September 26, 2017

A How-To Guide For New Tweeters


Scott Krugman MD, MS, FAAP
Chairman, Department of Pediatrics
MedStar Franklin Square Medical Center

I joined Twitter almost 2 years ago. I wouldn’t say I’m a “pro,” but I’ve learned a few things about what to do, and what not to do. As many of our mentors told us as residents – it’s OK to make mistakes, just not twice. It’s easy to make mistakes on Twitter, but not so easy to correct them, since Twitter doesn’t have an edit function. 

Most physicians join to learn, to advocate, and to engage in thoughtful conversation. But unfortunately, that’s not all you get. Occasionally there are trolls, bullies and inane memes. So what can a new Twitter doctor do (and not do) to be part of the productive discourse?

  •    Re-read your tweet before sending it. Would you be comfortable with it on the front page of your local newspaper? If not, don’t send it.

  •    Avoid any tweet that can be linked to a patient. HIPAA laws apply and most institutions do not want descriptions of the care that goes on their hospital broadcast to the whole world. If you must talk about that awesome case you just saw, make sure you have approval from the patient, your hospital, and it is completely de-identified.

              Do you want to amplify a message or story? Don’t just re-tweet – add a comment and quote tweet it. This allows you to provide context or your opinion, and is a good use of quote tweeting. But don’t just read the headline, read the story! You don’t want to tweet out something you either haven’t read or actually don’t agree with.


  •    Do you want to have a conversation with someone? Use the reply function. Two (or more) people can engage in effective banter by replying to each other. Quote tweeting and commenting on a post does not foster conversation.

  •    Do you agree with a tweet? Easy, just like it and re-tweet it.

  •    Do you disagree with an opinion? You have two options: ignore or engage. There are definitely times to ignore. The most obvious is when the person tweeting has fixed beliefs that may or may not be based in reality (just search “vaccines”). If you choose to respond, be prepared for an onslaught of vile personal attacks (especially if you tweet about political issues or guns). The same goes for bots or trolls. If you are brave, you can engage, but sometimes it’s better not to feed the trolls. If you do choose to engage, don’t forget the first rule, and be professional. State your opinion and stick with facts. Don’t just make vague contradictory statements. And remember, you can always leave the conversation.
  •    When you get annoyed or frustrated with someone or a topic, you have options: block and mute. You can block anyone on Twitter. If you do, you cannot see their tweets, they cannot see your page, and they can’t tweet at you. If you feel someone is being abusive or hateful, you can report a tweet to @support and they will investigate and potentially take action on the user. The mute function can be used for users, or even words. If you are tired of a thread that keeps coming up in your conversation, you can mute a word, and no tweets with that word will appear.
  •    Finally, don’t forget to take a break from Twitter. It can be a time suck, it can be addicting, and you can feel like you’re missing something when you aren’t on. Don’t feel obligated to see every tweet that comes your way. One tool that can help manage your time is lists. You can group users together in a personal list, like “doctors,” “politicians,” or “news”, and then see topical tweets quickly. Even easier, there are public lists, and lists you can subscribe to, like the American Academy of Pediatrics “tweetiatricians”, so you don’t have to create your own.


Good luck new user. Be careful out there in the Twitter universe, and make sure you clear with your organization what you may (and may not) tweet (Pro-tip: don’t call out a specific organization). Otherwise you might get that dreaded call from your hospital’s public relations department or your boss calling you to task. 

August 28, 2017

TV Harming Kids' Health?

Paul Smolen MD FAAP
Adjunct Associate Professor
UNC School of Medicine
DocSmo of Portable Practical Pediatrics
Charlotte, NC

A Real Life Story
Recently, I got a real-life lesson in the effects of media consumption on illness while helping my 93-year-old mother, a passionate Democrat, recover from a small stroke that occurred the day after the 2016 presidential election. Her stroke a coincidence, you say? I thought so too, but I have become convinced otherwise.
According to her doctors, the triggering event for my mother’s stroke was severe hypertension – 212/110 upon arrival at the ED. 

Since her discharge and recovery, we have been monitoring her blood pressure carefully, and here is the strange thing I have noticed: her blood pressure while at home watching “cable news” is invariably high, but when we take her to a medical facility, away from the television, her blood pressure normalizes. I’ve coined a name for this phenomenon: “The Cable News Hypertension Syndrome” or CNHS. Simply watching cable news seems to cause my mother to develop a malignant spike in her blood pressure.


