What were once vices are now habits

ImageOnce a year for six years now, a bunch of inquisitive, often bright and frequently argumentative people get together to discuss how social media, the Internet, on-line communities and medical apps can and already have changed how health care is conceptualized and delivered.

Medicine 2.0 (#med2) as the conference is known was held in London, UK this year and attracted 520 delegates over the two days.  The conference was a non-stop series of simultaneous lectures, presentations, posters, and hallway conversations all overlaid with an ongoing Twitter channel that sucked in participation from around the globe.

This year I was privileged to give a presentation that attempted to not only synthesize the key developments over the conference since it began in 2008 in Toronto but also to match this to what was going on in the bigger world of health care and society.

Of course such an analysis is bound to be idiosyncratic because of the sheer volume of information to be compacted into a 15-minute talk.

The title of my talk was the title of this blog, and I’ll tell you why.

Six years ago many of us were already experimenting with the tools and platforms now known generically as social media. Twitter may have just been mere chirp in 2008 but online communities, Facebook and YouTube were already going concerns. But most of us were doing this outside of work time as nobody was quite sure how social media tools could be used professionally.

Fast forward to 2013 and many people working in health care are using social media as part of their work – from vices to habits, if you will. Perhaps this is most marked with the medical profession. In 2008 few physicians were participating in Medicine 2.0 and hardly any could see how social media could improve how they do their work. This year, four of the five top Tweeters at Medicine 2.0 were physicians and many others delivered papers on how they were using social media to deliver care in new and innovative ways.

This community is still in the minority but after six years you really can’t call them early adopters any more.

The full set of slides from my address is available at: http://www.slideshare.net/prich/what-were-once-vices-are-now-habits-med-20-20082013  

A doc, a Tweet, an Island


Emergency physicians can be an ornery bunch, often opinionated and not afraid to speak out on a wide variety of issues. As emergency room (ER) overcrowding in Canada is seen as an early-warning signal for more wide-ranging problems within the health care system, having ER doctors who are willing to be vocal about their concerns is not necessarily a bad thing. (It’s worth noting that arguably the most high-profile media physician in Canada – Dr. Brian Goldman @NightShiftMD, host of the Canadian Broadcasting Corporation’s White Coat Black Art is an ER doc).

Combining an ER physician with Twitter, as you can imagine, can be a potent mixture.

Nowhere has this been more dramatically demonstrated than last week in Prince Edward Island, a province of only 140,000 individuals and about 235 physicians

Dr. Trevor Jain (@Jainbrae), is an ER physician at the Queen Elizabeth Hospital in Charlottetown, the province’s largest acute care facility. On August 27, he posted a series of tweets expressing concerns about staffing levels in the hospital’s ER noting that one physician had quit and another was considering leaving over safety concerns. Now, Dr. Jain is not highly active on the Twitter and at the time of these tweets he had about 250 followers and had fewer than 450 tweets to his credit.

However, the tweets came to the attention of the regional CBC news bureau which wrote a story based solely on their contents, as Dr. Jain declined to be interviewed. In the story, the hospital’s medical director admitted the staffing situation in the ER had caused “considerable consternation” but was only temporary. The story in almost identical form was picked up by the other major network in the province as well as the province’s only daily newspaper.

Dr. Jain has told us he has been criticized for using Twitter to express his concerns but he is unrepentant. Certainly, I am sure many in the hospital bureaucracy would have preferred him to have gone through the proper channels to express his views. Without knowing the specifics of the hospital policies or bylaws on this topic it is hard to say whether Dr. Jain was actually doing something that was formally forbidden. Given that many hospitals in Canada continue to lack social media policies, it may be that guidance or rules in this area were lacking.

While Dr. Jain may be on the receiving end of criticism for the approach he took, it is undeniable that it was effective. Numerous messages of support have appeared in his Twitter feed and the CBC news story was retweeted by many, including possibly the globe’s most active social media physician advocate Dr. Berci Meskó, who at last count had 33,678 followers.

This situation serves as a case study to how – without ever communicating with established media – a physician can bring attention to a local health care issue he feels is of concern. Given the growing concern in Canada about undue restrictions placed on the right of physicians to speak out about such issues by local authorities, here again, surely we have a demonstration that social media is changing the playing field.