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How physicians can avoid pitfalls in social media

Bragging and sarcasm will get you unfollowed fast

November 2021

WHEN YOU SEE disinformation on Twitter, should you get involved? When discussing patient cases on social media, how much detail can you get into? And how much of your own personal information should you reveal?

Social media can be a treacherous place, particularly for physicians. Two articles in the October Journal of Hospital Medicine (JHM) take a look at how physicians should participate. We talked to two authors of those papers for some advice on how physicians— both as individuals and group members—can survive and thrive on social media.

What’s the best platform?
There are so many social media platforms around that it can be daunting to choose. But rather than taking a shotgun approach and trying to manage multiple platforms, digital-savvy physicians suggest targeting your efforts. Twitter is on the top of many physicians’ list, and for good reason. Hospitalist Charlie Wray, DO, MS, (@WrayCharles) digital media editor at the Journal of Hospital Medicine and lead author of one of the JHM pieces, says that Twitter is a good match for physicians because of its concise format. Further, says Dr. Wray, the way information is disseminated on Twitter is how physicians process information.

“Right now, Twitter seems to be the platform where most physicians are operating.”

Charlie-Wray, DO, MS

~ Charlie Wray, DO, MS
San Francisco VA Medical Center

“Physicians are juggling hundreds if not thousands of decisions a day,” he says. “We’re very much used to the idea of consuming data quickly and in small bite-sized pieces. Twitter fits that mental profile really well.”

Dr. Wray, who is assistant professor of medicine at the University of California, San Francisco, and a hospitalist at the San Francisco VA Medical Center, says that focusing on Twitter is a practical decision, particularly for physicians or groups just getting started. “Go where the people are,” Dr. Wray explains. “For me, at least right now, Twitter seems to be the platform where most physicians are operating.”

If 280 characters seems short, take heart. Twitter threads allow you to post a series of tweets at one time, giving you the option to cut loose and get a little verbose (by Twitter standards, anyway).

Who’s your audience?
It might sound like obvious advice, but you need to choose an audience before you go on social media. Knowing your audience should drive most, if not all, of your decisions about what and when you post.

“A lot of people skip this step,” says Dr. Wray. “But you need to think about what your voice is going to be, what you’re going to talk about most of the time and who you’re trying to reach.”

In his role managing social media for JHM, for example, Dr. Wray focuses on disseminating information on studies published in the journal. “We want to be a place where people can debate the science, methodologies and how results should be interpreted.”

He notes that the journal has expanded on that mission by addressing topics a little on the periphery of academic medicine. JHM Chat (#JHMChat), for example, are hour-long discussions of content in the journal that have focused on far-reaching topics like race and mental health. “We’ll take work that deserves a discussion beyond what can be published in a journal,” he explains. “We’ll have that conversation on social media.”

“If someone spreads information you know to be false, we suggest not trying to change their minds.”

Allan-Detsky, MD, PhD

~ Allan Detsky, MD, PhD
Mount Sinai Hospital

Overall, however, people outside of health care or hospital medicine aren’t a primary target of the journal’s social media activities.

Expect surprise visitors
Perhaps not surprisingly, patients do occasionally visit the journal’s Twitter page or log onto JHM Chats. That illustrates another important point of social media: You can never fully control or anticipate who’s consuming your content.

“The audience is not within the control of someone using social media,” explains Allan Detsky, MD, PhD, (@ADetsky) a hospitalist at Mount Sinai Hospital in Toronto and co-author of the other JHM paper. “When you put something out there in social media, anyone can access it. You have to remember that you’re not just talking to your friends.”

That’s where things can get a little dicey. Some of those people who are not your friends are going to post things you disagree with. And some of the information they post will be flat out wrong. How should you react as an “expert?”

In his JHM article, Dr. Detsky notes that physicians should engage, but they should pick their battles. “If someone spreads information you know to be false,” says Dr. Detsky, “we suggest not trying to change their minds. But point out to the audience that the information is incorrect and why you think it’s incorrect. We don’t suggest trying to get them to change their behavior.”

On two occasions, he’s convinced colleagues in health care—not laypeople—to take down inaccurate tweets. Interestingly, however, Dr. Detsky convinced them not by haranguing them on Twitter, but by picking up the phone and calling them.

It can be a different story when dealing with disinformation from someone outside of health care. And Dr. Wray says that divining someone’s intentions is a critical step in knowing how hard to push back.