The Mind Body Connection
How can exposure to images, music, sound effects, and dialogue cause such a strong physical response adversely affecting someone’s health?   We have all heard of the severe and devastating long-term health effects of real life adverse childhood experiences (or ACE factors).

Children exposed to ACE factors tend to have; higher cortisol levels, higher blood pressure, higher sympathetic tone, and less well developed self control than children who have not endured such exposure. 

Could exposure to emotionally charged events such as images of terrorism and war on TV, have the same deleterious influence on a child?  Could watching carefully crafted, emotionally charged television content have negative effects on children  just like on my mother?  Of course. Evidence already exists that, in children between the ages of three and eight years of age, watching television has the effect of raising blood pressure, independent of whether the children are obese or not. 


Big Brother is Watching
To make matters worse, the invention of the internet, social media, and big data has magnified the effect of media on all of us.  In today’s world, when children watch something on TV, a website, or YouTube, the producers of that content are measuring not only the size of their audience but often the emotional response of the audience to their content. They are tweaking content to maximize its emotional and physical impact on viewership, the better to attract and benefit advertisers. 

Orwellian you say?  You bet. Ever wonder why news outlets give their articles away on your Facebook feed? You used to have to buy the paper or magazine to read these articles. No more. They “give” them to you because the publishers are collecting data on what interests you and learning how to connect with you emotionally via your likes and shares. 

The same is true for children. Even the words children use in social media posts are analyzed and sold to advertisers. Think Google and Facebook are just ways of connecting children with information and their friends? While they do achieve this goal, they are also some of the largest advertising companies in the world, targeting children with laser-like precision.


Parents Need to Take Control of the Messages
Instant access to information and entertainment is fundamentally changing childhood in the United States. Ever more adroit media companies, combined with ubiquitous access to screens, are gradually eroding the influence of family members on the emotional and physical development of children. Unless parents actively understand and deflect the new media reality, many will lose control of the most important positive influence a child can have: the time and attention of their parents.  


Just as my mother’s example demonstrates, exposure to media with strong emotional messages can be harmful to one’s health. We have known about the potentially negative effects of media consumption on the health of children for some time. Childhood obesity, sleep difficulties, and greater childhood aggression have all been correlated with high media consumption during childhood. My advice to today’s parents is the same as the advice I gave my mother after her stroke,  “Turn off the TV mom”.

July 27, 2017

Truth or Consequences

Don Shifrin MD FAAP
COCM
Mercer Island WA

Here’s my question for all AAP ‘Mediatricians’ (apologies to the original Mediatrician, Michael Rich FAAP,  of Harvard’s Center on Media and Child Health).


Which of these statements do you envision as the most important when you go on record advocating for children in media interviews?

1)      You calmly and quickly establish your single overriding communication objective (SOCO). Then consistently reinforce that message. 

2)      No matter how uniformed, hostile, or far afield your interviewer seems,  you can comfortably bridge back to your SOCO.

3)      Despite being pushed, prompted, or provoked you remain undaunted and steadfast while always remaining truthful.

Full marks to those who selected number three. As Mediatricians we have had personal and painful media experiences when science succumbs to ‘alternative facts’ and belief systems.  As clinicians we repartee with families, or in public such subjects as spanking, guns, screen-time, and vaccinations.  How many times have we debated Dr. Google during clinical interactions?


However, in the last 18 months pre-and post the November 2016 presidential election Americans have noted a significant and seismic shift in what could be reasonably interpreted as the ‘truth’. We can find ample evidence for the Oxford Dictionary’s choice for their 2016 Word of the Year to be “post-truth,” an adjective defined as “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion or personal belief”.


A clarifying explanation comes from the Yale professor Jason Stanley, whose 2016 book, “How Propaganda Works”, analyzes modern propaganda. In his New York Times Op-Ed of November 4, he stated that Americans heard candidates that “engaged in rhetorical tactics unprecedented in recent electoral history” and repeatedly “endorsed false claims.”  Professor Stanley’s book reinforced that calling someone a liar “misses the point of authoritarian propaganda altogether.” Stanley’s message is that the speaker attempts to convey power by defining a reality that will change listener’s value systems. Once that power is granted it can effectively supersede accuracy and honesty. and erode public trust.


