Doctors and Social Media — Increasing the good we do?

“Mass social media is a crock. It is an inherent contradiction. This is why I like LinkedIn more than Facebook. It has a special purpose and therefore doesn’t feel like a time waster.

FWIW, I predict the next huge win in social media will be in health care.”

              –Rich Karlgaard (Forbes.com) writing in WSJ Notable and Quotable

I am thinking about the big picture again. The one from far above—where you can’t see statins, stents or ablations. From this far up, you see the sorry state of public health and the failure of doctors to improve it. I’m wondering about my presence on social media—and the dreamy idea of whether a blog could be a therapeutic tool.

Let’s get started…

Here’s a fact about doctors: Most of us measure our self-worth by the amount of good we do.

Which does more good: Burning (ablating) a complicated rogue pathway that formed in maze of heart scar tissue or preventing the behaviors that led to the scar tissue?

For regular heart doctors, it’s really a false choice. Both tasks are important—though burning/ablating/resecting/squishing disease is far easier (and better compensated) than preventing it.

When one is thinking about the big picture, it’s hard not to imagine the good that could be had if we better influenced our patients’ lifestyle behaviors? Oh, the procedural messes that could be prevented.

This is the dilemma faced by doctors on the front lines. When you are a young heart doctor, fascinated by new-found skills and enticed by the sensations of hero status, the acts of burning, squishing and implanting devices pleases your pleasure centers. The more you treat, the more good you do. And so goes a young doctor’s self-worth.

Things change with years in practice. Patients often ask how many procedures I’ve done. “Stopped counting after 5000,” is my truthful answer. (I used to keep a spreadsheet, but seriously, after 5000, what’s the point?) After doing thousands of devices and ablations, you start seeing a big picture. Yes of course, you still love helping the one patient on that one table on that one afternoon. The short-term rush of adrenaline is still there. But over time, and with thousands of cases, you begin to wonder about making a greater impact. You start thinking, “What the heck are we doing here? This is like Groundhog Day.” My interventional colleagues have it worse. They drag themselves out of a deep sleep nearly every night they are on call. What for? More times than not, it is to squish a blockage wrought from years of bad choices. Note, this isn’t mean; it is fact.

Let’s get to the point: Last week, noted journalist turned women’s heart advocate, Carolyn Thomas, mentioned me on a post on the Prepared Patient Forum. Ms. Thomas, a heart attack survivor and author of two blogs, Heart Sisters and The Ethical Nag, wondered why patients would sign up in droves to listen to her talk about heart health—but often fail to hear their doctor’s advice. In her post, Why You’ll Listen to Me – but Not to Your Doctor, Ms. Thomas explores the reasons why doctors’ messages are not resonating with patients? She thinks the problem might be in the delivery.

To support her contention, she invokes the words of Dr. Mike Evans, a Canadian physician now famous for his 23 ½ Hours YouTube video. Dr. Evans suggests we use peer-to-peer methods: stories trump data; relationships trump stories and individuals trump organizations.

My translation:

I can burn one patient’s AF, but what if DrJohnM teaches thousands of patients about ways to prevent AF? And maybe some of them teach their friends and family. I can teach one patient about the risks and benefits of blood thinners. But why not extend it to anyone with an Internet connection? Yes…If I get the word out that moderate alcohol intake might not damage arteries but could increase the risk of getting AF; have I accomplished more than ablating AF in a single patient? If I told you that successful bike racing mandates eating well, getting good rest and exercising smartly, and that I often fail in this regard; would you trust me more than a brochure that says eat more broccoli? If I told you that before my recent surgery the nurse getting me ready never looked up from her keyboard; would my message about the pitfalls of healthcare reform strike you as more than yet another doctor’s rant? (Note: The nurse did not even budge when asking an injured mountain biker if he has thought about hurting himself! What a question.)

