Like a Diamond Mine

Follow the right people and hashtags on Twitter and every so often you will inevitably hit a seam of great content.

Dr. Bryan Vertabedian (@Doctor_V), an assistant professor of pediatrics at Baylor College of Medicine is one of the most thoughtful physicians going when it comes to looking at the role of doctors and the impact of social media and his blog (33charts.com) is usually a must-read.

Earlier this week using the hashtag #BCMdigital and an automated posting tool, Vertabedian transmitted a series of tweets to coincide with a lecture he was giving to first-year medical students at Baylor.

They immediately struck myself and others who were watching a pithy synopsis of the huge changes new technology is having on the practice of medicine as well as some unalterable realities medical students should understand.

A summary of a few of those tweets follow.

• A variety of forces r conspiring to redefine the physician: tech | information | health 2.0. Must understand our evolving role
• Reality of the networked world: social communication will define the way MDs engage, learn and communicate
• The most important decision a physician will make is who and what to listen to
• The internet has changed the way patients see doctors, their diseases and themselves
• Med students are at a very unique point in med history: Between a collapsing analog age and an emerging digital age
• A great digital footprint will never cover for a doctor’s poor care
• The ultimate user experience in medicine is face-to-face

Lectures have always been a means of communicating great ideas in medicine.

While Dr. William Osler was not a fan of lectures as a communications tool himself (he preferred training at the bedside), this description from the preface to his Evolution of Modern Medicine lecture series describes the exhaustive process whereby such lectures used to reach the masses one hundred years ago:

“The manuscript of Sir William Osler’s lectures on the “Evolution of Modern Medicine,” delivered at Yale University in April, 1913, on the Silliman Foundation, was immediately turned in to the Yale University Press for publication. Duly set in type, proofs in galley form had been submitted to him and despite countless interruptions he had already corrected and revised a number of the galleys when the great war came.. The careful corrections which Sir William made in the earlier galleys show that the lectures were dictated, in the first instance, as loose memoranda for oral delivery rather than as finished compositions for the eye, while maintaining throughout the logical continuity and the engaging con moto which were so characteristic of his literary style.”

Vertabedian demonstrates the new reality of such lectures – namely how the key messages can delivered globally simultaneously with giving the lecture itself.

A series of tweets given over the course of two hours will never constitute great literature as some of the classic university lectures of the past. Nor will they contain the connective tissue that makes the lecture a cohesive whole.

But for those of us trolling Twitter on a Monday afternoon in July, the opportunity to see the takeaway messages from as thoughtful a commentator as Vertabedian shows just how informative this channel can be.

 

Let’s all sing like the birdies sing

Doctors who aren’t on Twitter are missing out. Really.
That conclusion came through loud and clear from recent conversations I had with several physicians in the small Ontario city of Kingston recently. These individuals represented the whole spectrum of the medical profession from student, to primary care community care doc to specialists and academic teachers.
Given that only an estimated 1 in 10 Canadian doctors uses Twitter even now, it was somewhat surprising how adamant these physicians were about the benefits of the tool for medical professionals, as well as patients and the public.
They were very clear that they felt Twitter represented a unique channel for providing new connectivity between doctors, between medical teachers and students, and between physicians and other members of the community.
Many of those I interviewed had come to Twitter via non-medical routes – one initially used Twitter for traffic reports, another to connect with fellow fans of the television show ‘Lost’ and one had become hooked when they followed my own 23-hour ordeal when stranded at Chicago’s O’Hare Airport this winter. Others had been introduced to the tool by colleagues or had deliberately chosen to use Twitter for research or information-gathering purposes.
But what all had in common was that they had come to acknowledge the value of Twitter in their professional lives.
For these physicians, Twitter is providing an-easy-to-manage tool to build connections that had not existed in the past. This included using Twitter as another route to assist in the referral process for patients between family doctors and specialists; as a way to organize easy access to medical literature or other key medical organizations; to provide ‘value added’ information to medical students who chose to follow them; or to assist in gaining knowledge from international medical conferences.
These doctors felt that Twitter is just one of a number of technological innovations that are fundamentally changing the practice of medicine and while some of those interviewed could be called ‘academics’ these changes were certainly more than ‘academic’ in nature.
The message was clear – ignore Twitter and other innovations in health information technology at your peril. What may seem like time-wasting and frivolous activities may actually be tomorrow’s standard of practice.
(BTW, The title of this piece comes from a 1932 song and is worth looking up on YouTube)

Follow you, follow me

Long ago, in the days before social media was known as social media and before most hospitals had even thought about having guidelines for them (2009 to be precise), a researcher presented a small survey showing some doctors at a major Canadian city were lurking on online disease-specific communities to get what they felt was a better view of how their patients were doing.

This just seems wrong and could be attributed to the lack of guidance physicians had around appropriate use of social media in those bygone days. But the truth is the whole area of what is appropriate when it comes to a health care provider monitoring a patient on social media platforms is one that is rarely addressed in guidelines about social media use.

Is it wrong for a physician to look at a patient’s publicly accessible social media profile and posts and if so why, especially if patients are encouraged to research and interact with their physicians online?

This topic received a good airing in April during a #hcsm tweet chat and the responses came down more against doctors checking up on their patient.

Some of those responses:

• Makes me uneasy. Docs should only use info patients provide & nothing they discover through a digital footprint: Dangerous territory
• I don’t see an ethical issue with it. It’s public information. Secure what you don’t want public
• There may be pertinent information there, but I must/should trust that patients will tell me what I need to know to help provide care.
• Have no interest or time to go down that road
• If I believe in a trusting doctor/patient  relationship, checking out my patient’s digital presence seems out of bounds and hopefully

While many are urging patients and the public to interact with physicians and other providers online, few address the issues of how this could impact on the physician-patient relationship.

 If a patient profile or comments on social media can provide a more comprehensive (but possibly misleading) perspective of the patient that may aid in improving care, should a conscientious physician limit himself or herself to only the information disclosed in a face-to-face clinical encounter?

Of course, this is a moot point for busy clinicians as most will tell you they have absolutely no time to be conducting online searches of their patients.

But as we see more and more interactions between physicians and the public or their patients in social media spaces and outside clinical encounter, it’s another facet of just how social media is posing questions that may have no easy answers.