I’m shocked, shocked to see live tweeting going on at this conference

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One has to have some pity on the American Diabetes Association.

This highly prestigious and influential organization drew the wrath and scorn of Twitter aficionados worldwide last week when they asked people to delete tweets about their scientific sessions showing images from presentations at the meeting (Medscape has a nice gated account of the fiasco here).

Some pity … but not a whole lot because we are in the latter half of the 2010s after all. Live tweeting from medical conferences is not just the norm but a now, a well-established form of knowledge transfer.

A lively twitter chat at the Philippine-based #healthxph last Saturday showed just how unanimous social media advocates have been in condemning what the ADA attempted to do.

The rationale used by the ADA was that they were just protecting the copyright of presenters and as such could not permit photographs of presentations which often contain as-yet unpublished data. Following the events of last week the ADA said they would be re-evaluating their policy, and so they should.

In a world where major medical conferences (including the ADA) go to some trouble to establish hashtags and encourage people to tweet from their meetings, policies which restrict this free flow of information and ideas are doomed to failure.

The ADA is not alone in fighting a rearguard action to restrict wider circulation of information presented at their meetings. More than once in the last six months I have been at meetings where repeated attempts to ban taking photos of presentation images have been made. In addition, I have heard speakers ask people to not more broadly circulate some but not all of their remarks (“Then, I adulterated my lab mate’s Petri dish so as to render his experiment invalid. Oh, but please don’t Tweet that.”)

Having attended medical conferences for 40 years, it is clear social media is dramatically changing the world within which such conferences operate.

Conferences are often financially important for the organizations that host them so it is logical to see them wanting to restrict the benefits of hearing presentations to those who have paid to attend. The fact this is no longer possible or even necessarily desirable could render moot the business model upon which these meetings are based.

Alternately – and this is a scary idea raised by someone at the #healthxph chat – conference organizers could start blocking transmission from the conference rooms during presentations so live tweeting would be impossible.

In the #healthxph chat I made two other points that bear repeating, I think.

  • Since attendees to a meeting are going to repeat the information they hear anyway, wouldn’t you rather have them do so through direct images of your data rather than rely on their scribbled notes.
  • If you are presenting at a conference for reasons other than the broader dissemination of your findings, then you are probably in the wrong place and in the wrong business.

Finally, there are still some grey areas. While mobile phones and other devices make it impossible to prevent taking images from presentations, there is a stronger case for banning live transmission of talks through Periscope or Facebook due to more significant issues of copyright.

Even though only a minority of medical conference delegates make use of social media, live tweeting is changing this very fundamental channel for the dissemination of medical information. How it will all play out, remains to be seen.

(For another excellent view of this issue please read @JBBC (Marie Ennis-O’Connor)’s: How The American Diabetes Society Unleashed The Streisand Effect

Patient engagement with muscle

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When Dave deBronkart (@ePatientDave) wanted access to his own medical record several years ago in the US, he didn’t just fill out a form requesting this information or politely ask the hospital involved, he went public in a big way, loudly demanding “Give me my damn data!”

While his act was not unique it can arguably be seen as initiating a new era of the muscular type of patient engagement currently prevalent in the US. These are patients who are not prepared to sit meekly and wait for an invitation to participate in decisions about their own health care or the health of patients in general.

Engaged patients are demanding their place at the health care decision-making table and have little patience for policy makers or conference organizers who want to keep discussions of patient engagement at theoretical level.

Look at the growth of the #patientsincluded movement in which conferences globally are being told they should include patients at all levels of planning and presenting health care information in a way that accommodates patients.  Anyone who dares hold a conference on patient engagement without having patients on the planning committee and speaker list risks being loudly shamed on social media. Even one element of #ehealth2017 has not been spared such criticism.

Similarly, recent discussions on social media are asking very pointed questions about why patient are often the only ones at the table who are not being paid for their time to provide their input.

This new form of patient engagement is transforming how health care is being planned and delivered in Canada but frankly we still trail the US in truly integrating this approach. Canada has several engaged patient leaders but none with the profile of their American counterparts.

Which bring us to the June 2 pre-conference symposium on Consumer Digital Health at #ehealth2017.

