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Fiona Pathiraja: Twitter – the medium and the message?

20 Apr, 11 | by BMJ Group

Fiona PathirajaIn his BMJ blog last week, David Kerr asked whether Twitter would ever be used for healthcare.  As soon as this blog was posted, the Twitter healthcare community was buzzing with responses including: “It already is [being used for healthcare]: we are developing healthcare through our discussions,” “Does he mean the same Twitter that is currently being used to drive discussion and debate in healthcare?” and “Yes! It will be as normal as phones.”

Private companies use Twitter’s open platform to raise awareness of their brand and use secure micro-blogging systems like Yammer to facilitate cross-organisational discussions between employees. Healthcare often lags behind other industries in embracing new technology but we are finally waking up to Twitter’s potential.  Its capacity for democratisation of information, intellectual capital, and professional networking means that doctors who are not tweeting are missing a trick.

I was recently at dinner with doctors involved in central government health policy, most of whom were incredibly enthusiastic about social media. They talked passionately about using Twitter to keep abreast of the latest healthcare news and innovations, and its value as a professional networking tool. Generally, their productivity levels were high due to judicious time management and the vast choice of mobile Twitter clients available for tweeting on the go.

It seems that Twitter has many benefits for the individual clinician. Social networking certainly encourages intellectual curiosity, networking, and creativity. However, we are still far from it creating system-wide benefits, as it has done in other industries. The Twitter healthcare community is a vibrant one and we have previously been involved with spreading ideas via “hashtagging” key discussion themes e.g. #nhsreforms and #scienceisvital.

As anyone who has managed change knows, it is much easier to do when there is a clear strategy and direction. So perhaps system wide benefits will only come from translating the intangible Twitter healthcare conversation into a tangible Twitter healthcare strategy. This could be through well-targeted hashtagging attached to key conversations, e.g. #qualityimprovement, and carbon-copying interested and influential healthcare Tweeters into your tweets. If tweeting about things integral to your organisation, include them in your tweet, e.g. @dhgovuk, @uclh, or @thekingsfund. The Health Service Journal (@HSJnews) has a list of all NHS trusts that may be a good starting point for this. Strategic tweeting might not seem spontaneous but can help to spread your ideas to a wider audience. These ideas may then come to the attention of people with the organisational power to implement change.

It seems that healthcare is often late in embracing new innovations. However, now that we have engaged with Twitter, perhaps we can apply direction to the healthcare conversation to enable system wide benefits and make a positive difference to our patients. If enough frontline clinicians are tweeting about the value that a Yammer-type system will bring to the NHS, it might just happen. As we have seen with the role of social media in the recent Middle East revolutions, anything is possible.

Those new to Twitter often ask me for recommendations on whom to follow. A selection of my healthcare favourites to get you started (in no particular order):

@doctorblogs Annabel Bentley, medical director, BUPA health and wellbeing
@HPIAndyCowper Andy Cowper, editor, health policy insight
@muirgray Muir Gray, NHS chief knowledge officer
@trished Trish Groves, deputy editor, BMJ
@ndeaks Nicholas Deakin, medical student and former chair, BMA medical students committee
@nedwards_1 Nigel Edwards, acting chief executive, NHS confederation
@silv24 Natalie Silvey, foundation year one doctor
@martinmckee Martin McKee, professor of European public health at London School of Hygiene and Tropical Medicine
@doctorpreneur Emma Stanton, Commonwealth Fund Harkness fellow, Boston
@cebmblog Carl Heneghan, director of the centre for evidence based medicine, Oxford
@TheBMA The official Twitter feed of the British Medical Association
Read more on this topic in BMJ Careers:
Pathiraja F and Bentley A. Twitter going global. BMJ Careers (January 2011)
http://careers.bmj.com/careers/advice/view-article.html?id=20001768

Fiona Pathiraja is navigating a medical portfolio career. She has worked as a junior doctor, management consultant, entrepreneur and most recently as clinical adviser to the NHS medical director at the Department of Health. Follow her on Twitter @dr_fiona

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  • amcunningham

    Thanks Fiona.
    Here are a few more ways to find people.
    A list of health-related tweeters in the UK (by peer index) http://www.peerindex.net/amcun
    #nhsreform list : http://twitter.com/#/list/amcu
    #ukdocs list : http://twitter.com/#/list/amcu
    #meded list : http://twitter.com/#/list/amcu

    Anne Marie
    @amcunningham

  • http://andrewspong.myopenid.com/ Andrew Spong

    Thank you for keeping the conversation going, Fiona. Suggesting that 'we are still far from [Twitter] creating system-wide benefits' infers that it may some day able to.

    Advocate though I am, I don't see how that could ever happen.

    It it something of a leap of faith to conceive of the creations of the conditions of possibility wherein a status updating platform, adept though it may be in connecting people and sharing information, albeit in a rather unstructured way, is capable of facilitating structural change in the design of healthcare systems.

