Published in the March 2019 issue of Today’s Hospitalist
AS A YOUNG HOSPITALIST trying to develop his academic career, Charlie M. Wray, DO, MS, (@WrayCharles) opened a Twitter account in 2014. After a year of taking note of what was being discussed and who else was engaged, he upped his game, posting articles he found interesting and conversing with people who responded. As Dr. Wray became more active, he discovered his voice and, in so doing, found not only a following but a community.
“I saw this as a way to spread my own and others’ work and to engage other hospitalists,” says Dr. Wray, assistant professor of medicine at the University of California, San Francisco (UCSF). “Now, I’m trying to spread the word: Because of social media, I’ve become a better doctor.”
He and other experienced users are convinced that engaging in interactive-heavy social media like Twitter—which can work synergistically with blogs and podcasts—can be an asset rather than a distraction for already busy hospitalists.
“Because of social media, I’ve become a better doctor.”
~ Charlie M. Wray, DO, MS
University of California, San Francisco
Vineet Arora, MD, MAPP, (@FutureDocs) whose Twitter goals are to “learn, engage and inspire,” has found that focusing on education has resonated with physicians: She now has 29,600 followers. In addition to sharing links to articles, she and Dr. Wray lead #JHMChat, the Journal of Hospital Medicine’s monthly Twitter-based journal club that focuses on recent articles and topics important to hospitalists.
Not everyone has to go from lurker to leader to benefit from being on social media. Because social media engages users by topic, traditional medical specialty divisions blur for social as well as clinical issues. Last November, for example, when the National Rifle Association responded to the American College of Physicians’ gun violence policy paper by tweeting that doctors should stay in their lane, doctors across specialties pushed back using the hashtag #ThisIsOurLane. That account now has 28,600 followers.
And as users share interests and information, they forge connections not only across specialties but age groups and locations—a particular boon for those working in small or rural locations. Dr. Arora, professor of medicine at the University of Chicago and associate chief medical officer-clinical learning environment, says it’s no less than a seismic shift in finding new and better ways to learn and communicate.
“We’re in the middle,” she says, “of a revolution.”
What works for hospitalists
While Twitter is not the only social media game in town, it’s a good fit for hospitalists because tweets are limited to 280 characters. With Twitter, you can also include links, photos and other graphics to further engage and inform your audience, says Dr. Wray.
“Its brevity fits into hospitalists’ lives,” he says. “It forces individuals to think and be precise, and that’s what busy clinicians need.”
Twitter also meets the needs of physicians looking to find an audience. Bryan S. Vartabedian, MD, (@Doctor_V) originally created “33 charts,” a blog to promote a book he’d written. But he quickly found that he liked having a platform to discuss his passion: physicians and technology. He joined Twitter a decade ago and now has more than 32,000 followers.
“Everyone has a passion, something they want to achieve, whether it’s to promote a practice or vaccine advocacy.”
~ Bryan S. Vartabedian, MD
Texas Children’s Hospital
“Everyone has a passion, something they want to achieve, whether it’s to promote a practice or vaccine advocacy,” says Dr. Vartabedian, a pediatric gastroenterologist and director of community medicine at Texas Children’s Hospital in The Woodlands, Texas. “Twitter creates visibility and the opportunity to connect with people, which in turn creates opportunities.”
For Shreya P. Trivedi, MD, (@ShreyaTrivediMD) a hospitalist at New York’s NYU Langone Health, such opportunities include mentorship and collaborations that she says came as a direct result of her Twitter connections. While she joined Twitter as a resident two years ago for clinical pearls, she got more involved when she saw the potential to boost her personal and professional growth.
“I have so many connections outside of my institution because of it,” says Dr. Trivedi, a general internal medicine fellow.
She taps into Twitter when she wants quick feedback. For example, after a difficult day when patients who had been fasting pre-surgery were upset that their surgeries were cancelled, she posted on #medtwitter asking for advice. Dr. Trivedi heard from anesthesiologists and surgeons from other institutions who offered clarity and options.
“It blew me away,” she says, “and social media has made me feel this is where real change can come from. It facilitates the interprofessional dialogue that can be so difficult to achieve between busy departments that don’t work in the same physical space.”
