I recently took on a position of medical journal editor. It is with the Journal of Kentucky Medical Association.
It’s been a good learning experience. Part of the job of editorial board members is to write an opinion column. (Check, I’ve done that before.) What follows below was published in this month’s journal.
The editorial board put no restrictions on me. So I decided to write about social media and why it is time that doctors make the leap from analog to digital. (It breaks the less than 500 words rule.)
The Greek philosopher Heraclitus gets credit for the idea that change is central to the universe. Physicians know this doctrine well. For us, in the practice of medicine, change is a constant. And in recent years, a major vehicle for change is the Internet and social media. Facebook boasts more than a billion users, Twitter more than 120 million, and up to 80% of patients go online for health information. Google yourself and you will discover your digital footprintâ€”whether you like it or not.
Social media expert Dr. Bryan Vartebedian (Texas Children’s Hospital/Baylor College of Medicine) writes that there are two realities of online reputation management: 1) you have no control over what people say; and 2) you have 100% control of the story you create. Yet doctors have been slow to embrace social media. Thatâ€™s not surprising; we are hardwired to be risk-averse.
Itâ€™s true; engaging with social media brings risk. That which is digital is permanentâ€”a sobering reality for sure.
But I ask: What medical intervention, what shot at making things better, comes free of risk? A rule of doctoring is that to do good a doctor must risk doing harm. A distinguished heart surgeon once consoled meâ€”after I had caused a procedural complicationâ€”that if I didnâ€™t want complications, I shouldnâ€™t do anything.
Itâ€™s the same with engaging in social media. In the hyper-connected world of 2014, medical professionals have reached a fork in the road. One path is a road well traveled. On this familiar route, we continue to keep our heads down, stay in the weeds, out of trouble. Donâ€™t wiggle; donâ€™t rock the boat; check the boxes; fill out the forms and accept what comes. Donâ€™t dare engage in the online conversation. Choosing this path is like not treating a disease: less ownership confers less personal risk.
The purpose of what follows is to encourage you to consider the other path: the path of engaging in the online conversation and using the tools of social media to enhance the good that can be doneâ€”for patients, for ourselves, and for the profession at large.
As a multi-year participant in social media, I see more benefit and opportunity than risk. Here are five factors to consider while pausing at that fork in the road.
First, consider the blank-slate status of the playing field for health care social media. Beyond common sense and decency, there are few rules. Digital nativesâ€”like me, and perhaps youâ€”will make the rules. Pause for a moment here and consider that idea: making rules rather than following them. Sounds good, doesnâ€™t it?
Second, as a doctor, you are different. People will listen to you; your voice matters. Currently the Internet overwhelms people with information but, too often, the details come in the form of highly edited groupspeak from medical societies, or pseudo-science from people selling things, or anecdotes from patient forums. What patients really want to read is what their doctor says. How does John Mandrola feel about anticoagulation; what does James Patrick Murphy say about opioid addiction, and how does Kathy Nieder feel about electronic medical records?
Third, social media can be therapeutic. Itâ€™s an understatement to say morale amongst caregivers is low, and sinking lower. The primary reason for this, I believe, is that joy is being debrided from our job. Itâ€™s as if joy is extra; thereâ€™s not time for it anymore. Bulleted HPIs and 10-pt review of systems replace the beautiful stories; white screens inhibit human-human connections; and appropriate use criteria supersede the pleasure of using clinical judgment. Social media offers an elixir, a chance to reflect about what is still so good about our work. When you write, or Tweet, or blog, or create videos, you are forced to dwell on the patient who actually lost the weight, the pacing lead that found the perfect branch of the coronary sinus, or the family who sent you a Thank You note for having had the courage to discuss end-of-life care. Whatâ€™s more, the social aspect of social media connects you with colleagues across the world, not just your hospitalâ€™s doctorsâ€™ lounge. I regularly connect with colleagues in Germany, Australia, and the UK. This is nice.
Fourth, social media can make you a better doctor. The pace of change in health care is increasing. Look no farther than the new cholesterol and hypertension guidelines. In the course of three weeks in late 2013, two ensconced paradigms of cardiovascular medicine were upended. Social media covered the story in real time; print journal coverage came later. Another example: one of my favorite types of sessions at medical meetings is the pro/con debate. Social media brings these lively discussions to your smartphone or tablet. (In fact, as a participant in social media, you could be a debater.) The challenge for physicians of the past was having enough to do for patients. The challenge for todayâ€™s caregiver is about managing the expanding menu of options. Staying current and informed has never been more important. The micro-blogging platform Twitter allows easy curation of content from trusted sources as it comes available. Another aspect of creating content is the depth of knowledge it requires. In this way, I have no doubt that participating in social media has made me a more informed clinician.
Finally, the democracy of social media levels the playing field of influence–for patients, doctors and even journalists. The blog and Twitter feed of stage IV breast cancer patient Lisa Adams has stirred the mainstream of journalism and medicine. When writers Bill and Emma Keller (of the NY Times and the Guardian, respectively) weighed-in on Ms. Adams poignant posts, a torrent of criticism and conversation followed. The vastness of the response (from the New Yorker, Wired, NPR, Atlantic, The Nation, the American College of Oncology and many more outlets) removed any doubt that social media has transformed the sphere of influence.
I recently presented at an Indiana University Medical Student Council Leadership conference. One of the other speakers, Dr. Richard Gunderman, a radiology professor and author, told attendees about the importance of narrative. â€œIf you can tell a story, you are a leader. Stories are powerful. Medicine is story-penic.â€ He went further, speaking a truth well known to todayâ€™s clinicians: â€œthere are things in medicine that need to be said. But it takes courage to speak candidlyâ€¦. If you are courageous, you are a leader.â€
My recent experience provides proof of this concept. Although I am an academic nobody, at the 2013 Heart Rhythm Society Sessions I shared a stage with three other distinguished leaders in the field. Why? Dr. Rich Fogel, the president of HRS said this when I posed the why me question to him: â€œJohn, you say things we need to hear.â€ Social media gives regular doctors a voice, a chance to influence.
Perchance I have piqued your interest in social media, that the benefits outweigh the risks, the peril of not engaging greater than engaging. If so, I invite you to read my Ten Simple Rules for doctors on social media and follow me on Twitter at @DrJohnM.
John Mandrola, MD