Tag Archives: Twitter

What Would YOU Do With An Extra Second….Better Decide Soon, Its the Day of the Leap Second!

In medicine, I have learned that time is a precious commodity. Too often, when life slips away and patients and families wish they had just a little more time. For physicians, a little more time may make the difference in a patient’s ultimate outcome and sometimes makes the difference between making it home in time for a family dinner. Today, we add ONE second to the international world clock at midnight. Over fifty years ago, world clocks began keeping time with atomic clocks that are governed by oscillations of an atom–which are determined in part by the rotation of the earth. The earth’s rotation is slowing over time, and in order to keep these clocks coordinated with the earth’s rotation, we must add an extra second from time to time.

What Can You Do With An Extra Second?

While a second may seem like an insignificant amount of time, when you are a careful steward of time much can be accomplished quickly. An extra second can have a substantial impact—Here is my list of possible plans for my extra second:

1.  One more chance to say “I love you”

Too often, the pace of the world gets in the way. We forget those most dear to us and allow our daily challenges—both at work and at home- to take center stage. I may use this extra moment in time to make sure that my wife and daughter know exactly how I feel. Time is unwavering and unyielding. Time rarely stops—actually almost never stops—but today we have a brief pause. We must use it wisely and take advantage of the extra “time” with loved ones and remind ourselves that time spent with those we love is precious

2. An opportunity to pause before pressing send on an angry email

In the heat of the moment, many of us have sent a note that we wish we could have back. Email and electronic communication can be unforgiving. Just think if we were able to use the extra second we are given to pause before sending an angry reply. That one second to ponder the implications of an email response may actually save even more time by preventing hurt feelings, damaged relationships and tarnished reputations.

3. A chance to pause and take a breath

Lets’ face it, today’s world moves at a very quick pace. Electronic communication, social media and instant messaging leave each of us with very little down time. Just recently I flew to Italy from New York and was amazed to have active internet service for the entire flight. Rather than unplug and enjoy the beginning of my vacation, I remained connected and engaged through the flight. Much can be gained from taking a few minutes to meditate, unplug and recharge. All of us can benefit from stepping away from the business of a hectic day—just one second may help relieve stress and recharge the mind–Maybe I should use the extra second to take a deep breath, reflect and relax. If a 5minute meditation works, why wouldn’t a 1 second mini meditation work as well?

4. Send a tweet

Social Media is an excellent example of how we can reach out to others—all over the world—in a matter of seconds. We are now more connected than ever. Twitter brings doctors and patients together and makes the world a smaller place. Twitter provides for the brief communication of ideas, exchange of information and socialization all in a moment. One second is all that is needed to send a tweet. At midnight tonight, I may decide to use my extra second to push send and publish a tweet.  Maybe I will connect with a new friend or colleague.  Maybe my tweet will reach a patient suffering with chronic disease and provide them with new hope.  Maybe my tweet will make someone laugh, or (if I am really lucky) make a lonely person smile.

Tonight, we have a rare opportunity to stop time. At midnight we are able to take back time—if only for a second. I have shared a few of my ideas. What will YOU choose to do with it? Time is ticking away–we have to decide soon how to use that extra time.  Midnight will be upon us soon.  How we use it could change a life….or result in time for one more Zzzz…

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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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Patient Engagement and Improving Outcomes: Tweeting for Success

Patient engagement is critical to success–particularly in treating chronic medical conditions such as heart disease, diabetes and asthma.  In this era of healthcare reform and cost-containment we must now, more than ever, rely on patient participation in their own care.  Studies have shown that when patients play an active role in the management of their disease, hospitalization rates and complications are minimized.  Examples of “engagement” include daily recording of blood pressure and heart rate, blood sugar logs, daily exercise logs, and the like.  Engagement requires that patients not only partner with their physicians during office visits but take individual responsibility for their own healthcare—showing up three times a year as a passive participant in the office visit is not nearly enough.

This week in the Wall Street Journal, author Laura Landro explores the issues surrounding patient participation in management of chronic illnesses.  In her piece, Ms Landro uses chronic kidney disease as an example of how patient engagement and strict adherence to a physician’s recommendations can make a difference in outcomes.  Exercise, dietary changes and monitoring of blood pressure can make a significant impact on kidney disease and, in many cases, slow progressing to kidney failure for many years.  However, this type of intervention only works when the patient and physician are “partnered”.  With increasing workloads and more clerical demands, physicians are not able to reach out to patients as often as they would like between formal visits.  Through patient engagement, however, we have the potential to bridge the gap between visits.  As Ms Landro points out, one of the biggest challenges is in “getting the word out” to patients.  Most patients lack disease specific education and are not sure how to go about “at home” management.  Moreover, with increasing patient volumes and less time available to spend with each patient in the office, many physicians are not able to adequately educate patients during a quarterly office visit.

What is the solution?  How can we educate more patients effectively?

For me, the answer is simple.  Let’s use the tools we have that are easily accessible to most patients. Today, more than 60% of all Americans own a smartphone or other “connected” mobile device.  Most households have at least one computer.  While today’s children are “born” understanding and interacting with the computer and mobile world, older Americans are also becoming more tech savvy.  Social media and the virtual world lend itself perfectly to helping support patients as they engage in the co-management of their own diseases.  Virtual health coaching and support can be the way in which we support patients between “real time” office visits in the future.   Applications for smart phones such as Lift can be an essential part of engagement and ultimately may become part of routine patient care activities.