“If you can tell an individual is trying to poke you in the eye and give you a hard time, don’t engage,” he says. He sees tweets that peddle lies in his personal feed—and he ignores most of them. “More often than not, you’re not going to change someone’s mind on Twitter. All you’re doing is throwing fuel on the fire by giving those people airtime.”

If, however, someone reaches out with what seems to be genuine apprehension or confusion about a topic, Dr. Wray may respond.

What should you post?
So what exactly should you post on social media? “It can be intimidating to try to come up with original material all the time,” Dr. Wray says.

His advice: We can’t all be deep thinkers all the time, but that doesn’t mean there aren’t interesting things to post about. “Look around and find something that’s interesting to you and tweet about it,” Dr. Wray explains. “That’s a good way to allow the world to direct how you’re engaging through social media.”

For hospitalist groups looking for inspiration, Dr. Wray recommends looking at what the geriatrics department at UCSF does on Twitter (@UCSFGeriatrics). “They do a fantastic job of highlighting the work their physicians are doing,” he notes. “They have this oversized Twitter presence because they’re always supporting each other.”

According to Dr. Wray, highlighting the accomplishments of individual members of a group can be a good social media strategy for smaller groups that don’t have lot of resources to create original content. It can also lead to significant engagement offline.

“I see that one of my colleagues won an award and I mentally note that so the next time I’m walking down the hall I can congratulate them,” he says. “Pushing out some of that material is a great way to bring people into your Twitter feed and allow them to identify not just with your organization, but with the people behind your organization.”

Mixing personal and professional
For physicians who use their Twitter accounts largely for work, is it OK to mix personal information in with the professional? Dr. Wray says he used to shy away from posting anything personal. “But over time, I found that the people who I really liked on social media shared a little bit about themselves or things beyond work.” That, he realized, allowed him to have more of a connection with them. “So if my kids do something sort of funny or I can make some connection between work and my family, I find that people relate to that and engage with me a little more. Bringing humanism into social media makes it a more humanistic place.”

But Dr. Detsky warns to be careful about how many details you divulge, particularly when describing patient cases. “We see lots of tweets where people are giving out information that a patient or patient’s family can clearly identify who they’re talking about.”

Avoid the Twitter traps
Dr. Detsky says the too-much-patient-information situation raises an even bigger question: Why are you telling the story at all?

He gives the following example of a Twitter post that makes him wonder what the physician is thinking: ” ‘I just told this patient she has cancer, and it was such a difficult conversation.’ What’s the purpose of that communication? Are you trying to make yourself sound like a hero? Or maybe you’re trying to say that you learned something from the experience and that next time you’ll deliver the news in a different way.” Dr. Detsky knows people who are reasonable—until they get on Twitter. “If I were to just look at their postings, I would think they brag a lot, lack humility and use a lot of sarcasm. I think the medium induces that kind of behavior.”

He regularly sees Twitter posts that embrace the physician-as-hero narrative: “He says things like, ‘Look at me, I’m working on Christmas!’ or ‘Look at me, I’m doing a job for which I’m paid.’ ”

It’s one of the many “traps” that Dr. Detsky sees on display in physicians’ posts on Twitter, which he believes are fueled by “the addiction to the dopamine rush of getting likes.” The medium trains its users to say something that will provoke a response. “You rapidly learn that the way to get a response is to say something outrageous,” Dr. Detsky says. “The quest for likes encourages people to say things they don’t really want to say.”

Another potential trap, Dr. Detsky explains, is the medium’s immediacy. “People get a tweet and feel they have to respond right now—so they respond without thinking.”

Dr. Detsky admits that he has fallen into some of those traps himself. “When I put something on Twitter,” he explains, “I’m back 10 minutes later looking to see how many likes I have. It’s very addicting, so be careful that it doesn’t become your life.”

Reinforcing your own beliefs
Despite those caveats, Dr. Detsky does regularly use Twitter. He’ll often review his feed at night while watching a movie or something on television. “I’ll run through maybe the last eight hours of tweets and look to see who’s misbehaving and if there’s any new information I didn’t know about.”

But he always tries to remember one thing while using Twitter: Most people—and he’s no exception— seek out information that reinforces what they already think. “Recognize that it’s mostly a bubble,” he explains, “and that you’re mostly talking to people whose opinions you want to hear, not the people who you don’t want to hear.”

Edward Doyle is Editor of Today’s Hospitalist.

Published in the November/December issue of Today’s Hospitalist

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