From MarketWatch:
"If you use Twitter, you too are a public figure. And one egregious tweet could blow up your life.
The political climate puts all employers on high alert when it comes to the words and behavior of their employees.
Many people are plugged into the news cycle all day long. One in five employers think staff is productive fewer than five hours a day, with most citing smartphone use as the culprit.
The First Amendment protects free speech, but it may not protect your job if you do or say anything that is contrary to the company’s values, even if it’s a joke.
Anyone with a public Twitter account is a de facto public figure.
“We have to be mindful of every word we speak and everything we write.” Even posting photographs or retweeting someone else’s tweet can be enough to get fired.
In fairness to American workers, it’s a double-edged sword: They’re often times encouraged to tweet and maintain an active social media presence."
References:
Like Roseanne, all Americans are just one bad tweet away from being fired https://buff.ly/2xB5bAm
Showing posts with label Twitter. Show all posts
Showing posts with label Twitter. Show all posts
Your choice of social media service/website/app may reveal your personality
This study from Germany included 633 students.
Use of computer games was found to be negatively related to all personality and mental health variables: self-esteem, extraversion, narcissism, life satisfaction, social support and resilience.
The use of platforms that focus more on written interaction (Twitter, Tumblr) was linked to depression, anxiety, and stress symptoms.
In contrast, Instagram use, which focuses more on photo-sharing, was linked to positive mental health variables.
References:
What does media use reveal about personality and mental health? An exploratory investigation among German students http://bit.ly/2nxE7ef
Use of computer games was found to be negatively related to all personality and mental health variables: self-esteem, extraversion, narcissism, life satisfaction, social support and resilience.
The use of platforms that focus more on written interaction (Twitter, Tumblr) was linked to depression, anxiety, and stress symptoms.
In contrast, Instagram use, which focuses more on photo-sharing, was linked to positive mental health variables.
References:
What does media use reveal about personality and mental health? An exploratory investigation among German students http://bit.ly/2nxE7ef
"Half-baked research": MD degree does not teach doctors how to tweet scientific meetings
MD degree does not teach doctors how to tweet scientific meetings, reported Reuters (http://buff.ly/1xAOPkO): A study assessed the accuracy of tweets posted by physicians at a medical conference and concluded "it is very easy to misunderstand tone and brevity, so there are dangers here."First the study authors asked speakers at the meeting to identify key messages for their presentations. Then, they asked the speakers to review tweets posted during their talks to see how accurately these points were communicated.
Duty calls. Image source: Xkcd.com, Creative Commons license.
14 speakers participated in the experiment, and 13 had at least one tweet posted about their presentations. There were only 37 tweets altogether! Editor's note: This seems incredibly low. Allergy/Immunology conferences such as AAAAI and ACAAI generate thousands of tweets, sometimes more than 30-50 for each talk.
The speakers found 16 of the tweets accurately reflected their findings, while an additional 16 posts were partially accurate. In 3 instances, the tweets misrepresented key points. In 2 cases, the speakers were uncertain about the accuracy.
It's possible that the inaccurate tweets indicate that the speakers didn't do a good job of explaining their research. And it's also possible that the doctors listening to presentations didn't use the best language to tweet results.
To be sure, the sample size was quite small. This is the biggest limitation of the study and it qualifies it as what we sometimes call "half-baked research."
This statement also looked inaccurate in the Reuters report: "Asked about the impact of social media on medical education, 82 percent of survey participants said they didn't access websites for medical journals, research articles or major gastroenterology professional organizations." And indeed, it was inaccurate: 82% of GI's didn’t access social media sites of professional organizations, not their main websites.
We all agree on this though: Many physicians prefer to limit use of social media to their personal lives.
Here is an example how to use Twitter when attending a scientific conference:
http://allergynotes.blogspot.com/search/label/Twitter
Here is an approach I suggested a few years ago:
Cycle of Patient Education (click here to enlarge the image):
Cycle of Online Information and Physician Education (click here to enlarge the image):
"And it’s free."
References:
MD degree may not teach doctors how to tweet | Reuters http://buff.ly/1xAOPkO
Are you a SCEPTIC? SoCial mEdia Precision & uTility In Conferences - Emergency Medicine Journal http://buff.ly/1vQCq6j, and bit.ly/1tii1pz Digestive and Liver Disease
Comments from Twitter:
re: SCEPTIC? SoCial mEdia Precision & uTility In Conferences -- Skeptical Scalpel @Skepticscalpel: I've seen some forced acronyms in my time, but that one wins the prize.
@DrVes re: acronym, agree. the whole research endeavor left more to be desired...
Skeptical Scalpel @Skepticscalpel: I liked it because it supported my bias, but really--37 tweets?
Michael Katz @MGKatz036: Pls remember this as I tweet from @Boston_AF! MT @DrVes: MD does not teach doctors how to tweet scientific meetings buff.ly/1xzpiXF
Why use Twitter - tips from Mayo Clinic's social media director
In this video, Dr. Timimi discusses the quiet revolution of Twitter in healthcare, including how it can be used in practice and in education. Of time spent online in the US, one in six minutes is spent in a social network. Of the popular social networks, Twitter is one of the best introductory platforms, with one in five adult Internet users in the United States maintaining a presence on Twitter.
The top 50 science stars of Twitter according to AAAS/Science. What does it mean?
It's nice to be on the list of The top 50 science stars of Twitter according to AAAS/Science. However, the list is based on somewhat arbitrary criteria and is meant to provoke discussion rather than to be taken seriously. What is valuable, however, are some of the quotes by scientists interviewed for the story. A selection of the quotes is posted below. The skeptic view on Twitter
Fact of life: Most high-performing scientists have not embraced Twitter. Why? "Highest ranking chemist considers Twitter a waste of time that he’d much prefer spending on reading, writing papers".
Twitter proponents win this argument
However, this is changing. Researcher: "Twitter may be the most valuable time I spend in terms of learning things". "Twitter is a virtual classroom connecting people interested in psychology of happiness. It’s another teaching tool". “In a minute, I can skim through a hundred Twitter posts. It’s pretty amazing for getting a feel of what’s going on". Tweeting ongoing research at research lab has attracted graduate students as well as two grants. Active social media presence might aid applications for research funding, as it shows a commitment to public outreach.
Know the risks
There are pitfall to Twitter user, of course. Spontaneity of Twitter can backfire, for example, live-tweeted brusque criticism at academic conferences can come back to bite you.
Twitter is ill-suited for nuanced, in-depth scientific discussions. The tweets are only 140-characters after all, and it is difficult to follow a conversation because every single tweet is a separate web page. One approach is to tweet links that appeal to a general audience, rather than complex scientific papers.
How to use Twitter in science
Twitter can be a crowdsourcing platform for new ideas and research.
Twitter can surface and bring to you the latest, most noteworthy research in medical science. Your own tweets about papers and presentations you find interesting can form an archive.
Twitter functions as “another dimension of peer review”.
Here is an approach I suggested a few years ago:
Cycle of Patient Education (click here to enlarge the image):
Cycle of Online Information and Physician Education (click here to enlarge the image):
References:
The top 50 science stars of Twitter | Science/AAAS | News http://buff.ly/1uiCBqK
The Kardashian index: a measure of discrepant Tiwtter profile and publication record for scientists http://bit.ly/1xXm8uv
Disclaimer and clarification: I am listed at 44 among The top 50 science stars of Twitter. Also, in 08/2014, I made a transition from University of Chicago to Cleveland Clinic.