Could words and videos and tweets from real doctors motivate patients more than textbook-like sites written by experts? It’s hard to know for sure. But I can say this:

It’s obvious to me that heart doctors offer more than just skillful manipulation of plastic catheters. We are regular people who sometimes eat too much, sleep too little and make mistakes. We are patients too. All this makes us experienced teachers. We are motivated to help patients; it’s what we do.

Needing to do more:

Despite breath-taking advances in medical technology, heart disease remains our number-one killer. Heart doctors should despise this news. They should cringe at what they see in their office waiting rooms. I’d love to help–in my small way–knock heart disease down a notch. Achieving that goal won’t come by squishing, stenting and ablating alone. We need to affect the big picture. We must become better motivators. And yes, this is possible. I’ve seen patients flip because of a doctor’s message. It’s beautiful when it happens.

Though 99.9% of us will never have the communication skills of Dr. Evans and his team, we can and should engage with patients on a personal level—stories trump data, relationships trump stories and individuals [bloggers] might trump organizations.

Social media has the potential to move the needle. Our (imperfect) blogs and tweets and stories are surely more motivating than boring brochures, textbooks and sterile websites–which all say the same thing.

I’m sitting at this MacBook looking to make a difference in the field that I love. I’m hoping that some day these words are as valuable as an ablation or stent. Surely they are better than a pill.

JMM

References:

Dr.Mike Evans TEDx Talk.

Ms. Carolyn Thomas’ Heart Sisters.

Comments

  1. says

    Hello Dr. John and my humble thanks for including me and my article in this post. Whether you’re aware of it or not, you have already made a profound difference through DrJohnM.org – and this qualifies you as a bona fide role model for other docs wanting to dip a toe into health care social media that works.

    Here’s just one example: I now freely share your eminently quotable quotes at every presentation on women’s heart health that I do (and I’ve spoken to literally thousands of women since surviving my own heart attack in 2008). My very favourite Mandrolaism is, as you like to say here:

    “You Only Need To Exercise On The Days You Plan To Eat!”

    My audiences LOVE this line of yours. And best of all, I suspect that they will actually REMEMBER this line next time they’re trying to talk themselves out of doing some kind of physical exercise.

    I have the arguable luxury of focusing on heart disease PREVENTION in my blog(s) and during my presentations. Most docs believe (right or wrong) that they simply don’t have this luxury if they’d like to also pay bills, put food on the table or send their kids to college. But when people like me have access to doctors like you who are basically pushing the same message of prevention (and personal accountability!) it makes me and other health care advocates feel like we have some amazingly credible muscle behind our messages.

    Thanks once again for all you do here.
    regards,
    C.

  2. says

    Another GREAT post by Dr. John and touching reply by Carolyn.

    I’m blessed with the time I never had when teaching and seeing patients (now that I’ve “retired”) – but I’ve become addicted with the “fever” of on-line corresponding and social media – and my cardiology writing that keeps me as busy as I was in full-time academia with clinical practice and hospital attending.

    Most practicing clinicians understandably don’t have much time for on-line corresponding – but Dr.John.org is a powerful role model for how an electrophysiologist / proceduralist can magnify his impact by living what he preaches and focusing on prevention as much as on ablations.

    To me, the lure and power of Social Media in medicine is allowing anyone so motivated to reach thousands daily with important messages – instead of only “touching” the limited few who are on the patient schedule. KEEP UP the great work John!

  3. says

    This is a terrific blog post and I hope you don’t mind if I steal the video link for my own blog. It’s a message well-presented and would like to see it watched by all my patients. Thanks for the words and the link!

  4. says

    Wow! Powerful observations. This is definitely why we need more doctors participating in the discussion on blogs, on videos and other social media channels. A beautiful description of the challenge doctors face. Thanks for sharing. I’ll definitely be linking to this and adding some of my own thoughts to this on one of my blogs.

    I’ve often said, it’s amazing that a little blogger in Las Vegas (that’s me) can have any influence over an industry. I guess the same could be said for a cardiologist blog.

