Family medicine should be a prominent voice in social media

July 16, 2012

Initially posted on the Society of Teachers of Family Medicine blog, July 16 2012.


In this post, I described why I think physicians benefit from being active in social media.  The combined benefits of enhanced partnerships and new connections, keeping up to date with recent clinical and health policy information, and expanding one’s understanding of healthcare from the perspective of patients and other health care providers are valuable outcomes that all physicians should value.  After all, why do we read journals, attend CME, watch webinars and listen to conference calls?  To keep our clinical knowledge up to date in order to provide the best care for our patients and to learn from each others’ experiences.  Active participation in social media can provide those same benefits.

Over the last couple of years, I have seen more and more family physicians becoming active on social media, especially on Twitter.  I have been trying to keep a list of all the FPs (and GPs) I have encountered on Twitter, though I know that this must be incomplete.  A quick scan of the list, however, shows the breadth of perspectives and opinions held by family physicians, and gives insight into the challenges and the rewards of being a family doctor.

Many family medicine doctors on Twitter use the #FMRevolution hashtag as a way to organize and share ideas.  I believe that family medicine can, and should, be even more active on social media.  In fact, I believe that family medicine should be the prominent medical specialty in social media and especially on Twitter.  Here are the reasons that I believe should impel more family medicine physicians to be active in these settings:

  • Family medicine believes in empowering our patients to take an active role in their care.  Social media is a prime venue for patients who are seeking to learn from each other and share experiences.  The e-patient movement makes active use of social media to inform themselves and each other about health, wellness, and specific illnesses.  Physicians are all-too-rarely part of that discussion.  With the breadth of knowledge family physicians have, we can be an active part of these discussions, and we can help ensure patients have accurate and reliable information.  Family medicine’s bio-psycho-social approach to care, which enables us to provide capable and effective care for patients with chronic illness, would also be valuable in discussions with engaged and empowered patients who are seeking to improve their own health statuses.
  • Family medicine still suffers from a lack of understanding of what it entails.  As noted in this recent post, primary care and family medicine are not usually given starring roles in the media, and are often confronted with the argument that the role of family physicians can be easily assumed by NPs and PAs.  By talking about our careers, our practices and (within the bounds of patient privacy and confidentiality) our patients’–their illnesses, struggles, and victories–we can control the message and we can show the public what it means to be a family medicine physician.
  • Family physicians are taught to educate and inform patients, and to be a resource to patients who are seeking information about their health.  The Pew Internet Project has noted that, even if they would not necessarily consider themselves e-patients, large numbers of Americans are looking for health information online and are using peer-to-peer connections to find this information.  If our patients are already using social media, then why aren’t we?  Given family medicine’s whole-person orientation and patient-centered approach to care, we should strive to meet our patients where they are.  Increasingly, they will be online.
  • For many years, it has been difficult to recruit US medical students into family medicine.  Now that more and more medical students are using social media for their own purposes, we could act as virtual role models and mentors.  If there is a robust and vibrant family medicine community online, if we discuss what we love about being family physicians, we might encourage medical students (and premedical students) to look at a career in family medicine.
  • Family medicine can be a voice of advocacy online.  As seen in Mike Sevilla’s #SaveGME campaign, when family docs organize we can have a notable reach.  The #SaveGME initiative was a short-notice, one-time effort to discuss the importance of protecting GME funding, but even with this limited preparation the group was able to reach tens of thousands of people.  Imagine if all family physicians on social media organized to advocate on key positions: I suspect we could reach hundreds of thousands of people.
  • Finally, family medicine should be the most prominent voice on social media because we represent one of the largest medical specialties in the United States.  I think there are more members of the American College of Physicians (ACP) than in the American Academy of Family Physicians (AAFP), but this is deceptive: many of the ACP’s members are sub-specialty physicians (Cardiology, Pulmonary/Critical Care, etc) who do not provide full-service primary care.  The American Academy of Pediatrics (AAP) lists approximately 60% of the AAFP’s membership.  There are more primary care physicians in family medicine than in any other specialty…and we should be willing to use that fact to ensure that our voices are heard loud and clear.

Family medicine’s leadership has already understood the importance of strong family medicine voices on social media.  The AAFP’s President has a Twitter account, the AAFP Twitter account is updated regularly, various AAFP board members are on Twitter (Reid Blackwelder being the most active), and the STFM Twitter account is interactive and valuable.  Other family medicine physicians should follow these leads: with increased involvement, family medicine’s voice should be at the center of healthcare discussions on social media.

Balancing Social with Serious: One Doctor’s Prescription to Avoid Overload​

July 11, 2012

This post was originally published on the Albert Einstein College of Medicine Blog, July 10 2012.


In a previous post, I made an argument as to why physicians should be involved in social media—especially on Twitter.  The purpose of this post is to describe how I use social media as a busy clinician and teacher of family medicine to keep up to date with clinical and policy information and also how I find the time to use social media. Yes, social media can fit into a busy schedule.

One of the most daunting challenges facing any newcomer to social media is the volume and scope of information that is available.  Once one starts following other social media accounts, the incoming “stream” of information can quickly become overwhelming. A number of social media participants have likened it to drinking from a fire hose.