A Twitter Chat Connects Medical Experts - Mayo Clinic video
A Twitter chat on immunotherapy was organized by the American Association for Cancer Research, the Cancer Research Institute and the Mayo Clinic Cancer Center. Researchers from Memorial Sloan Kettering, MD Anderson and Yale University were "gathered in virtual attendance".
Here is some of the feedback from the participating physicians: “I think the concepts are a lot more complex than you can get out with just 140 characters.”
References:
Transcript of Medical Expert Twitter Chat (PDF)
http://newsnetwork.mayoclinic.org/files/2014/06/Medical-Twitter-Chat.SCRIPT.pdf
Here is some of the feedback from the participating physicians: “I think the concepts are a lot more complex than you can get out with just 140 characters.”
References:
Transcript of Medical Expert Twitter Chat (PDF)
http://newsnetwork.mayoclinic.org/files/2014/06/Medical-Twitter-Chat.SCRIPT.pdf
Altmetric tracks the buzz around scholarly articles: You can make a difference
Altmetric tracks the buzz around scholarly articles - see an example: http://bit.ly/1lF9KtR You can make a difference.
See how my blog contributed to one of highest ever scores in this journal for this article (ranked #7 of 972): Children with severe asthma have 32 times higher risk for developing COPD http://buff.ly/1oIJ3FH
Here is the blog post: Allergy Notes: What are the top 3 asthma articles for March 2014? Vote here http://bit.ly/1hjZ6Ju
The article will be included in the next edition of What Is New In Small Airways Research
http://www.worldallergy.org/small_airways_group/reviews/
The beautiful flower of Internet Conversation has lost quite a few petals since 2008 but it still works:
Don't close blog comments on your site. See how one comment changed influenza treatment: http://buff.ly/1hDJ2MN and http://buff.ly/1i5b3le
From the Guardian:
"But then a Japanese paediatrician called Keiji Hayashi left a comment that would trigger a revolution in our understanding of how evidence-based medicine should work. This wasn't in a publication, or even a letter: it was a simple online comment, posted informally underneath the Tamiflu review on the Cochrane website, almost like a blog comment.
Cochrane had summarised the data from all the trials, explained Hayashi, but its positive conclusion was driven by data from just one of the papers it cited: an industry-funded summary of 10 previous trials, led by an author called Kaiser. From these 10 trials, only two had ever been published in the scientific literature. For the remaining eight, the only available information on the methods used came from the brief summary in this secondary source, created by industry. That's not reliable enough.
This is science at its best. The Cochrane review is readily accessible online; it explains transparently the methods by which it looked for trials, and then analysed them, so any informed reader can pull the review apart, and understand where the conclusions came from. Cochrane provides an easy way for readers to raise criticisms. And, crucially, these criticisms did not fall on deaf ears. Dr Tom Jefferson is the head of the Cochrane respiratory group, and the lead author on the 2008 review. He realised immediately that he had made a mistake in blindly trusting the Kaiser data. He said so, without defensiveness, and then set about getting the information needed."
References:
CasesBlog - Medical and Health Blog: The beautiful flower of Internet conversation: how many petals do you have? http://bit.ly/1ekAt9D
Healthcare social media #HCSM - top articles
Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 2-4 weeks:"Is Google accidentally killing Wikipedia?" with "Knowledge Graph" snippets http://buff.ly/1hiuwNx - page views fell by 12% in 2013.
Patient with cancer tweets about her diease - Guardian and NYTimes columnists misinterpret her tweets - outcome: http://buff.ly/1hvnOnt
Bloggers have the same First Amendment rights as professional journalists (US federal court decision) http://buff.ly/1eSCJHW
Social Media Workshop for Emergency Medicine Physicians http://buff.ly/1f5hByf - Great basic info for a quick start.
The majority of Canadian physicians are avoiding social media: "too many pitfalls and too few benefits". 90% of Canadian doctors believe the use of social media tools in medicine poses professional and legal risks. 40% think social media are of little or no use in day-to-day medical practice http://buff.ly/1cX96AE
"Facebook like a spreading disease that's about to fade away" (study) http://buff.ly/1f7STxt
Expand your CME and broaden your academic community with Twitter, urges members Royal College of Physicians of Canada http://buff.ly/1f9RVka
Study: AA parents are active users of mobile tech for social interactions, but less so for accessing health info http://buff.ly/Ml7FXo
Social media use by orthodontic patients: only 13% posted comments about braces, only 6.7% would like to get orthodontic info from social media sites http://buff.ly/Ml8kIC
Milk sharing networks on Facebook; thousands of individuals participate in direct exchange of raw human milk http://buff.ly/NccWku
Smartphone Apps for Diabetes: Do They Really Work? http://buff.ly/1c96qQU - probably not, at least not when studied in trial that extend beyond 3 months.
Social media's role in otolaryngology-head and neck surgery: informing clinicians, empowering patients http://buff.ly/NceJWO
Physicians need to be aware of what information patients can find online because many are unwilling to share it http://buff.ly/1c96U9O
Social Media Engagement by Public Health Researchers: only 24% said SM was helpful for career advancement http://buff.ly/1ggxnX0
The 1% Rule in Digital Health Social Networks: Superusers generate the vast majority of traffic and create value http://buff.ly/1ggw7TQ
The articles were selected from Twitter @DrVes and and RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases at gmail.com and you will receive an acknowledgement in the next edition of this publication.
How to Effectively Participate in a Twitter Chat - Mayo Clinic video
When it comes to social media outreach, Twitter chats are one of the best ways to reach a large audience -- and unlike traditional media, you can interact with a large number of people interested in a topic, including followers and non-followers instantly.
Only problem? Unless you've participated in a few Twitter chats, they can be tricky to follow and confusing at first.
Even worse, if you're in a poorly moderated chat -- the conversation can get stale quickly. Mayo Clinic's social media team has been participating in, and hosting quite a few health care Twitter chats. Although this video applies to health related topics, these tips on how to participate, moderate and effectively communicate during a Twitter chat should be helpful to all.
Only problem? Unless you've participated in a few Twitter chats, they can be tricky to follow and confusing at first.
Even worse, if you're in a poorly moderated chat -- the conversation can get stale quickly. Mayo Clinic's social media team has been participating in, and hosting quite a few health care Twitter chats. Although this video applies to health related topics, these tips on how to participate, moderate and effectively communicate during a Twitter chat should be helpful to all.
Physician: "I think it's time to put the blogging down"
My good Twitter friend, and probably the most famous orthopedic surgeon using social media, @hjluks recently wrote: "Think it's time to put the blogging down...." Is it time? Does blogging still have some place in the busy day of a practicing physician?
It really depends on what you use the blogging for. Here are just three examples:
- My blogs are my personal archive. I often post brief summaries of interesting articles with my personal comments. When I need to retrieve those during discussions with residents, students or patients, finding them is just a click away by using the custom search engine of the blog. Depending on the purpose of your blogs, the readership size and engagement often do not matter that much. For example, I have blogs that almost no one reads (my gardening blog) but I still post there and find them useful.
