A Different Take on Social Media: Our patients...Today's YouTube Stars?

“Did you see, I made the news”, said my teenage patient a few hours after being shot twice in the legs.

“No”, I said, “I’ve been busy taking care of the other patients in the ED”.

“Too bad”, he replied. “It was pretty cool”.

I have never thought of having a gunshot wound as pretty cool. However, I am not part of this new generation that expects to be a part of social media, YouTube, Twitter, Facebook, etc.

A moment on the trends I have been seeing….

1. Teens with injuries sustained while doing some activity (likely not a safe or wise activity) that is being taped for production on YouTube. For example, with the warm weather brings the annual “what can we do to make a Slip-and-Slide more dangerous”? The last two teens with splenic lacerations opted to show me the injury as it was happening as depicted by video on YouTube. That is, before coming to the hospital, the patient (or the patient’s friend) took the time to post the video of the injury inducing event to YouTube.

2. Families videotaping injuries instead of helping the child being injured. I recently cared for a young man that was attacked in a local park. When I asked for a description of what happened, his older brother (of adult age) said he could show me the video if I wanted. When I asked why he chose to video the event instead of help his brother, he replied that he thought it would be better for the police and the news to have the video.

3. Victims of violence feeling a sense of accomplishment when their stories are covered on the local news. The gunshot victim provides a classic example.

Perhaps our entrance into social media is not best served by the medical professionals producing their own spots, but instead helping to prevent our young patients (and when necessary, their families) from being the star of these less than endearing media clips.

This is a new health crisis impacting the youth of today. I am at a loss as to the root of the problem. Is it due to the dramatic increase in reality TV? Are kids getting the message that since anyone can post a video on-line they are not worthy unless their video is the most dramatic, dangerous, outlandish, or destructive? What would cause a family member to choose allowing injury to a loved one over stopping an assault? Perhaps in addition to reviewing our patients’ charts prior to a visit, we need to Google them too…then discuss what we find when we see them in our offices!

By Elizabeth Murray DO MBA

Editor's Note:

Dr. Murray has offered us a bird's eye view into the real world of how kids are using social media. Our job is to figure out how to use this information clinically. Perhaps it's as simple as asking "been on YouTube recently?"

R Rated at 40,000 Feet?

As I make my mental checklist to prepare for family vacations, I instinctively remember the booster seats, Ziploc bags to carry snacks, and card games and books for the long flight. But I’ve been caught short-handed on a few flights with my kids due to unexpected entertainment provided free of charge by my airline “hosts” and without the opportunity of refusal. I am sometimes at a loss when my kids are staring right up at the airline’s offering of a violent R movie on the overhead screens. I took frequent transcontinental flights when my elder son (now 12) was an infant and toddler and learned the hard way that my discerning taste for my child was not shared by the airlines. I actually purchased one of the first laptops with a DVD player just so I could use that in a pinch…and I used it shortly afterwards when my toddler son looked up and saw that Matrix was playing right in his view. The Tigger Movie was my quick replacement!

Federal broadcast laws do not apply to in-flight entertainment, and airlines are not required to adhere to motion picture ratings. The Family Friendly Flights Act was introduced in Congress in September 2007 (the 110th session of Congress) to require separate airplane seating areas for kids and families to protect them from violent inflight entertainment. Although it was referred to committee, it did not get referred back to the House and is not law. However, child advocacy groups and flight attendants have continued to work with the airlines and movie studios to lobby for logical guidelines on the selection of movies for inflight entertainment on overhead screens.

On my most recent flight with my kids, now 7 and 12, we were fortunate. The boys had their portable entertainment available but the overhead fare was reasonable for their eyes. But searching the airline websites for last month’s movies showed me that they might have been faced with Gran Torino, Dark Knight, or Quantum of Solace. US Airways, Delta and countless other airlines assert their prerogative to screen any movie for the enjoyment of all of their passengers and to edit them as they see fit.

So what is a parent to do to protect his child from inappropriate inflight films? While airline spokespersons have suggested that a parent contact a flight attendant who might be able to switch the family to “obstructed view” seats during the flight, we all know that the planes are usually filled to capacity these days. This is a chancy option at best. So here are my tips for a safer flight:

1) Choose an airline that has signed onto the principles of the Family Friendly Flights Act or at least have individual screens for each passenger. This includes Southwest, Virgin Atlantic, and Jet Blue.