Feedback and evidence
Another reason Twitter is so popular, says Dr. Vartabedian: It combats information overload without replacing medical literature. “If you follow 25 or 50 really smart hospitalists, all you have to do is go to your Twitter feed,” he points out. “If something is important, it will find you.”
“Social media has made me feel this is where real change can come from.”
~ Shreya P. Trivedi, MD
NYU Langone Health
For those who want to dig deeper into topics, Twitter threads can include 10 or 15 tweets as well as links to literature and pictures. Anthony C. Breu, MD, (@ tony_breu) hospitalist and director of resident education at the VA Boston Healthcare System, has garnered 15,000 followers by finding a niche in creating Twitter threads to answer pathophysiology questions that pique his interest.
Dr. Breu says he lurked on Twitter for a few years before launching his first string last summer. He had finally found the answer to a question that had gnawed at him—Why do patients with acute blood loss become anemic?—and wanted to share the answer without creating a blog.
“I thought it would be one and done,” he notes. “But the positive response was so overwhelming, I haven’t been able to stop.” For him, his tweet strings complement rather than replace traditional published literature by offering the advantage of more and faster feedback.
“It’s added a layer to the conversation that 20 years ago we wouldn’t have had, and in real time,” Dr. Breu says. “Within an hour, you immediately have the opinions of dozens of people you respect.”
Twitter also allows for easy conversation, which in turn promotes building a community that can live outside of cyberspace. Dr. Wray, for example, says he has made close friends and acquaintances with people who started as media interactions but who he has since gone on to meet at conferences. Veteran blogger and podcaster Robert Centor, MD, (@medrants) says Twitter fills a unique need.
“Sometimes all you want to do is point out an article to someone or browse other people’s accounts to find articles you wouldn’t have seen otherwise,” says Dr. Centor, professor emeritus of internal medicine at the University of Alabama at Birmingham.
While he used to blog every day, he’s cut back to three or four times a month and now uses Twitter to refer to his blog post. He also notes that being on Twitter has resulted in something pretty remarkable, given his long career: “I’m more up-to-date now than ever.”
Lurk and follow
To get a feel for what’s on Twitter and where you might comfortably fit in, a good way to start is to open an account and lurk for a few months. Follow people who are posting content that interests you and use them as social media mentors, Dr. Wray suggests.
As for joining in, be authentic and you’ll find something to say, advises Dr. Trivedi. She says her best tweets arise when something thought-provoking happens at work.
“You don’t have to be in charge of an organization or have a podcast,” she points out. “You have your story as a physician. You’re doing the frontline work.”
Dr. Wray transitioned from listening to posting when he realized what he was thinking would be interesting to others. How did he know? Because his comments were retweeted and his following grew.
“Once you overcome that initial fear, you realize that everybody has something to say and the intimidation factor falls off,” he says. “At this point, I’ve created a community of individuals on Twitter that I can go to for clinical, medical education or research questions. That’s validated my presence in this medium.”
And all those social media leaders? Now, says Dr. Wray, they follow him.
Sources also say that even as hospitalists get up to speed on what’s cutting edge in social media, they should be ready for change.
Dr. Vartabedian anticipates that hospitals and medical schools will develop policies addressing the ethics of digital activity for physicians within five years. And Dr. Breu says having a tweet viewed by thousands of people might at some point hold sway with a promotion committee and may also factor into tenure decisions. Mayo Clinic already recognizes digital scholarship when considering academic promotion.
According to Dr. Wray, he never would have anticipated he’d be modeling social media for students or writing articles on physicians and social media strategy. So now he’s keeping an open mind to whatever comes next. “I’m not sure where social media use for doctors is going,” he admits. “But I’m confident it will open doors for me in a capacity I can’t comprehend at this time.”
Paula S. Katz is a freelance health care writer based in Vernon Hills, Ill.
• Your biography. Sources point out that on Twitter, you will get more followers and retweets if you include a picture of yourself as well as a description of your academic or research interests and connections. This is limited to 160 characters. It’s also important to use a phrase like “all views are my own.” Here, for example, is the bio of Vineet Arora, MD, MAPP, professor of medicine at the University of Chicago: Doc improving care & #MedEd in teaching hospitals. @costofcare team. @JHospMedicine SoMe editor. Tweets my own. @UChicagoMed @UChiPritzker.