We are familiar with  Daniel Moynihan’s dictum that, “everyone is entitled to his own opinion, but not his own facts.” However, that statement seems unlikely to be validated in viewing today’s mass media communications. Everyone has access to their own version of ‘the truth.’ 


Pediatricians can verify that when patients come to us with a particular purpose in mind, that purpose often isn’t to uncover the truth, but to defend themselves or attack  the current science topic.


Parents and the public will continue to rely on motivated reasoning to accept authoritarian propaganda that conforms to their opinions. Perhaps then if a vaccine is not 100% effective it could be 100% dangerous. Fear often leverages science. Fears that appeal to the vaccine-hesitant are no secret to our pediatric community. Paul Offit summarizes this when he states, “It is easier to scare people. It’s harder to unscare them.”
  

Of the seven Cs of communicating media content, - be current, clear, concise, consistent, compelling, caring, and correct - which would you rate highest? 

ABC: always be correct! 


If you do not know, do not bluff, bluster, or be boorish. Do not speculate. Admit what you do know (SOCO) and that certain questions do not currently have accurate answers backed by solid science.  When that occurs, you can and will follow up with accuracy.


To be credible we must be believable. And to be believable we must not misconstrue the truth. Truth or Consequences is not just an arcane reference to a 1950’s TV show. All Mediatricians should remember one of your mother’s most oft-repeated mantras (other than wash your hands or wear clean underwear): no matter how much it may hurt, always tell the truth.


June 18, 2017

Three Steps to an Awesome Interview

Elizabeth Murray DO MBA FAAP
Assistant Professor
Department of Pediatrics and Emergency Medicine
Strong Memorial Hospital, University of Rochester


I’m pretty chatty.  Give me a topic to discuss and I’m on it.  However, ask me to write 500 words and I freeze (maybe because I cannot type and “use my hands to talk” at the same time!).  Regardless, a video blog seemed appropriate for this month’s topic of “Three quick steps to an awesome interview”.  

I have experienced great mentorship over the past 15 years.  Even so, I have encountered situations that I never would have predicted.  I’ve found that if I follow these steps (wow, I sound like an infomercial) things work out pretty well.  Remember the goal: provide concise, accurate information that will help children and families lead healthier lives.  You are the expert, you’re a Pediatrician!  Time to get out there and share what you know!


https://youtu.be/FAqbnu8JWnA



May 23, 2017

Part 2: Healthcare Communications and Social Media (#HCSM) - Why It's Important

Jaime Friedman MD FAAP
San Diego CA
drjaimefriedman.com
@drjaimefriedman  Facebook and Twitter

How to safely be online as a physician
It’s important for healthcare providers to be online, but as seen in the Cleveland Clinic case, (see previous post) it can be a scary place.  One error can make a big difference for a physician or organization.  But it can be a lot of fun too, so don’t be discouraged!  

When physicians decide to have an online presence, the first thing they need to do is  to make sure who they want to be, how they want to portray themselves, and who their intended audience will be.  They need to understand the policies of their employer, place disclaimers in their bios, and be very careful about posting any protected health information.   Probably the  major reasons many physicians opt out;  are the fear of saying too much, damaging their reputation, or causing someone harm.  That and the time factor.  

Many physicians stick to posting only medical information and don’t get very involved with conversations.  That’s helpful from the standpoint of providing healthcare-related information, but is not very social.  Over time, you might find that you connect enough with colleagues on Twitter that you actually become friends!  This is when many start to let their guard down and show their personalities.  

I think it’s perfectly  OK to have fun, be yourself, and tweet about non-healthcare topics that interest you.  As I’ve previously written, this is what makes us human and humans are social beings. However, if your primary goal on Twitter is to be an expert voice as a physician, and you are using MD, Dr, DO, or other identifying information in your name/handle, I believe it is important to be truthful about who you are and to stick to your message as much as possible.  

Your intended audience may be other doctors, students or colleagues, but if you have a public account, anyone can see your feed.  The public will expect you to know what you are talking about and will expect you to communicate accurately.  Furthermore, your institution or employer will expect that you  represent them well.  Anonymous accounts not only make it hard for someone to own their words (a phrase I borrowed), but also makes it hard for the public to trust that you are who you say you are.  

