Tag Archives: social media

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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The Supreme Court Tackles Social Media: The First Amendment and the Rule of Law on the Internet

Social Media and the internet have often been compared to the “Wild West” at times when it comes to the posting of ideas, opinions and beliefs.  There has been very little regulation of what is posted and how it is utilized–which may actually be a good thing.  However, many of us have learned (often the hard way) that many posts on Facebook, Twitter or other social media sites can be taken out of context and misinterpreted by the masses whom the information may not have been intended for.  As physicians who are active on social media we have even more to consider when taking to the internet.  We must be very careful to choose our words for posts wisely and make sure that we leave very little open to interpretation.  We must be mindful of the legal implications of what we say and do online and must be mindful of patient confidentiality issues as well as standards for professional conduct.  Medical boards across the country have developed guidelines for physicians on social media and academic papers have been published on the subject in the Annals of Internal Medicine.  Now, even the nation’s highest court is venturing into the regulation of social media and the intricacies and legal implications of both the subjective and objective interpretation of online posts.

This week, the Supreme Court will be hearing arguments concerning the classification of social media posts as “free speech.” Unlike face to face interactions, cyber interactions can often be interpreted many different ways.  Social media posts can lack context, facial expression and inflection.  Last year a man was sent to prison for posting threats to harm his estranged wife on Facebook.  His posts were absolutely violent and inappropriate in nature and–when simply read out loud–conveyed a sense of intent.  While no crime was committed and no act of violence occurred the defendant was prosecuted and convicted based on a Federal statute involving the criminality of the interstate communication of threats to harm others.  The defendant argued that he was simply writing a “rap” on his Facebook page, expressing his feelings and had no real intention of harming his wife or acting on any of the perceived threats.  However, the interpretation of these comments by the estranged wife and others constituted a criminal offense and resulted in his imprisonment.  While I do not in any way condone this type of online behavior and speech, I do think that it may greatly influence rules the internet “playground” in the future.

Because of its national attention and the fact that arguments will be held in front of the nation’s highest court, this case will have lasting impact on social media and the classification of what is considered free speech in cyberspace.  As outlined in an article published in the New York Times earlier this year, at issue is whether or not posts on social media should be interpreted “objectively” or “subjectively”.  If you interpret the threatening words objectively, you may conclude that the threat is real and that most reasonable individuals would see this as an imminent danger–however, as the counsel for the defendant argues, if you subjectively interpret the words you may be convinced that it was simply the musings of an artist creating a poem or a rap song in response to a life crisis and posed no danger.

Regardless of the outcome of this Supreme Court case, it should serve as a wake up call to all of us who are active on Social Media.  We must continue protect our rights to free speech and expression on the internet.  However, we must also be mindful of our words and how they may be interpreted by others.  Social media is an important tool for all of us to use in order to positively impact others and influence opinion–certainly free speech is protected but we must take care not to abuse these protections.  The individual involved in the criminal case–regardless of intent–showed poor judgement in his public posting and is now dealing with the consequences of his decisions.  However,  I certainly hope that the Supreme Court carefully considers the impact of any opinion they may render in this case. The internet and social media must remain a place for creative expression and innovation–too much regulation and any limits to our right to free speech in cyberspace would have serious negative consequences for all of us.  This case should serve to remind us of one important fact–As physicians and healthcare professionals active on social media, we must hold ourselves to a higher standard of online behavior and continue to remain professional in all that we do online.

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The Power of Social Media in Medicine: Using Facebook to Save Lives

Recently, there has been a great deal in the press surrounding organ transplantation.  Sara Murnhagan, the courageous little girl with end stage cystic fibrosis, captured the nation’s attention as she waited for a life saving lung transplant.  The organ transplantation and procurement system in the US today is not without flaws.  Organs are at a premium and finding the best way to allocate them to matched patients who need them the most is a daunting task.

Today, nearly 120,000 people (men, women and children) are actively waiting for organ transplantations and are listed on the UNOS.  However, only 29,000 organ transplants were performed in 2012.  Obviously the demand far exceeds the supply for suitable organs for patients who need transplantation for survival.  Paradoxically, 90% of Americans say that they support organ donation but only 20% have taken the necessary steps to be a donor.  The rate of registered donors has remained static over the last twenty years while the numbers of those waiting for transplantation has increased 20 fold over the same time period.