1. Twitter:  Twitter can be a great way to conduct “disease-specific” chats–engage patients virtually with regularly scheduled group events identified by a specific hashtag.  A physician or other healthcare provider can serve as a moderator for the chat.  This is a great forum for support groups, educational events and information exchange.  As a legal side note, this is NOT an acceptable forum to provide specific medical advice or patient care.  It is more about support, engagement and education.  For patients it is a wonderful way to “check in” and track their progress in a supportive non threatening environment.  For instance, a twitter chat amongst patients with kidney disease may involve an exchange of healthy recipes.  By connecting with others (and likely a healthcare professional who is moderating the chat) the patient is supported and remains engaged during the time between real live office visits.

2. Blogging:  Regular blogging can provide a wonderful resource for patients and their families.  Disease specific blogs may provide nutritional advice, exercise tips, and help disseminate important information about drugs and disease.  Blogging can help educate and inform patients–as Ms Landro correctly points out in the WSJ education is a major reason that patients sometimes fail to engage.  Thru regular posts (by physicians, nutritionists, exercise physiologists, etc) a broad range of topics can be covered and the patient is provided with the tools they will need to succeed.

3. Facebook posts:  Maintaining a “Disease-Specific” Facebook page for patients is another outlet for successfully educating patients and disseminating information between office visits.  These pages can be a great place to post pictures of interesting recipes or provide information on new therapies for a particular disease.  As with Twitter, clinicians must take care to provide information only and NOT use it as a platform for discussing privileged medical information or for providing treatment.

4. Prescribing Apps:  As I have discussed before in previous blogs, applications for mobile devices are likely to play a major role in disease management in the future.  There are already numerous applications available for tracking blood pressure or blood sugars.  These applications are a wonderful way to store data and share the data with physicians during a live quarterly visit to the clinic.  The physician is better able to track progress and the engaged patient is able to see real change.  In fact, Lift has developed an app that is specifically designed to help patients achieve health related goals and is in the midst of a large diet tracking and comparison project called the quantified diet.

Patient engagement is critical to the management of chronic diseases under our new healthcare system.  Physicians have less time to devote to patient care due to paperwork, documentation mandates and higher volumes.  In order to maintain a high level of care and clinical success, we must also rely on patients to take individual responsibility for their own healthcare issues.  In the past, engagement between visits has been difficult to accomplish due to the lack of resources available for communication and interaction with patients.  Now, with the proliferation of mobile technologies and the use of social media outlets patients can be engaged daily–if they will accept the responsibility of co-managing their own disease in concert with their physician.  With widespread engagement, I expect to see outcomes improve and patient lives changed for the better.  #Engage now!  (in 140 characters or less!)

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Connectivity, Email and Stress: Finding the Proper Balance for Success

Well, here I am.  Again.  On vacation and connected to the internet.  I must admit, I am addicted.  Twitter, blogging, and email.  I cannot seem to just let it go–not even for a week.  Email, in particular, seems to have taken a dominating role in all of our lives.  Constant hip checks for email downloads to our iphones have become an obsession.  As we speak, I am on a beautiful 4 hour train ride from Edinburgh to London (the same route that Harry Potter and his friends take from Hogwarts, no less).

This week on the website Inc.com, I came across an interesting article that explores the ways in which email is ruining our health.  A group of UK researchers decided to examine the effect of email on a group of workers.  Objective measures such as blood pressure, heart rate and cortisol levels were measured and the workers also kept a log of their work activities during the study period.  Results of the study indicated that a single email was no more stressful than taking a single phone call–however, an inbox full of a large amount of email produced a powerful stress reaction with elevations in cortisol, heart rate and blood pressure.  Interestingly, the study did find that the type of email received had a significant effect on stress.  Email that was received about current activities and contained time relevant information as well as emails that congratulated a “job well done” were not at all stressful.  in contrast, emails that were completely irrelevant and interrupted tasks were incredibly stressful and levels of cortisol, blood pressure and heart rate all spiked.  The lead researcher, Dr Tom Jackson, concluded that the email itself is not the issue–it is how the email is used that causes the problems with increased stress.  We are managing email in the  midst of phone calls, family time, and other in person meetings.  Often, responding to and filtering through email can be a distractor and take us away from more important tasks. Hence–email is stressing us all out.

As I mentioned, I am currently on “holiday” in the United Kingdom with my family.  I have tried very hard not to use email but I have failed miserably.  For me, the act of checking email twice a day has lowered my levels of anxiety about work.  However, when I stumbled upon certain email messages my levels of stress began to spike.  These were often emails that I could  do nothing about until I return to the states.  (As with most folks, feelings of loss of control and the inability to respond also create elevated levels of stress).  Luckily, I have my family with me on our tour through the UK to set me straight–instead of fretting over the emails and how to handle them, I was “convinced” to take a walk to Edinburgh castle and enjoyed a nice day in the sun (It may have been the only sunny day in Scotland this year).  My family and I had a wonderful day together in the castle.

I think that, in reality, one must find a balance between connectivity and relaxation.  For each person this balance is going to be different and based on individual personality traits.  I enjoy blogging and it is a very relaxing, stress reducing activity for me.  As I have mentioned in a previous blog, writing allows me to process my thoughts and share my feelings.  (Hence this blog is being written over the course of a four hour train ride).  For others, a completely disconnected holiday is the best course.  Whatever it may be, find your own balance.  Understand that email is an important tool for productivity and that it can be abused.  For me, I am learning what types of emails tend to elevate my own cortisol levels and will attempt to avoid these emails on future vacations.  Life work balance is essential to success and longevity–finding your own balance with email and connectivity is a critical component to this process.  With that, I am going to sign off and stare out the window at the beautiful Scottish wind blown sheep.

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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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