The keynote speaker will be Lygeia Ricciardi (@Lygeia), a US based expert in consumer engagement and digital health. Lygeia established and directed the Office of Consumer eHealth at the Office of the National Coordinator for Health IT (ONC) in the US federal government and is a compelling speaker. The presentation promises to deliver an update on major emerging trends in patient engagement

COACH, Infoway and the Canadian Institute for Health Information (CIHI) will follow Ricciardi’s keynote address with breakout sessions on different aspects of empowering healthcare consumers. This symposium should provide an invaluable snapshot of where Canada will be heading in the next few years.

Health Quality Ontario (for which I work), is currently one of the national leaders in providing the tools and infrastructure to meaningfully involve patients in health care decision-making.

It’s not a straightforward or easy task.

As Health Quality Ontario CEO Dr. Joshua Tepper wrote in @HealthyDebate blog post two years ago, “simply ‘commanding’ or ‘expecting’ health system providers and leaders to engage with patients is unrealistic.

In addition, he noted, “the patients we need to hear from the most are often the hardest to reach. Those who face economic, social, language, cultural, physical and psychological challenges to engagement will need thoughtful and respectful partnership efforts.”

For all of this, he concluded “courage is going to be a pre-requisite.”

Even as more patient involvement in health care planning and delivery is mandated in legislation and becoming embedded in the culture of quality care in Canada, hearing from US experts like Ricciardi is important to help us map where things are heading.

In a digital world, health care delivery models may be determined by jurisdictions but trends such as patient engagement effortlessly cross borders and Canada’s engaged patient community are quick to learn from their peers elsewhere and apply the lessons here.

Broken windows in the house of medicine

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At a time when physicians are feeling besieged from all sides it hardly seems fair to write about the lack of civility demonstrated by some members of the profession on social media.

But it’s still an important issue that needs to be addressed – with the caveat that no profession or segment of society is blameless when it comes to such behavior and the focus is due to the focus of this particular blog.

The post is prompted by a recent workshop held at the annual Canadian Conference on Physician Leadership (#CCPL17) held in Vancouver titled “Professionalism and respect within the profession: demonstrating leadership and creating a safe space for debate”.

The good news from the discussion: social media is not to blame for outbreaks of incivility and bullying which can occur between physicians. The bad news? Incivility appears to be rampant throughout medicine and has yet to be satisfactorily addressed.

The impetus for the workshop was a fracas on social media last summer associated with a vote on a proposed fee deal for the Ontario Medical Association which saw a leader of the OMA student association subjected to threatening social media posts, and the subsequent public attention drawn to the dispute,

The decision was taken by conference organizers in Vancouver not just to focus on physician behavior on social media but rather to look at incivility and bad behavior in medicine in general and work being undertaken by the Canadian Medical Association (@CMA_docs) to address this in the spirit of professionalism.

During the discussion, Dr. Michael Kaufmann, the recently retired head of the physician health program in Ontario noted he dealt with problems caused by incivility between physicians on a weekly basis. It was also stated that hundreds of physicians across the country have been or will found guilty of unprofessional conduct by demonstrating disruptive behavior.

“The lack of civility in the medical profession is mindboggling,” is how one physician audience member described the scope of this behavior. Or, as Dr. Kaufmann put it more poetically, “we have some broken windows in the house of medicine.”

So, while social media is clearly not to blame for doctors behaving badly the point was also made that social media can breed incivility by prompting spur-of-the-moment outbursts, misinterpretations due to the sketchiness of the posts, and in some cases, the dimension of anonymity.

With the medical profession feeling under attack from all sides, views that break ranks with the majority are going to be challenged, often emotionally. Students and recent graduates are often the most common targets because they are said not to understand the realities of the situation.

The problem is that social media is not designed to promote measured, respectful debate.

“We will tell you when you can speak and what you can speak about,” is how panel member Dr. Dennis Kendel (@DennisKendel), a Saskatchewan physician and active tweeter described the response when he was seen as questioning that pro-physician unity.

Sadly, social media continues to be severely underused by physician as a professional tool for information gathering and networking (despite being used by peer leader in many areas).

It is also clear that the rules of engagement on social media platforms by their very nature can aggravate instances of poor communication and cause difficult situations to deteriorate.

Despite encouraging social media use at the Vancouver conference, organizers and speakers appeared very cognizant of this. Witness the fact that more than once, delegates were cautioned against tweeting certain remarks or asked to do so with a degree of exquisite sensitivity rarely taught professional journalists let alone well-intentioned civilian commentators.

Well, as the late Hunter S. Thompson might have remarked, this particular missive seems to be drawing to a close without pulling together all the narrative threads as required.

