Recommendations for electronic medical record providers, commentary on the latest medical research, and opinions on movies and sports are just a few of the topics being discussed by nephrologists on Twitter.
Although so far only a handful of them have signed up for the social networking and microblogging service, those who have say that Twitter facilitates connections between people who may not otherwise have crossed paths.
“Twitter is very quick and easy and doesn't take a ton of preparation,” said Simon Prince, MD, Founder of North Shore Nephrology PC in Manhasset, NY, who registered for the service about a year ago.
“You get quick feedback and quick interactions, and you meet different people from all over whom you wouldn't necessarily have a chance to interact with otherwise,” said Dr. Prince, who is also creator of the blog Uremic Frost (www.uremicfrost.com).
On Twitter, account holders are known by their user names, written in this format: @username. Dr. Prince is @simon prince.
While use is not yet widespread among nephrologists, the larger medical community has taken hold of Twitter and other forms of social media, like Facebook and self-published blogs, using them to connect with health care professionals and consumers from all over the world. As of January 10, 540 hospitals were using such forms of new media, according to a hospital social networking list maintained by Edward Bennett, Director of Web Strategy for the University of Maryland Medical System.
“One reason Twitter is so popular is that it excels in creating instant online communities of people with similar interests—medicine, photography, politics, technology—you name it,” wrote Joshua Schwimmer (@JoshuaSchwimmer; www.jschwimmer.net), MD, Assistant Director of Nephrology at Lenox Hill Hospital and Assistant Professor of Medicine at New York University School of Medicine, in an e-mail exchange. “Your experience is customized entirely based on which users you ‘follow.’”
Twitter users post 140-character-or-less dispatches, called “tweets,” that are seen by other users who've elected to “follow” them. These tweets may be stand-alone comments; a repeated tweet, or “retweet,” of someone else's update; or a response to another user's tweet.
Creating an Online Identity
Engagement in social media also enables physicians to establish their own online identity, said Joel Topf (@kidney_boy), MD, a staff nephrologist with St. Clair Specialty Physicians PC in Detroit, MI, and creator of the blog Precious Bodily Fluids (www.pbfluids.com), in a phone interview.
“I have a friend from residency who when you put his name in Google the first thing that comes up is a patient review that's pretty damning. This is something that you are at risk of happening to you if you don't take control of your online presence.
“Everyone is going to have an online identity, and if you don't create it, someone else will.”
Kevin Pho (@kevinmd), MD, a leading physician voice in social media and an internal medicine physician with the Nashua Medical Group in Nashua, NH, started his blog, KevinMD.com (www.kevinmd.com), about five years ago because he wanted to give a physician perspective on medical news, he said in a phone interview.
“You see a lot of studies in the newspaper or on television without a lot of context, so a blog is a great way to interact and answer any questions and offer some perspective on the news that you read.
“A lot of my patients would ask me what do I think about a study, and on my blog I'm able to really give up-to-date and dynamic commentary and opinion, giving a lot of stuff that you read in the media some context, and it's really been great to be able to do that.”
Tweeting is a natural extension of blogging, said Dr. Pho, who has accumulated over 18,000 followers since joining Twitter about a year and a half ago.
“Twitter offers the opportunity to update my readers more quickly than blogging, and I'm able to respond and interact much more closely with readers on Twitter than I am on my blog just because the medium is really almost conversational.”
A number of practices and hospitals are also engaging in social media as a marketing tool, Dr. Pho noted.
“I think people are starting to realize the marketing potential and the fact that Twitter reaches a lot of people, and they want to really be visible in that social space. … I think that's the forward-thinking thing to do.”
Dr. Prince said he initially thought Twitter would be a useful tool for promoting his five-physician practice.
“I think there was the thought and hope on my side of a marketing and networking platform, but I really haven't found that to be the case because medicine is a very local phenomenon, and Twitter is not.
“It's not like I'm meeting new doctors who are going to refer me patients or I'm finding patients from different sources because I'm talking to people in Ohio and California and in Europe. That marketing and networking component is nice, in a sense, but it doesn't translate necessarily into private-practice medicine and to building a practice.”
Maintaining patient confidentiality is perhaps the most important aspect physician users of social media must keep in mind, agreed those interviewed for this article.
“I am always checking when I write something to see am I giving up someone's privacy,” Dr. Topf said. “It's something you have to continually ask yourself when you talk about real patients.
“I do talk about real patients, but of course I never give names, and I try to change some of the facts to provide them anonymity and honestly to protect myself because, although it might seem innocent, people are really personal about their health.”