Researchers are actively engaged in clinical investigations designed to identify better ways to recruit potential organ donors.  In order to improve the availability of organs for those in need we must find a better way to successfully register potential donors and allocate organs.  In particular, certain groups such as minorities and children are poorly represented as registered donors.

Our society today is more connected than ever.  Social media outlets including Twitter, Facebook, and YouTube are easily accessible and widely utilized.  In particular, Facebook is one of the most commonly visited websites in the world–second only to google.  Facebook is often the first stop for those who begin their exploration of the world of social media.  Facebook has become a great place to connect and to share ideas and news.  In addition, Facebook has been a place to inform others of an important cause or event.

Researchers at Johns Hopkins reported on a demonstrated effect of Facebook on organ donor registration rates.  In the report, the rate of increase was nearly 21-fold in one day–this was a day in May 2012 when Facebook allowed users to make their organ donor status public on the site (and also provided easy links to DMV sites so that users could make their status official).  On the first day that the new service was available on Facebook there were over 13,000 new DMV organ donor registrations–as compared to an average day where there are only 600 new registrations in a day.  This enormous bump in organ donor registration demonstrates the power of social media to move people towards action in ways that can benefit others.  Social media outlets such as Facebook are not only a great place to share pictures and reconnect with friends–they can be a new way to effect social change.

In medicine, we have only begun to scratch the surface of the full potential of social media.  It is imperative that physicians begin to interact virtually and engage fully in social media in order to effect change.  As we have seen with the New York Stock Exchange, social media outlet such as twitter can move markets (reference the largest 3 minute drop in the Dow in history when the AP twitter account was hacked).  WE must ALL work together to realize the untapped potential of social media in medicine–it can save lives–improve health–and even provide a large number of new registered organ donors.

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Twitter Moves Markets: Can It Impact Disease?

For those who are engaged in social media, nothing is more powerful than an active Twitter account. Twitter demands engagement and fosters a sense of community. Medicine, although quick to adopt many new technologies has been slow to embrace social media outlets and, in particular, Twitter. The ability to share ideas and information in 140 characters provides a unique platform for physicians to communicate with one another, with patients and with the world. Twitter allows physicians to teach, to counsel, to support and to dispel rumors and myths. Twitter allows physicians from different parts of the world to consult with one another and share knowledge in order to determine the best treatment plan for a particular disease process or patient. Twitter affords patients with an opportunity to connect with other patients who may have similar medical problems and challenges.

Recently, as many who follow the financial markets are aware, the Dow Jones average took a 144 point plunge in 2 minutes.

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Fortunately, the market quickly rebounded and within a few minutes was back to its opening level. The SEC determined that a tweet suggesting violence or terrorism at the White House was responsible for the plummet. The tweet had been produced from a “hacked” Associated Press (AP) twitter account. As reported in the New York Times today, regulators have taken notice to the power of social media. The incident with the stock market serves to further demonstrate the influence that twitter and other social media outlets can have on human behavior as their repercussions on government and financial institutions. In the case of the Boston bombing tragedy on April 15th, social media and mobile technologies provided much needed evidence and assisted in police efforts to apprehend the men who carried out the senseless attack.

So, why are physicians and other healthcare providers so reluctant to embrace Twitter?

I think that there are several reasons and many valid concerns. Here are some of the most common: (The Top Three Questions I get when discussing social media with physicians)

1. “Silly Rabbit, Twitter is for kids”–Dispelling the Myth

Most often, when I ask colleagues, they respond by saying that twitter is something that their kids use on their iphones. They do not see it as a viable option for a serious medical professional. However, done correctly, Twitter has the potential to impact patients, physicians and healthcare as a whole.

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2.” I’m Late, I’m Late, I’m Late !” Twitter is time consuming–This is absolutely the truth

Providing engaging and meaningful twitter content takes time and research. Physicians must commit to the daily effort of developing new tweets that make people want to follow you and engage in conversation. Just as time management during residency and fellowship was critical to success, time must be set aside every single day and devoted to producing content and engaging with those in cyberspace.

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3. Twitter may not be something my Lawyer wants me to use–Legal implications of online engagement are real.

Before embarking on a social media campaign in medicine, it is essential that you meet with a legal professional and develop guidelines for your social media presence. Understanding exactly what constitutes a doctor-patient relationship and the nuances of HIPAA laws are important considerations. An excellent resource is www.lawandmedicine.com . Victor Cotton, a MD, JD provides wonderful insight into these issues and can be a great place to start. By having a good understanding of the legal issues surrounding online professional interactions and using a little common sense, many pitfalls can be avoided completely.