• Following others. Find people with similar interests and follow them; they will often follow you back. Consider following specialists in other areas. For example, Bryan S. Vartabedian, MD, a pediatric gastroenterologist at Texas Children’s, follows five cardiologists who he says save him time by providing valuable links. Robert Centor, MD, professor emeritus of internal medicine at the University of Alabama at Birmingham, follows Joel Topf, MD, who he calls “king of the renal twitterverse” and researcher and pediatrician Aaron Carroll, MD, “who always has interesting things to say.”
• Say something. When someone posts, consider replying. Even just retweeting will increase your visibility. Use one or two hashtags (like #MedTwitter) and tag specific people who might be interested in your tweet and likely to respond or share.
• Join a chat. Twitter chats are typically held at a set time. For example, the Journal of Hospital Medicine holds an hour-long monthly chat (#JHMChat) about articles that offers CME credit, @mededchat is on Thursday nights and #WomeninMedicine chat takes place every week on Sunday night. Participate by posting questions or by using the hashtag in other posts and build your following.
• Etiquette. Don’t discuss work situations or specific patients or hot button topics like politics or religion, and assume that everyone—from patients to hospital administrators—can follow you, says Dr. Vartabedian. To avoid miscommunication, hospitalist Charlie M. Wray, DO, MS, assistant professor of medicine at the University of California, San Francisco, says he reads his posts two or three times before posting. “If you can’t say something out loud in a crowded elevator, you shouldn’t yell it out to 5,000 followers,” he says. And always be polite— even when you disagree, Dr. Centor notes.
• Frequency. You don’t need to post every day. Dr. Wray posts only when he finds something interesting rather than posting filler he says would dilute his voice. Dr. Vartabedian uses the social media management app Buffer to schedule postings. He finds a few links in the morning, then schedules them to go out between 7 a.m. and 9 a.m. He reshares material from his blog three times a day.
• Timing. Know when your audience is tuning in because tweets have a half-life of 25 minutes, according to Shreya P. Trivedi, MD, a hospitalist at New York’s NYU Langone Health. After that, they’re likely pushed down in someone’s feed. Dr. Trivedi gets the most response from hospitalists at 6 a.m., 9 a.m., 5 p.m. and 9 p.m.
• Finding time. You don’t need an hour to catch up on social media, Dr. Wray says. Instead, find ways to efficiently work browsing into your day. He looks at Twitter in the five minutes he has between meetings or while his computer is turning on. “In that time I can scroll through a couple hundred tweets or take the pulse of what hot papers there are this week,” he says. To further save time and avoid interruptions, consider turning off notifications about likes and retweets. And if you feel overwhelmed by a long Twitter feed, Dr. Vartabedian advises paring it down. “Be ruthless about where you give your attention.”
• Because Facebook may be the most familiar to many, it could be an easy way to get more involved with private groups on topics such as physician moms.
• Instagram, which is more photo-oriented, has groups such as #thisiswhatasurgeonlookslike and #shecanbeboth. The application may be particularly familiar to residents because residency programs are on it.
• Blogs and podcasts are geared to those who want to explore topics in more depth with or without interaction, and they can be linked to Twitter feeds. For example, Shreya P. Trivedi, MD, a hospitalist at New York’s NYU Langone Health who is executive producer of Core IM Podcast, provides a link to that site in her Twitter bio.
Robert Centor, MD, created “medrants,” a blog, because of his desire to write, as well as to voice his opinions. “I consider myself primarily a medical educator,” he says. He has also created a dozen Annals On Call podcasts for Annals of Internal Medicine. And Anthony C. Breu, MD, hospitalist and director of resident education at the VA Boston Healthcare System, recommends the curbsiders for physicians looking for internal medicine podcasts.
• YouTube allows for short clips, which can be especially useful for those who don’t have time to watch entire podcasts.
• LinkedIn is becoming, according to the University of Chicago’s Vineet Arora, MD, MAPP, the “go-to place” for those looking to move up the leadership ladder.