Social Media and the Digital Physician
#UCIMedGrandRounds
UC Irvine Department of Medicine
Grand Rounds
October 16, 2012
Robert S. Miller, MD, FACP, FASCO
Clinical Associate, Breast Cancer Program
Johns Hopkins University School of Medicine
Oncology Medical Information Officer
Sidney Kimmel Comprehensive Cancer Center
Objectives
 Describe social media tools and applications relevant
to healthcare and medicine
 Define current levels of social media adoption by
physicians
 Demonstrate how social media can be used by
physicians for professional education/continuous
professional development, networking, clinical trials
promotion, and patient education through authoritative
health messaging
 Identify institutional and individual best practices for
social media
Social media is user generated content that is shared over the
internet via technologies that promote engagement, sharing and collaboration.*
* Definition from The Social Media Guide.com
weill.cornell.edu
Social media is the second Internet revolution.
Used w/ permissions GNU License
http://en.wikiversity.org/wiki/File:Web_2.0_elements.png
http://en.wikiversity.org/wiki/File:Web_1.0_elements.png
weill.cornell.edu
http://www.flickr.com/photos/interactegypt/6882960792
Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0)
“Facebook hits milestone of 1 billion users”
--Washington Post 10/4/12
(CC) JD Lasica, socialmedia.biz
Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0)
“Presidential Debates 'Most Tweeted' Event In
(Post-Twitter) U.S. Political History”
--Forbes 10/4/12
http://blog.twitter.com/2012/10/dispatch-from-denver-debate.html
Social media categories & applications
•
•
•
•
•
Blogging – WordPress, Blogger (Google)
Microblogging – Twitter, Tumblr
Social networking – Facebook, Google+, LinkedIn
Collaborating – wiki’s, Google Docs
Multimedia content sharing – YouTube, Flickr,
podcasts, Instagram, Pinterest, Prezi, Slideshare
• Social bookmarking – Diigo, Delicious, CiteULike
• Rating/reviewing – Yelp, Epinions
• Location-based social networking – Foursquare
http://instagr.am/p/nm695 via @DouglasWRay
“Why would any physician bother
with this stuff?”
“Isn’t it risky and a total waste of
time?”
“I don’t get Twitter.”
Our patients are online, and they
expect us to be there, too…
Pew Internet & American Life Project
Peer-to-peer healthcare
February 28, 2011
 80% of Internet users (59% of all U.S. adults) search
for health information online
 34% of Internet users have read someone else’s
commentary or experience about health or medical
issues on an online news group, website, or blog
 24% of Internet users have consulted online reviews of
particular drugs or medical treatments
 18% of Internet users have gone online to find others
who might have health concerns similar to theirs
(especially those with chronic diseases)
http://pewinternet.org/Reports/2011/P2PHealthcare.aspx
http://www.pewinternet.org/~/media//Files/Presentations/2012/Sept/FoxMed2Panel_PDF.pdf
Our institutions are online…
3 ways physicians might use social media
1. To treat – engaging directly w/ patients about care
2. To teach – providing timely & credible education
3. To learn – sharing of medical information/knowledge
Bucket 1
Bucket 2
Bucket 3
Bucket 1
Bucket 2
Care
Info
Bucket 3
Info
Data re physician adoption of
social media
Reviewing social media use by clinicians
(von Muhlen & Ohno-Machado)
 Systematic review of 370 articles indexed in PubMed




(50 in final data set, 15 addressed adoption)
Shortcomings – variable definitions of social media
Wikipedia: 70% junior physicians use as medical
reference
Facebook: Use by 64-96% health sciences students,
13-47% of professionals
Extent and impact of use of social media by clinicians
not well characterized; lack of common terminology &
research methods
J Am Med Inform Assoc 2012;19:777-781 doi:10.1136/amiajnl-2012-000990
Physicians who use social media and other
internet-based communication technologies
(Cooper, Gelb, et al.)
 Epocrates-sponsored DocStyles survey 2009: 1750
physicians in 4 primary care specialties + dermatology
 Surveyed use in the preceding 6 months of “Internetbased communication technologies”
 Participation in social networking sites = 59%
 Downloading podcasts = 41%
 Subscription to RSS feeds = 19%
 Blogging = 13%
 Age 35-44, male sex, and practicing in a teaching
hospital modestly correlated with increased use
 Personal vs. professional use not distinguished
J Am Med Inform Assoc doi:10.1136/amiajnl-2011-000628
http://www.quantiamd.com/q-qcp/DoctorsPatientSocialMedia.pdf
http://www.quantiamd.com/q-qcp/DoctorsPatientSocialMedia.pdf
The “Meaningful Use” of
Social Media by Physicians
Brian S. McGowan, Ph.D.
