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Putting Twitter to Use Among Oncologists: Shared Note-Taking at National Meetings and Other Stuff

Michael Fisch, MD, MPH

05 Dec 2012 6:07 PM

“Still having trouble wrapping my head around all the tweets. They say so little…but I’ll keep trying.”

This simple statement by a colleague via email is completely understandable. I can appreciate that the value of reading or sending tweets can be obscure. And often there is little or no value—it varies. It depends on the person tweeting, the relevance of the content to you, and the quality of the information being shared. And like anything else, the whole deal might not resonate with some people. It is perfectly fine to ignore it altogether (just like some people don’t ride bikes, or go swimming, or listen to country music).

Let me explain the anatomy of three example tweets (below): tweets A, B, and C.

Tweet A
@fischmd December 3, 2012. 12:40 PM via HootSuite

  • Patient experience design: @ClevelandClinic strategy, culture shift push for better care dlvr.iYVTS4 via @n8pennell #health #hpm

    Tweet A tells you that the Cleveland Clinic is working on a culture shift related to patient experience design. That alone may have no value to you if you are not interested. If you are interested, the tiny URL link takes you to a newspaper article from the Cleveland Plain Dealer explaining this in more detail and telling you about Dr. James Merlino, the colorectal surgeon who is now the Chief Experience Officer at the Cleveland Clinic and what that unusual job title entails. The article was noticed by a thoracic oncologist at the Cleveland Clinic (Dr. Pennell). Because he found it of value and tweeted it—I noticed it and found it of value and retweeted it. Through retweets, it was shared with others like you (who might not notice it at all, or who might skim over it if it is not of value to you…). The #hpm hashtag indexes this content to those from the world of hospice and palliative care who might be interested.

Tweet B
@fischmd Dec 2, 2012. 10:05 PM via HootSuite

  • Reverse translational science: how #cardiotoxicity from HER2-directed tx of #breastcancer led to rNRG1 therapy for CHF ow.ly/fLfgf

    Tweet B is a straightforward "heads up" about a recent NEJM essay illustrating how cardiotoxicity with trastuzumab has led to some basic cardiovascular science insights about how the heart repairs itself and triggered new drug development with recombinant neuregulin-1 to treat congestive heart failure. The tweet entails a short headline to describe the topic and then a tiny URL that takes you to the PubMed citation for the NEJM essay. Within PubMed, you can click on the link to get the full text if you have NEJM access. If you are interested in this topic, this tweet can be a useful alert. It is all too easy to overlook stuff even when you subscribe to the NEJM or JCO etc. What if you are not interested in the topic? It is skimmed over painlessly. You can screen a lot of “headlines” on twitter rapidly…and you can access Twitter (or useful dashboard applications like Hootsuite or Tweetdeck) using your smartphone. This should not take up your valuable attention when you are in clinic or doing something else at your computer or paying attention to your family. It can be used when you are waiting at the airport or when you have some other small fragment of time available for this kind of exploring for information and connection.

Tweet C
@fischmd Nov 30, 2012. 11:32 AM via HootSuite

  • Hard for oncologists! Newcomer at #ASCOQLTY: It is more important that you do it the same than that you do it "right" (Brent James quote)

    Tweet C is an example of using twitter as a shared note-taking method. The Brent James quote that struck me as so insightful was tweeted by me during the ASCO Quality Care Symposium. I took some notes on my laptop and also sent some tweets to help me recall and review the key points (because I can gather the tweets and review them afterwards). Tweeting some key points also shares my "notes" with others at the meeting as well as those who aren’t there but may have interest. At this ASCO meeting, by following the hashtag #ASCOQLTY, I could see who else was there and which of the speakers' statements resonated with them. It was a good conversation starter during the breaks. It also helped me catch some good points from others that I missed (due to distraction or fatigue). Moreover, I felt more engaged with the patient viewpoint about various issues being discussed, because I saw the various tweets from a variety of patient advocates and survivors. As an aside, remember that you can gobble the great information from this inaugural ASCO Quality Symposium by going to quality2012.asco.org

While I am not attending the San Antonio Breast Conference currently, I have already seen a few key points from this morning’s AACR talk on minority issues by Dr. Sexton. I can do this because highlights are being tweeted by generous note takers that I can find by searching #SABCS [Example: RT @regrounding: Can’t lump Hispanic women together—area of origin changes risk factors for #breastcancer. #SABCS @AACR].

Although Twitter will not appeal to every oncologist, or even most oncologists, I hope that this explanation helps my colleague who expressed trouble “wrapping my head around all the tweets.” The more oncologists who tweet, the more we will learn from each other, understand the perspectives of patients and caregivers, and ultimately influence cancer care and science for the better.