    Only a ground-up redesign of such a complex system as healthcare delivery, where every decision precipitates a cascade of effects, could achieve such a goal.

    That isn't going to happen either.

    So: what's left?

    The possibility that the social media tools themselves can help to deliver substantive improvements to elements of the design of healthcare systems, and thereby improve healthcare delivery, and thereby improve patient outcomes – because if we're not doing that, there's no point in doing any of it.

    There are simple wins that can be achieved a very little cost. The very first of these would be to ensure that the trinity of SM platforms (Twitter, Facebook, YouTube) are available (as in 'not blocked') within NHS systems. Only when that has been achieved can providers be expected to have created an account. Lack of access is not so much an excuse for non-participation as it is a cause of it. It should subsequently be ensured: that the look and feel of all of the NHS presences on all of the sites are the same. That they convey the basic information (contact details, times, names) local users would expect when searching for their local provider. That they all link to the same reliable, relevant, best-evidence, patient-oriented health information (curated at one source), because they will be searching for their provider not because they want to 'Like' them, but because they are seeking insight.

    A second would be to raise awareness of the ubiquity of social media within the NHS. HSJ may have a list of NHS Trusts (although I can't find it – link me?), but who is keeping track of who is using what in the way that Ed Bennett's 'Found in Cache' blog does for the US? So: create a Wiki that not only lists existing official Twitter, Facebook and YouTube presences within the UK, but also identifies what they are already doing, analyses and learns from what they have achieved, and distils their knowledge into:

    Third: crowdsourced from among the #NHSsm community and the networks of the leading contributors some of whom you list above, a living document defining what constitutes best practice in the use of social media within the NHS looks like from the provider side, and make it open for user (patient) comment. This has to be a dialogue.
    Yes, it should offer a live feed of and archive access to the excellent suggestion you make above regarding the creation of a suite of hashtags defining and refining key questions such as #qualityimprovement (may need to shorten that a little, though ;)) on an ongoing basis. Again, I'd favour that conversation being conducted in the open with participation from all stakeholder groups.

    So, that's my $0.02. Actually, more like $0.10 ;)

    @andrewspong

  • Fiona Pathiraja

    Thanks Anne Marie. Really useful info. I also have a 'medics' list of interesting medically-qualified people in the UK healthcare landscape. If people are interested in following this list, it is located here –> http://twitter.com/dr_fiona/me

    Fiona (@dr_fiona)

  • http://twitter.com/Stevancw Stevan C Wing

    To me the most interesting thing about twitter, as you have pointed out Fiona, is its flexibility. The microblogging system is used in a variety of different ways. Even one individual user may use the system to fulfil a plethora of functions. Some use the system predominantly to keep abreast with news, whist others like to network, debate particular issues, organise events or perhaps share and get reactions to their own ideas. The platform has certainly irrevocably changed the way I consume content and communicate.

    I have multiple social graphs on the system and certainly feel that there is room for a partial separation. A UK specific network of doctors with similar interests would be great for collaboration. I feel that for too long now the competitive nature of medical career progression is a barrier to collaboration. If we were to work more together we could make a much greater impact. Twitter has certainly done much to break those barriers down and the journey starts with us.

  • Daniel McGuinness

    It's greatest strengths are firstly it's networking opportunities, and secondly it's ability to expose you to the thoughts and ideas of those involved in healthcare (be it frontline/policy development/think tank activity/or any group/individual with in interest in our health system) that you might not ordinarily have an opportunity to experience. Using Twitter for the past few months has been both enjoyable and a great tool, I'd strongly advocate it for those interested in all aspects of healthcare!

    @dannymcg

  • http://twitter.com/fentonaw Andrew Fenton

    Some v good observations here. As a fairly recent newcomer to Twitter, and in the context of the rapidly developing discourse on NHS reform, it's been an excellent way to tap into 'thought leadership' and key strands of policy news and developments. One point not made in the blog is the power to help overcome professional boundaries, and the tribalism that is so common in the NHS. With some form of clinically-led commisssioning on its way, the interchange between clinicians in different parts of the health system, and non-clinicians (managers, analysts, IT professionals etc) is increasingly vital. Whilst it's evident that social media is beginning to take off more in the NHS, it's still as far as I can see a minority pursuit; I'm surprised by how few of my local peers and colleagues are on Twitter for example, both clinicians and managers alike. I wonder if many NHS staff are nervous of engaging in socmed in a semi-professional way, as there can be a fear of censure from above. But we must push for more democratisation in the NHS, as this blog suggests, and enable a greater exchange of thinking and 'knowledge management' across the system.