  5. Sasha says

    Dr. Mandrola, I came across your blog last week and I am one of those ‘non-adherent patients’ you mentioned in one of your previous posts. I have had a pacemaker for 36 years (congenital heart block) and have experienced many of the complications that PM wearers can experience (fractured epicardial leads; detached transvenous leads, migrating PM, subclavian occlusions, lead failure, (hard to diagnose) PM endocarditis from 2006 to 2007 resulting in open heart surgery to remove leads and repair tricuspid valve). If I could get rid of my PM , I most certainly would, but at 49 that’s not really an option.

    However, this post is timely because Carolyn Thomas is correct that it is in the delivery that doctors set patient’s backs up. Today I visited my own EP, excited because I had recently started walking again and have lost 6 lbs since doing so and 12 lbs since my last EP visit. Instead of simply encouraging me to keep up the work and helping me to set a goal for the next time, he starts lecturing me that with extra weight I will more than likely become diabetic and then have to start coumadin/warfarin/Pradaxa since I have been experience periods of AF and/or flutter (post OHS). He never told me exactly when they occurred other than to say while I was sleeping (an assumption on his part, I believe, since I do not always sleep at night), how long they lasted or if I was aware of the events or what could be triggering them. Very disheartening to me.

    • says

      The tact I take with my patients comes from my persona experience to stay fit and trim for cycling. I say it’s a daily struggle. Try to make the little choices, the everyday ones. Don’t beat yourself up for relapses, just go on to try to do better. Choices. It’s all choices.

  6. Tom Meade says

    Hi – cool site, thanks. Am 76 and recent AF diagnosee (no
    rapid heartbeat). Have steady history of hi cardio exercise
    but my EF’s just a tab below normal. The hill I ride several
    times a week gains 1,000 ft. at 10% with plenty of opportunities
    for metrics (landmarks). Guys in their 40′s may skunk me
    but I continually improve and have no intention of stopping.
    Had several blowouts (incl. one front) descending so now I
    hold speed to 18 mph, especially in contemplation of Pradaxa.
    All best, Tom

    Story

    Every couple of days I climb a 10-something percent grade for a mile and a half on my mtn. bike, stopping for a breath several times as I’ve long had emphysema from never smoking – truly – and I like to challenge myself. The ride is some 40 minutes to the top, I do two or three loops on the steepest section then finish with a 5 or 6 minute bombing descent at around 30 -36mph. That’s before last month’s blowout of my front tire on a long curve.

    What happens when a bike tube goes, after what sounds like a .22 going off and no other sensation, leaving you to wonder if someone’s pinging at birds or rabbits, is that the tire starts to wobble. Wobbling quickly gives way to squirming as the tire, now trying desperately to get off a rim which is busy trying to chop it in two – first on the left then on the right; it becomes a desperate rattlesnake trying to keep from getting its head cut off. There’s no way to tell if you should lean one way or the other. I had no idea how to apply the brakes (my son asked me later “Dad, did you hit the rear brake?” Answer: No, I couldn’t remember right from left. My only instinct was to center my weight fore and aft as the bike, unresponsive to steering, yawed this way and that – and just ride it out. My other thought – why don’t I have a helmet protecting my teeth and lower jaw, which sure as hell I’m going use to bite the pavement with when angry Mr. Front Tire gets his way in flying off the rim and lodging up into the fork,launching me instantly into the void. So here I sit today, reverently praising the makers who moulded that Kryptonite cable into the bead, the cable that defeated the tire that worked to repay me for exceeding my basic downhill speed and common sense at the age of seventy-six.

  7. Justin Moore says

    Excellent post! I came across your blog after hearing you on ERcast with Rob, looking for info on RFCA for Afib (my Dad is having one in two weeks).

    And in the vein of ‘its a small world’ Dr. Mann did my RFCA for WPW almost 11 years ago at CU. I wondered where in the heck he went and now I know. One of the best physicians I have ever met.

    Cheers!

    • says

      I’ll second that. DM and I learned to do AF ablation together. We still collaborate on cases. He’s a great teacher, and I have been fortunate to be his “student.”