A Starter’s Guide to Twitter and Hashtags for Hospice and Palliative Medicine

By Dr Matthew Katz, MD  @subatomicdoc

Department of Radiation MedicineDr_Katz2

Lowell General Hospital

MA 01854 USA

Many people find Twitter a bit confusing when they first sign up. This article aims to help palliative care professionals ease their way in, and find it an educationally valuable tool. And turning it the other way round, how can we bring more awareness of ourspecialty’s ideas, news and values to wider society?


With 288 million active users in March 2015, Twitter is one of the most popular social networks (1) The microblogging website’s regular users include many healthcare professionals, patients and caregivers interested in hospice and palliative care.

So, tell me again about the Hashtags?

Hashtags are character strings that include the # symbol and create a labeling system. First used on Twitter in 2007,(2) hashtags began to be used regularly in medicine in 2010. Hospice and palliative medicine participants were early adopters, using #hpm (hospice and palliative medicine), #hospice and #palliative in tweets first in September 2010. Using Twitter or third-party software, users can organize live chats at set times. #hpm adopted this practice early with weekly chats (or tweetchats).

Wrestling with #HPM

The use of #hospice and #palliative has been accurate and active but less focused around a particular community. #hpm emerged and has sustained because of the dedicated weekly organized chat powering conversation and community development. Short hashtags have the benefit of brevity but risk incursions of “noise” from use by other people on Twitter with a completely different meaning. Despite a recent incursion of professional wrestling, it remains strongly focused on palliative care. (3) Based upon data tracked on Symplur.com, a healthcare analytics company that also aggregates hashtags, the most active ones for hospice and palliative medicine are listed in Table 1.

Table 1:

Hashtag First Use Chat Frequency Chat Time (GMT) Tweets (in thousands)*
#hpm Sept 2010 Weekly 1 AM Thurs 306.5
#hospice Sept 2010 189.1
#palliative Sept 2010 104.6
#dwdchat Jun 2011 Discontinued 43.7
#eol Jan 2011 39.4
#hpmglobal Mar 2012 Weekly 12 Noon Mon 33.3
#hpmjc Jan 2014 Monthly Varies 3.7
#PallOnc Aug 2014 6.5

* As of 6 April 2015

Hashtag leaders

No one owns a hashtag; it’s simply a string of characters. There is a tendency for certain users to take a leadership role, like stewards. Leaders can attract others interested in the same topic to the community. The most common ways to identify interesting topics or health-oriented communities are to review interesting people’s hashtag use, ask others on Twitter, or use a hashtag search tool. For the last option, there are many websites but the leader has been Symplur LLC, which has a large database of tags and allows dynamic new submissions by users in its Health Hashtag Project.(4)

Expanding on existing tags

The ability to submit new tags makes it easy for communities to branch into new ones. #hpmglobal and #hpmjc have been ways to discuss specific domains of palliative care with more coherence, a higher signal-to-noise ratio desired by some participants. As the perceived value of online participation increases, some participants may want to pursue leadership opportunities by forming new communities through new tags. Currently Symplur identifies any hashtag’s founder(s), which may provide some incentive to use it as a way to establish leadership.

Multiple communities provide variety. However, there is a strategic advantage for influence if a tag is very active. ‘Trending’ tags, the most active at any given time, are visible to all of Twitters’ users. Even active users that support multiple channels see some value in a stronger signal.

Source: Twitter.com


Differentiator or Dual Tags

Currently, neither Twitter nor Symplur have a planned structural solution to the dilemma. But one way to leverage #hpm and focus it on a single topic is by adding a second tag as a differentiator. Though it doesn’t have the activity of #hpm, I have found it successful for radiation oncology’s tag #radonc to create a separate stream in Spanish to discuss radiation oncology using #radonc #es together.(5)

The approach of dual tags has the advantage of providing traffic to the prime tag while giving specificity. If you think of the hashtag as an interactive radio station, then multiple chats can exist at different times using dual tags. You just ‘tune in’ at set times to the relevant dual tags, yet someone can still find #hpm and discover each niche.

Crowdsourcing tactics

If there is a desire to structure communities rather than see them develop organically, hospice and palliative care professionals and advocates could crowdsource tags representing the specialty, similar to experiments by oncology and radiology.(6,7) This tactic may create diversity while maintaining coherent channels which attract new users and be useful for scientific meetings. The current conventional wisdom is that the best tags are user-generated; whether that principle applies to organized medicine’s needs is undetermined.

What community-building strategies will work best for hospice and palliative care? That is up to those that participate. What do you think?


1. Leading social networks worldwide as of March 2015, ranked by number of active users (in millions). [Internet] From Statista.com. http://www.statista.com/statistics/272014/global-social-networks-ranked-by-number-of-users/ Accessed 13 Apr 2015

2. Messina C. Groups for Twitter; or a proposal for Twitter tag channels. [Internet] From factoryjoe.com.
http://factoryjoe.com/blog/2007/08/25/groups-for-twitter-or-a-proposal-for-twitter-tag-channels/ Accessed 14 Apr 2015

3. Sinclair CT. What to do when your hashtag gets a new meaning. [Internet] From Storify.com. https://storify.com/Pallimed/collaboration-on-hashtags Accessed 14 Apr 2015

4. Lee TS. Healthcare hashtags – a social project. [Internet] From Symplur.com. http://www.symplur.com/blog/healthcare-hashtags-social-project/ Accessed 15 Apr 2015

5. Katz M. Live tweet chats in multiple languages. [Internet] From RadiationNation.com. http://radiationnation.com/health-communications/live-tweet-chats-multiple-languages Accessed 15 Apr 2015

6. Katz M. The oncology tag ontology: professional-centered collaboration and networking. [Internet] From Symplur.com. http://www.symplur.com/blog/oncology-tag-ontology-professional-centered-collaboration-networking/

7. Hawkins M. Radiology hashtag oncology project. [Internet] From Symplur.com. http://www.symplur.com/blog/radiology-hashtag-ontology-project/ Accessed 15 April 2015

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