Comments

Number of Comments: 10
Michael Fisch, MD, MPH

Sunday, December 09, 2012 11:08 AM

In the first 4 days since this blog posted, there have been no comments on the ASCO Connection blog.  But not surprisingly, there have been a variety of comments via Twitter.  Here is one Sunday morning example: 

ElaineSchattner 8:59am via TweetDeck Like idea of shared notes, incl. questions: MT @mtmdphd: Putting Twitter to use among oncologists, @fischmd - ow.ly/fS5Ro #ASH12

Here's a few interesting aspects of this example from my standpoint: 

1.  It occurs on a Sunday morning.  Many physicians look at Twitter on weekend mornings more than during their hopelessly frenetic workdays.  It is worth paying attention to the time during any given day that you send a tweet.  The Tweet is like putting a note in a bottle and throwing it into the ever-flowing Twitter stream of info.  The likelihood of getting your note read by your intended audience depends on not only how often the message is amplified (via retweets), but also whether your intended audience is likely to be looking at the Twitter stream for information when your note floats by.   I am not saying that weekend mornings are the only time to Tweet, but it is probably a decent time.  Also, it is OK to send a given message more than once, but if you do that, you may as well send it at different times of a day and/or different days of a week.

 2. The root of this message by Dr. Schattner is a heads-up tweet with the link to this ASCO connection blog by oncologist and social media key leader Dr. Michael Thompson (@mtmdphd, with 1809 followers--also called "tweeps"). Dr. Schattner (@ElaineSchattner) is a medical oncologist and breast cancer survivor and a writer with a unique perspective on health, research, and medical education.  She has 3819 tweeps, and she undoubtedly has some overlapping tweeps with Dr. Thompson, but her audience is going to be mostly different.  I don't know exactly how many unique followers would be expected to have an opportunity see a tweet mentioning this blog based on Drs. Thompson and Schattner tweeting the link.  I do know that most of those who had the opportunity will miss it anyway (won't notice, won't be near the river when the tweet floats by, etc.).  And only a subset of those that see it will click the link and read it, and only a subset of those might retweet it.  But alas, if you start including not only these individuals but others,  you start to get a handle on how ideas can spread via Twitter, and how chaotic and uncertain this process really is.

 3.  Dr. Schattner added a hashtag to her tweet.  She added #ASH12.  What does this mean, and why did she do it?  I've described the hastag as a way of indexing tweets.  But perhaps a better way to think about it would be to consider it as a distribution outlet.  It is like saying: "Dear people on Twitter who are following the American Society of Hematology 2012 meeting via the #ASH indicator, here's a tweet with a link that might interest you."  This is one way tweets can flow to vast and eclectic audiences.  If somebody else retweets this and adds #hcsm (healthcare social media) and then somebody else adds #bcsm (breast cancer social media) and then #meded (medical education) and #biotech, you can imagine that the compounding is not just by individual tweeps but by entire audiences of tweeps. 
Michael A. Thompson, MD, PhD

Sunday, December 09, 2012 2:05 PM

Mike –


A few comments…


1)    Elegant initial and follow up posts. Thanks for noting relevance to the #ASH12 meeting.
2)    I believe the ASCO Connection blog posts are read by many, but interesting to note the relative paucity of comments. Maybe we can discuss offline the potential barriers. Ideally this would be a place to discuss (as your follow up post did) more nuanced comments and expansion of thoughts not easily done on twitter. Also, the ASCO Connection forum offers an oncology specific focus that differs from other potentially utilized online forums.
3)    Your posts have sparked some online commentary especially "...see who else was there / which speakers' statements resonated". I’ll attempt to synthesize and get back to you on further possibilities. I think there are ways to explore/expand the oncology community beyond what we are currently doing. Because as you state: “The more oncologists who tweet, the more we will learn from each other, understand the perspectives of patients and caregivers, and ultimately influence cancer care and science for the better.”
4)    Fisch food for thought sound bites that I pulled out of the blog and tweeted with enthusiastic interest on Twitter:


"...the whole deal might not resonate with some people."  RE: Twitter/Oncologists/Shared Note-Taking at Nat'l Mtgs 


"Tweeting some key points also shares my "notes" w/ others..." 


"...see who else was there / which speakers' statements resonated" 


"The more oncologists who tweet, the more we will learn from each other, understand perspectives of Pts & caregivers.."


"The Tweet is like putting a note in a bottle and throwing it into the ever-flowing Twitter stream of info."


And response -- and collecting the info from the stream = > fun than a Grizzly in Salmon.

Michael A. Thompson, MD, PhD

Monday, December 10, 2012 5:51 PM

A recent tweet and post relevant to twitter and oncology digital life (this regarding breast cancer).

@brianreid: Say you have a database of 2,000+ verified tweeting docs. What can you learn? Quite a lot:bit.ly/SRY8Xn

MDigitalLife – Diving in to the Data

"Digging into the Breast Cancer links that were shared most online, we’re able to identify doctors who are creating content on their personal blogs and how they’re connecting within the digital ecosystem via Twitter." 
(bold added)

 
Michael A. Thompson, MD, PhD

Tuesday, December 18, 2012 5:22 AM

Mike -
If you haven't seen it yet, you might want to check out this blog post "Clinical Sketchnotes"from  Bryan Vartabedian, MD (@Doctor_V) at 33 Charts:
http://33charts.com/2012/12/sketchnotes.html#comments

" It details a method of note taking that I’ve been witnessing at major meetings over the last couple of years.