Dr. Pho said he makes it a personal policy not to blog about patients under any circumstances, restricting his commentary to current medical events and news in order to protect himself from such risks.
“Doctors who do talk about patients or cases have to be careful about what they tweet or post on blogs because once it's out there and indexed by search engines … it's very hard to erase, so I think that's something that any medical professional needs to be aware of.”
When asked his thoughts on the use of Twitter to give real-time details of medical procedures like surgery, Dr. Pho said it's a very powerful tool but patient privacy has to be first and foremost.
“As long as it's done with the patient's permission and the patient is aware of what it entails, then I certainly don't see a problem with it.”
Dr. Prince said he has used Twitter for real-time updates of personal events, like the birth of his first child last summer, and to give information on professional activities, like medical procedures and patient consults.
“I think there is a line that should not be crossed with confidentiality, but I think it also generates interesting discussion and input from professionals who are involved in patient care as well,” he said.
While the physicians said they will answer health questions that are asked on their blogs, they are very careful about these interactions.
“I think doctors are held to a higher standard in terms of what they write,” Dr. Pho said. “Patient privacy has to come first and foremost, and because of liability and malpractice, I probably wouldn't give any medical advice.
“From a patient standpoint, I probably wouldn't take any medical advice from social networks either because you can't really confirm that whom you're talking to online or on Twitter or Facebook is really a doctor or medical professional, so I think that works both ways.”
A Timely Commitment
One downside of social media is that you have to carefully manage your time and attention, Dr. Schwimmer wrote in his e-mail.
“There's too much potentially useful information out there. Learning how to search efficiently, manage the signal-to-noise ratio, and connect productively with others online—these are new skills for the 21st century.”
Dr. Prince agreed, noting that it is hard to keep up with his nearly 1,300 followers on Twitter.
“In order to be a good networker it needs to be a little more give-and-take. You have to respond to tweets, not just tweet on your own, and it's hard sometimes to see what's going on and be responsive to and follow other people's tweets and trains of thoughts. That part is challenging. There is a time commitment to doing it well.”
For Dr. Topf, blogging is a more deliberate online activity than Facebook or Twitter, both of which he tends to during downtime for maybe 20 minutes a day.
He averages about two to three blog posts per week, each of which takes anywhere from 15 minutes to two hours to write, depending on the topic.
“When I have grand rounds, I consider it a pretty good showing if we get 80 people, and I get more than that every day on my blog. In my view, out of any other way that I could get to talk to people about nephrology, this is the widest audience.”
Mind the Gap
The use of social networking also reveals a generation gap between established physicians who are newer to the medium and younger physicians and medical students who are the more traditional users of new media.
In a survey study of 130 US medical schools that was published in the Journal of the American Medical Association (2009;302: 1309–1315), 60% of the 78 schools that responded to the survey reported incidents of students posting unprofessional content online, including profanity, frankly discriminatory language, depiction of intoxication, and sexually suggestive material.
“I think some of the more established professionals or senior physicians are coming onto this and maybe have a different threshold for discussing things, and the younger generation is so at ease and comfortable using social media that their filter might be skewed and needs to be adjusted appropriately as they become more professional—as students and undergraduates before medical school, and then as they progress on,” Dr. Prince said.
Medical students have always had inappropriate discussions about personal experiences, Dr. Topf said. The difference now is that the Internet leaves a trail of these discussions for the public to see.
“My sense is you're going to see a change in society where people are going to be less concerned about what comes up online. People have such a long history of online life, so the only way to deal with that is for people to become a little more forgiving of these old transgressions.
“I can't imagine that you're going to want employees, students, and residents to never be able to express a thought or idea, or that a minor transgression online would permanently scar them.
“I think during this transition, people will be harmed by this behavior, but I think in the long run the way society is going to react to this is we're not going to exclude good people.”
Morals and ethics are not particularly different for students and younger physicians than they are for more established physicians, Dr. Topf said.
“We just didn't have this publishing platform. I think that's the long-term issue, but the reality is right now you've got to be careful with it.”
In spite of the various concerns, the most important rule of social networking is to embrace new technology and enjoy yourself, the physicians interviewed agreed.
“Facebook and Twitter seem to be dominating the social media sphere, but we always need to be aware of what may be coming around the corner because what may be popular today may not be so tomorrow,” Dr. Pho said.
“I think it's an exciting place to be and really provides a change of pace from what I do in primary care.”