So:

  • It’s a tough time to be a physician
  • It’s a tougher time to be a young physician with unpopular views
  • It is to be hoped the CMA initiative will have an impact
  • Social media is impacting discourse across society in positive and negative ways we have yet to fully figure out.

A death on Twitter

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I was on a train moving through the darkness of Eastern Ontario between Toronto and Ottawa when I saw the notification on Twitter that the body of Dr. Elana Fric-Shamji, a family physician at Scarborough General Hospital in Toronto had been found.

It was news that hit the small but active community of Ontario doctors using social media very hard because Dr. Fric-Shamji had been one of them.

For a couple of hours before the announcement of the body’s discovery there had been uneasy communications between some on Twitter after a news report that she had been reported missing. Those worried comments were quickly followed by expressions of sadness and dismay.

Her Twitter account reflected the vibracy of an individual who was enjoying playing with the media as well as becoming more engaged in the local politics of medicine in Ontario.

“What can I say, I love Lord of the Rings,” was her final tweet.

Days earlier, Dr. Fric-Shamji had found Twitter fame (such as it is) with a tweet posted as part of the #trudeaueulogies hashtag mocking Canada’s Prime Minister for praising Fidel Castro at his death, without remarking on the negative qualities of his rule.

“Saddened about the passing of Sauron who, while heavy-handed, did advocate for open borders and usher in industrial era,” tweeted Dr. Fric-Shamji in a tweet that yielded 622 retweets and 945 likes. (For those needing an explanation, Sauron is the main villain in Lord of the Rings)

A week previously, Dr. Fric-Shamji had participated in the council meeting of the Ontario Medical Association – the body which represents the province’s physicians. It was a cathartic meeting for an organization badly torn recently by internal divisions on how to deal with a government unwilling to negotiate on equal terms.

It is also an organization whose members have made transformative changes through the use of social media, and especially Twitter, as internal advocacy and networking tools.

Many who were in attendance at that meeting remembered Dr. Fric-Shamji and her excitement with her new roles and opportunities – in both the professional and personal spheres.

“Proud to represent #Scarborough physicians at #OMACouncil16,” she had tweeted. “Unity, change and advocacy on the agenda.”

The day after the announcement of her death, the Ontario Medical Association issued a news release from President Dr. Virginia Walley, also posted to Twitter, noting how the “close knit community” of Ontario doctors was stunned by the “tragic news” of her untimely death.

That community is now looking for a way to honour Dr. Fric-Shamji’s legacy and help her three surviving young children.

It took a couple of days for the print media to catch up but local and national newspaper are now filled by the story of her death and news that her physician husband had been charged with her murder.

Dr. Fric-Shamjii is not the first of the Twitter physician community to die this year.

Dr. Kate Granger (#hellomynameis) passed away after arguably bringing more humanity to the provision of medical care in the U.K. by asking those providing care to identify themselves by name. Tens of thousands have been touched by her message and her last days of life.

And there were others.  Dr. David Lewis (@DrPlumEU) who died a few years ago, for instance, lives on through his Twitter account which continues to curate news content based on parameters set by Dr. Lewis himself.

I did not know Dr. Fric-Shamji personally and I am not a physician but I was one of 157 people she followed on Twitter … and I followed her.

I felt a few words should be said from here.

Walk and chew gum @Helenbevan? I fear not

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Is it possible to walk and chew gum at the same time?

Helen Bevan, the leading expert in transformative change for the U.K.’s National Health Service recently posed a similar question to an audience at a major health policy conference in Toronto, Canada and the answer, unfortunately, was ‘no’.

The actual issue raised by Bevan had nothing to do with ambulation and mastication but rather with the potential to listen and comprehend a speaker while simultaneously engaging with others in a discussion of the speaker’s comments on social media.

Results of the real time experiment seemed to suggest there is a limit to the amount of engagement even the most dedicated networkers can undertake with one of the best social media tools – Twitter – while also paying attention to an absorbing presenter.

At her suggestion, a few people tried gamely to discuss issues raised by Bevan on Twitter while she was still speaking, but these conversations quickly petered out as those in the audience returned their attention to Bevan, and directly tweeting her comments.

What Bevan definitely did not do was undermine her argument about the power of social media to expand the dissemination of the important ideas – even though this exercise may have provided fuel for those who argue that live tweeting distracts from taking full benefit from listening to speakers at conferences.

