Social Media-Savvy Cardiologists Discuss Tips and Pitfalls

Melissa Walton-Shirley, MD; Seth Bilazarian, MD; John M. Mandrola, MD; Mintu P. Turakhia, MD


May 04, 2015

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Cardiologists' Use of Social Media

Melissa Walton-Shirley, MD (@MWShirley): Welcome to and Medscape Cardiology. We are coming to you from Chicago and the 2014 American Heart Association (AHA) meeting. The topic today is social media. We have Dr Seth Bilazarian, fellow blogger and videographer, from Massachusetts; Dr Mintu Turakhia, from Stanford, Director of Cardiac Electrophysiology at the VA Palo Alto Health System; and Dr John Mandrola, an electrophysiologist from Kentucky, who is also a fellow blogger on the

With respect to social media and its interface with medicine, it's like your Aunt Bessie. You may not like her, but she's coming to Thanksgiving dinner anyway. Maybe the best way to get used to her is to get to know her.

Social media has made an impact. Twitter has more than 232 million members, and Facebook has 1.32 billion users as of October 2014, half of whom surf and post from their mobile devices. The current access pales in comparison to where we will be in about a decade. Out of 7 billion people on our planet, 6.7 billion people have a cell phone. That's 97 out of 100 people. The trajectory for social media use is going straight up.

Our audience would like to know whether we, as individuals, use social media. Do you use it to communicate with patients? Do you promote education, or blast breaking medical news? Perhaps you don't like it and you don't use it at all. That is what we want to know.

Intention to Tweet

Dr Walton-Shirley: Mintu, I would like to start with you. Would you discuss the intention-to-tweet study?[1] In this study looking at whether social media utilization has affected readership, it didn't seem to help Circulation to circulate. Can you tell me about that?

Mintu P. Turakhia, MD (@leftbundle): This is a landmark study that was reported at the AHA in a late-breaking format, in which the editorial board at Circulation—and Caroline Fox is a lead investigator—wanted to see whether tweeting reports or announcements about publications in press or online first affected the journal's reach in several ways. The primary way that they measured this was publication views or downloads—how many times someone clicked on the link to go to that article on the website. They found, unfortunately, that there was no difference.

In my opinion, this is not a negative study. It's actually a positive study. We are at step one in trying to figure out how to integrate social media into our very old, stodgy, traditional medical media formats. For example, we spend a lot of time polishing papers in the review and acceptance process to get them out there. Once they get out there, we have to figure out how to deliver them with a bigger bang. Perhaps page views is not the right metric. We live in a world where not everyone clicks on links and downloads the full-text manuscript, or even the abstract. Perhaps the idea is figuring out how to get the message across quickly and concisely in fewer words, and looking at other metrics. We have just started on that road.

Dr Walton-Shirley: There is a complex issue here. There is networking, and the social and fun aspect of communication. What do you think the next step is to try to boost page views?

Dr Turakhia: It depends on the goals and who you are. But what does a journal want to accomplish? If it's to get to their usual readers in a quicker way, we are doing that through email and other "traditional" electronic media. If you want to extend your reach beyond who subscribes to the journal—the aging members of Circulation—then it's about using social media to disseminate and letting the social network do the dissemination for you.

Tweeting With Intent

Dr Walton-Shirley: John, where does social media fit into your practice?

John M. Mandrola, MD (@drjohnm): For me, social media is not for patients. I don't use it to interact with patients. Maybe that will come, but right now I'm pretty careful with that.

In terms of my practice, social media has been for learning and for gathering more information. I definitely feel that I am a more informed clinician now that I have been on social media. Part of what I do is write about studies, and to write about studies, you have to read studies.

Dr Walton-Shirley: What do you hope to accomplish when you tweet?

Dr Mandrola: Whenever I hit the tweet button, I ask myself, "Is this tweet going to help?" I try to make it something that will help, not hurt.

Dr Walton-Shirley: Seth, it seems that you have reluctantly embraced Twitter. How do you use Twitter, and what else do you use? You told me that you have another gadget.

Seth Bilazarian, MD (@DrSethdb): My experience is similar to what we have already heard. It's cliché now to say so, but social media is a tool. Within that toolkit, there are several different tools: the hammer, wrench, and the screwdriver.

Twitter is a very useful tool. I use it at meetings for note-taking and reporting. I find it very useful at different sessions. Is this something that I want to share with nurses when I go back home or with other physicians? Is it something that I can use? We are able to download our own Twitter feeds to an archive. If you take pictures of slides and take brief notes, you are able to capture the essence of a session with Twitter.

I try to use the golden rule about Twitter, which is similar to what John implied: Is it something that I would want to see if I were the recipient of this tweet? I try to limit tweeting to health or cardiology topics. I don't tweet about other things.

I'm not a one-dimensional person. I have other interests. I have political interests, artistic interests, and sports interests, but I don't tweet about those things. Those other areas may not overlap with people who follow my Twitter feeds, so I limit it in that respect. Others have chosen a different path, but that's been my approach. I think of my Twitter feed as something that I'm sharing with other cardiologists, hoping that they will share things that they find interesting or useful; things that are factoids in my mind.

Separately, I have found a microcurating blog site called useful. I have shared that with patients and had good success with that. If I see an article in the Wall Street Journal or an article in one of our journals, I can link that article and make a very brief comment, such as, "I find this to be a useful strategy for exercise and nutrition." I have included items about exercise testing to help people understand the impact of imaging vs nonimaging stress tests. I have had success, with patients giving good feedback that it is a resource, saying that I endorse these articles and provide the context for the article. It's less effort for me than blogging, but a little bit more than tweeting.