I understand the reasons some, especially medical students, want to stay anonymous.  Future employers may not look kindly on you due to your social media activities.  Although if you have an account you wouldn’t want your employer to see, it may be a good idea to rethink what you post.  Also, physicians can have a personal account that is separate from their professional account.  This is common on Facebook, with personal accounts frequently kept private. 

Sometimes physicians and medical students, both anonymous and non-anonymous, share patient information, act in a way that is unbecoming of a physician, or say things that they later regret.  Again, it is up to each individual to decide how you want to be perceived online, and it is perfectly acceptable to delete tweets if you feel your original post misrepresents you.  It’s important to be accountable, learn from your experiences, and represent your profession (or future profession) well.  Think before you tweet.


Trolls
One thing that turns doctors off from being online is being trolled by people who will attack them and their message.  They will be called a “shill”, their whole profession will be demonized, and they will be accused of horrible things.  Some physicians don’t mind arguing online, and that is certainly a personal choice.  My technique to respond to trolls comes from Kevin Pho of KevinMD. Give a calm, evidence based response and if they keep attacking, end it.  Don’t feed the trolls. Twitter has “mute” and “block” options if needed.

Long term goals
Ultimately, I think physicians need to be in the digital space in order to stand out among the many voices that parents/patients hear.  For those of us building our practice and hoping to carry our message further, being online can help that happen.  Being online can also provide a wonderful network to connect with and learn from.  There may be a steep learning curve as you get started, but it can be very rewarding.  For anyone interested in getting started, I definitely encourage you to do so. Feel free to contact me with any questions.



May 1, 2017

Healthcare Communications and Social Media (#HCSM) - Why It's Important

Jaime Friedman MD FAAP
San Diego CA
drjaimefriedman.com
@drjaimefriedman  Facebook and Twitter

The art of communication is something that isn’t always taught in medical school (at least it wasn’t back in the day when I was a student).  Of course we are taught how to take a history, but what about communicating a diagnosis with a patient, or even with the public?  It’s not as easy as it looks.  Here’s a prime example  of the variability in how doctors communicate - my post about the phrase,  "just a virus".  The way a physician discusses a diagnosis, treatment plan, risks versus benefits and potential outcomes will be different for each doctor and can really have an impact on patients.  A patient’s trust and confidence in their physician can vary depending on how they are communicated with, or at least how they perceive that communication.  

Now that we have the digital space where anyone and everyone gives and receives information, the importance of communicating effectively and accurately is more important than ever.  Furthermore, a physician’s presence in the digital space can have a large impact on his/her reputation and practice, both positive and negative.  As I am now almost 5 years into Twitter and over 2 years into my blog, I have a lot of reflections on healthcare communications and social media  It has been an amazing learning experience, and very humbling.  My hope is that this post will help physicians young and old get into the digital space in a way that enriches their lives and helps patients.

My start in the digital world

In 2012 I was given the amazing opportunity by my company to move into a brand new office as the lead physician for that office.  The office is in a growing neighborhood much closer to my home and was a complete start-up.  I knew I needed to do some marketing, something I was never trained to do.  My company already had a Facebook page, so I wasn’t able to start a new page for my new office.  (We now have location pages for all of our offices thanks to some hard work by my marketing director, and after much pleading on my part to get it done.) 

My next stop was Twitter, since we don’t have a company account.  That is where I found a home.  It didn’t take me long to realize that Twitter was not necessarily the place to get new patients, but it certainly was a place to connect with many other physicians, scientists, nurses, nutritionists, parents and all-around awesome people from all over the world.  I also connected with journalists,  which led to exposure in both printed media and on television, and I connected with several people who run websites for parents and have asked for my contribution. This is not direct marketing, but it has definitely helped build my brand.  Having my name out there has helped prospective parents find me through a simple online search.  

As much as I love connecting on Twitter, it’s hard to relay good medical information in 140 characters.  After attending sessions on social media at the Medical Group Management Association meetings in 2014, I was convinced that I needed to blog,  and so my site was born.  This is where I really get to provide education to my patients and the internet at large.  This is my chance to seed the web with medically factual articles in a sea of…well all kinds of stuff.

