10. Social media for doctors - where the brains meet

Now and then... A whole lot has been written about social media but not so much for doctors and many of my colleagues still are confused what all the fuzz is about, still excited to try it out but tiptoeing around it like a cat around hot pot of milk as some stigmata is tied to it. As an emergency physician with many years of interest in IT and social media I would like to share with you my thoughts and help you to start a rewarding journey, an odyssey, you will not regret. It is definitely not a one day travel but it is exciting and fun from the first moment and will leave you with new contacts and educational sources changing  your way of practice forever. Personally it took me weeks to get the full grasp of it but everyday brought a new exciting discovery. So let's dig into this strange new technology everybody is talking about.

1. Why should doctors care?

The one most important question doctors will ask about social media is "what's in it for me, why should I put time and energy in this?".
  • You will meet new smart and interesting colleagues from around the world, broadening your horizon by far as you expand your contact network. They will be your new source of wisdom, feeding you with interesting journal articles and reading material, podcasts and vodcasts (video recordings of talks) to enjoy and learn from right from your laptop. They will summarize articles, leave you clinical pearls or tips from cases they have learned from, all having the power to change how you practice.
  • Your new contacts will also provide you with answers to your critical questions, aka crowdsourcing!
  • Speakers or authors of articles you are inspired by are now reachable as easily as your local colleagues , giving you opportunity for direct feedback and conversations.
  • You will discover and learn to use the most important online learning material; websites and blogs which are slowly but steadily becoming the new textbooks for many emergency physicians. Emergency medicine written by emergency physicians!
  • When you meet your new e-contacts on the conferences you will already have been introduced so that you can go directly to business.
  • While sitting the conversations; use Twitter to stay awake and suck in more learning points than before

We are just seeing the beginning of what social media has to bring to us as individuals and corporations are jumping the train and then a new generation of doctors is coming to practice who was raised with computers and the Internet from the beginning. Social media may only be a part of a bigger IT revolution but it's something you have too much to gain to pass it by. => LITFL recently had a interesting discussion in the comments section where people were asked to mention if and how social media had changed their practice in some way, check out for some great real-life examples.

2. Debunking some myths

As for every new technology, some skepticism and stigmata is surrounding social media and we'll start by addressing these.

#1 "I don't have time for that"

It's true that getting to know social media requires investing some of your time but there is a high return of investment (ROI). There are some websites and technologies you need to get comfortable with but going through that learning curve is a journey which can easily be enjoyed as it's path is through a jungle full of life. And you will do that journey with your new e-friends who will be glad to help you.
That is the whole point with social media; meeting new people and discovering new, valuable information. In the end, social media will save you time as you will learn more by new, more rewarding methods than before.

#2 "It will only bring me patients breathing down my throat"

Using social media to connect with your patients is a totally different story than the one I am putting through in this blogpost. Social media is the people's revolution leading to better communication and access to information and obviously a tremendous potential for patients and some doctors who have long-term contact with their patients. Social media for patient contact is obviously irrelevant for emergency physicians but most certainly you will want to encourage your patients to use it to connect to other patients and be better informed (the 'e-patients').
As you go online with your profile it is totally up to you how much of yourself you want to disclose. You can be invisible if that is what you want or you can go 'Full Monty' and patients will be able to discover you and contact you online. Privacy settings is something you will learn as you go along and you can always fine tune these afterwards. Fear not, your patients will not be on your doorstep in cyberspace unless you want them to.

#3 "I will get fired if I say something wrong"

Certainly if you're not careful. But this only holds true for doctors who are posting sensitive information with details tying them to a specific patient or touching hospital policies you would normally only discuss with trusted colleagues. There are lots of good articles to teach you the silent etiquette of posting online, see below in the 'more reading' section.
It has been said "don't post what you wouldn't say in the hospital elevator". Respect your patients, respect your colleagues and your hospital and you will not have anything to fear.

3. What social media really is - a brief history

If you google "what is social media" you will get lost since the definitions and answers are in the count of thousands. So you will sit there wishing you had a colleague to ask directly instead. With that, you have actually learned the basics of social media: it's all about people and contact networks.

The Internet boomed about year 2000, by which social media was an unknown concept. Fancy webpages popped up everywhere but  the information they contained was created by a few who web programmers or those hiring them. The content was the same for everyone since you browsed the web as a guest. Logins and user accounts evolved and set the stage for browsing the web as an active user, a person with a name and profile. Now you could interact with the pages, leave comments and see what others had to say.

Web 2.0: the Internet created by the people Suddenly, average Joe was creating big part of the Internet without knowing web-programming or mastering IT tools. The concept of a "e-friend" was born as you could meet people you never met physically and follow their activities, almost like in real life. This silent milestone in the development of the Internet has been called Web 2.0 and marks the the era where the Internet was created by the people and thus, social media. A blogpost would be written about some article and in the comments, the author of the article would now appear and leave his or her feedback!