Watching a graphic representation of tweeting during Bevan’s plenary address at the Health Quality Transformation conference is like watching a fireworks display as Bevan’s point on the map explodes as hundreds of tweets referencing @HelenBevan and her presentation spread out over the map during the hour of her talk.

The growing power of the type of informal networks that social media platforms support to make real change in the health care system was one of the key themes in the multiple keynote and more informal presentations Bevan made while attending a number of meetings hosted by Health Quality Ontario.

She also talked about the importance of the new connectivity these social media platforms provide to link people within organizations as well as nationally and globally.

But Bevan’s impromptu attempt to get people to participate in multi-task engagement suggests there are some limits to what even social media can accomplish if you ask that it all happen at the same time.

 

 

 

 

 

 

Social media and hospitals: Now more than just pretty pictures

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For leading hospitals, the use of social media tools and platforms has moved from giving in to the demands of the head of marketing to at least have a Facebook page, to a recognition that use of social media can add value throughout the enterprise.

This evolution beyond using social media to post nice pictures and videos of hospitals doing good things has occurred rapidly since the emergence of the first social media platforms a decade ago and holds great potential for health care institutions who want to communicate effectively with their patients.

This is my conclusion following an extensive review of the literature on social media use in North American hospitals and interviews with experts both in Canada and the U.S. who confirm this trend. This work was done on behalf of Lakeridge Health in Oshawa, Ontario as part of a review to improve patient experience at that institution.

While they acknowledge the huge potential for social media in the health care setting, leaders in health communications also recognize that social tools and channels represent just another series of communications options and should be used only as appropriate.

The only comprehensive survey of social media use by U.S. hospitals published by University of Pennsylvania researchers in 2014 showed 94.4% of the more than 3,300 hospitals polled had a Facebook account and just over half had a Twitter account. Anecdotal evidence suggests the same is true of Canadian hospitals.

“There are some really creative people out there who are finding ways to use these tools to engage patients and get their messages out,” said Christina Thielst, a Santa Barbara, California-based hospital administrator, consultant and author who has been following the use of social media by health care organizations for more than 30 years.

Ann Fuller, VP for volunteers, communications and information resources for the Children’s Hospital of Eastern Ontario, was quoted in 2013 as saying: “In Canada, in health care we’re at a point where most hospitals accept the role of social media for branding and communication, but only the lead adopters are using it for patient engagement and for clinical use.”

Since that time, she says “a lot of the perceived risks and threats of social media have lessened” yet, she adds, while “everyone agrees that social media can and should be used, and there are benefits to it, some of that stigma still exists.”

“It’s not about creating a community and trying to integrate those experts into it. It’s using social media to come up with a new platform for doing what they already do—such as engaging patients. It’s another way of bringing people together,” said Dave Bourne, a former communications director for Baycrest and the Scarborough Hospital and now director of communications for Sienna Senior Living.

But despite the most popular social media tools having been around for a decade or more, the optimal use of these tools in hospitals has yet to solidify.

“I don’t think anybody has nailed it to the point where there are best practices,” said Bourne.

Those looking for a leading Canadian hospital with regards to social media could do far worse than to study the experience of the Michael Garron Hospital in Toronto. That institution has taken an incremental approach and changed the hospital culture to slowly integrate social media into many of the hospital’s functions. Elements of that approach include

  • Publication of a policy or guidelines to assist hospital staff in the appropriate use of social media
  • Training of the senior management team as a group in how to use common social media tools such as Twitter.
  • Ongoing education and support from the communications team to assist any staff in using social media
  • Integrating social media tools into a new proactive approach to patient engagement which included aggressive timelines for dealing with patient concerns.
  • Integrating social media use into a new, more responsive approach to leadership

While social media remains an important and innovative set of tools for telling stories about the good things a hospital can do, it is clear that the most innovative institutions are also using those tools to facilitate both internal and external engagement with the communities they serve.

As Isabel Jordon, a BC-based patient advocate and chair of the Rare Disease Foundation, says: “the way I would like a hospital to use social media is to reach out to people to find out what we want from them; if there are going to be changes or something new coming down the pipe—to reach out and engage us before something is going to happen.”

(P.S. Anyone interested interested in publishing a more extensive analysis of this research please feel free to get in touch)

 

 

 

Social media transforms (@OntariosDoctors) dispute

Never has Canadian medical politics been so accessible, informative and, frankly, entertaining – all thanks to social media.

For good or bad, this is the new reality for a profession used to dealing with its financial negotiations in confidential discussions behind closed doors.