- Sometimes you need to point your Twitter/Facebook followers to a longer form explanation on a topic or a controversial issue. Blogs work well for that. A cardiologist was misunderstood by an e-patient recently. It took a 1,000-word blog post for him to explain what he really meant.
- You can create a practice website using blogging software. For example, FAQs for a physician practice can be hosted on a blog. Facebook and Twitter are disorganized and not easily searchable, and not everyone has the patience to watch videos to find (or miss) the answer to their question at the end.
Reasons to stop blogging
I know medical bloggers who stopped blogging or closed their Twitter accounts for similar reasons to those summarized below:"He says in his final blog post that while he intended the personal blog to be a place where he could talk about ideas, his posts had started to “spark whole conversations that I never intended to start in the first place, conversations that leech precious time and energy while contributing precious little back.”
More related thoughts:
"So many things can go wrong (with social media) if you don’t do it right. You can get stampeded and lose the game. Playing on the sidelines is more appealing.
If you run a hospital and decide to establish a vast living presence on the Web, people will say bad things about your doctors, your nurses, your waiting times in the ER, your food. You’ll have to deal with HIPAA. There’s also a chance that you’ll say something you’ll regret. Playing on the sidelines is more appealing."
On the other hand, consider this:
Duty calls. Image source: Xkcd.com, Creative Commons license.
See a perfect example why you must read medical blogs in this post by a practicing electrophysiologist: The first 4 months of a new era - anticoagulation with dabigatran. You can't find this first-hand real-life experience in any textbook or medical journal.
6 Reasons Why Doctors Blog
Here are the 6 Reasons Why Doctors Blog, according to Dr. John M., a cardiologist and electrophysiologist:
Here are the top six reasons why I and other doctors choose to author medical blogs:
1. The Practice of Medicine inspires
2. To educate
3. To better mankind
4. To give a look behind the curtain
5. To archive useful information
6. To display our humanness
My comment is here:
Thank you for the wonderful post and sharing insights, John.
Blogging "To better mankind" is beyond reach for me, I think. However, I hope that my blogs helped "To educate" at least some of the readers who flipped through more than 8 million pages since 2005...
Doctors are highly-qualified experts who limit their impact only to patients they see - if they don't publish, give lectures - and blog. In most cases, benefits far outweigh the risk and doctors should be encouraged to at least give it a try.
I tried to describe a practical and time-efficient approach here:
Social media in medicine: How to be a Twitter superstar and help your patients and your practice
http://casesblog.blogspot.com/2011/10/social-media-in-medicine-how-to-be.html
Blogging also keeps you grounded and humble. Critical comments prompt you to back your clinical opinion, expressed in a blog post, with solid scientific references and that's a good thing.
This is a suggested Cycle of Patient Education (click here to enlarge the image):
A here is the suggested Cycle of Online Information and Physician Education (click here to enlarge the image):
The two cycles work together as two interlocking cogwheels. Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:
Why you should start blogging
Quotes from an interview with Seth Godin and Tom Peters:
"Blogging is free. It doesn’t matter if anyone reads it. What matters is the humility that comes from writing it. What matters is the metacognition of thinking about what you’re going to say.
No single thing in the last 15 years professionally has been more important to my life than blogging. It has changed my life, it has changed my perspective, it has changed my intellectual outlook, it’s changed my emotional outlook.
And it’s free."
Don't limit yourself to your blog - use Facebook and Twitter
Blogging can be great for personal growth but there is a lot more interaction on Twitter and Facebook nowadays as compared to blogs. If you have a blog, you must also have a Facebook "like" page (previously called "fan" page) and a Twitter account. These serve the dual purpose of distribution and commenting channels ("two-way street").
For example, Facebook pages get a lot more interaction than blogs for some medical journals - you can count the comments on the NEJM Facebook updates (the range is 9-180) vs. their blog (0). The blog has comments enabled, of course.
Facebook is the clear "winner" in terms of commenting activity, it is not even close:
NEJM Facebook page vs. NEJM blog
What is the oldest medical blog?
I have maintained medical blogs since 2004 but never thought about blog anniversaries - blogging seems such a mundane task of daily life.
What is the "life expectancy" of a medical blog?
The studies are ongoing but the current record is around 8-10 years... http://goo.gl/5LRx
In the medical blogging world, the physician bloggers who produce high volume of original content often quit after 1-2 years. There is too much to handle. Medical blogging is a difficult task that requires a lot of time and mental energy (scientific accuracy, HIPAA compliance, ethics, etc.), and the financial rewards are nonexistent or negligible.
As pointed out in the comments, the "oldest" medical blog probably is Family Medicine Notes, followed by GruntDoc.
Related reading and a lot of comments:
What is the oldest medical blog? http://bit.ly/1aSL3VY
Why you should start blogging in 2011 http://bit.ly/1aSKGdO
Doctors are natural communicators - social media is extension of what they do every day http://bit.ly/U2wB7O
6 Reasons Why Doctors Blog http://bit.ly/1aSL8c7
Who blogs? Personality predictors of blogging http://bit.ly/1aSLb7M
12 tips for using Twitter as a learning tool in medical education - PubMed article
The suggested tips are organized into the following categories:- mechanics of using Twitter
- suggestions and evidence for incorporating Twitter into many medical education contexts
- promoting research into the use of Twitter in medical education
However, you will need paid (or institutional) access to read the actual 12 tips for using Twitter as a learning tool in medical education, published at the Informa website:
http://informahealthcare.com/doi/abs/10.3109/0142159X.2012.746448
References:
Twelve tips for using Twitter as a learning tool in medical education. Forgie SE, Duff JP, Ross S. Med Teach. 2012 Dec 21.
http://www.ncbi.nlm.nih.gov/pubmed/23259608
140-character Resume: How Twitter is Changing the Job Hunt
How Twitter is Changing the Job Hunt. Some recruiters say Twitter has transformed their prospecting and hiring, helping them identify candidates they wouldn't have found otherwise, but others say the messaging platform has some way to go before it can replace LinkedIn, Facebook or other job-hunting tools. Lauren Weber from the WSJ reports:
Will traditional scientific journals follow newspapers into oblivion, asks former BMJ editor
Richard Smith is a former editor of the BMJ and chief executive of the BMJ Publishing Group. He is well-known for provocative editorials. Here is an excerpt from one, published recently in The Scientist:"Elsevier, the world’s largest publisher of scientific journals, has seen broadly stable revenues (€2,236 million in 2006, €2,370 million in 2010) but growing profits (€683 million in 2006, €847 million in 2010).
Scientific journals remain very profitable. Few industries manage a profit margin of 35.7% (that for Elsevier in 2010), but then few industries are given their raw material—in this case, scientific studies—not only for free, but also in a form that needs minimal processing."
It is nice to see that the current and a former editor of the two most famous British medical journals, The Lancet and BMJ, are now on Twitter:
Why has the Cochrane Collaboration never quite taken off in the US?
— richard horton (@richardhorton1) April 5, 2012
Any symptom in an elderly person should be considered to be a drug side effect until proved otherwise. Jerry Avern
— Richard Smith (@Richard56) April 2, 2012
References:
Reading Into the Future | The Scientist, 2012.