2) Check on airline website for the movies that are scheduled for the upcoming month. This may or may not be helpful if you are purchasing ticket months ahead, but it will give you a heads up about the relative risk of your 2 year old watching Gran Torino or Watchmen.

3) Either purchase/borrow a portable DVD player (we bought one for about $60 at Christmas) or consider renting from an airport facility or from the airline itself. Alaska Airlines rents onboard digEplayers (personal entertainment players) to passengers with 24 hours notice. InMotion Entertainment has stores in major airports and will rent you a personal DVD player and DVDs for the flight or the whole trip. In a pinch, as I have done, use the DVD player in your laptop. For those with really good eyes, you may hand over your iPod pre-loaded with an appropriate movie for the little ones! In the case of a VERY curious preschooler, a blanket “tent” might make a fun diversion to keep her eyes on her movie and off the overhead screen.

4) Of course, try to limit your kids’ screen time on the flights. Bring books, music, playing cards and travel games for the whole family. Kids often love the one-on-one time with a parent held captive right next to them for 6 hours straight. Scrabble, Mastermind, and many other classic games come in travel editions. My younger son cajoled my husband into reading a 300 page adventure novel to him on a series of flights when he was four.

5) Provide feedback on inflight entertainment to EVERYONE in the travel industry. I have been receiving more post-flight surveys these days and I make comments on the movie issue even when it is not the topic of the survey. I applaud those flights in which I am not scrambling to “distract” (Horton Hears a Hoo followed Yes Man on our transatlantic flight…good option but the kids were already asleep for the G movie!) and I draw attention to the times that I am not so pleased (The Day the World Stood Still did not make my cut on a recent flight due to apocalyptic scenes).

Letting airlines know that you will be looking elsewhere for your travel needs is the best way to protect all of our children from these films. Airlines are traveling movie theatres but are not members of the MPAA and do not have to follow MPAA rating guidelines. So your efforts to keep your child from a PG-13 or R movie while at home are being undermined by the airlines’ lack of commitment to families. The airline industry needs your dollars and advocacy may start with consumer decisions. Until the friendly skies change, however, travel with kids means travelling prepared. Bon voyage!

By Mary Beth Miotto, MD, FAAP


Editor's Note:

Readers may be interested in checking out www.kidsafefilms.org, an organization dedicated to this very issue.

Sexting: dangerous but is it a crime?

“Come gather round people wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone
Then you better start swimming
Or you’ll sink like a stone
For the times they are a changing”

Bob Dylan’s song of protest (voted #59 of the top 500 songs ever written by Rolling Stone) seems as prescient today as in 1964, especially as COCM members recognize the latest teen-technology on-line behavior:sexting. Research studies reflecting usage reveal that between 20-25% of all teens have sent or posted semi-naked or naked pictures. A higher percentage says that exchanging sexy content makes dating or hooking up more likely.

Teens have been recently charged with disseminating child pornography in 9 states, many have to then register as sex offenders. Meanwhile,the media (as usual) has sensationalized the issue by the way it has covered the topic, often confusing parents, teens and even pediatricians.

But the real question here is this: should laws made to protect children be used to prosecute them? I believe that misses the point. Pediatricians and parents should look beyond the headlines to the convergence of adolescence and these electronic devices that allow instant communication decisions from immature teen brains.

These kids are not threats to society.They’re reckless hormonal narcissists who are tasked with growing up in a sexualized society. Their previously private thoughts are now revealed all too publically. They often are the real victims here: assaulted by a desire and opportunity to get older-younger.

Parents need to become aware that the media has ensured that adolescence occurs well before Tanner stage II. The media has framed the issue, but not focused on real solutions. That's where we can help enormously with our pediatric knowledge and media skills!

So what is the Pediatrician’s role when it seems that teens are more connected to their devices, and each other, but disconnected from their parents? It doesn’t have to be complicated.

1) Don’t wait until a health maintenance appointment to frame the issue of texting/sexting. Rarely does a teen or tween appear in the office without a cell phone. (Or receive a call during the appointment).

2) Remind them that a text or sext, once sent, is out of their control permanently. Examples abound from the pictures of Vanessa Hudgins (HSM 1,2,3-oh google her) or Michael Phelps and his famous bong picture.