The current knock ‘em down drag ‘em out fight between those supporting and those opposing a new draft professional services agreement between the Ontario Medical Association (@OntariosDoctors) and the provincial government comes to a head this Sunday at a general meeting of the association to vote on the proposed deal.

The backstory behind this particular agreement to set fees for Ontario doctors is too long and complex to explain in this blog post. Suffice it do say that the leadership of the OMA is lobbying the membership hard to support the deal, while a well-organized opposition is urging its rejection and a return to the bargaining table to better halt government cuts and gain the right to binding arbitration.

All of this is being played out daily on social media and especially Twitter and blogs, as advocates for both sides post thoughtful essays on their views or engage in lively wars of words with their opponents. For its part the OMA has supplemented tweets and blog posts by leaders such as @GailYentaBeck, @ScottWooder and @VirginiaWalley with YouTube clips from well-known provincial physicians voicing support for the deal.

The profile of the whole situation has been raised by the involvement of André Picard (@picardonhealth), the nation’s leading health reporter and Steve Paikin (@spaikin), a leading provincial TV political affairs commentator, who together have more than 120,000 followers on Twitter. Picard especially has taken an active role in the debate challenging some views and chiding others for inappropriate comments.

Ontario doctors were among the first in Canada to recognize the potential for advocacy offered by social media platforms such as Twitter. It is sad that probably only a minority of the province’s physicians are observing Twitter and other channels to follow the discussions, debate, arguments, and bon mots.

Some leading Ontario physician bloggers and social media commentators were asked whether social media had inflamed or informed the current debate about the Ontario deal.

“I believe all communication does both,” said Dr. Shawn Whatley (@shawn_whatley). “Social media is no exception.”

“In my now nearly 40 years as an Ontario physician I have never witnessed such passionate engagement with OMA affairs or the political process,” said Dr. Alan Drummond (@alandrummond2). “That ‘movement’, if I can call it that, was directly fueled by the use of social media and the enhanced connectivity between different regions and specialties.”

“I was surprised by how many of my physician colleagues in Perth have expressed that their opinions were being formulated by arguments made on Twitter.  This was not necessarily all for the good.   Initially they were pleased with the nuanced concerns about the agreement; as things dragged on they were starting to get pissed off with all the negativity. Nevertheless, it is clear to me that social media has changed the game.”

Drummond noted the “vitriolic and misguided personal attacks” by some on social media and added “if we are going to put ourselves out there in public we have to remember that “the whole world is watching” and behave accordingly.”

Dr. Cathy Faulds (@fauldsca) said there are pros and cons to using social media for such discussions. On the plus side she references the ability to spread a diversity of views, prevent groupthink and “eliminate the paternalism that has plagued organizations and our medical culture.”

“The depth of learning and sharing is fantastic and reminds me of the surgeons’ lounge in my earlier days of practice. It is generally fun to be part of this (Twitter) crowd and the majority respect boundaries and are collegial),” she said.

The downside of debating on Twitter according to Faulds, include the 140 character limit, the “conversational swirl” that can make it difficult at times to follow discussion threads, and anonymity that can make it difficult to give context to some comments. She also noted the presence of “schoolyard bullies” and the fact cliques can easily develop that people block others they do not agree with.

Dr. Mario Elia (@supermarioelia) has a much broader condemnation of the social media element of the current debate.

“SM has allowed this (debate) process to spiral right out of control, allowing opposing positions to be distorted and for each side to attribute their worst fears to the opposing group. It has been horrific.”

Dr. Nadia Alam (@DocSchmadia), has possibly been the most active Ontario doctor in the social media debate and she describes that discussion as “eye-opening.”

“Normally mild-mannered docs now appear fierce, antagonistic even. Normally complex ideas are distilled into pivotal moments of wisdom.

“Social media decentralizes communication and is unparalleled in its reach across time and physical boundary. The price though is in the steep learning curve. I find it can be an unforgiving environment: adept users will judge and sometimes shame the clumsier novices.”

She describes the use of social media as a “two-edged sword” in that “it informs but it can also inadvertently ignite hostility. It can bring people together or tear them apart. It can be inclusive, but can also be used to ostracize people. It can help in the spread of information, but it can also feel like you’re lost amidst the noise.”

From these comments it appears that to many Ontario doctors, the social media platforms that most of their colleagues are reluctant to use for professional purposes has changed forever the nature of political discourse within the profession in this country.

(The author would like to thank all physicians who provided input into this post)