The scientific journal throuh the centuries - a little bit of history from Health Librarian (HL) Wiki http://buff.ly/WZqP2S
The Number of Tweets Predicts Future Citations of a Specific Journal Article
Citations of journal articles and the impact factor are widely used measures of scientific impact. Web 2.0 tools such as Twitter, Facebook, blogs and social bookmarking tools provide the possibility to construct article-level or journal-level metrics to gauge impact and influence. Between 2008 and 2011, all tweets containing links to articles in the Journal of Medical Internet Research (JMIR) were data mined.The tweets were compared to subsequent citation data 17-29 months later.
4,000 tweets cited 280 JMIR articles. The distribution of tweets followed a power law, with most tweets sent on the day when an article was published (44% of all tweets in a 60-day period) or on the following day (16%), followed by a rapid decay.
The Pearson correlations between "tweetations" and regular citations were moderate and statistically significant (0.42 to 0.72).
Highly tweeted articles were 11 times more likely to be highly cited than less-tweeted articles.
Top-cited articles could be predicted from top-tweeted articles with 93% specificity and 75% sensitivity.
Tweets can predict highly cited articles within the first 3 days of article publication.
Social media activity may:
- increase citations
- reflect the underlying qualities of the article
Social impact measures based on tweets are proposed to complement traditional citation metrics. The study author proposed a "twimpact" factor that measures uptake and filters research resonating with the public in real time.
After the initial publication, some science blogs have pointed out potential issues and conflicts of interests in relation to the topic and the single author who is also the founder, owner, and Editor-in-Chief of the journal. You can find more by performing a Google search for "twimpact" factor or checking the references section at the end of this post. Overall, I think this is an interesting concept and Gunther Eysenbach did a great job focusing the attention of the journal publishers on Twitter and Facebook as distribution channels that can also guide in measuring the impact of their articles.
References:
Can Tweets Predict Citations? Metrics of Social Impact Based on Twitter and Correlation with Traditional Metrics of Scientific Impact. Gunther Eysenbach. J Med Internet Res 2011;13(4):e123.
New research plus twitter. Does it make a difference in the clinic. Heidi Allen Digital Strategy in Health.
'Highly Tweeted Articles Were 11 Times More Likely to Be Highly Cited'. The Atlantic.
Twimpact factors: can tweets really predict citations? BMJ.
Tweets, and Our Obsession with Alt Metrics
Image source: Twitter.com.
Comments from Twitter:
@paediatrix: Interesting. Makes sense
Harris Lygidakis @lygidakis: And Twimpact Factor is a good sign of what's ahead!
Best Tweets - Selection of Twitter Favorites
Being a SuperHero has its drawbacks RT @Bongi1: Just about to fly to cape town just to turn around and fly back.
— GruntDoc (@gruntdoc) December 13, 2011
This is amusing: Amy Chua's "Battle Hymn of the Tiger Mother" was sold in China as "Being an American Mom." bit.ly/vI0zNo #hardcore
— Heidi N. Moore (@moorehn) December 11, 2011
Chickens' water keeps freezing. I propose adding vodka to it. I have been overruled. Something about killing them.
— Robert Silge, MD (@DoctorMac) December 10, 2011
Walked by a minor car accident earlier & a cop said to passersby: "Nothing to TWEET here, move along now."
— Nick Bilton (@nickbilton) December9, 2011
Study shows people can guess personality via body odor. From inkblot to stinkblot? j.mp/v6DDNX
— Dr John Weiner (@AllergyNet) December5, 2011
I attended a really long talk today.The only thing I learned from it is the flash-drive-around-the-neck is not a good look for lecturers.
— Jonathan,DO,MS,NCC (@DrJonathan) December1, 2011
Dental assistant (before I met dentist): "Ok I'm going to do the routine 14 x-rays." Me: "Uhhh, no that's ok."Her:"But, but-we always do!"
— Jonathan,DO,MS,NCC (@DrJonathan) December1, 2011
The inclusion of a Twitter update (tweet) in Best Tweets - Selection of Twitter Favorites does not represent endorsement or agreement of any kind. If you are included in this post but you would like to have your tweet removed for any reason, please email me and will comply with your request the same day.
Why you shouldn't close your blog and Twitter account
A few months ago, @Doctor_V and an anonymous doctor on Twitter had an argument, she closed her account and now DrV's blog is the only one left to tell the story: http://goo.gl/mIS3NI understand and appreciate the arguments of both parties. However, when she deleted her Twitter account, we lost one side of the story forever.
All doctors should consider having online presence because they need to tell their side of the story.
For example, if the majority of pediatricians had blogs, the false autism/immunization link would not have become accepted by celebrities and misled a large part of the general public.
Comments from Google Plus:
Arin Basu: Excellent point by Ves about how false findings spread (read the bit about immunization and autism). I think by the same stretch of logic, I'd strongly vouch for clinician-epidemiologists, and epidemiologists should have their own blogs, and take part in social media more often and raise awareness about findings and interpretation of studies. Well said, Ves.
Related reading:
Why blog? Notes from Dr. RW. A perfectly reasonable list. All doctors should consider blogging. It's do-it-yourself CME.
Social media in medicine: How to be a Twitter rockstar and help your patients and your practice
This is the key concept from a series of talks that I presented at several national and international meetings in 2011-2012 (CSACI, AAAAI and WAO) - TIC, Two Interlocking Cycles:
- Cycle of Patient Education
- Cycle of Online Information and Physician Education
The two cycles work together as two interlocking cogwheels (TIC).
Cycle of Patient Education (click here to enlarge the image). An editable copy for your presentation is available at Google Drive:
Cycle of Online Information and Physician Education (click here to enlarge the image). An editable copy for your presentation is available at Google Drive:
The first presentation was during the annual meeting of the Canadian Society of Allergy and Clinical Immunology (CSACI) and brought a lot of engaged, useful, and interesting questions. Feel free to use the images in your own presentations with credit to AllergyCases.org.
The two cycles work together as two interlocking cogwheels. Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:
Products of the Cycle of Patient Education: EQUALS
- Energized patients and health staff
- Quality of life is improved
- Understanding of patient condition is improved
- "Affinity" - better physician-patient relationship leads to increased referrals to the practice, e.g. 2-5 new patients per week per physician, increased revenue
- Lower rate of ER visits, hospital admissions, phone calls
- Savings for patient and health system
What is Return On Investment (ROI) of Cycle of Patient Education?
Calculated ROI:
- 2 new patients per week who come to the clinic directly from the blog/Twitter account
- $500 reimbursement for 2-3 visits (initial visit and 1-2 followup visits)
- 50 weeks x 2 patients = 100 new patients per year
- 100 patients x $500 = $50,000 per year
The best interest of the patient is the only interest to be considered
The purpose of the cycle is not to make money. As the Mayo Clinic CEO pointed out recently, Mayo Clinic intends to be the leader in social media in healthcare but this is not about competitive advantage, it is about the patient. The best interest of the patient is the only interest to be considered. Social media makes the union of forces more broadly practical than at any time in human history.
Social media for physicians: Do I really need to be on Twitter, Facebook and YouTube?