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So, What is the bottom line?

Twitter is a powerful tool. To date, only a very small percentage of healthcare professionals are engaged. Not surprisingly, the new generation of physicians that are training today are much more involved in twitter and other social media outlets. A recent survey found that 95% of all medical students use at least one form of social media as compared to 40% for practicing physicians. Twitter provides an enormous opportunity to impact disease, educate our patients and interact with and learn from colleagues. WE, as physicians, must act now–we must shape the way in which social media will be utilized in medicine in the future. The time is now–we can move markets AND impact disease

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Policing The Internet: Physician Behavior In Cyberspace

In the last few weeks there have been several articles published examining the behavior of physicians and other healthcare providers on social media outlets.  Certainly, professionals must take care as to what is posted online–as I tell my 11 year old daughter–the internet is forever.  Social media is now commonplace and smartphones and tablet computers make for almost unlimited access.  Because of the ease of use and ubiquitous access to social media, these outlets can be a powerful tool for interacting with patients.  As you might imagine because of visibility, the internet and social media outlets in particular, are another enormous area for potential regulation.  Physicians are held to high standards for behavior both in and outside of the hospital (as they should be) and the cyberspace is no exception.

In spite of the potential pitfalls of social media, I believe that reaching out to patients and colleagues via cyberspace is the future of medicine and will positively impact our ability to provide healthcare in the future.A recent study published in Archives of Internal Medicine in January identified high risk online physician behaviors to be avoided.  As the authors state, there are no formal policies in place  to address physician online behavior in most state medical boards.  However, the intent of the Archives article was to identify behaviors that are likely to be considered violations of online professionalism.  Many of the behaviors identified are just simply common sense–Physicians should not post pictures of drunken debauchery or make inappropriate, sexist or racist comments on social media outlets.  In addition, physicians should never inaccurately present outcomes data, present false credentials, or post pictures without patient permission.  Most certainly, physicians should not engage in non professional relationships with patients in cyberspace.  A recent article on the NPR website published examples of tweets that are likely to get a physician in trouble with professional governing bodies.

Yesterday in the Wall Street Journal, author Anna Mathews explores the controversy associated with physician-patient relationships on Facebook.    In the world of social media, Facebook is the number one viewed website in the world.  It facilitates connections between old friends and fosters new interactions.  However, when physicians become active on Facebook, there is potential for both positive and negative impact.  In a survey in the Journal of General Internal Medicine, researchers found that nearly 85% of all medical students are involved in social media sites–this suggests that the next generation of physicians will become increasingly more active and engaged with each other and with patients via sites like Twitter and Facebook in the future.  Another survey found that while more than 80% of physicians who are active on Twitter and Facebook are likely to engage and interact with one another, less than 8% interact with patients via social media.  However, for those that do use Facebook and Twitter to interact with patients, there are significant legal and ethical questions that arise.  In an extreme example discussed in the WSJ article, one physician actually returns calls when contacted via his Facebook account.  I worry that universal and unrestricted access to healthcare providers may blur the line between one’s personal and professional lives.  In order to provide the highest quality care, physicians and other healthcare providers must also have some downtime–everyone needs to recharge and relax.  Moreover, once a provider sets a precedent for interacting via social media with active patients (and establishes a doctor-patient relationship) a legal obligation to continue to respond in the same manner may be created.  Just how deep does the rabbit hole go?

I am an active social media user.  I enjoy engaging other physicians and patients in cyberspace.  I believe that social media is a powerful tool that medicine and physicians must embrace.  However, I am careful in how I interact with patients and colleagues in the social media world.

Here are my thoughts:

Things to AVOID in Medical Social Media

1. Never share privileged information
2. Never identify patients or provide information that could be used to identify patients
3. Never, ever give specific medical advice to a patient (never ever engage in patient care and create a doctor-patient relationship)
4. Never misrepresent my credentials or my training and expertise
5. Never provide inaccurate outcomes data
6. Never post pictures or make statements that reflect poorly on my professional reputation

Things to DO EVERY DAY in Medical Social Media

1. Engage your audience with interesting posts–provide commentary on timely medical information as it is released in the press
2. Promote yourself and your abilities–let potential patients and other providers know what you do and how to reach you
3. Become a Key Opinion Leader–engage colleagues in discussions about current therapies, emerging technologies, etc4. Educate–Twitter, Facebook and Blogging are great ways to teach patients about health related topics of interest WITHOUT developing a doctor-patient relationship and giving patient specific device.  Patients frequently turn to the internet for medical information.