3) Ask about whether parent is concerned about texting as nauseum. Most will agree
about the numbers, but will be clueless as to potential solutions.

4) Advise visiting ThatsNotCool.com (go there yourself). A great site with tools and guidance, prime parenting directives actually, to buffer cyber-stalking and cyber-pressures. The site also has great posts that could be taken from the site to stimulate a discussion in your examination rooms, newsletters, websites.

Note that as the January archives article revealed, uncovering the problem does not imply you have to solve it. Expressing awareness and concern, could, hopefully, motivate parents to seek opportunities to learn and engage in collaborative conversations that would lead to constructive solutions.

“Come Mothers and fathers throughout the land
And don’t criticize what you don’t understand
Your sons and your daughters are beyond your command
Your old record is rapidly aging
Please get a new one
If you can’t lend a hand
For the times they are a changing”

By Don Shifrin, MD, FAAP

What if every pediatrician was on twitter?

Is the absence of pediatricians on social media platforms a public health issue for children? It might be. Misinformation predisposes children to risk. We all can identify instances where poor decisions for a child were made on corrupt information obtained online.

And as doctors we complain. We see ourselves as victims. Our patients are reading someone else’s information and opinion. And most of us handle matters by taking precious time to get the facts straight. Time that could be better spent on anticipatory guidance or counseling in other areas.

But to some extent the issue of bad information is our responsibility.

As pediatricians our response to online misinformation tends to be reactive. For some reason we never think that we should be the ones generating the information and dialogue. As the group charged with the well-being of the next generation we need to be proactive. We have a commitment to see to it that we are visible and vocal online.

So what can you as a fellow of the AAP do?

Contribute to a blog. It doesn’t have to be your own blog. There are many that would be happy to host you as a guest author. Offer practical input on the issues that you see creating confusion in your parent base. If every fellow of the AAP posted one blog post annually on the absent association between vaccines and autism, for example, there would be 60,000 online entries which would likely dominate search engines.

Comment regularly on news sites, blogs or anywhere there’s dialog on children’s health. With no input from those of us with the facts, discussion will be dominated by a vocal minority, many of whom have an agenda not representing the interests of the parental reader.

Begin a Twitter account. Just a few minutes a day cultivating relationships with peers, patients and ‘followers’, AAP fellows have the potential to change minds and influence thinking. Twitter is a platform for the dissemination of ideas, thoughts and information in ‘tweets’ of 140 characters. Assuming just 250 followers (I have 1,000), the news of a measles outbreak associated with undervaccination, for example, could instantly reach 15 million individuals with a single tweet from AAP members.

The battle for the health of our children and the sanity of our parents is now fought online. A commitment to online literacy through active involvement by AAP Fellows in social media should be seen as a critical advocacy role.

By Bryan Vartbedian, MD, FAAP

Being A TV Medical Expert: Tips to get asked back

Being asked to appear as a guest medical expert for the first time is an exciting experience. How do you ensure you will be asked to come back on the show again? The following are a few tips I have picked up along the way:

1) Arrive early. The last thing the producer wants to do is worry about whether you are going to make it to a live appearance. It's better for you stroll around the neighborhood and collect your thoughts on the topic for a few minutes, rather than run the risk of receiving panicked phone calls from a producer.

2) Be courteous from the moment you enter the building. Smile at the security guard, be friendly to the intern or page who escorts you in the building, and make small talk with the people in the green room. Not only will it make good impressions, but you will appear relaxed and confident. Often times, the make-up artist or others in the green room will ask what you are about to talk about…it's great practice to speak your thoughts aloud, so be sure to use the opportunity. Just remember that what's spoken in the green room may be repeated in public.

3) Ask ahead of time if you need to arrive camera-ready. Some shows will have a stylist on set to do hair and make-up, others will expect you to arrive camera-ready, and some will have someone ready to touch up what you have applied ahead of time. It pays to ask before you arrive. Additionally, I recommend that the ladies always carry some make-up and hairspray, in case you get stuck in traffic and don't have time for the full stylist treatment. Gentlemen, I encourage you to accept the offer of face powder. Distracting shine can take attention away from your good messages.

4) Discuss the segment with the producer ahead of time. Some producers will want to pre-interview you on the telephone, while others will want you to email 'talking points' in advance of the show. Either way, make sure you have some contact with the producer ahead of time, so you know what to expect and aren’t faced with any surprises on camera.