(the text below uses the specialty of allergy and immunology as an example, an edited version was published on the website of the World Allergy Organization where I write a monthly column)
It certainly looks like social media is taking over the world. Facebook is a “country” with more than 750 millions citizens. Twitter has more than 250 millions users. Google+ is the fastest growing web service and history and reached 25 million users in just one month after its launch. As an allergist, you may ask yourself, “Where is my place in all this? Do I have to be on Twitter? Do I have to use Facebook and YouTube to stay relevant?” The answer is yes.
With the recent update of Google called "Search Plus Your World", individuals, physician practices and organizations without social media presence will be pushed further down the page of search results. That means, unfortunately, that if your practice does not have a strong social media presence, when patients/physicians search for a health topic, they may not see the quality results they deserve.
Number of Tweets Predicts Future Citations of a Specific Journal Article
Twitter is becoming essential for both authors and publishers of scientific literature. Highly tweeted journal articles are 11 times more likely to be highly cited than less-tweeted articles. Top-cited articles could be predicted from top-tweeted articles with 93% specificity and 75% sensitivity. A "twimpact" factor is proposed that measures uptake and filters research resonating with the public in real time (Med Internet Res 2011;13(4):e123. http://www.jmir.org/2011/4/e123).
You can be a physician and a social media superstar at the same time
Social media can provide a focused and time-efficient learning experience. Sharing relevant medical news with patients is just a click away. The paramount is to protect patient privacy at all times and to comply with your employer and professional organization guidelines. You can be a physician and a social media superstar at the same time. Here is how in 3 easy steps.
1. Use of Internet to learn and stay up-to-date
- Web feeds (RSS and Atom) work great for for targeted updates from journals, websites, and allergy/immunology news. RSS stands for Really Simple Syndication and consists of updates pulled from a particular website whenever something new is published. RSS feeds can be separated in different categories, e.g. asthma, allergic rhinitis, etc. Web-based RSS readers (Google Reader, Feedly, Flipboard) function as “inbox for the web”. You can get all sources delivered in one location - a web-based reader
- Blogs and Twitter accounts. A selected list of high-yield blogs and Twitter accounts of board-certified allergists/immunologists includes: @JuanCIvancevich (Juan C. Ivancevich, Buenos Aires, Web Editor of the World Allergy Organization), @wheezemd (Michael Blaiss, MD, Past President of the American College of Allergy, Asthma, and Immunology), @DrSilge (Robert Silge, MD, allergist/immunologist, Salt Lake City, Utah), @AllergyNet ( John Weiner, allergist, clinical immunologist, Melbourne, Australia), @MatthewBowdish (Matthew Bowdish MD, allergist/clinical immunologist, Colorado), @allergydoc4kidz (Stuart Carr, allergist/immunologist, Canada), and the author’s own Twitter account at @Allergy.
- Podcasts for allergy and immunology education represent mobile-based MP3 files and services with automatic subscription. Free podcasts/videocasts are provided by COLA Allergy (ACAAI, http://childrensmercy.org/content/view.aspx?id=5979), Journal of Allergy and Clinical Immunology (AAAAI, http://jacionline.org/content/podcast), and World Allergy Organization (http://journals.lww.com/waojournal/Pages/podcasts.aspx).
- Persistent searches for topics of interests in allergy/immunology. You can subscribe to RSS feeds for "persistent searches" in PubMed and Google News for the topic of your interest, e.g. “oral immunotherapy for food allergy”.
- Text-to-speech (TTS). You can use text-to-speech to listen to journal articles at a later time. The text-to-speech programs convert the the text of a journal article into an MP3 file. A free program is Balabolka (http://cross-plus-a.com/balabolka.htm).
- Clinical cases and practical questions are available from the World Allergy Organization Journal, AllergyCases.org (disclaimer: the author is the founder of the website), AAAAI Ask the Expert (http://aaaai.org/ask-the-expert.aspx).
2. Use of Internet and computers for patient education
- Patient education diagrams - web- and iPad/tablet-based diagrams are well-received by patients and doctors in training. The the author's survey at the allergy clinic of the University of Chicago showed a 95% patient approval rate for iPad use for patient education. The diagrams used in the study are available here: Diagrams for Patient Education.
- Videos for patient education can be viewed on tablet or netbook. The videos can be streatmed from the physician's website or downloaded locally. Targeted videos can be used for patient education before and during the visit, for example, “what to expect from your visit at the allergist office”, “how to use an inhaler”, etc. There is a continuum of education - start at the office (tablet or netbook), then continue at home (web-based videos and selected educational brochures and links).
- Ready-made patient education brochures can be printed from allergist's website. A custom-made search engine can generate brochures on demand, e.g. Medline Plus.
3. Use of Internet to promote your practice and collaborate
- Start a website for free (WordPress.com or Blogger.com). Start a Twitter account and professional Facebook page for your practice.
- Setup persistent searches for your name/practice on Google, Twitter, etc. and subscribe to RSS for automatic updates. You can address questions and concerns whenever they arise.
- Use Google Docs for research collaboration, creating diagrams for patient education, office calendar, and spreadsheets.
Risks of social media use by physicians
Physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just as they would in any other context. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content first to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities (Source: AMA Policy: Professionalism in the Use of Social Media, 2011).
12-Word Social Media Policy by Mayo Clinic: "Don’t Lie, Don’t Pry, Don’t Cheat, Can’t Delete, Don’t Steal, Don’t Reveal" (http://goo.gl/1Jwdo).
Advice for Physician Who Use Social Media for Professional Purposes
- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA, e.g. never publish any identifiable information without patient permission
- Consider using your name and credentials on your blog and other social media accounts
- If your blog is work-related, it is better to let your employer know.
- Inquire if there are any employee social media guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
Summary
Social media is here to stay and is fast becoming the dominant way of information consumption and sharing for the general population and patients. Allergists have to be on social media to stay relevant and to provide meaningful service to patients.
The author can personally confirm the benefits of the approach outlined above. Dr. Dimov has used social media for professional purposes for more than 7 years while on staff at Cleveland Clinic and the University of Chicago. During that time his websites have had more than 8 million page views and attract daily 16,000 RSS subscribers, 9,000 Twitter followers and 2,600 visitors.
There are other physicians who are even more popular on social media and make the stats above look minuscule. You can be one of them. It benefits both your patients and your professional life.
RSS bundles of medical news
You can use the following RSS bundles to subscribe to medical news items. The bundles are exported from my personal Google Reader page. They update automatically several times per day. When in Google Reader, just select the ones that you find interesting and share them on Twitter. Feel free to add your own comments to some of the tweets.
Top Twitter Doctors
This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:
Related reading
Should oncologists 'prescribe' accurate web sites in combination with chemotherapy? Ann Oncol. 2011 Nov 22.
How to Prepare For and Execute An Online Presence - by Howard Luks, MD http://goo.gl/zsg3m
What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging
Patients directed to online tools don't necessarily use them: 25% checked website vs. 42% read same material on paper. Am Medical News, 2012.
- Cycle of Patient Education
- Cycle of Online Information and Physician Education
The two cycles work together as two interlocking cogwheels (TIC).
Cycle of Patient Education (click here to enlarge the image). An editable copy for your presentation is available at Google Drive:
Cycle of Online Information and Physician Education (click here to enlarge the image). An editable copy for your presentation is available at Google Drive:
The first presentation was during the annual meeting of the Canadian Society of Allergy and Clinical Immunology (CSACI) and brought a lot of engaged, useful, and interesting questions. Feel free to use the images in your own presentations with credit to AllergyCases.org.
