February 27, 2018

Top 10 Tips for Hosting a Twitter Chat

Peggy Stager, M.D.
Director, Division of Adolescent Health
MetroHealth Medical Center
Cleveland, Ohio

By now, as a savvy #Tweetiatrician you have likely participated in a Twitter chat.  It is usually hosted by one individual or organization, centers around one topic, and has a specific date and start/stop time (typically lasting 1 hour).  The conversation is posted on a single specific hashtag, such as #HPVvaccine, to allow for a central location for all to “attend”.  The chat platform creates an open forum for questions/answers, postings of resources, and sharing of ideas and solutions to particular challenges or issues.  The role of the host is to post questions to generate discussion, engage the participants, and summarize resources or links related to the topic of discussion.  It’s an excellent tool for meeting people who are champions or experts in the field, and for sharing ideas.  Think of it as a power learning collaborative condensed into one hour.
If you are experienced with Twitter chats, are you ready to host one? Anyone can host a Twitter chat. Hosts can be an individual, organization, or campaign with a desire to generate discussion around a specific issue. I was approached by the AAP Media team and hosted my first Twitter chat in October on the hashtag #AskAPediatrician.  The chat was sponsored by the AAP and focused on the topic of parental resistance to the HPV vaccine, as well as general information about the vaccine. I learned a lot from the experience and if you’d like to host a Twitter chat then consider my top ten tips: 
  1. 1. Pick a specific healthcare issue.  If the topic is too broad, the conversation may be too diffuse without addressing pertinent questions or discussion points.  
  2. 2. Recruit organizational sponsors.  Reach out to those organizations whose work centers around the topic. Many organizations have large numbers of people following them which will expand your potential audience. For example if your topic is related to sports concussions, contact sports medicine professional organizations, or concussion prevention awareness campaign organizations.   
  3. 3. Consider the specifics of your topic.  Ask yourself, “What specific questions need discussion?”, “What do I want to be sure to convey?” This will help in the preparation of your questions and slides.
  4. 4. Reach out to individuals on Twitter who are experts on the subject – even if you’ve never met them.  In addition, there are many non-physician advocates/educators on Twitter who have powerful voices and platforms for their causes.  Examples include: Moms Demand Action (gun control).
  5. 5. Set the date and time and announce it on Twitter frequently.  Be sure to mention the sponsors, and experts who’ll be on the chat.  Create a colorful powerpoint slide as promotion for the chat. You may want to include a logo or a jpeg picture to set the visual theme.  Once you have your slide design selected, use it for every subsequent slide.
  6. 6. Create 4-5 questions that flow as a progression of the topic.  Again, I recommend powerpoint slides with the same design as the announcement slide.  Label each question 1-5 so as participants respond they can label their responses as “A1”, meaning answer to question 1, etc.  Have the slides at easy access during the chat.  
  7. 7. Send out countdown messages as the chat time approaches: one day prior, 4 hours prior, 1 hour prior and 5 minutes prior.  Be sure to include your specific chat hashtag on every message.  Countdown messages can be posted on other platforms like Facebook, organizational websites, or Instagram.  
  8. 8. Create a distraction-free setting.  The participants’ posts come fast and furiously and you’ll need to be typing and responding as quickly as you can.  I advise working from your computer with your cell phone as a backup.  
  9. 9. Welcome all of the participants and invited experts. Post your questions every 10-12 minutes, and watch how the conversation is flowing and evolving.  Retweet and like those posts that you want to be sure to share and amplify.  
  10. 10. Wrap up the chat with a summary statement.  As the hour comes to an end, thank the participants. Offer to share additional resources and links post-chat.  
If you’d like to see the reach of your chat, Twitter has analytics embedded in each account. But keep in mind the analytics won’t track the specific hashtag of the chat.  For that information, you can try Symplur.  It’s a software product that allows you to track a hashtag and get specific data on your chat such as number of participants, impressions, and top influencers.  In closing, hosting a Twitter chat is a great opportunity to create an open forum for dialogue on a specific healthcare topic.  You’ll likely meet new people, connect with fellow advocates, and learn from other healthcare professionals from all around the country- in one quick hour!

February 17, 2018

Centering the Power of Our Networks With Our Hearts

Julie M. Linton, MD, FAAP

Executive Committee, AAP Council on Community Pediatrics 
Co-Chair, AAP Immigrant Health Special Interest Group
A Culture of Health Leader (1)

This is my first solo blog. Typical of most of my social media interactions, I confess I have not been an early adopter. I didn’t join Facebook until 2010. I joined Twitter in 2014but didn’t really use it until 2016 and am still getting the hang of it. I still don’t really understand LinkedIn.

