CMA (@CMA_Docs) ups social media ante

Quebec City

The Canadian Medical Association (CMA) celebrated its 150th anniversary in Quebec City by moving boldly into the 21st century in terms of the organization’s use of social media and digital communications.

The CMA has always attempted to keep up with communications trends and many years ago designated a Twitter hashtag to the meeting (#CMA150 this year) as well as making live broadcasts of most sessions at the meeting available online for some time.

This is in keeping with the ethos of the volunteer, national organization which represents more than 80,000 doctors. At the very first meeting in 1867 (the same year as the birth of Canada), delegates noted the media had been excluded from the meeting and were quick to invite them to attend. Ever since – even on issues as heated as abortion or medical assistance in dying – the meetings have been open to the media.

But this year represents somewhat of a seismic shift for the CMA in line with a fundamental re-think of how the annual General Council meeting can remain relevant. Interestingly it came at the same time as delegates tackled head-on issues of “incivility” that have marked interactions between some of Canada’s doctors on Twitter and Facebook.

Not surprisingly, the meeting was heavily tweeted (graphic courtesy of Symplur). While only a small minority of Canadian physicians use Twitter professionally many of these were in attendance at the meeting.

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But this Twitter activity was accompanied for the first time by live discussions of the most important topics on both Periscope and Facebook live. In fact, a discussion of senior’s care issues with Federal Health Minister Dr. Jane Philpott was driven by questions from those who follow the CMA’s Facebook page.

Discussion in the Council chambers was also informed by questions from doctors participating via a conference app – another first for the CMA. This app was heavily promoted both as a way of participating during the meeting but also as an opportunity to continue the discussion on various topics after the meeting concluded.

The discussion of physician’s improper use of social media to attack colleagues was the subject of a panel discussion nested within a broader debate about developing a first professional code of conduct and professionalism for Canadian doctors. Examples of such conduct were available even in the days leading up to the meeting.

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Those who had been challenged on social media appeared willing to forgive their colleagues and attribute the negative comments to the excessive stresses and challenges facing doctors in Canada today. But what many might consider unprofessional conduct on Twitter continued even during CMA’s meeting and was commented on by the Speaker for the meeting.

While CMA’s has always been seen as the foremost national advocate for doctors and indirectly the interest of patients, its latest strategic plan puts an emphasis on being “patient-centred” and there is even discussion of considering putting patients on the CMA Board of Directors.

Quebec City is where the CMA began but this year demonstrated that the organization was definitely not planning its future by looking back.


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


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

Broken windows in the house of medicine


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.


  • 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


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.

Speak your mind, but …. #hcsmca chat summary

Last Wednesday, 77 engaged individuals participated in a lively tweet chat at #hcsmca about whether health care professionals have the same rights to free speech when using social media as other members of society.
The impetus for this chat – which I moderated – were two recent disparate examples of what is happening with Canadian nurses and doctors who use social media. One example was that of a nurse facing disciplinary action from her regulatory body in Saskatchewan for posting details of her late father’s care on her Facebook page. The other referenced the positive response to a blog post by Ontario physician Dr. Gail Beck (@gailyentabeck) about the care received by her husband in a local hospital.
One of the points I wanted to make that was nurses and other allied health professionals who are employees of hospitals or health care institutions may face more restrictions than many physicians who are self-employed because the terms of their employment may limit their right to make public comments about their own institution.
So it is somewhat ironic that two days after the chat, The Medical Post newspaper for physicians posted a gated article quoting an unnamed Hamilton physician as stating many physicians had been threatened with the loss of hospital privileges for vocally criticizing the provincial government for recent pay cuts.
During the chat we were lucky enough to be joined by several physicians including Dr. Beck, who provided their perspective on their ability to use social media.
It quickly became clear from the comments made by these physicians and other informed observers that while health care providers can and should be urged to use social media to make comments and engage in debate, they must do so with caution.
It was noted not only that physicians and other providers all have a sacred duty to protect patient confidentiality but also that the statements made by health care providers may be scrutinized more closely and so extra caution must be taken in what they post.
To quote some notable tweets from that chat:
“Believe EVERYONE has right to speak their mind #SoMe or otherwise, but there are always consequences. This applies to HCPs too,” @Colin_Hung (#hcldr co-founder)
“As long as patients’ rights are not infringed, health care professionals should have same rights as all.” @gailyentabeck
“We have additional regulations we need to follow and more best practice to consider, but we have a voice.” @rdjfraser (nurse)
“As healthcare professional on social media, I’ve learnt to bite my tongue at necessary times (most of the time)” @Dr.WaiSun (family physician)
“Health professionals shoud lbe aware that everything they tweet is a publication for public domain. Tweet with care & confidentiality” @DrWaiSun
Most of my health care colleagues are not on #SoMe because of concerns. However in my 2 years on Twitter it’s been 99% positive. @drcchambers (psychologist and pediatric pain expert)
“Pts & HCPs should be allies. We are different views on same system. Our United voices are engine of change.” @seastarbatita (patient advocate)

While the chat just scratched the surface of this important issue for those ‘in the tent’ – be they providers or patients – it was clear the provider voice on social media is an important one that needs to be encouraged.

Back to the freezer

On the flight back from Cebu City, the Phillipines to Ottawa through a 60c degree variation in temperature I have  been trying to figure out what to make of it all.