Senior Director, Oncology;
Medical Education Group, Pfizer Inc
Chair, Committee on Emerging Technologies in Education
Alliance for Continuing Medical Education
Consult Columnist, Social Media Connections
Medical Meetings, A MeetingsNet Magazine
Presented at “Medicine 2.0” September, 2011, Stanford, CA
A collaborative study
Adoption and Use of Social Media by
Physicians to Share Medical Information
McGowan B, Vartabedian B, Miller R, Wasko M: The “meaningful use” of social media by physicians for learning. Presented
at Medicine 2.0 ‘11, 4th World Congress on Social Media & Web 2.0 in Health, Medicine, & Biomedical Research, Stanford,
CA www.medicine20congress.com/ocs/index.php/med/med2011/paper/view/764
Defining ‘Sharing Medical Information’
• Sharing medical knowledge is
defined as the exchange of
information, advice, ideas,
reports and scientific
discoveries with other
physicians in the medical
community.
Bucket 3
Survey Sample Demographics
Oncology
n = 186
Primary Care
n = 299
100%
100%
24 years/10
24 years/9
75%
72%
100 patients/56
124 patients/73
Urban
Suburban
Rural
47%
44%
9%
23%
60%
17%
Solo Practice
Group Practice
Medical School
Non-Government Hospital
12%
68%
9%
5%
34%
60%
1%
3%
Demographic Characteristics
Degree
MD/DO
Years since graduation from medical school
Mean/St. dev.
Percent
Male
Patients seen per week
Mean/St.dev.
Practice Location
Practice Setting
Sharing Medical Knowledge
Email 1 10
Restricted Online Communities
2 5
Texting
1 9
Cell Phone Apps
3 9
i-Tunes
5
Wikipedia/Wikis
3
YouTube
4
Facebook
2
Podcasting
Blogs
52
14
31
18
16
21
43
26
47
33
13
19
25
Not Aware
Will Never Use
23
Unlikely/Not Sure
19
17
54
19
27
10
48
21
13
10
43
16
22
36
37
21
3
40
38
14
0%
19
35
2
RSS Feeds
71
22
5
LinkedIn
Twitter
18
Likely/Very Likely
13
7=Current user
13
11
9
11
50
8
7
49
10
6
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Adopters versus Adamant Non-Adopters
% of Physicians
80
71
70
60
52
50
40
33
30
20
10
26
21
13
6
40
36
7
19
11
11
16
13
19
21 23
27
25
16
18
9
0
Will Never Use
Current user
9
5
1
Adamant Non Adopters: ONCs vs PCPs
% of Physicians
40
35
Oncologists more skeptical
overall than PCPS
30
25
20
15
ONC
10
PCP
5
0
•
•
•
•
http://www.jmir.org/2012/5/e117
24% use SM daily to explore/share medical
information; 14% use SM daily to
contribute
60% say SM improves quality of pt care
Oncologists more likely to use SM due to
“personal innovativeness”
PCP’s more likely to use SM to have access
to peers
January 2010
Sept 2012
http://rsm2800.blogspot.com
http://jop.ascopubs.org/site/podcasts/index.xhtml
Costs
 Twitter
=
$0 (Twitter account)
$0 (TweetDeck for Mac/PC)
$2.99 (TweetBot for iOS)
$2.99 total
 Blog
=
$0 (Google Blogger account)
 Podcast
=
$0 (cost of posting to iTunes)
$0 (Skype account/software)
$0 (additional cost of GarageBand)
$99 (USB studio microphone)
$99 total
Why I like Twitter
 Low barrier to entry
 Platform agnostic
 Minimal requirements for content production (140




character tweets vs. 500-word blog posts)
Emphasis on frequency, breadth not depth
Asymmetric (“following” does not require
reciprocation)
Ability to embed shortened links
#hashtags = metadata
Instantaneous dissemination of information
Diagram of a Tweet
“@” + username
calls that user’s
attention to
message
“shortened”
link
Actions you can
take after posting
Science at the heart of medicine
6/21/2016 | 45
Diagram of a ReTweet
2nd RT indicates
@EinsteinMed is
fowarding this
message
RT + @user =
referencing
original message
creator
# Hashtags =
easier way to find
groups of tweets
Science at the heart of medicine
6/21/2016 | 46
How I use Twitter every day - outbound
• Part of my daily online workflow – share content
with my 2200+ followers
• What I tweet:
o Usual topics – breast oncology, health IT/informatics
especially EHR’s, social media
o News stories (e.g., AMA News, MedPage, WSJ, NYT)
o Journal articles (NEJM, JCO, JOP, Annals, JAMIA, etc.)
o Blog posts
o Occ. random observations & pictures
o Almost never what I ate for breakfast
• Embed links to extend content
How I use Twitter every day - outbound
How I use Twitter every day - inbound
• Twitter accounts I follow:
o Oncologists & other MD’s
o Thought leaders in organized medicine & IT
o Journalists, bloggers, patient advocates, public
figures
o Professional societies, institutions
o Not necessarily everyone who follows me
• New insights – patient empowerment,
patient-centered health IT, safety/quality
How I use Twitter (cont.)
• Is there enough time?
o Interaction with this personal learning network replaces
time spent surfing news & journal sites
• Crowdsourcing questions
o Kent Bottles, MD: “My research department works for
free and is scattered across U.S.”