The Impact and Power of Social Media

One thing I can say for doctors on Twitter, they are a powerful force.  And that’s not even coming from every doctor in the country!  Imagine if every pediatrician had blog posts and Twitter feeds giving evidence-based advice.  How much would that drown out the anecdotes and fear mongering?  

Take for example the Disneyland measles outbreak in early 2015.  My tweet was the first tweet about the cases, and you can read more about that here, but there was also a very loud and powerful outcry from many pediatricians about the importance of vaccination.  Over 650,000 tweets were sent between February 1 and March 9, 2015 mentioning vaccinations.  Furthermore, two members of the American Academy of Pediatrics decided to have a “Twitter storm on February 6, 2015 under the hashtag #MeaslesTruth to highlight how dangerous the infection is.  Symplur noted that not only were there thousands of tweets during the Twitter storm, but the impressions were through the roof.  That’s powerful!

Recently, a physician from the well-known and respected Cleveland Clinic wrote an opinion piece spouting unproven myths about vaccines.  Because he used the Cleveland Clinic name and logo in his byline, the doctors on Twitter took the Clinic to task in full force.  Several articles were written debunking the piece and calling for the Clinic to respond.  Not only can this one article ruin a physician’s reputation, but it also harms the reputation of the Cleveland Clinic.   With a tweet, We fully support vaccines to protect patients & employees. Statements made by our physician do not reflect the position of Cleveland Clinic,”  they  tried to distance themselves from the physician’s statement.  They have since promised discipline.  A public relations nightmare for them but a win for all the (other) physician voices online!

cont. 




March 28, 2017

Doctors and Oversharing

Jaime Friedman MD FAAP
San Diego CA
drjaimefriedman.com
@drjaimefriedman  Facebook and Twitter

In medical school budding doctors are typically taught not to share personal information with their patients.  Doctors should be neutral professionals, so their patients feel comfortable without feeling judged.    Furthermore, the visit is 100% about the patient, not the physician.

However, we aren’t robots.  We want so much for doctors to be seen and treated as humans with human emotions and flaws.  When we aren’t available one day, it’s OK that we need to stay home with a sick child, attend a continuing education course or just take a much needed vacation.  If we are a bit irritated by the late patient at 5:00, it’s because we may be missing Back To School night or an important soccer game. It’s OK for us to be sad when we give bad news or to have happy tears when we give reassuring news.  Doctors are people too.  We have families and personal needs that are often overlooked, as the demands of medicine pull us in many directions.  Our needs get sacrificed.

So where is the balance?  How do we relate to our patients on a human level without ever sharing any information about ourselves that make us more human?  In my opinion, it can’t be done.  Now before everyone freaks out, remember I am a pediatrician.  The majority of my discussions take place with parents, not patients.  Furthermore, my own experiences as a parent have made me a better pediatrician, and I want to be able to share the wealth.  Imagine how empowering it is for parents (who feel like they always need to be perfect) to know that their own pediatrician isn’t a perfect parent. 

Imagine getting advice from a million different sources on a variety of topics; it might carry more weight hearing what actually worked for their child’s doctor.  I think being able to share my own sleep, feeding, and behavior successes and failures not only makes me more human but also helps my patients and their parents.  And sometimes it’s just plain fun to talk to my young patients about my favorite ice cream flavor, or a good movie they may like, or what my Halloween costume will be this year.

Many times parents ask me, “What would you do if it were your child?”. They want to know, when they are hesitant,  if my child had their shots.  They ask how old my kids are and when I let them stay home alone.  They want advice on everything from book ideas for the kids who aren’t excited about reading, to ideas about potty training, to ideas for behavior modification.

As a human being, I learn and grow from my patients as well.  We bond and build our relationship by sharing with each other.  I get, as well as give, book ideas from my teens.  I get vacation ideas from parents.  I even learn about therapists or other health professionals that parents have liked or haven’t liked.  One of my favorite parts of a visit is “schmoozing” with a family about their summer, or school, or a new pet, or an upcoming holiday…the list goes on.

I do think it’s important to know when it is appropriate to share and when it isn’t.  There are way more times that I’ve held back from sharing personal information than I have actually chimed in.  But when I think it’s helpful or might make a mom feel better that I have been in her shoes, I choose to share.