The two cycles work together as two interlocking cogwheels. Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:
Products of the Cycle of Patient Education: EQUALS
- Energized patients and health staff
- Quality of life is improved
- Understanding of patient condition is improved
- "Affinity" - better physician-patient relationship leads to increased referrals to the practice, e.g. 2-5 new patients per week per physician, increased revenue
- Lower rate of ER visits, hospital admissions, phone calls
- Savings for patient and health system
What is Return On Investment (ROI) of Cycle of Patient Education?
Calculated ROI:
- 2 new patients per week who come to the clinic directly from the blog/Twitter account
- $500 reimbursement for 2-3 visits (initial visit and 1-2 followup visits)
- 50 weeks x 2 patients = 100 new patients per year
- 100 patients x $500 = $50,000 per year
The best interest of the patient is the only interest to be considered
The purpose of the cycle is not to make money. As the Mayo Clinic CEO pointed out recently, Mayo Clinic intends to be the leader in social media in healthcare but this is not about competitive advantage, it is about the patient. The best interest of the patient is the only interest to be considered. Social media makes the union of forces more broadly practical than at any time in human history.
Social media for physicians: Do I really need to be on Twitter, Facebook and YouTube?
(the text below uses the specialty of allergy and immunology as an example, an edited version was published on the website of the World Allergy Organization where I write a monthly column)
It certainly looks like social media is taking over the world. Facebook is a “country” with more than 750 millions citizens. Twitter has more than 250 millions users. Google+ is the fastest growing web service and history and reached 25 million users in just one month after its launch. As an allergist, you may ask yourself, “Where is my place in all this? Do I have to be on Twitter? Do I have to use Facebook and YouTube to stay relevant?” The answer is yes.
With the recent update of Google called "Search Plus Your World", individuals, physician practices and organizations without social media presence will be pushed further down the page of search results. That means, unfortunately, that if your practice does not have a strong social media presence, when patients/physicians search for a health topic, they may not see the quality results they deserve.
Number of Tweets Predicts Future Citations of a Specific Journal Article
Twitter is becoming essential for both authors and publishers of scientific literature. Highly tweeted journal articles are 11 times more likely to be highly cited than less-tweeted articles. Top-cited articles could be predicted from top-tweeted articles with 93% specificity and 75% sensitivity. A "twimpact" factor is proposed that measures uptake and filters research resonating with the public in real time (Med Internet Res 2011;13(4):e123. http://www.jmir.org/2011/4/e123).
You can be a physician and a social media superstar at the same time
Social media can provide a focused and time-efficient learning experience. Sharing relevant medical news with patients is just a click away. The paramount is to protect patient privacy at all times and to comply with your employer and professional organization guidelines. You can be a physician and a social media superstar at the same time. Here is how in 3 easy steps.
1. Use of Internet to learn and stay up-to-date
- Web feeds (RSS and Atom) work great for for targeted updates from journals, websites, and allergy/immunology news. RSS stands for Really Simple Syndication and consists of updates pulled from a particular website whenever something new is published. RSS feeds can be separated in different categories, e.g. asthma, allergic rhinitis, etc. Web-based RSS readers (Google Reader, Feedly, Flipboard) function as “inbox for the web”. You can get all sources delivered in one location - a web-based reader
- Blogs and Twitter accounts. A selected list of high-yield blogs and Twitter accounts of board-certified allergists/immunologists includes: @JuanCIvancevich (Juan C. Ivancevich, Buenos Aires, Web Editor of the World Allergy Organization), @wheezemd (Michael Blaiss, MD, Past President of the American College of Allergy, Asthma, and Immunology), @DrSilge (Robert Silge, MD, allergist/immunologist, Salt Lake City, Utah), @AllergyNet ( John Weiner, allergist, clinical immunologist, Melbourne, Australia), @MatthewBowdish (Matthew Bowdish MD, allergist/clinical immunologist, Colorado), @allergydoc4kidz (Stuart Carr, allergist/immunologist, Canada), and the author’s own Twitter account at @Allergy.
- Podcasts for allergy and immunology education represent mobile-based MP3 files and services with automatic subscription. Free podcasts/videocasts are provided by COLA Allergy (ACAAI, http://childrensmercy.org/content/view.aspx?id=5979), Journal of Allergy and Clinical Immunology (AAAAI, http://jacionline.org/content/podcast), and World Allergy Organization (http://journals.lww.com/waojournal/Pages/podcasts.aspx).
- Persistent searches for topics of interests in allergy/immunology. You can subscribe to RSS feeds for "persistent searches" in PubMed and Google News for the topic of your interest, e.g. “oral immunotherapy for food allergy”.
- Text-to-speech (TTS). You can use text-to-speech to listen to journal articles at a later time. The text-to-speech programs convert the the text of a journal article into an MP3 file. A free program is Balabolka (http://cross-plus-a.com/balabolka.htm).
- Clinical cases and practical questions are available from the World Allergy Organization Journal, AllergyCases.org (disclaimer: the author is the founder of the website), AAAAI Ask the Expert (http://aaaai.org/ask-the-expert.aspx).
2. Use of Internet and computers for patient education
- Patient education diagrams - web- and iPad/tablet-based diagrams are well-received by patients and doctors in training. The the author's survey at the allergy clinic of the University of Chicago showed a 95% patient approval rate for iPad use for patient education. The diagrams used in the study are available here: Diagrams for Patient Education.
- Videos for patient education can be viewed on tablet or netbook. The videos can be streatmed from the physician's website or downloaded locally. Targeted videos can be used for patient education before and during the visit, for example, “what to expect from your visit at the allergist office”, “how to use an inhaler”, etc. There is a continuum of education - start at the office (tablet or netbook), then continue at home (web-based videos and selected educational brochures and links).
- Ready-made patient education brochures can be printed from allergist's website. A custom-made search engine can generate brochures on demand, e.g. Medline Plus.
3. Use of Internet to promote your practice and collaborate
- Start a website for free (WordPress.com or Blogger.com). Start a Twitter account and professional Facebook page for your practice.
- Setup persistent searches for your name/practice on Google, Twitter, etc. and subscribe to RSS for automatic updates. You can address questions and concerns whenever they arise.
- Use Google Docs for research collaboration, creating diagrams for patient education, office calendar, and spreadsheets.
Risks of social media use by physicians
Physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just as they would in any other context. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content first to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities (Source: AMA Policy: Professionalism in the Use of Social Media, 2011).
12-Word Social Media Policy by Mayo Clinic: "Don’t Lie, Don’t Pry, Don’t Cheat, Can’t Delete, Don’t Steal, Don’t Reveal" (http://goo.gl/1Jwdo).
Advice for Physician Who Use Social Media for Professional Purposes
- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA, e.g. never publish any identifiable information without patient permission
- Consider using your name and credentials on your blog and other social media accounts
- If your blog is work-related, it is better to let your employer know.
- Inquire if there are any employee social media guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
Summary
Social media is here to stay and is fast becoming the dominant way of information consumption and sharing for the general population and patients. Allergists have to be on social media to stay relevant and to provide meaningful service to patients.