The producer will ask you about the topic you will be discussing so before you speak with the producer take a few minutes to do a quick internet search, even if you are well-versed on the topic. One great resource is the AAP "children's health topics" page on your topic at www.aap.org. A small bit of mental organization goes a long way in making you sound like an expert who can convey a lot of valuable information in a short period of time.

While on the phone, ask the producer if he or she would like you to email formal ‘talking points’ for the show. If so, send these in Q&A form. Even if the producer does not desire ‘talking points’ from you, creating some for your own personal use is a fantastic way to prepare for the segment.

Issues to ask the producer about include duration of the segment, who will be interviewing you, what to expect when you arrive at the studio, and whether hair and make up touch up are provided.


5) Be flexible. Things frequently change in the broadcast world, and they can change last minute. I have had a topic change upon arrival at the studio, leaving me only 10 minutes to review the topic on my i-phone. Though this would fluster almost anyone, try not to let the producers know you are uncomfortable about a last minute switch. The more easygoing you are, the more likely they are to have you back. And, unfortunately, we all get cancelled. Sometimes it's the day before, sometimes it's the morning of, and sometimes it's even after sitting on the set. I personally have been sitting next to the interviewer with my microphone on, only to have my medical segment bumped by someone talking about vegetarian turkeys for Thanksgiving! But don't give away your annoyance, even if you (ahem) changed around your whole schedule, only to have the segment be canceled at the last second.

6) Be reachable. Immediate access to email is a must. Often you will receive an appearance request in the form of an email. If your response time isn't quick enough, you risk losing the opportunity. A blackberry or i-phone really comes in handy if you plan to appear on air often.

7) Send a quick thank you email. It's always nice to send a brief "thank you for having me" email, and it gives you an opportunity to say that you would love to come on again if the need should arise. Many times this has opened the door for me to send pitches back to the producer.

By: Alanna Levine, MD, FAAP

Discussing On-Line Profiles - A New Addition To The Well-Child Exam

Through social networking sites, teens can now hangout with their friends without leaving their homes. But unlike sitting in a friend's basement, you're not always sure who else is there. There are unseen risks involved with virtual communities. Depending on the settings of one's web profile, personal information, photos, etc. may be open to anyone who wants to see them. Teens may be more lax about what they share on-line. They may say and do things on-line that they would shy away from in person. Teens may also feel pressured by their virtual community to post comments or pictures that may be inappropriate or illicit unwanted attention.

With how common these sites have become in everyday adolescent life, it would be wise for us as pediatricians to begin to include them in the teenage well-child exam. On-line activity and its risks can easily be worked into the "activities" part of a HEADSS exam. Incorporating it into the HEADSS exam can open the door to discussing the risks involved with putting personal information on-line as well as how to protect one's self and maintain one's privacy.

A recent study published in January's Archives of Adolescent and Pediatric Medicine has shown that adolescents may be open to advice regarding how and what they display about themselves on-line. In this study, a physician using MySpace sent an email to 18- to-20 year olds who displayed risky behavior in their on-line profiles. She informed them that the information they were sharing was open for anyone to see and advised that they take steps to maintain their privacy. 42% of the interventional group versus about 30% of the control group (P=0.7) made some sort of protective change whether it was reducing references to sex and substance use or changing their web profile setting to private.

These results were based on an unsolicited email from an unknown physician. It is likely that advise from one's own pediatrician with whom they have had a relationship for many years would be much more influential. Although there are many things to cover at the teenage well-child visit, given how much time teenagers spend on-line and in these virtual communities it is incumbent upon us to find the time and make the effort to discuss the risks involved.

By
Corinn Cross, MD, FAAP
COCM Website and Blog Editorial Advisory Group Member

The Nation's Doctor

As Surgeon General, from 1998-2002, Dr. David Satcher described his role as the “Nation’s Doctor”. In 2007, he testified before Congress stating in part, “I believe that it is the responsibility of the Surgeon General to communicate directly with the American people….” (Committee on Oversight and Government Reform The Surgeon General’s Vital Mission: Challenges for the Future Testimony by David Satcher, M.D., Ph.D. July 10, 2007.) Surgeon General nominee, Sanjay Gupta has already proven that he can communicate with the American people. The prevailing argument however, is that it takes more than a reporter to be the Surgeon General. His first challenge will be Congressional approval. After approval, Dr. Gupta will likely spend the majority of his time winning the support of those who believe he is not qualified.

