Tag Archives: psychosocial effects

Using Twitter and Social Media to Predict Disease: Identifying Risk and Impacting Change

Social media can be an exceptionally useful tool in Medicine.  Many platforms are  ideal for educating colleagues, patients and the community at large about chronic medical conditions as well as spreading the news of new medical innovations and treatments.  Social media platforms such as twitter, YouTube and Facebook (among others) can allow communication between people from different backgrounds and can connect those separated by oceans and thousands of miles all across the world.  While the medical establishment remains skeptical of social media and is often slow to adopt its routine use, it is emerging as an important part of many practices.

Twitter–both in and outside of its use in medicine–certainly has been shown to stir media controversies, influence politics and significantly impact careers (both positively and negatively) due to its ease of use and potential for immediate widespread dissemination.  Beyond the more traditional uses of social media platforms in medicine, a new study has recently been released that shows that one particular platform may actually be useful in predicting disease.  Researchers at the University of Pennsylvania published a study in the January issue of Psychological Science in which they carefully examined the relationship between the “type” of language posted on twitter and an individual’s risk for cardiovascular disease.  Stress, anger and other hostile emotions have long been associated with increased levels of cortisol, catecholamines (stress hormones) and increased inflammation.  These biologic byproducts of anger and hostile emotion have been associated with an increased risk for cardiovascular events.  Based on this information, researchers set out to identify whether or not the type of language utilized in tweets by a defined population could predict those at greater risk of cardiac events such as heart attack and stroke.  In the study, researchers analysed tweets between 2009 and 1010 using a previously validated emotional dictionary and classified them as to whether they represented anger, stress or other types of emotions.  They found that negative emotion laden tweets–particularly those that expressed anger or hate–were significantly correlated with a higher rate of cardiovascular disease and death.  Conversely, those whose tweets were more positive and optimistic seemed to confer a much lower risk for heart disease and cardiovascular related death.

While this is certainly not a randomized controlled clinical trial–and while we must interpret these results in the context of the study design–it does illustrate an new utility for social media.  As we continue to reach out and engage with patients on social media, our interactions may actually provide more than just communication of ideas–these interactions may produce important clinical data that may provide clues to assist us in the treatment of our patients in the future.  This particular study allowed researchers to predict risk for entire communities based on an analysis of random tweets from those residing in that geographical area.  For primary care physicians, using clues provided from social media interaction may provide insight into both an entire community’s health risk as well as an individual patient’s demeanor and allow for more aggressive screening and treatment for a wide variety of diseases from depression to cardiovascular disease.

Social media use will continue to grow among medical professionals.  I believe that when healthcare providers use all available tools and data in the care of their patients, outcomes will improve.  We must continue to explore the use of social media platforms such as twitter in clinical care and we must continue to examine ways in which the social media behavior of patient populations can predict disease.  I commend the researchers from the University of Pennsylvania for their creativity and vision–we need more creative minds who are willing to use pioneering strategies to improve care for our patients.  We can no longer shy away from social media in medicine–we must embrace it and begin to learn how to use it as a tool to effect change.


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Helping Patients Successfully Weigh Options: Effectively Discussing Risks and Benefits Prior to Procedures

Medicine is about balancing risk and benefit.  Certainly, as healthcare providers, we attempt to provide the best care for our patients based on available evidence.  Physicians often are seen as shepherds, helping to guide patients through disease and therapy.  As I have mentioned in previous blogs, ultimately medicine will be personalized and tailored to one’s particular genetic make-up.  However, the need for a clear discussion of treatment options with patients will remain a necessary and important part of the doctor patient relationship–even in the era of genomics.

Recently an article was published in the Archives of Internal Medicine that examined the way in which cardiologists communicated with patients prior to implantation of an Implantable Cardioverter Defibrillator (ICD).  As an Electrophysiologist who routinely performs ICD implantations, this particular study hit pretty close to home. The authors used patient focus groups to determine just how well each was informed prior to their respective procedures.  Researchers found that many patients felt inadequately prepared specifically for the emotional and psychological impacts of ICD therapy prior to proceeding with implantation.  Moreover, many patients felt that they did not fully understand the reason for the procedure or its possible complications.

For the most part, I think that procedurally based physicians do a fair job of explaining the technical aspects of the planned procedure and readily quote complication rates (as required by informed consent).  What we don’t do a great job of is making sure the patient actually understands the explanation or the risks.  Physicians who are procedurally focused often do not consider the long term emotional and psychological impacts that procedures such as ICD implants may have on the patient down the road.  As Electrophysiologists, we are aware that there is a growing body of evidence to support the significant psychosocial and emotional side effects for patients living with an ICD (mostly thanks to the outstanding work by colleagues such as Dr Sam Sears).  In the last decade, device recalls and lead failures have led to significant patient morbidity and mortality.  All of these complications come with a price–both physical and emotional.  

Clearly, we are not doing enough when discussing a potential procedure with a patient.  I do not believe this is in any way limited to Electrophysiologists who are implanting ICDs.  I think that this study brings up an important issue for every physician to consider.  The results of these patient focus groups should cause us all to pause and evaluate our ability to communicate with our patients.  In my practice, I make a conscious effort to carefully explain the procedure, why it is indicated and what the potential side effects are to both patient and family.  But, after reading the Archives piece, I am left wondering, do I do enough?

Given the shortcomings that are illustrated in ICD consents in this survey, Where do we go from here?  I think that we must reevaluate the way in which we discuss procedures with our patients.  Certainly the principles of informed consent must continue to be documented for the lawyers of the world.  However, we must go beyond basic informed consent and make sure that we are able to provide a reasonable explanation of possible long term emotional and psychological side effects (as well as the immediate impact on our patient’s lives).  We must also do more than simply discuss the statistics and the potential for risk vs. benefit.  We must provide the patient the opportunity to ask questions and to explore with our patients how the implant of an ICD may impact their lives–both positively and negatively.  Only then, can we feel as though we have truly served as a guide for those we are charged with caring for.  After all, one of our most important jobs is to communicate options in a way that allows our patients to make the best treatment decisions for themselves and for their families over the long haul.