Almost overnight, hundreds of platforms were started with different approaches to how people profiled themselves online and created content. Many of these have drowned in  fierce competition while a few have stood up as the giants, we'll be back to these later. Now that you know the history, let's see what social media is really about.

4. Why social media matters

Doctors browsing the Internet are there to find facts and answers relating to real-life patient scenarios. Let's take as an example that you want to know the prognosis for type A dissection.
Traditionally we use the search engines and browse through a swarm of results but there is a huge random factor deciding if we ever find what we are looking for. After all, we are being answered by robots who despite clever algorithms and genuine wish to give us the best possible results don't have the human factor; knowing who is behind that question and molding the answer accordingly. The robots don't know if we want to know the mortality number or how patients surviving this disaster fare after discharge. If we had a colleague to ask, he or she would give us much better answers by knowing our interests and background. Our colleagues at work, our contact network, is and has always been our most important resource. Long before the Internet, we asked and learned from our colleagues because they are doing the same things as we are and provide us with an environment which stimulates us to learn more and stay up to date to provide best possible patient care.

Your contact network is your one most important resource When it comes down to it all, your contact network is your primary source of information, discoveries and opportunities. Every doctor relies on a good contact network. Ergo, this is where social media is changing it all by providing for new technology to expand your contact network and thus access to valuable resources and knowledge. In the old days your network consisted mainly of colleagues from your workplace and a few you met in conferences - with social media you will discover colleagues from all over the world, sharing same interests as you do in providing best possible patient care.

5. The different platforms

As said previously there are too many social media platforms today to know them all. Fortunately only a few stand out and knowing these is an important step for embracing social media. Today, there are three main social media networks worth putting effort into, each with their own characteristics.

Twitter (140m users)

One simple technology, thousands of platforms Twitter is the 'short and convenient', limited by 140 characters the stories are straight to point and rich of content. With Twitter it's very easy to follow people you think are interesting for the first 'e-contact', any communication more than that needs to be done on more sophisticated platforms like email or Facebook/Google+. In short, great for discovery. It also works great the other way around that is if you want to attract attention to your product (like blogs).

Facebook (900m users)

Facebook is the biggest social network and has a critical mass to do powerful things. Facebook started as a small network for colleague students sharing their acts of heroism or stupidity to make impressions. This background overshadows Facebook as users' privacy are a low priority and interesting posts tend to disappear in a pool of useless information. Facebook is good for keeping contact with family and friends and even reviving old relationships but as a professional network there better alternatives.

Google+ (170m users)

Google was a late to enter the game but with monstrous muscle power and anticipation to give Facebook some real competition it's launch of Google+ in 2011 was welcomed all over the world, breaking records as new users flocked in. Despite great user interface, innovative and aesthetic, only a few users have stayed because of lack of activity, compared to Facebook (a true Catch 22) - thus G+ being called the ghost town.
Google+ has a completely different approach to privacy than Facebook. The Circles method invites you to categorize your contacts for complete privacy control and minimal distractions while browsing. Google+ is stratified; you don't read everything from everybody but decide for yourself what you want to read, giving you breathing space to socialize.
Thus, many are expecting Google+ to see first time users coming back because it has turned out to be a great platform to discover new people and follow hobbies and interests, without being bombarded by the uninteresting clutter prevailing on Facebook.

=> Why Google+ is better than Facebook as a professional social media platform
It has been said "Twitter is people I don't know posting interesting stuff, Facebook is people I know posting uninteresting stuff". I'd like to add "that's why Google+". I've tried out them all and Google+ is the one I'm staying with. For me, it brings me great way of creating contact networks, filters information flow to me to fit only my interests and giving me complete control over the visibility of my own posts. It just needs the masses so please do try it out!

6. How to get started with social media

There is only one thing you need to get started, genuine interest. Let curiosity drive you deeper and deeper into the jungle, enjoy every part of the journey and before you know it you'll be an expert. What you need to learn is not sophisticated or else there would never have been the social media revolution (the people's revolution, remember).

Here are a few starting points to start your journey:

Create a Twitter account

and spend some time to learn the 'Twitter way'. On the Twitter help page there is an excellent tutorial for beginners explaining the basics. Start with updating your profile so that people can get to know you, take care to reveal your full name and some highlights of your current position. Just as you would while giving your name tag on a conference. Don't worry about being followed by people you don't want to connect to - you can reject followers and even change the default settings so that you have to accept each request. Remember though, all tweets are public (there are no private groups or channels) it's just much more difficult (almost impossible) to find your posts amongst the 5-10.000 tweets created per second.
Then start looking for your soon-to-be e-colleagues, a good starting point is the #emergencymedicine or #acep channel (enter that string exactly in the search bar). Follow the people you think are writing interesting posts. As you start following more and more colleagues your main stream (the first/home page on Twitter) will be filled with posts from these, that's you sitting in a cafeteria with your new friends, listening to what they're chatting (tweeting) about. Sometimes there will be conversations, other times flow of random posts about this and that. The more interesting people you find to follow the more interesting posts you will be seeing on your main flow.
For a real kickstart, check Ivor Kovic's list of emergency physicians on Twitter and even see recent activity from this group to pick some.