The author can personally confirm the benefits of the approach outlined above. Dr. Dimov has used social media for professional purposes for more than 7 years while on staff at Cleveland Clinic and the University of Chicago. During that time his websites have had more than 8 million page views and attract daily 16,000 RSS subscribers, 9,000 Twitter followers and 2,600 visitors.
There are other physicians who are even more popular on social media and make the stats above look minuscule. You can be one of them. It benefits both your patients and your professional life.
RSS bundles of medical news
You can use the following RSS bundles to subscribe to medical news items. The bundles are exported from my personal Google Reader page. They update automatically several times per day. When in Google Reader, just select the ones that you find interesting and share them on Twitter. Feel free to add your own comments to some of the tweets.
Top Twitter Doctors
This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:
Related reading
Should oncologists 'prescribe' accurate web sites in combination with chemotherapy? Ann Oncol. 2011 Nov 22.
How to Prepare For and Execute An Online Presence - by Howard Luks, MD http://goo.gl/zsg3m
What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging
Patients directed to online tools don't necessarily use them: 25% checked website vs. 42% read same material on paper. Am Medical News, 2012.
Should a doctor block his/her patients on Google+ or Twitter?
According to the Guardian newspaper, the current UK guidelines state that "Doctors must not "friend" their patients on Facebook." Should a doctor block his/her patients on Google+ then? What about Twitter?
Social media platforms, their use, and the perception of the ways they are used are all changing. The ban of professional use of the most popular services is not the way forward.
Doctors are natural communicators and should do very well on social media platforms. Patients, and society in general, would only benefit from physicians who share ideas and focus on education.
Simple guidance for social media use
The suggested guidance for social media use by health professionals is very simple and based on a recent book by a nurse and social media advocate:
1. Remember the basics:
- your professional focus
- the laws around patient privacy (HIPAA in the U.S.)
- the professional standards of regulatory bodies and of your employers
2. After that, explore all the different social media tools that are out there:
The Cycle of Online Information (click to enlarge the image).
12-Word Social Media Policy by Mayo Clinic: "Don’t Lie, Don’t Pry, Don’t Cheat, Can’t Delete, Don’t Steal, Don’t Reveal" (http://goo.gl/1Jwdo).
References:
Facebook friends a no-no for doctors. Guardian.
Doctors are natural communicators - social media is extension of what they do every day
Comments from Google+:
Steven Eisenberg - Create a circle of patients and share/filter as appropriate? Hmmmm... Thoughts?
Neil Mehta - In real life, what would you do if you run into a patient at a party? At a grocery store? Would BMA ask the docs to not talk with them? Turn their backs? Would that be professional? Do you ask you patients about their hobbies, interests travels? Does it help you become a more patient-centered provider?
Social Media is here to stay. Just as we have boundaries in RL we need to talk about appropriate boundaries in SoMe. The answer is probably use common sense and put the interest of the patient first. In some countries, it is routine practice to give your patient your cell phone number. So does the answer depend on your cultural and societal norms? It is a slippery slope and a number of issues need to be figured out - privacy, reimbursement, liability etc. What if the Social (professional) network exchange was behind appropriate firewalls/tunneled, what if the pts, PHR was accessible? What if we had a ACO model with no fee for service but the system was responsible for keeping their patients healthy?
Jeffrey Benabio, MD - Ves, here's the comment I put on David Lewis's post:
The difficulty is in how we define friends in this space. The doctor-patient relationship is unique and it's difficult (usually impossible) to have both a healthy friendship and healthy doctor-patient relationship without compromising both.
Patients depend on me, not as a friend, but as their physician. The expectations for a friend and a physician are different; it is difficult to have two sets of expectations for the same person.
As a physician, I'm privy to information that is personal, sometimes compromising, and often affects other people that both I and the patient knows. Patients must share things with me that they would never share with a friend. My duty as physician is only to care for her; if she and I were friends, then what she shared with me could be damaging to her in her social or personal life. I could not be both her friend and her physician.
Friends can also sometimes become romantic partners. This is verboten in a doctor-patient relationship.
The relationship between friends must be egalitarian and mutual. This is not true of doctor-patient relationships. I must advise patients what to do. I cannot tell my patients about my problems ("Boy you think that's a rash, look at this one on my leg!").
Their role as patient is to get and stay well. My role is to do everything in my ability to help them achieve that. They pay me to do this. They expect me to do this. There cannot be any reciprocity.
In fact, unlike friends, it's inappropriate for physicians to accept gifts from patients. Do patients who buy me a bottle of wine get special treatment? Do my "friend" patients have special access to me? Special privileges? It would be unfair to all my "non-friend" patients. This is where something innocuous in a friendship becomes unethical in medicine.
I examine, touch and sometimes hurt patients this is unique to medicine. Imagine that I must touch the genitals of a patient to treat him or her. This action has no place in a friendship and both the doctor-patient relationship the friendship would be compromised.
Imagine if a patient found that my political or religious beliefs were inconsonant with his beliefs. This could compromise my ability to be the best physician for him if he was unable to trust me because I was Jewish or Muslim or Catholic. This might force him to find a new physician at a time when he's sick or vulnerable and would compromise his ability to get the best care.
I have a great relationship with my patients; we are friendly and engage in enjoyable conversations about life, politics and the weather. But each of these relationships is a doctor-patient relationship that best serves the needs of the patient above all else.
The problem with social media friendships for physicians is that they're too close to real life friendships. All my online patient friends are "doctor-patient-friends" and I endeavor to keep it that way for their sake.
Steven Eisenberg - Jeffrey- SO well said. Very complex indeed.
Nancy Onyett, FNP-C - I totally agree with Jeffrey Benabio MD. The AMA and ANA for Advanced Practice has these points under the Code of Ethics for Professioal Conduct. Dr. Benabio breaks this down ito layman terms. Great post TY:)
Neil Mehta - Great discussion. Social Media (web 2.0) means a two way discussion as opposed to a static one way lecture (web 1.0). The facebook model is just one type of a social networking model which is one type of social media (medium). Seems professional bodies would not want us to "Friend" our patients and most people would agree. "Friend" is very much a FB term which has a connotation that means Friends see each others posts, photos, videos on Facebook. What do people think of doctor-patient communications using Online Social Media in the broad sense of the term?
Examples include:
A doctor posts some patient education material on YouTube that the patient sees and comments on.
What about the functionality of asymmetric circles? That prevents reciprocity.
We have seen how sending periodic SMS to pts with chronic conditions improves adherence. Is it possible to extend that model?
Nancy Onyett, FNP-C - I feel safer using my own EMR for patient correspondence through encrypted email. I am not sure if creating a circle of patients would be feasible unless it was for education and HIPPA/Privacy would not be violated --may be difficult to do.
Bader ALHablani - Great discussion...please allow me to ask a question here.Quote from the article: "Yet accepting Facebook friends presents doctors with difficult ethical issues," he said. "For example, doctors could become aware of information about their patients that has not been disclosed as part of a clinical consultation." End of quote. Suppose patient XYZ is one of my friends on Google+. And I am following Dr. ABC and vice versa. What would happen when I post an article (to my extended circles) and patient XYZ writes a comment/reply that contain an information which “could [make] Dr. ABC “aware of information about their patients that has not been disclosed as part of clinical consultation”, please? Dr. ABC would be able to see his/her comments, right please?
doc emer - I also have excellent friendship relationships with my online patient-friends in FB. I think it even helps in treatment/management. Problems may occur, as in any form of communicating, but are rare and isolated. A good doctor is friends with his patients, be it online or otherwise.