And yet, I am curious, willing to explore, and at times even hungry to understand why certain ideas that seem unjust or unfounded are often perpetuated through the power of networks. Where I struggle is the balance between the breadth of connections via these often artificial networks and the depth of genuine human connection.

When I see patients (in my case, when I see children), I often have only a short time to understand the essence what is ailing them. That understanding is based on an instinct for human connection.  To do so, physicians have a responsibility to establish an environment of cultural safety, embody cultural humility, and embrace shared humanity.

In medicine, the network for care must not only include the child but the family. Taking that to a broader level, it includes the community. And when I consider the impact of policy on the children I see - the risk of family separation due to threatened deportation, educational inequity based on race or zip code - I recognize that clinical care falls within an even broader network. And that is where my daily human connections intersect with the power to combat inequity with networks.

Pediatricians inherently see advocacy as fundamental to our field. This concept is increasingly recognized across the field of medicine (see the recent Blog by Dr. Esther Choo, https://opmed.doximity.com/dr-esther-choo-discusses-why-advocacy-is-medicine-too-cdce79f784f1). We can take this even further, towards a world where most physicians are part of authentic partnerships between sectors that may not lie within traditional views of health, such as education, business, and law. And again, that is where the power of the network has its appeal.

One approach to communication, called the Heart, Head & Hand framework by Thaler Pekar (http://pndblog.typepad.com/pndblog/2010/09/heart-head-hand.html) prioritizes the critical role of appealing to the heart with stories, the head with data, and the hand with a call to action. And this, I believe, is the essence of my role as a physician, a social scientist, and an advocate.

I am still not sure what this intersection will look like. But as a pediatrician to the core, I am committed to explore respect for intimate human connection with recognition of the power of the network.

1. Culture of Health Leaders is a national leadership program supported by the Robert Wood Johnson Foundation to support leaders—from all sectors that have an influence on people’s health—to create collaborative solutions that address health inequities and move their communities and organizations toward a Culture of Health.

January 25, 2018

EMR; Harming My Patient Relationships

Mary McAteer MD FAAP
General Pediatrician
President Indianapolis Medical Society
Indianapolis, IN

One of the biggest failures in health care is the use of the electronic medical record.  By proving to be inefficient and unreliable, EMR systems have undermined confidence in the patient/physician relationship.  The quality of the relationship is essential to improving our patients’ health outcomes and the health of our profession.  Building that relationship involves developing trust by personally committing to creating respectful communication and defining mutual expectations. 

Workflows involving EMR distract doctors from practicing the complicated skills involved in treating patients.  Using EMR requires doctors to validate, navigate and input data in the system, rather than give personal attention to their patients.  This has resulted in dissatisfaction for all involved in the patient experience, a known factor leading to physician burnout. Patients are given the impression that the doctor is not communicating meaningfully with themwhich disengages patients from being open, decreases compliance and worsens health outcomes.  Patients come with expectations that their health information is valid and complete, like their experiences conducting searches for themselves.  Physicians also expect the information to be valid. But with the inefficiencies of data entry and retrieval, that reliance on validity is up for grabs.

I believe our patients trust us to bring it all together for them, and I hope they realize how much we all would like that too.  To illustrate the cooperation needed, here is my story about Chris, who came to my office for his wellness visit prior to college.  We are in the exam room laughing about the last time he received shots and passed out in his dad’s arms.  He swallows hard when he asks about shots he may need this visit, believing that they are necessary and good.  I turn to the electronic version of our 18-year relationship, which had previously existed on paper.  I am searching his data, still searching, his laughter is getting a little more anxious. I am getting a bit more anxious too, trying to talk about the Colts' upcoming season or something….anything else. 

Soon, Chris offers his help. He has rebuilt computers, has programming experience and feels confident with anything electronic.  Appreciatively, I show him his EMR and the vast array of possible spaces where his records of past immunizations may reside.  He studies the screen and we navigate through some of the options.  After a while, he stands up and shrugs saying, “This is a mess. I feel sorry for you, so go ahead and give me any of the shots you think I might need.”  My office staff interrupts us with a knock on the door, supplying the old paper records.  Upon consulting those, he receives the appropriate vaccinations.  The tragedy of this story is the waste of time, precious time, that we could have spent preparing him for this new phase of his life.  

