been good to me. It might also be good to you too.
Also see the following STs:
Alex Smith's (@AlexSmithMD) intro post on Geri Pal.
Vinny Arora's (@FutureDocs) post on FutureDocs.
Bob Centor's (@medrants) post on DB's Medical Rants.
Eric Widera's (@ewidera) post on Geri Pal.
I was precepting last week at our busiest outpatient site. One of the residents there is very interested in all things technology and we got to talking about the iPad. Knowing that he uses Twitter, I told him about some of the neat ideas I had recently seen there about the use of tablets in patient care.The preceptor room is a public place, and it's pretty easy to be overheard. This resident and I were only about two minutes into this conversation when the comments began to fly from the other residents - and the other preceptor - in the room.
"Twitter? That's just for celebrities."
"Twitter's a waste of time."
"Twitter's just to make yourself feel important."Even more discouraging was that my attempts to explain the positives of Twitter - networking, idea sharing, collegial support - were brushed away.
"I have enough things to check every day already with e-mail, Facebook, and texts."
"Twitter is all self-serving. Does anybody really care what you have to say?"I have heard these types of comments across all ages and generations. I have heard them at conferences, among the faculty I work with, in the monthly book group I attend. Twitter is decidedly not mainstream in medicine, at least not in the circles I travel in.
I have seen and read countless articles, ideas, and opinions that I wouldn't have found without Twitter. Yes, it takes a little time to find good people to follow, and it then takes a little time to actually follow them. But the pay-off in new ideas and inspired thinking is marvelous - far better than the same amount of time on Facebook or an RSS reader.
For the most part, physicians are notoriously late adopters of new ideas. Health systems had to mandate EHRs to get most physicians to use them. In an age of e-mail and text messages, most of our offices remind people of appointments with a phone call. Heck, I was a Twitter skeptic a year ago.
Interestingly, though, once docs have these new technologies, they're equally reluctant to change back. (You should have heard the uproar here the last time the computers went down. "Write my notes...on paper?!?") Which leads me to wonder if some of these Twitter bashers would be still so negative if they were actually Twitter users. So, how about it, Twitter detractors - why not give it a try?
I dare you.
On Monday night, Dr Bryan Vartabedian, a pediatric gastroenterologist in Texas, wrote a blog post about physician behavior on Twitter. In the world of health and social media, it’s caused a near nuclear explosion of thought, an outpouring of opinion, and most importantly a much-needed discussion. Discourse is perfect for progress.
I think about this all the time.
In the post, Doctor V called out an anonymous physician blogger and tweeter, (@Mommy_Doctor), on her tweets about a patient suffering from an embarrassing and painful medical condition. Nearly 100 comments later and numerous other blog posts, physicians and patients are openly battling and exchanging perspectives.
I wonder, what do you think? I rarely write about patients directly. More, I write about what I learn from patients. I never want a patient or family member to stumble upon anything I write and wonder if I’m writing about them. When I have written about patients, I have asked permission and even then, waited for a period of time before writing about them to avoid the time-stamp the internet provides.
The reason many physicians don’t author content online is their concern about privacy. Their hesitancy is admirable. In our own time, I suspect most of us will end up communicating online, but it will be at different times (decades) for each of us.
Some history: I have had one tweet that I’ve taken down after a physician called it a HIPAA breach. It wasn’t (I even consulted with my colleagues in bioethics) but I swiftly took it down. I’m not here to be devout and certainly not trying to stoke the fire. I was thankful for the feedback and remain pleased I took that particular tweet down. I talked with the family involved immediately. I learned a great deal from a peer’s observation. We are dependent on our wise and smart community to help guide what we do for our patients, particularly online.
I really wonder what you think about this. Will you read Doctor V’s post and let me know? My comment on Dr V’s post is number 98:
When I speak about physician use of social media, I take the stand against anonymity for physicians. Simply put, remaining anonymous protects the person/physician tweeting, not the patients, or the profession for that matter.
Like many have said before, we need to aim above HIPAA and we sincerely need to consider how our content and voices over social media reflect not just the respect of our profession, but trust in what we do. Compliance and patient outcomes depend on it. Consider what distrust in physicians does to vaccine hesitancy, for example. It has public health ramifications (118 measles cases since January).
You might also have to step back from the democracy of opinion here. It’s not the majority that matters (how many people chime in and state which side of this particular tweet stream they support). I’d say if one or more individuals believe your content is a breach of privacy and professionalism, you ought to step back, consider taking it down, and revisit your oath.
Don't worry, we won't post anything.
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