Michael Zelman - Psychologists have explicit rules about avoiding multiple relationships, being "friends" with patients falls under that category. The intent is to protect the patient and therapeutic relationship between client and professional. There are obvious parallels between physician and patient. This is not to say that every aspect of a social media relationship would be negative, but virtual friending can blur boundaries, change expectations, violate confidentiality, and lead to expectations of more out of the relationship than is healthy or allowed. It may be possible to navigate social media relationships while avoiding multiple relationships with a practitioner as a business; i.e., group practice, hospital, community clinic where patients and community members follow the entity (not individual), but in a 1-way, asymmetric manner as proposed above. Even with that much care is needed to protect patient rights under various Federal and State privacy laws.
http://www.apa.org/ethics/code/index.aspx
"3.05 Multiple Relationships
(a) A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.
A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.
Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.
(b) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.
(c) When psychologists are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, at the outset they clarify role expectations and the extent of confidentiality and thereafter as changes occur. (See also Standards 3.04, Avoiding Harm, and 3.07, Third-Party Requests for Services.)
When are you starting a Journal Club on Google Plus?
One of the BMJ blogs recently asked if Twitter Journal Club is yet another ‘revolution’ in scientific communication.
I think Twitter Journal Club is an incremental change in the way the scientists and physicians communicate. It is a good idea but limited by the medium of Twitter.
Does anybody have plans for a Journal Club on the newly-launched Google Plus? It is the fastest growing social network in history (25 million members in month) and it seems like a natural platform for that.
I think Twitter Journal Club is an incremental change in the way the scientists and physicians communicate. It is a good idea but limited by the medium of Twitter.
Does anybody have plans for a Journal Club on the newly-launched Google Plus? It is the fastest growing social network in history (25 million members in month) and it seems like a natural platform for that.
Arin Basu - Google + is a very natural medium for hosting journal clubs or say even grand rounds! I am more than happy to start giving it a shot!
Ves Dimov - We first tried Journal Club on Twitter in 2008 but didn't like it that much:
This 2011 version is "Twitter-only" (with a blog that provides some background) but can't go beyond the natural limitations of the medium.
Google+ seems like a better fit for a more involved discussion with a richer background. And you can actually follow the conversation...
Related reading:
Virtual Journal Club for Hospital Medicine by the Washington University in St. Louis
Related reading:
Virtual Journal Club for Hospital Medicine by the Washington University in St. Louis
What happens when you ask for medical advice on Twitter - CNN's Anderson Cooper knows from experience
What happens when you ask for medical advice on Twitter and you are CNN's host Anderson Cooper with 1.5 million followers:
Replies:
@thehighsign I generally just go with the opinion of a million and a half strangers.
@SashaTalebi Crazy times we're living in when @andersoncooper can crowdsource his bronchitis diagnosis via Twitter. Get well soon.
@JPLondon72 When a doctor says "You have bronchitis". Usually. Not always.
@emokidsloveme I feel like @andersoncooper has health insurance. Call me crazy, but I think he could afford to pay out of pocket too. #TwitterER
@Technikohler But why don't you just hit up good ole Gupta and ask him ?
@SadaoTurner hey @sanjayguptaCNN, do u know this guy @andersoncooper
@sherrybutlerpr Tight breathing, Burning in chest, fever. B careful, walking pneumonia
@LizaLizzieHalim i knew when i had troubled breathing&it makes sounds.Then i get the doctor checked&was diagnosed with it. Still have it now.
@lynngosselin I've had bronchitis many times so yes I know...but maybe a Dr. will pick up your post
@feathersong Two words - doctor, antibiotics. Make that three words - stat. Feel better soon, you've got a show to do!
@EldinaV And use a mist vaporizer in your dream and lots of OJ
@teresac8 fever, cough, wheezing and irritated breathing but to be sure see a doctor.
@cheeki3 well you want to the homeopathic route. Oregano oil (diluted in juice) will knock it right out.#justsaying
@sherrybutlerpr Also coughing up phlegm. Get on meds. U don't slow down, so will need that or will really go down. Take good care.
Mind map of differential diagnosis of cough. See more Allergy and Immunology mind maps here.
Replies:
@thehighsign I generally just go with the opinion of a million and a half strangers.
@SashaTalebi Crazy times we're living in when @andersoncooper can crowdsource his bronchitis diagnosis via Twitter. Get well soon.
@JPLondon72 When a doctor says "You have bronchitis". Usually. Not always.
@emokidsloveme I feel like @andersoncooper has health insurance. Call me crazy, but I think he could afford to pay out of pocket too. #TwitterER
@Technikohler But why don't you just hit up good ole Gupta and ask him ?
@SadaoTurner hey @sanjayguptaCNN, do u know this guy @andersoncooper
@sherrybutlerpr Tight breathing, Burning in chest, fever. B careful, walking pneumonia
@LizaLizzieHalim i knew when i had troubled breathing&it makes sounds.Then i get the doctor checked&was diagnosed with it. Still have it now.
@lynngosselin I've had bronchitis many times so yes I know...but maybe a Dr. will pick up your post
@feathersong Two words - doctor, antibiotics. Make that three words - stat. Feel better soon, you've got a show to do!
@EldinaV And use a mist vaporizer in your dream and lots of OJ
@teresac8 fever, cough, wheezing and irritated breathing but to be sure see a doctor.
@cheeki3 well you want to the homeopathic route. Oregano oil (diluted in juice) will knock it right out.#justsaying
@sherrybutlerpr Also coughing up phlegm. Get on meds. U don't slow down, so will need that or will really go down. Take good care.
Acute bronchitis: Many patients expect to be treated with antibiotics and cough meds but this differs from guidelines
Mind map of differential diagnosis of cough. See more Allergy and Immunology mind maps here.
Cough is the most common symptom bringing patients to the primary care physician's office. The most common diagnosis in these patients is acute bronchitis, according to a recent review in the official journal of AFP, American Family Physician.
Acute bronchitis should be differentiated from other common causes of cough such as pneumonia and asthma - because the therapies are clearly different.
Symptoms of acute bronchitis typically last 3 weeks. As we already know, the presence of colored (e.g., yellow or green) sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections. This statement was contradicted by a recent study: Green or yellow phlegm likely to be bacterial - confirming beliefs by doctors and patients alike (http://goo.gl/zff8X and http://goo.gl/cwKGs).
Viruses cause more than 90% of acute bronchitis, and therefore, antibiotics are generally not indicated. They should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia (e.g., patients 65 years or older).
The typical therapies that have been traditionally used for managing acute bronchitis symptoms have been shown to be ineffective. The U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than 6 years.
The supplement pelargonium may help reduce symptom severity in adults.
Many patients expect to be treated with antibiotics and cough medications but this differs from evidence-based recommendations.
References:
Diagnosis and treatment of acute bronchitis. Albert RH. Am Fam Physician. 2010 Dec 1;82(11):1345-50.
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