To tweet or not to tweet: Social media for physicians

4th April, 2014

Nepal? I don’t know anyone in Nepal. Yet not long ago I received a courteous email from a physician there, asking my permission to translate an article of mine into Nepali. The topic: advice for older patients who need anesthesia. He wants to distribute it to patients and publish it in his local newspaper.

I asked how he came across the article. He was browsing online among anesthesia blogs, and found mine, “A Penned Point“. Now “blog” isn’t a word Jane Austen would have recognized. It is a lumpish merger of “web” and “log”, and is generally defined today as a website on which an individual records opinions. The proliferation of blogs–like Tribbles–may be seen as a pernicious trend, but it demonstrates the power and reach of the Internet. Business Insider estimates that 22% of the people in the world own smartphones, an increase of 1.3 billion smartphones since 2009. In social media, once you put content out, you have no idea how far it will travel.

Many physicians consider social media a frivolous waste of time. Certainly they can be horribly misused–think of the cyber-bullying that goes on among teenagers. But used wisely, social media can be valuable communication tools. Here follows a brief guide to social media for physicians, admittedly subjective, with caveats included.

The doctor with an opinion

We all have opinions. Occasionally, we want the world to know about them. If you want to publish an opinion column and don’t want to create your own blog, there are online sites where your submission may be welcome. Probably the best-known public site for medical topics is KevinMD, which is curated by Dr. Kevin Pho, a New Hampshire internist. He came early to the game, starting his blog in 2004, and now has over 1000 regular contributors, myself included. You can submit a 500-700 word piece on almost any topic within medicine, aimed at an audience of physicians or at the general public. There’s a good chance that if you can put together a coherent sentence, Kevin will find a place for it. Brace yourself for the comments: Kevin’s readers tend to hold opinions as strongly as the writers do.

If you think the public is entitled to your opinion but haven’t much time, then Twitter is the place for you if you can contain yourself to 140 characters. For the novice tweeter, the shorthand on Twitter can be daunting. If you want to make sure I see your tweet, send it to me personally @KarenSibertMD. But if you want your tweet to contribute to a topic under general discussion, master the use of hashtags. #SOTU will take you to all the comments on President Obama’s State of the Union address (see also #Obamacare). A lively Twitter crowd spent the second half of the 2014 Super Bowl waiting for the commercial about the Clydesdale horses and the puppy (#BestBuds). A quick check of #anesthesia just now directed me to posts on the hazards of fluid overload, a patient’s question about epidurals, and heated debate about independent nursing practice at VA hospitals. Check Twitter to follow news and magazine sources for interesting stories you might otherwise miss.

There are excellent individual physician blogs. “Skeptical Scalpel” is the product of a veteran surgeon and former department chair who remains anonymous; his posts often critique recent developments in medicine and medical education, but are always pithy and hit their target. “Wachter’s World” features the enlightening ruminations of Robert Wachter MD, who first coined the term “hospitalist”. For the primary care physician’s perspective, you can’t top “In My Humble Opinion“, the work of Jordan Grumet MD. And don’t miss the comments of Shirie Leng MD, a former nurse who became a physician anesthesiologist, on her blog, “medicine for real“.

Professional online networks

LinkedIn is the best-known professional network. It’s easy to connect with colleagues inside and outside of medicine. You can join in online discussions among groups of your choice–the ASA, your state component society, and your college and medical school alumni associations, for instance. LinkedIn is a good way to follow developments and trends beyond your hospital’s walls, particularly in the business world. The LinkedIn tablet app is more visually appealing and easier to navigate than the website.

For connections within medicine, Doximity–a social network exclusively for physicians–is clearly on the ascendant. VentureBeat reported in January that Doximity’s network doubled in size last year to 250,000 members, more than the American Medical Association, and now reaches 35% of all physicians in the US. You can locate colleagues and former classmates across the country, and post your own profile and resume. The DocNews feature provides a digest of articles in the mainstream media as well as in in major medical journals. You can earn and track CME credits. Doximity will even give you your own electronic fax number, free. The app needs work, though; right now the website has better functionality.

Sermo also is a physician-only website, and is trying to reinvent itself by emphasizing its function as a curbside-consult resource. But Sermo’s big mistake early on was allowing its members to create posts and write comments under pseudonyms. This, and a lack of filtering, gave rise to a level of vituperative, profanity-laced, and highly politicized commentary that drove away many readers. Occasionally, Sermo will offer to pay $15 for a new post on an anesthesiology topic–$30 if yours is judged the best of the day.

Connecting with patients

Telemedicine may not have the bright future in anesthesiology that it does in other specialties like dermatology and radiology. There’s no such thing as a virtual intubation. But patients are always on the lookout for online information. And one of the “meaningful use” objectives for electronic health records is to engage patients and families in two-way communication. So it behooves us to look for other ways that we can interact with patients online, responsibly. Many physicians already exchange secure email routinely with their patients.

The Institute of Medicine recently surveyed social networking sites, and concluded that as of December, 67% of American adults with Internet access used some form of social media, and 59% used the Internet to look for health-related information. Patients use a number of sites that allow them to connect with other people who have similar health conditions, such as “PatientsLikeMe” for chronic conditions or “TheBody” for HIV. Perhaps the most surprising finding is that patients are willing to share their personal health data to help improve care:

—92% of social media users agree with sharing their health data to help research

—84% would be willing to share information with drug companies to help them make safer products

—94% agree with sharing their health data to help patients like themselves.

The IOM concluded that social media change the traditional relationship between researcher and patient. They now must work together as peers, the IOM declared, predicting that data sharing will become the standard in the delivery of care for everyone.

If you’re willing to spend time online answering patients’ questions for free, HealthTap will welcome you as one of its physician experts. Questions are limited to 150 characters, and answers to 400 characters. Many of the questions about anesthesiology fall into one of four categories:

1.  Fears about having anesthesia

2.  Postoperative problems: memory loss after general anesthesia; back pain after epidural analgesia for labor

3.  Questions about anesthesia and underlying diseases: asthma, heart disease

4.  Questions about narcotics and pain management.

It’s important for us to answer patients’ questions about anesthesia rather than leave the task to other physicians who may not answer accurately. For example, one physician advised an asthmatic patient that general anesthesia wouldn’t be safe, and I was able to set the record straight by emphasizing preoperative control of asthma symptoms. If we don’t participate, patients may glean information from biased or misinformed web sources.

Finally, Facebook

Facebook is for friends, not patients. Post pictures of your dog, or snow on your patio furniture. Post links to interesting articles you’ve enjoyed. Certainly no physician would be well advised to combine personal and business communication together on Facebook. At least set up a separate professional Facebook page that is completely different from your personal account, and don’t make the mistake of posting personal information on the professional page. Photos of your fabulous vacation should be posted only on your personal page (if at all), and only after you get home–don’t forget that thieves have been known to check Facebook to find out when you’re gone.

The Internet and social media can be powerful allies, but it’s best to remember that there is no real privacy online. Look at anything you post online, or even in a “private” email, as a postcard. Though most people won’t bother to read it, anyone anywhere could.
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This article was published first in the April 2014 issue of the American Society of Anesthesiologists Newsletter.

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