Only two of the last eleven Surgeon Generals are easily remembered: C. Everett Koop and Joycelyn Elders. C. Everett Koop was Surgeon General from 1982-1989. He is a Pediatric Surgeon and continues to make television appearances. He was very public during his service and fit the stereotype of what most Americans associate with wisdom and experience. The Surgeon General warning labels and C. Everett Koop are synonymous in the minds of Americans who witnessed the obscure office become a very public platform. The second memorable Surgeon General is Jocelyn Elders who was Surgeon General from 1993-1994. She is a Pediatric Endocrinologist and created a media firestorm with comments about masturbation. Her firing began a rift in the perception of what the Surgeon General should promote. Public health advocates and political conservatives do not always agree on what message the Country should hear.

These two examples demonstrate contrasting communication styles and media experience. Media knowledge is a vital skill for an effective Surgeon General. It is this role as the “Nation’s Doctor” and his ability to communicate that illuminates the choice of Dr. Gupta for Surgeon General. Dr. Gupta is a neurosurgeon who has already become a trusted source of information for millions. However, he may not have the support of many in the scientific community or the Public Health Corps, which he would oversee. As with many institutions, experience is the currency that pays the dues. Other physicians also look at the choice as a threat to public health and primary care because he is a sub-specialist without a Public Health degree. The past eleven Surgeon Generals have had specialties to include neonatology, family medicine, nephrology and veterinarian medicine. The current acting Surgeon General Dr. Steven Galson specializes in Preventative Medicine and Occupational Health. Dr. Gupta’s credentials as an expert in neurosurgery confirm his ability to practice medicine. His success in public health would depend on taking full advantage of the vast resources at his disposal. If Dr. Gupta utilizes the scientific and medical advise of experts to analyze the evidence and then, uses his skills as a communicator to direct the National health goals he has the potential to be one of the best remembered Surgeon Generals in a generation. Imagine 15 year-olds talking at lunch, “Dr. Gupta said, ‘Ephedra can kill you.”

The Office of the Surgeon General may be poised for the spotlight and focus America’s medical needs toward the best care practices. Or it may become another distraction from important issues. We may see how ready for change everyone is and how an effective communicator can make a difference.

by
Jeff Hutchinson, MD, FAAP, FSAM
COCM Website and Blog Editorial Advisory Committee Member

Social Media Sites and Inauguration Coverage: A Glimpse Into Communication of Today and The Future

This week's Inauguration will not easily be forgotten. From the earliest moments to the First Couple's First Dance, it was a day filled with hope, memorable "tissue" moments, though-provoking music and words, and images of a gracious passing of the Presidential torch of power that will be carried with all of us for a very long time.

In addition to the usual TV coverage, a surprising twist to my day was how much more enhanced the experience became for me due to the power of my social media involvement on Twitter and Facebook. As the Inaugural events were unfolding, simultaneously, my virtual community of friends and colleagues were posting their impressions and images real-time from all 4 corners the United States. We even shared what we were snacking on! No longer sitting alone with our thoughts, we became a rich community of voices sharing our thoughts and impressions real-time.In the blink of an eye, a virtual living room of spectators for the biggest historical moment in most of our lives emerged.

And, we were not alone! JuJu Chang from ABC News had a flipcamera and her iPhone at the Inauguration. She not only posted videos on her ABC News blog but updated to Twitter and Facebook throughout the day. It was a cool way to give views another way to experience the Inauguration besides the more traditional TV coverage ABC was also doing, which was excellent.

We have yet to really tap into the full power of these communication tools but if Tuesday was any indication, a door has been opened that we have only just begun to walk through. It will be interesting to see how we all end up using social media in our media and communication lives and to learn from each other's experiences. We are likely to find we will only be bound by the limits of our own individual creativeness.

There was a true sense of unity and community this week that was visible and palpable on the Mall, parade route, the many evening balls, and in all our communities on and off line. While I had a bit of Inaugural media coverage brain burnout the following day, I woke up that morning hopeful about the future and looking forward to exploring more the power of the world of social networking.

Image: First Dance (FoxNews)

Republished with permission from Dr. Gwenn Is In