I have heard many defenses of the EMR as a necessary evolution in health care. Using an unreliable and inefficient tool will never evolve into better health care.  It is imperative to develop better technologic tools to result in more productive and reliable communication, reasonable expectations, and personal commitment to patient care.  We need improvements focusing on more efficient workflows and communication that uses valid clinical information.  The standard for adopting clinical tools should be primarily to improve the quality of the patient experience, leading to rewarding, trusting relationships with physicians.  With tools designed with the goal of serving the patient/physician relationship we will rejuvenate health care.

December 18, 2017

Doc Smo's Holiday Message 2017

Paul Smolen MD FAAP
Semi Retired Pediatrician Charlotte, NC
Founder of the pediatric blog, docsmo.com, Portable Practical Pediatrics
Author of Can Doesn't Mean Should, Essential Knowledge for 21st Century Parents

The world seems to be getting into more and more of a mess; global warming, global political conspiracies, global terrorism, and global threats of nuclear war.  Undoubtedly, your children are paying attention to all this chaos and wonder what is happening. They can’t avoid the negativity and hate on 24-hour cable news, on social media, on their ever-present mobile devices, and even at school with bullying, social cliques, and gangs. Not only are children worrying about horrific events they see in the media, but they are also wondering who will protect them, how can they escape from the chaos, and how can the world become a better place?  

 Your children may ask you “How did the world become so polarized and dangerous?” I think the answer lies deep in our own human nature. In contemporary America, like many places in the world, we are quick to construct barriers between us and people who are different. We choose our friends, schools, neighborhoods, and places of worship to surround ourselves with people like ourselves rather than seeking to meet people from different backgrounds. 

There is safety in being with people like ourselves.  It’s all so safe and predictable. It’s comfortable… but polarizing. Our ancient tribal instincts may tell us to live this way, but following these instincts leads to demonization of people we don’t know much about and living our lives in fear of strangers. Tribal existence was once the key to our ancestors’ survival, but today it could be the cause of our destruction. 

How do we counter and mitigate these destructive forces on our children? Here are three ways to begin that process:

1. By teaching your children to accept and appreciate people who are different. That starts locally, with you and your children - in your homes, schools, neighborhoods, and communities.

2. By making sure that you set a good example for your children. Put aside cynicism and negativity and live a life that is positive and inclusive. Your children should learn that small acts of kindness, volunteering, and openness to people who come from different cultures and backgrounds can be fulfilling and downright refreshing. A parent’s powerful influence on their children depends not on your words but on your behavior.

3. And finally, by working collectively for positive change. Individually we have limited influence, but collectively we are powerful. As Henry Ford eloquently put it, “Coming together is a beginning. Keeping together is progress. Working together is success.”   The same is true about our lives; by working together we can achieve wonderful things.

Parents who commit themselves to act collectively for causes greater than themselves can enrich their children’s lives immensely. The cause can be the Boy Scouts, the local PTA, an organization to feed the hungry, a religious charity, or anything that serves others. Don’t pass up the opportunity to instill in your children the desire and joy of serving others. And what better time to start than the holidays!

So this is my 2017 holiday wish for you and your family. Leave your comfort zone and meet and serve people your instincts tell you to avoid, whether your resistance is based on race, socioeconomic background, religion, country of origin, language spoken, sexual orientation. or whatever.
Here are some ideas about how you can help your children counteract the negativity they are witnessing and move toward more understanding and tolerance.

- Limit the negativity they experience by limiting screen time. Whenever possible, turn off the TV.

- When your children view disturbing info, help them understand it. Listen, and give them your perspective.

- Reassure your children that you will protect them with all your power.

- Try taking your children to a church, mosque, or synagogue you and they have never been before.

- If you can afford it, travel, so your family can experience other cultures.

- Talk with your children about their fears and hopes for the future.


- Volunteer your time to help those that need assistance.

- Socialize with someone unexpected whether that is a coworker or a more incidental acquaintance,

- Be charitable with your money and your time.

- Greet people on the street with respect, especially if they have been marginalized. It’s easy to turn away and look past people in trouble but try not to do that.

Why should you do these things? Because your children are watching and learning and will likely imitate your behavior when they are adults. If we could collectively change our worldview and concentrate on what we have in common with others rather than our differences, we might stop the current spiral of polarization. 

At the end of the day, the human experience is all the same. We are all looking for acceptance, respect, love, and security. The world desperately needs us to stop segregating ourselves based on our differences and move toward a bigger sense of we. Your tent has plenty of room for members from other tribes. It’s hard to be fearful of people that you know.

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
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.