“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.