Beyond the overwhelming experiences of being thrown into the loud and fast-paced heart of a Phillipine city with all its beeping jeepneys and indescribable cuisine, I would like to encapsulate just what it meant to be part of the first ever Phillipine conference on social media in health care(#hcsmph).

Truly, the success of the conference with 450 delegates and a full day of well-attended and debated sessions (and a twitter stream with more than 6 million impressions) speaks directly to the influence of social media itself.

This conference came about solely because four physicians in different parts of the country met on Twitter and started a regular tweetchat in the Phillipines (#healthxph) which has served to jumpstart the entire movement.

Drs. Gia Sison (@giasison), Iris Thiele Isip Tan (@endocrine_witch), Remo Aquilar (@bonedoc) and Narciso Tapia (@cebumd) had never all met in person before the Cebu conference. But together with Dr. Helen Madamba (@helenvmadamba) , a respected ob/gyn who they refer to as the baby of the group, they coalesced around Twitter and logistically were able to pull together the planning, sponsorship and other details necessary to hold the meeting.

They also put their stamp on how social media will be used properly by cloudsourcing a manifesto on the appropriate use of social media tools by health care professionals, of which I was truly honoured to be one of the initial signatories.

Discussions at the conference made it clear that Phillipine health care professionals from physicians and nurses to informatics experts and patient advocates are already exploring the use of social media want to use it more to deliver care in that country.

But discussions also underscored how the individual realities of available infrastructure and cultural differences will shape just how social media gets used by a health care community even if the face of social media is a global one.

At #hcsmph I was privileged to meet Dr. Teddy Herbosa (@teddybird), an emergency physician and former Undersecretary of Health. In discussions we realized that the ‘think globally, act locally” mantra applies well to social media in health care.

Hearing Gia discuss first hand her experiences with using social media to deal with breast cancer was a professional highlight of this trip. But what will live in my memory is riding through the dark streets of Cebu in the back of an SUV listening to Dr. Tapia mangle popular songs with Twitter references accompanied by laughter from all.

An open letter to medical educators (#ccme14)

Please teach medical students about the value of using social media in health care and medicine
That’s my plea delivered in what I hope is a timely manner to delegates currently attending the annual Canadian Conference on Medical Education (CCME) here in Ottawa.
It’s a message I feel badly needs to be delivered in the face of statistics and anecdotal evidence suggesting practising doctors still do not appreciate the value of Twitter, LinkedIn, YouTube, and other social media tools for improving their own professional lives and the care they are delivering.
It is clear that if physicians are going to learn the value of social media tools and platforms they need to be taught about it in medical school. Despite the ubiquitious use of social media by young people, most entering medical school have little understanding of how social media tools can improve their learning experiences and their future professional lives.
If examples are needed of just how social media tools can be incorporated into the curriculum one needed look no further than the CCME meeting itself where panelists at a pre-conference symposium delivered a crash course in just how social media can be used effectively to improve the learning experience in medical school
The panelists:
* Dr. Alireza Jalali (@ARJalali), professor of anatomy at the University of Ottawa and social media lead for the Royal College of Physicians and Surgeons of Canada
* Dr. Ann Marie Cunningham (@AMCunningham), GP and clinical lecturer at Cardiff University, UK and acknowledged expert in using new media in medical education
* Natalie Lafferty (@NLafferty), lecturer at the University of Dundee, UK
* Dr. Neil Mehta (@Neil_Mehta), associate professor of medicine, Cleveland Clinic
* Catherine Peirce (@c_peirce) Project Manager, e-learning at Association of Faculties of Medicine of Canada
Given that the title of the session was “Everything you wanted to know about social media but were afraid to ask your students” it is impossible to quickly summarize the information transmitted at this session – one replete with both wisdom and practical tips and tools to use.
(To those unfamiliar with Twitter and hashtags, the meeting feed at #SMB14 was a demonstration in itself about how Twitter can be used to relay information and promote discussions far beyond the geographic confines of one meeting room)
A few one liners from the panelists provide some pearls of wisdom and a sense of the sentiments expressed:

“Twitter has become my personal learning network” @nlafferty

“Computers don’t stop people from listening. Boring teachers do.” -@ARJalali

Curation “is more than just posting a link. It’s giving it context as well.” ‪@nlafferty
“A big part of this is introducing students to our networks” ‪@amcunningham

‪@ARJalali “think twice, tweet once.

”Think about relationships rather than rules“: ‪@amcunningham

Of 9 Cdn med school with social media guidelines “all are enthusiastic and encourage use of SM” CHEC-CESC scan via @c_peirce

‪@ARJalali tells med students on use of social media: “we’re not there to catch you”

Important to promote principles of Digital Professonalism by education, not rules: @toppsd

Time management an important component of teaching med students about SM: ‪@amcunningham

‪@ARJalali “My students are in a digital world that I’m not a part of.”

“Social media has helped me break out from the boundaries of my own institution” ‪@nlafferty

Perhaps the most telling moment during the course came through Twitter when – as Dr. Jalali was emphasizing the value of Twitter as a tool for teaching, networking and information gathering, – a medical student attending a session of the Canadian Federation of Medical Students at the same time tweeted a note that a straw poll of students at that meeting indicated few use Twitter.
Surely it’s time to do a better job of bridging that gap.