Twitter is still my medical home

For more than 12 years, Twitter has been my medical home. Just as family medicine sees the patient’s medical home as a vision for patients receiving comprehensive and proper care on an ongoing basis in family practice, so Twitter has provided me with the best place to foster two-way communications about medicine and healthcare in a comprehensive way.

The purchase of Twitter by Elon Musk and his subsequent actions threatens this vision. In recent weeks several credible and respected physicians and other healthcare experts have talked about abandoning Twitter for other platforms, with Mastodon being the safe haven of choice to date. Despite having many positive points, Mastodon is not Twitter and its shortcomings have shown us what we will lose if Twitter goes away. The recent proliferation of promotions for other platforms only shows how fragmented the healthcare and medical community will become without Twitter.

Also, Canadian physicians who are generalists now have few sources of credible, timely information curated just for them, with the online daily subscriber newspaper offered by The Medical Post (@Medical Post) being the only example that comes to mind. Mainstream Canadian journalists such as Andre Picard (@picardonhealth) and Aaron Derfel (@Aaron_Derfel) are best-in-class in curating and transmitting medical information to both the profession and the public but their numbers are dwindling. Twitter has provided physicians with the ability create their own information channels with links to sources they trust.

As @cmaer I helped the Canadian Medical Association (@CMA_Docs) on its road to using social media which it has done with increasing sophistication. Now, while sinking fast into semi-retirement, I continue to monitor Twitter for healthcare news, curate information, and on occasion live tweet medical conferences.

Twitter has connected me with a global community of medical experts and those with lived experience from the UK and Ireland to the Philippines and Australia. Unlike other forums where physicians connect as fellow specialists or talk among themselves, Twitter has created a place where physicians and patients can exchange views and expertise to the advantage of both. It is also a place where in recent years we have been able to see physicians as whole individuals and not just medical practitioners. As Tricia Pendergast wrote in a blog 3 years ago: “Welcome to the future… where doctors and nurses are no longer dispassionate enigmas; we’re humans      with online lives, dog pictures and grief that we need to process.”

Some aspects of Twitter such as tweet chats and live tweeting are less relevant today than previously. However, groups such as #healthxph in the Philippines continue to use scheduled tweet chats productively to continue to have respectful discussions on issues of importance to medical learners and physicians. And depending on the meeting and audience, even the chat function of virtual meetings has not totally eliminated the value of live tweeting to engage those not actually attending those meetings.

Social media have evolved over the past decade. Facebook, LinkedIn and Instagram have started to borrow innovations from each other. Like overprotective parents, social media platforms such as Twitter and Facebook now use algorithms to spoon-feed us posts they feel will be interesting to use based on previous history. While occasionally useful, this activity not only clutters our feed but can also increase the echo-chamber effect by feeding our biases and pre-conceived notions. Other platforms such as TikTok have successfully emerged to establish their own distinct niche.

While I have more than 9,000 followers and support unpopular (to some) pro-science stances such as masking mandates against COVID-19 (even in the context of such highly charged environments as the recent school board meeting in Ottawa), I have been spared abuse and threats maybe because I am not a physician or high-profile. I fully sympathize with those forced from Twitter because of such abuse and have no argument against those who no longer feel safe being here.

I also accept that a clarion to stay on Twitter or find a better platform is not universally accepted by others.

Social media pioneer and pediatrician Dr. Bryan Vartabedian (@Doctor_V) recently wrote that “the value with Twitter has devolved from a place of real community to an echo chamber for our own ideas. In discussing Mastodon he wrote:

Now we move to Mastodon. We celebrate our great exodus into the Promised Land. The problem is that we bring the same baggage and motivations with us. And all of our habits. The race for influence is a story as old and predictable as social media: Grab first mover advantage, evangelize the platform in the service of raising our game, and battle desperately for followers.

However, I would also like to quote an Australian scientist Dr. Manu Saunders (@ManuSaunders), who, as the Twitter/Mastodon situation emerged, wrote:

Twitter has been a beacon, a haven, an inspiration, and a cornerstone for me. I’ve tried insta and tiktok, but they never worked for me. Twitter is different. It is outward facing and hyper connected – whenever I felt alone or excluded in my local discipline or institutional networks, I always felt welcomed and connected on Twitter. It helped me grow my blog audience, found me new collaborators and new ideas. It kept me up to date with local and global news and events. I’m an ecologist, but I’m also a person, and Twitter kept me connected with all the communities that I felt connected to, however indirectly – academic twitter, ecology twitter, ag twitter, landcare twitter, insect twitter, nature twitter, Australian twitter, climate twitter, conservation twitter, journalism twitter, writing twitter, politics twitter, history twitter, the list goes on…

If Twitter becomes unviable, I think, it will be in one of three ways:

  • Disruptions to the organization of Twitter as a result of Musk’s corporate actions will cause the engineering infrastructure to collapse
  • Attempts to turn Twitter into a right-wing platform will make it unusable for anyone not sharing those views. Some actions by Musk such as the reported imminent “opening of the gates of Hell” and reinstating all accounts banned for flagrantly abusive behavior points ominously in this direction.
  • The hyper-evolutionary nature of communications science in the 21st century will cause it to be supplanted by something that better meets people’s needs for being simultaneously educated and informed. Until the Musk situation arose this is what I always thought would happen.

Twitter may go away in the short-term or become totally hostile to intelligent life as spelled out in the first two bullets. And inevitably at some point it will be supplanted by something better. But in the interim, I’m staying.

(Image: Tent room in the Esterhazy Palace, Tata, Hungary)

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