As you scroll through the tweets you will stumble upon all kinds of exciting blogs containing interesting articles,  podcasts (audio) and vodcasts (video). This is the first crop from your new contact network.

2. Learn to use a RSS reader

to collect your favorite blogs in one place. Here's a great post to learn about RSS. I use Feedly, a powerful yet intuitive tool for free.

3. Start collecting blogs

It's been said that emergency physicians are the most active medical bloggers and as this list from Life in the fast lane (the mothership of EM blogs!) confirms, there are great many blogs existing and you will never be able to follow them all, even with RSS. You should still take some time to go through them and pick a few favorites to follow since these are going to be your complementary reading material in the future.
In the future we all hope to see the great material dispersed on diverse blogs collected to a one single place but until then you could try using Google custom search to search your collection of blogs instead of doing the standard Internet search where you will commonly get guidelines for treating horses as well as your patients.
The LITFL list is a very good one to start from but for a more detailed description of the blogs you have my list of EM blogs where all of the big blogs (the ones you really should follow) are listed.

If you want to cheat you can have others do all the work for you, there's the LITFL Review, a weekly episode where highlights from all the major emergency medicine blogs are concentrated in one heap. A great way to sense what's going on in the emergency medicine world.

4. Start your own blog!

There is nothing as rewarding and as writing about your discoveries and pearls you have to share. It's easier than you think!
 => Dr. Steve Smith tells about how his now renowned ECG blog started and what he has achieved

7. How I and social media met

As a practicing emergency physician the last 10 years I can boldly state that few if any advances have impacted my learning curve as social media has done but it may have to do with my background. I specialized in southern Sweden, our emergency medicine program being one of the first of its kind in Scandinavia. With no long-time experienced specialists and limited educational resources we have been pretty much on our own.

This changed a few years ago when I was Googlin' to find something more than the traditional teachings in the textbooks. I needed something more than guidelines and tables; I needed clinical pearls and tips, pragmatic, real-life descriptions of how to handle the difficult scenarios not described in the textbooks. What started with small victories ended up as a whole new world of online learning material, finally I'd found my way home. From Life in the fast lane (the best EM blog ever) to free video recordings from great speakers on All LA Conference. I learned about Mel Herbert and his awesome products like EM Rap and USC Essentials. I found Free emergency talks and now Amal Mattu was in my headphones while out jogging, revealing to me pearls about difficult ECGs in the ED. And Stuart Swadron with his endless wisdom and medical knowledge. Scott Weingart on EM Crit entertained me with his amazing rants about advanced trauma and sepsis care in the ED, suddenly I felt like I knew at least a little about vasopressors. Then HQ MedEd arrived on the scene with amazing video recorded ultrasound cases, they got me at hello.

By commenting on the blogs or through Twitter I could now correspond directly with the authors of all this fantastic material and suddenly I was not alone any longer. And my interest in emergency medicine exploded as I felt much more in power of my specialty, being part of a network of great doctors and stimulated by them to learn more and never give up.

=> What a wonderful (IT) world
=> Video learning in emergency medicine
=> E-learning in emergency medicine

Today, I learn in a totally different way than before. I learn mostly online and with the help of all my note-taking system in Google Docs, I consider my self a much better doctor today than before.

8. The future of social media

With social media, physical barriers are no more and we now have unlimited access to colleagues all over the world and richer learning material with the possibility to interact with it. The coming years are even more exciting as this revolution comes to practice and we eventually witness a new generation of doctors who are better informed and better connected.
In my mind there are two special issues which wait to be addressed with the new recent revolution.

1) We need real-time consulting service; every doctor has a dream of being able to connect to their network in the middle of the night to ask for advice with the difficult patient. Or just that damn difficult case in daytime where expert opinion is needed. The current platforms like Twitter and Google+ are worth a try but we need an organized framework to make this happen.

2) We need a centralized database of guidelines/links. As huge amount of high quality text and multimedia about every possible clinical scenario occuring in the emergency department is being published online, it's getting painstakingly difficult to know where to look for what. Even with Google custom search as the amount of results are just growing.
We need all this in one place, categorized, tagged and easily searchable with not only text but photos, videos and links to articles or blogposts for further reading. Such a big project needs joint effort from lots of emergency physicians and should therefor be collaboratively edited, supervised by selected individuals to ensure maximum quality.

Actually LITFL has already begun some of this work with their amazing databases of cases, blogs, podcasts and what ever you can think of but (I hate to say but about LITFL!) I think we still need a A-Z page for each of the clinical scenarios we have in the ED with text, multimedia and links.

Emergency physicians have already shown they are geeky and smart with IT tools. I think we ought to make this a pioneer, exemplary project, in the hands of many it is an easy task. We have the technology, we have social media to get us connected - we just need it to be started, somehow.

I am all open for discussions and more than willing to help out so if any one out there is thinking the same, feel free to contact me!

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