  • Muir Gray

    great piece, Fiona,but i would not be on your list if it were not for your help

    should we not have a website ( terribly 2010 i know) with tips for people like me ; i still dont know how to work hashtaghs eg where have the 5 i posted from #nhshardknocks, only one shows, is there a limit?
    what a bout a Twitter campaign linked to nwnn eg #betterlife for docs in training by docs in training aimedat docs not in training as well to help young docs feel better .. i dont really believe in trying to make people happy, that is theri choice, but we can make manypeople be ;less unhappyi think

    great piece ; please write more on different perceptions of you as young doc or management consultant ;cf the club of queer feet by gk chesterton

    muir gray ps no longer chief knowledge officer , now qipp rightcare

  • http://twitter.com/crgonzalez Carmen Gonzalez

    Fiona,
    Wonderful post, thanks. I want to add to Andrew's insights below that Lucien Engelen has been accumulating some stats for Europe. His presentation on Social Media in Hospitals last year was a good start ( http://www.vimeo.com/8962119 ). For now, I think it takes devotees like Ed Bennett and Lucien to begin collecting data rather than waiting for the status quo to catch up. Certainly, articles on social media—such as your Fiona—are essential to keeping the focus on its possibilities.

    I am much more hopeful about Twitter's future in health care because it has already demonstrated its power during emergency situations. Its use in Haiti, Chile, and in Japan following major natural disasters is proof in itself. Twitter helped link people to care, so it isn't much of a leap of imagination to see it applied further into the patient care stream.

    Onward,
    Carmen

  • Fiona Pathiraja

    My pleasure re: providing you with some Twitter tips and my apologies re: wrong/old job title!

    Will have a think re: #betterlife hashtag and how to mobilise it to get more purposeful discussion and knowledge management between trainees. I agree that many juniors can get disillusioned during long periods of training and sharing information, knowledge and camaraderie on Twitter might just help.

    Fiona.

  • http://blogs.bmj.com/bmj/category/douglas-noble/ Douglas Noble

    I agree with Muir – some of us need more help to get the 'best value' out of Twitter and other social media for improving healthcare – website would be great as would a training day! Douglas Noble

  • http://andrewspong.myopenid.com/ Andrew Spong

    Hi Carmen

    Thanks! I forgot the preliminary work that Lucien has understaken to begin to investigate the use of SM in European secondary care. Thank you for sharing the Vimeo presentation. The data can be found on SlideShare too: http://slidesha.re/gcLd8A

    @andrewspong

  • @drdlittle

    I agree with what Stevan C Wing says below about the flexibility of twitter. When I joined, I never imagined it would actually be useful. I suspect it will always be a minority rather than a majority of people that embrace twitter and use it regularly but that doesn't mean it can't be exploited.

    Collaboration between people with a similar interest is so easy via twitter and I've seen some really interesting discussion take place via #tags. This is where I see twitter having more of an impact in future.

  • Ben Bray

    Another good blog post Fiona.

    As you say in your post, one of the most exciting aspects of these new ways of communicating are their power to democratise the sharing and spread of information. Sadly we have ended up in a situation where much of the great body of the world’s medical knowledge is behind walls – not only physical but also virtual in the form of pay-for-access medical journals. Access to this information is determined by wealth, not by need: indeed those populations who are most in need of good quality healthcare are least likely to be served by health systems that can afford widespread institutional access to this knowledge. It is difficult to think how anyone apart from the shareholders of the medical publishing companies benefit from this situation. Personally, I don’t buy the case that this is necessary to ensure quality and maintain standards of peer review – the Public Library of Science and indeed the BMJ have shown how it can be done in a different, and more equitable way.

    Perhaps the burgeoning of new media can support the development of fairer ways of sharing knowledge in medicine and give more people the chance to benefit from the information resources that only the privileged currently have access to.

    Bring on the Twitter revolution!

  • http://twitter.com/ndeaks ndeaks

    Completely agree with Fi (again). I'd add that its also a great place to moan about, albeit recently, the proposed healthcare reforms; but in keeping with the jist of the blog, it's fab if you just can't remember where you accessed a certain paper from – but think others might – Twitter is the perfect place to ask around. As such, Twitter can make your life constantly learning medicine and about health systems that bit easier….

    Looking forward to the next one Dr Fiona….

    Nick (@ndeaks)

  • http://twitter.com/dr_fiona Dr Fiona Pathiraja

    Hi Ben,
    Agree re: open access. I think that Twitter is democratising information but it is limited by where internet access is. Hopefully, in the near future, connectivity will have reached the most rural healthcare settings and open access journals/Twitter etc can really have an impact then.

    Fi

  • http://twitter.com/dr_fiona Dr Fiona Pathiraja

    Agree! I’m currently struggling with getting a group of well-motivated, intelligent people to collaborate, rather than compete. Trying to sell the ‘collaborate, collaborate’ motto with limited success….easier said than done, I suppose.

  • http://twitter.com/dr_fiona Dr Fiona Pathiraja

    Having only met you once in real life, I am amazed by the amount of conversation, banter and knowledge sharing we have done via Twitter. Really think that more trainees need to sign up to extrapolate and deepen the healthcare conversation we are all having here. I also think that Muir Gray's idea for the #betterlife hashtag might have legs. We should give it a go! Fi

  • Allyson

    Net New Growth just posted a blog entry regarding the use of Social Media in Healthcare: http://www.netnewgrowth.com/bl

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