Professional opportunities that
resulted from my use of social media
• Invited to participate in IRB-approved research
study on social media (manuscript published)
• Invited commentary in national oncology periodical
• Interviewed by AMA News on health IT topics
• Invited to lecture at class for physician writers at
Johns Hopkins
• Developed ties to national breast cancer advocacy
community
• Increased visibility but no academic
advancement…yet
1. Highly tweeted articles were 11 times more
likely to be cited than less-tweeted articles
2. Top-cited articles can be predicted from toptweeted articles with 93% specificity and 75%
sensitivity
How to use Twitter at a medical
conference
•
•
•
•
•
•
•
Twitter before, during, and after
Twitter as conversation starter
Twitter as feedback monitor
Twitter as influence generator
Twitter as event planner
Twitter as goodwill creator
Twitter as impact maker
Sinclair C (2011, Sept). How to use Twitter at your next medical conference
http://www.kevinmd.com/blog/2011/09/twitter-medical-conference.html
Use of Twitter at medical conferences
Twitter usage at ASCO Annual Meeting
• #ASCO10: 684 users, 4456 tweets (14 MD’s=979 tweets)
#ASCO11: 1537 users, 8188 tweets (34 MD’s=1477 tweets)
Chaudhry A, Glode LM, Gillman M, Miller RS (2012). Trends in Twitter use by physicians at the American
Society of Clinical Oncology Annual Meeting, 2010 and 2011. J Oncol Pract 8:173-178.
http://jop.ascopubs.org/content/8/3/173.full
Blogging:
Promoting participation in clinical trials
YouTube
Promoting clinical trials
Promoting Participation in Clinical Trials
Providing links to Clinicaltrials.gov
Social media & clinical trials
 Engage your institution’s media department and the








sponsor before creating Facebook page/Twitter account
Determine if IRB review required
No proprietary information
Avoid claims about efficacy or discussion about side effects
No disclosure of trial results
Monitor posts to avoid HIPAA violations
No screening of subjects via social media
Link only to sites for more info (e.g., clinicaltrials.gov)
No blogging about conduct of study (can be viewed as
advertising)
Adapted from Table 3 in Dizon DS et al J Oncol Pract Sep 1, 2012:e114-e124
Additional considerations re the
value of social media for physicians
 Defining your own digital footprint
 Reputation management/crisis control
 Creation/dissemination of authoritative content >>
misinformation and pseudoscience online
 Vaccine/autism example
Required literacies for the digital
physician
 Network awareness/collaboration
 Input management
 Creation/translation
 Mindfulness
--Dr. Bryan Vartabedian, 33charts.com
http://33charts.com/2012/09/new-physician-literacies.html
http://33charts.com/2011/12/physicians-risk-opportunity-social-media.html
JAMA. 2012;307(11):1141-1142. doi:10.1001/jama.2012.330
Professionalism in the Use of Social Media
(AMA Policy 11/8/10)
 Always maintain patient privacy/confidentiality.
 Monitor own Internet presence/use privacy settings




on SM (know they are not absolute).
Maintain boundaries when interacting with patients
online.
Consider separating personal & professional online
accounts.
Police colleagues’ online behavior.
Online behavior can affect reputation & undermine
trust in the medical profession.
http://www.ama-assn.org/ama/pub/meeting/professionalism-social-media.shtml
J Oncol Pract September 2012 vol. 8 no. 5 e114-e124
Mayo Clinic
12 Word Social Media Policy
 Don’t Lie, Don’t Pry
 Don’t Cheat, Can’t Delete
 Don’t Steal, Don’t Reveal
--Farris Timimi, M.D., Medical Director, Mayo Clinic Center for Social Media
http://socialmedia.mayoclinic.org/2012/04/05/a-twelve-word-social-media-policy
My version…
 Don’t be anonymous
 Don’t be stupid
 Remember everyone’s watching
 Developing trust in your online community takes time
– maintain a healthy skepticism
How to get started
• Be a lurker first
o Read blogs, listen to podcasts, learn how to use RSS feeds for
journals & news sites
• Join Twitter
o Pick a short, descriptive handle, use a real photo as an avatar
o “Who to follow” Twitter suggestions, follow people others follow
o Give it time to grow
• Share content – links to articles and stories that
interest you
• Create content – blog
• Cultivate your network – RT’s, #FF, @replies
Conclusions
 Social media (SM) has become embedded in our
culture, and its impact on medicine is undeniable.
 The Internet has democratized information and
eliminated traditional filters that constrained access to
medical knowledge; SM is the communication channel
resulting from this change in paradigm.
 Physicians can effectively use SM for connection and
networking with other physicians and scientists both
inside of and outside of traditional spheres of
influence.
 SM provides an unparalleled opportunity for the
authoritative voice of the physician to be heard in
patient education & health messaging.
Conclusions (cont.)
 Physicians will soon have an obligation to move from
being passive observers of online conversation to
being curators and creators of content.
 Concerns about patient privacy, liability, and time
commitment do not negate the value of participation in
SM.
 Physician professionalism and patient-centered focus
trump all other considerations.
Track this grand rounds on Twitter:
#UCIMedGrandRounds
Follow me on Twitter:
@rsm2800
Read my blog:
rsm2800.blogspot.com