In many cases, these streams of information are also not uniformly useful: friends’ updates may be personally important, but can make it harder to find relevant clinical or policy information.  It can also become quickly apparent that trying to keep up with every update on Twitter or Facebook is an exercise in futility and will take up the better part of your life.

Here are some tips that I have found useful:

  • Stop trying to read every update.  Early on, when I was new on Twitter, I would try to read every single update posted and visible in my timeline.  This took a ridiculous amount of time.  Instead, I have come to understand that I cannot read every update.  Instead, when I log into my accounts, I’ll glance at what updates are there and look back a bit at previous updates.  I trust that anything that is really important will be shared or commented upon more than once, and I have come to appreciate the randomness and serendipity associated with dipping my toe in the stream every now and then.
  • Organize your incoming information: this is one of the most valuable tricks that I have found.  Instead of trying to search my overall Twitter feed (I follow nearly 1,500) accounts, I have created lists that allow me to focus on certain themes.  I have a list for updates regarding health policy, clinical updates, family medicine-specific accounts, people in Richmond, etc.  Perhaps the most useful is the list I’ve titled “essentials”: this list includes accounts that have an especially high value for me whether it is because of the quality of material they share, the topics in which they are interested, etc.  When I have only a short window of time, I can skim the essentials list and get high quality information in short order.  Given that I use social media as myself and as administrator for a few organizational accounts, this list lets me find information I can share from various accounts.
  • Each social media user has different times of day when they might review their accounts: over breakfast, at lunch, etc.  However, you can make use of “interstitial time” (credit to Paul Tatum).  If you have a computer or mobile device available, you can glance at your stream during the time that you’re waiting for the nurses to room a patient, or if a patient no-shows.  These short windows of time can add up.
  • Look into using a third-party Twitter client, such as TweetDeck or HootSuite.   Twitter clients allow you to better organize the incoming information, and let you see multiple lists simultaneously.  If you are sharing information, Twitter clients also allow you to share on different platforms (Twitter, Facebook) and via different accounts.  This is a tremendous time-saver.  I am not beholden to any particular client: I use TweetDeck on my laptop, HootSuite on my mobile devices, as it seems to be a better fit for them.
  • Leverage your e-mail newsletters.  If you subscribe to any e-mail newsletters, you can use them to find resources that you can then share to your account’s followers.  For example, the American Academy of Pediatrics Smart Brief includes short capsules of useful information.  You can read the capsules, click to read the full article, and then share that directly to your social media accounts.  This prevents you from duplicating work, and allows others to see information you found to be relevant.  You can do the same with Physicians First Watch, and numerous other sources.
  • Finally, if you do not have much time to be on social media, look for relevant Tweetchats.  These live online conversations are identified by a “hashtag” (i.e. #hcsm stands for healthcare communications and social media ; #MedEd represents medical education , etc.—find a full listing here), scheduled at a pre-set time and day, and bring together a number of individuals and organizations with shared interests.  This can be an efficient way to make new connections, and to share information that can benefit the community of users.

In summary, do not be afraid that being on social media will inundate you with useless information and eat up any and all free time.  There are ways to compress and increase the efficiency of your social media use to ensure that you find what you want to find, share what you think is relevant, and make meaningful connections with other users.

What are the ethics of crowdsourcing a diagnosis?

July 3, 2012

About a month ago, I received a request from one of my practice partners.  They are working with a patient with a number of chronic, hard-to-treat medical illnesses that may or may not be part of a single syndrome or underlying problem.  Despite the fact that this physician is an excellent clinician, they have struggled to put the pieces together and are worried that they are missing something.

The e-mail they sent me reads “i have a patient with an odd constellation of chronic medical problems…it seems to me something might tie these together…i mentioned to the patient the crowdsourcing idea on twitter and he was open to trying this”

I have spoken with this physician, but I have not spoken personally with the patient yet.  I have not taken any steps to crowdsource this patient’s illness because I am honestly not sure how best to do it…or even if itshould be done.

So: I would like to crowdsource the ethics of crowdsourcing.  I am hoping to hear from other physicians, but especially from patients and patient advocates who have faced challenging illnesses and diagnoses.

  • Is it appropriate (with a patient’s permission, of course) to post a patient’s medical history in a public forum as a way to consider and evaluate possible diagnoses?
  • If so, what sort of permission is necessary?  Is there some sort of consent form that one can use to ensure that patients understand what it means to have their medical history posted on social media?  If a patient’s symptoms are unique enough, then they can presumably be identified by a reader, so how can this information be posted (or what sort of waiver/consent is needed) to ensure that HIPAA is not violated?
  • I would presume that making the information visible and accessible to the patient would be the best approach–for example, posting as a blog update that they can review and upon which they can comment even during the discussion among physicians.
  • How much do we need to vet this idea/process–if it goes forward–with our health system’s legal department?

I think that there could be great value in using social media as the world’s largest “curbside consult” in which we ask peers to provide suggestions and insight but the primary physician retains sole responsibility to determine treatment plans with their patient.  In essence, the crowdsourcing would be like an enormous brainstorming session to help come up with ideas that the primary physician might have overlooked or failed to consider.

Please send me your thoughts–feel free to comment below.  This feels like an awfully large step, and one that I do not want to take into thin air.


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