Social Media is the final frontier for the doctor-patient relationship.  As physicians and healthcare providers we are held to high behavioral standards.  In addition, legal considerations abound in medicine today and will continue to be an issue until our country addresses tort reform.  As a profession, we must develop standards for online behavior based on good judgement and common sense.  In addition, we must learn to embrace the power of social media and maximize its potential positive impacts on our patients and our profession.

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Bright Lights, Big City: Opening (My) Eyes and Dropping Jaws in Gotham

This week I had the privilege of serving as the academic program director for a medical conference held in New York City.  Traditionally, these events are held in large conference rooms and are very well attended.  The lure of the Christmas lights at Rockefeller Plaza bolsters attendance and physicians enjoy bringing their families to the event.  At least in Cardiology, these conferences are filled with lectures and powerpoint presentations.  The topics are often predictable and, while useful, can become a bit mundane.  The meeting room is always full early in the day and by the afternoon session the sights and sounds of New York at Christmas often results in an attrition rate that resembles the Allied push to victory over the Central Powers in WWI.Having had several years of experience in directing these programs, I decided to create a new vision and set new and unique goals for our meeting:

1. Engagement
2. Excitement
3. Debate
4. Amazement (or the “Light Bulb” moment )
5. Motivation to Act

Rather than discuss traditional academic subjects, this meeting focused on change and outcome.  The concepts presented were new to most in the room and the theme was all about Leadership through using novel technology, cooperation and co-management of disease through the continuum of care.  What I did not realize was the way in which those in the room would motivate me–I became inspired by my colleagues and their passion for providing care.

As we all are well aware, medicine is changing.  No longer will the status quo be adequate for maintaining a healthy practice (irrespective if one is in academics or private practice models).  My goals for the meeting this year were to MOTIVATE physicians to actively engage in and to prepare for the dawn of the new day in US healthcare.  I began the day by introducing the audience to the concept of the Physician Executive and I emphasized the importance of not only providing superior care, but engaging in the business of medicine on a daily basis.  I challenged them to improve patient outcomes through collaborative approaches to management of disease–by working together with colleagues from different specialties across the continuum of care in a disease process.   I challenged the audience to become leaders in their own practices.  I challenged the attendees to become involved in regulatory matters, to question the business practices of their healthcare systems and to engage in the use of new technology–Then I introduced the concept of social media.  From the outset, the jaws began to drop.  Not just the jaws of those in attendance, but mine as well.  I was amazed at the energy, interest and passion of my colleagues.  I began to feel better about the future of medicine.  The attendees not only were learning about new concepts–they were excited about them.  Physicians from all over the country were speaking up, arguing points and proposing solutions to our nation’s heathcare problems.  This type of engagement is what must happen as we shape a healthcare system that provides access and excellence for all but also allows for physicians to continue to practice the “art” of medicine.

And then there was my  “snake oil” sales pitch…

Most physicians are thinkers.  We love data and large randomized controlled trials.  The concept of using social media to improve medical care and outcomes was completely foreign to most in the room.  At the outset of the discussion on social media, I could read looks of skepticism and doubt on the faces in the room.  It was as if I were selling “snake oil” or vampire repellant.  However, I began to show concrete examples of the utility and effectiveness of social media in medicine, and the odd stares and dismissive chuckles began to fade.  The “tough crowd” had become at once engaged and interested.  As we discussed the way in which social media could be used to educate patients, influence opinions, interact with colleagues and effect change, many in the room became inspired.  I was amazed at the questions and the eagerness of those in attendance to wade into the waters of social media.  In the days following the meeting, I have picked up new followers from twitter with brand new accounts–I can only assume many were in attendance.

I am often humbled by the excellent care my colleagues provide.  This week at our meeting in New York, I was again humbled by the passion and eagerness of physicians to improve delivery of care.  I am grateful for the opportunity to present new concepts and sell the “snake oil” of social media to physicians from around the country.  I feel hopeful about the future of medicine.  Although there are many challenges that lie ahead, I believe that by opening eyes and dropping jaws, we can make a difference in the live of our patients, in our practice and in our world.  
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