Only a handful of oncologists are using Twitter, but those who do consider it to be an important extension of their professional activities.
The microblogging service limits communication to 140 characters—the number of characters in the sentence above. But the power of a few words is not to be diminished.
Anas Younes, MD, at the University of Texas M. D. Anderson Cancer Center, became intrigued about Twitter after seeing the impact of Twitter communication on President Obama's campaign and the aftermath of the Iranian election.
“I became very excited about the potential of using Twitter to reach a large number of people whether I knew them or not,” said Dr. Younes (@DrAnasYounes). “The power of spreading certain messages was very attractive to me.”
He and other tweeting physicians interviewed for this article identified several strategic uses of the technology:
* Disseminating, correcting, and expanding information in conversation with professional colleagues: Wafik S. El-Deiry, MD, PhD, Professor of Medicine at University of Pennsylvania, uses Twitter to share news about his professional interests—the genetics of cancer and progress in the development of new therapies and other discoveries in the field of cancer. “If I get excited about something I've read, I'll make a note of it on Twitter,” said Dr. El-Deiry (@weldeiry).
He takes responsibility for conversing with other Twitter users to make information as accurate as possible. “Occasionally others will report findings as novel, and I'll note that, ‘well, we've known this for a few years,’ and that often brings perspective and appreciation from others who are out there,” he said.
* Gathering information: Dr. Younes follows organizations that are involved in cancer and health care, including scientific publishers and the main media outlets, like The New York Times and CNN Health, that tweet on health care issues. By using search columns in TweetDeck, a Twitter browser, he can log on to Twitter in the evening and find every mention of lymphoma, for example, posted since he last checked.
Bryan Vartabedian, MD, a pediatric gastronenterologist at Texas Children's Hospital in Houston, follows about 800 Twitter users who share his professional interests. “Those are people I've selected to deliver really good information to me,” said Dr. Vartabedian (@Doctor_V). “I can't keep track of all of the information that's out there on the Internet, so, I trust those 800 people to clue me in when there's a really important article that I need to look at.”
* Conference reporting and discussion: Dr. El-Deiry tweeted about research findings reported at the most recent American Association for Cancer Re search Annual Meeting. “It was like another way of taking notes at scientific sessions in which I could also share with my colleagues,” he said. “I have the expertise to listen to the talks that are being given and can make comments about what the presenters were really trying to say to the audience.”
When Steven Tucker, MD, an American oncologist practicing in Singapore, attended the American Society of Clinical Oncology Annual Meeting last spring, his participation in an ongoing online conversation with a cadre of journalists, consultants, and others tweeters enriched the conference experience for him.
“We were tweeting broadly across ASCO, sharing information with each other and our opinions,” said Dr. Tucker (@drsteventucker). “From there, I've really not stopped using Twitter.”
More recently, he experienced another AACR meeting vicariously, courtesy of microbloggers—“I have friends at AACR who have been giving me updates, so I'm getting a sense of what's going on at the meetings.”
* Promoting their blogs or Facebook entries: Dr. Younes tweets links to his Facebook page (http://tinyurl.com/yjzoorb), where he seeks input from his “fans” on various medical topics. After the annual meeting of the American Society of Hematology in early December, he was scheduled to answer questions from fans—via either Twitter or Facebook—about new data on Hodgkin and non-Hodgkin lymphoma.
* Communicating with patients: The public nature of Twitter makes tweeting about a patient's medical information inappropriate, but some patients do want to follow their physicians online. Doing so allows them to see what their physician considers important. Beyond that, as patients become more actively engaged in decisions about their treatment, many want to follow top experts in cancer care to learn from their postings.
* Advocacy: Dr. El-Deiry uses Twitter to call attention to inadequate research funding. “I'll write about what research has done for the field of cancer and for patients, and for cancer survivors, and how much knowledge there is, how much opportunity there is, and how little has been spent on cancer research funding,” he said. “And I've applauded various legislative developments that support science funding.”