The Patient Interface: Yes or No?

Dr Walton-Shirley: I have a Facebook page that affects my daily practice. I might have a patient who is trying to get into my office, but the secretary does not know that I had a cancellation at 2:00 PM. The next thing you know, a patient is saying, "Melissa, I need to get in to see you today, but they tell me you are booked for X number of days." I tell them to come on in this afternoon.

I don't have a problem from a personal perspective of helping a patient with a problem if they initiate the conversation. I am not going to initiate a conversation on Facebook. I'm very comfortable with that. I also try to frame every message such that it could be read aloud in a court of law. That's the way I behave.

Do you have a Facebook page, Mintu? How do you use it in your practice?

Dr Turakhia: For me, Facebook is about looking and sharing baby and family photos. I have two young kids. I don't use it to interface with patients. I don't view Facebook as part of my professional domain. It's a very personal thing.

As Seth said, there are many tools in the social media toolkit. There is LinkedIn, which other people use for professional networking. It is very large in some industries that touch us, such as the medical device industry and pharmaceutical industry. I use Twitter as my main medium, as a clinician-scientist looking to disseminate my work and extend its reach to people who might be interested. I have not used Facebook or other social media outlets to communicate with patients. We are going to learn a lot about how people wrestle with this and tackle these issues.

Once in a while on my feed, I see a report about a case that somebody did in the electrophysiology lab. It makes me wonder how we are going to be thinking about this 5-10 years from now, as well.

The Sinister Side

Dr Walton-Shirley: There is also a sinister side to the entire social media issue. The University of Cincinnati Medical Center was sued this past June because allegedly, there was a screenshot of medical records revealing that the plaintiff had sexually transmitted diseases. There is also a class action suit on behalf of more than 17,000 Facebook users filed in the Austrian court system alleging that Facebook aided the US National Security Agency to mine their data.

At this point, we are still up in the air about the legal impact of how patients access data. John, do you have any medicolegal concerns about social media in your practice?

Dr Mandrola: I have the same medicolegal concerns with social media that I have with real life. Success in social media is the same as in real life. You master the obvious. It's obvious not to tweet or post on Facebook a picture of a patient or a case that is in the least bit identifiable. It's never been an issue for me to worry about that.

Dr Walton-Shirley: It should be intuitive, but it isn't for some people. Have you set rules, Seth, in your practice about social media for people in your employ or who you work with? Have you ever had a conversation about the rules of the game?

Dr Bilazarian: Yes. We have very strict rules. We are part of a large health system, and we have very strict rules that are annually reviewed by all employees.

The example you cited is not really a social media problem. It's a HIPAA violation to take a picture of someone's record, regardless of whether it was a sexually transmitted disease. You are already wrong; you are already in trouble by doing that. Then to take it to the next step, to transmit it, is making a bad problem worse. It's not a social media problem.

The issue that I would be concerned about—and I know that you feel comfortable with this—is the fear about certain aspects of social media. When you described use of Facebook as a communication tool (and I'm not a Facebook user, so maybe I'm heightening something that shouldn't be), the rules of Facebook privacy have changed. People have been caught in the wrong place, thinking that certain aspects of their profiles are private and they are not. That's one concern.

The other concern that has been highlighted is what happens when someone tries to reach you with a critical problem, and they can't reach you because you are at a conference or doing a procedure. There is a case in our state of a physician who gave a patient his card, and on the card was an email address. The patient sent an email saying, "I'm having chest pain." The physician was someone who didn't frequently check his email, and he didn't check it until 2 days later and the patient was dead at home. That physician paid a huge settlement just for having his email on his card. People say that the physician didn't do anything wrong. We would say, "Why would anybody use email for chest pain?" But a jury decided that it was a legitimate reason for the physician to be at fault.

Those are the kinds of concerns that we have about putting ourselves at risk. I have a card, but it doesn't have my email address on it for that reason. It seems to be a shame that I am limiting access.

Breaking New Ground

Dr Turakhia: Seth makes a great point. This is the inherent tension between the individual practice and providers and the use of social media in the context of the healthcare system, organizations and professional societies, and dissemination of science in clinical news. We are struggling with that because it's different in every situation.

At my hospital, something very interesting happened a few years ago. There was a big power outage in the city because of an electrical accident. The hospital was on back-up power. They blasted out on social media that clinics were canceled that day. All elective cases were canceled. About 20% of patients didn't come in because they picked up the news on their streams. That's remarkable. There are ways to use these devices for mass communication to the people who need to be reached at an organizational level.

At the AHA, I have been following how much tweeting has been going on, and it's been very interesting. I looked earlier today. The peak number of tweets at last year's sessions was 2100. We have already hit 3500 tweets today, on day 1. We have just had the opening session. This will be an interesting ongoing study of observational data.

As a scientist, there is the social argument. If I'm doing work using taxpayer dollars, whether it's National Institutes of Health money or other federal funds, do the taxpayers and citizens have a right to that information in ways that are easily accessible, which may not be the journal? They may not have subscriptions. Does social media address that gap by getting the information to the reader? We have historically relied on mainstream media, and that is not going to go away, but are social media going to fill that gap for more rapid delivery and dissemination?

Dr Walton-Shirley: Absolutely. Of course, we are in new territory. New rules have to be made, and some will have to be broken before they can be changed. It's a very interesting aspect of our practice now, and it's just part of it.

Thank you very much for joining us today. Whether we like social media or we don't, I'm sure there will be something about this talk somewhere on social media today. Please like us on our Facebook page for and Medscape Cardiology.


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