* Monitoring what is said about your institution. Listening is as important as speaking, Dr. Tucker notes. “If you're seeing lots of tweets about a topic—such as complaints about your hospital—you need to be able to use that information and react appropriately.”
A Responsibility to Tweet?
The physician with one of the largest Twitter presences is Kevin Pho, MD, a primary care physician and prolific blogger in Nashua, NH, with approximately 17,200 followers. His opinions are frequently quoted in The Wall Street Journal and other national media outlets.
Earlier this year, Dr. Pho (@KevinMD) spoke directly to his professional colleagues in a blog post titled “Do Physicians Have a Moral Obligation to Engage in Social Media?”
“Some physicians may be hesitant to participate in social media outlets, like Facebook and Twitter,” he wrote. “Well, get over it.”
His blog entry proceeded to promote a provocative post by Dr. Vartabedian, who said that, by failing to participate in online dialogue, physicians have allowed medical misinformation to spread on the Internet.
“Sound reason, good clinical judgment, and evidence-based thinking need to be part of the information stream,” he said. “And doctors could change the way the world thinks if they would only get together on this.”
Drawing on an example from his own specialty, Dr. Vartabedian points out that a Google search on the terms “vaccines and autism” turns up dozens of Web sites spreading an anti-vaccine message.
“There's a very vocal minority that is social media-savvy and they have created a lot of online content that dominates the search engines,” Dr. Vartabedian said in an interview. “You'll find very little information written by physicians on the myths of vaccines and autism. That's essentially a failure on the part of the medical profession to be present and vocal in the social media space.”
To illustrate the missed opportunity to educate parents, Dr. Vartabedian said he believes that the controversy over an autism-vaccine connection would die if each of the 60,000 members of the American Academy of Pediatrics discussed the issue online just one time each year.
“We would completely dominate the search engines and dispel that bad health information,” he said.
Barriers to Entry
Despite their own enthusiasm for the technology, tweeting physicians find that most of their colleagues shy away from it.
“Twitter will not be widely embraced by the physician community,” Dr. Tucker predicted, echoing the comments of the other physicians interviewed for this article.
For one thing, a reluctance to try new technology plagues both physicians and scientists, Dr. El-Deiry said. For another, many physicians are reluctant to add another item to their to-do list.
“A lot of physicians feel that they don't have the time to put into social media,” said Dr. Vartabedian, a professor at Baylor College of Medicine. “I have learned that you can take a very limited amount of time every day and do some high impact things that will make it worthwhile to you.”
For example, Dr. Younes has Twitter habits that allow him to receive and dispense information he values without a big time commitment: “I check things in the morning and the evening unless there is major news like the breast-cancer screening controversy,” he said. “And I retweet only what I think is important information, not people who retweet me.”
Although most physicians are extremely busy people, Dr. Vartabedian suspects the time issue may be an excuse given to mask a discomfort with two attributes of social networking. The first is that physicians tend to want immediate response or feedback from an action,
“They'll say, ‘I sent out a message on Twitter or a link on Twitter—what do I get from that? What's the return to me?’” he said. “The whole concept of social media is the development of relationships that bear fruit only over a long time.”
The other barrier: Posting on Twitter and other social media sites requires physicians to reveal something of themselves, even if it is just showing what they consider to be important.
“One of the underlying principles for success in social media is transparency—disclosing things about yourself that you may not normally do,” Dr. Vartabedian said. “That's how we cultivate relationships, and I think some physicians have a hard time doing that.”
John W. Little, Program Manager in the Office of Physician Relations at M. D. Anderson, believes that many oncologists will eventually follow the lead of Twitter pioneers. Only a few M. D. Anderson oncologists are active in social media now, but they are being watched.
“The other faculty members are seeing how some of these physicians are jumping in head first and benefitting from it,” said Little (@PhysRelations). “I think we're going to see more and more physicians actually having fan pages, taking questions online, getting themselves out there.”
Dr. El-Deiry encourages oncologists to join the online conversation.
“I would say try it out, go slow, and figure out how it can help you get the word out about what you're interested in,” he said. “And have fun doing it.”
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