 
Joseph Kim

Tuesday, June 04, 2013 10:36 AM

Twitter may not appeal to many oncologists who do not want to receive communication directly from patients. It can be awkward to "ignore" requests on popular sites like Facebook or Twitter from patients. Hence, the use of closed, restricted online communities for medical professionals like Doximity or QuantiaMD are valuable resources for doctors who wish to share information, ask questions, and collaborate. 
Michael A. Thompson, MD, PhD

Tuesday, June 04, 2013 10:45 AM

Joe -

Great comments.
I just started a closed group for a subset of oncologists on Doximity in order to help maintain contacts and allow for group discussions in the future. LinkedIn has some utility for that, but a smaller format with authentication of profiles is helpful.

Despite a lack of enthusiasm from some physicians to enter social media, we are seeing more uptake.

Dr. Anas Younes recently (6/3/13) commented on
Doctors in the Age of Social Media
http://chicago2013.asco.org/doctors-age-social-media

Excerpts:
The most common excuse is, “I do not have the time.”
This excuse reflects the lack of knowledge on how to use social media in medicine.
...
So participating in social media, such as tweeting a link to an interesting new medical finding published in a scientific journal, takes only a few seconds.

and concluded:
(bold added)

"Social media in medicine is not about socializing with others.
It is as professional a forum as presentation at a national meeting.
The difference is that with social media, the audience can consist of millions of people.
Public and patient reliance on social media for important information is a fact that physicians can no longer ignore. 
"
Michael Fisch, MD, MPH

Saturday, June 08, 2013 6:49 PM

Dr. Kim's comment is one that comes up a lot:  "Twitter may not appeal to many oncologists who do not want to receive communication directly from patients. It can be awkward to "ignore" requests on popular sites like Facebook or Twitter from patients." 

I have been using Twitter since February 2011, and requests to interact from my own patients have simply not been an issue.  Patients that we care for directly have other, more appropriate avenues for interacting with us in the context of the physician-patient relationship (telephone, secure messaging, sometimes email, etc.).  When I refer to interactions with "patients" on Twitter, I mean "people with illness, like cancer, who are not in my direct care."  For example, if I Tweet about an ASCO paper related to fatigue in breast cancer patients, some people who have breast cancer or their close contacts may make a comment in reference to the Tweet.  It is uncommon for me to receive many direct messages on Twitter, although I do get some.  I don't treat Twitter like email, where I feel compelled to check it regularly and systematically acknowledge and respond to stuff.  I check Twitter ad hoc, and engage as time (or my comfort zone) allows.  The key point, I think, is that Twitter is not a place for interacting with your own patients and it is not the kind of grind that email can be...at least in my own experience of it.  I'm curious about how others see it.
Claire Johnston

Wednesday, November 20, 2013 4:04 PM

Hi Dr. Fisch. I'm revisiting this particular blog of yours after Dr. Thompson shared it on Mayo's SM Health Network, as one way to think about the relevance and utility of hashtag use during meetings.

What do you think about updating this entry next year, in advance of #ASCO14? I think you provide really great guidance on how to use hashtags and Twitter during meetings. We saw phenomenal usage of our meeting hashtag this year, but as we move into the future, I think we'd all like to see more nuanced use of hashtags during our AM, so people can get the most out of the wealth of information being shared. Perhaps this nuanced use can be accomplished by tagging by track, or disease specific tags and then encourage use of those tags in conjuction with the meeting tag?
As you pointed out, Twitter threads and the thoughtful use of hashtags can enrich the experience of attending a meeting as well as engage those that aren't able to attend. The idea of sharing notes on Twitter, with the help of hashtags, is very compelling and may foster a richer experience for our attendees next year.

Look forward to any of your thoughts!

Michael Fisch, MD, MPH

Wednesday, November 20, 2013 8:32 PM

Hi Claire, thanks for your feedback and for revisiting this post.  I think that updating this kind of entry in advance of #ASCO14 would be fun to do and potentially useful for the reasons you outlined.  There is now a Social Medial Working Group in SWOG (using #SWOGOnc, @SWOG) and also is a new initiative in ECOG-ACRIN (using #EAOnc, @EAOnc). Various other clinical cooperative groups and cancer advocacy organizations and cancer centers and practices (as well as individual oncologists) are also getting involved with twitter.  Dr. Matthew Katz (@subatomicdoc) has done great work in thinking about the hashtag taxonomy (see this ASCO Connection post ow.ly/qZoHy), and with some guidance from ASCO, this might be able to be put to grand use at #ASCO14.
Claire Johnston

Saturday, November 23, 2013 4:07 PM

Thanks, Dr. Fisch!

Agreed. Dr. Katz has made some great contributions to forging clarity around cancer care hashtags. The Cancer Tag Ontology page he worked up is terrific. In fact, trying to puzzle out whether to post some of the disease type specific tags (#bcsm, #lcsm, etc.) on our social media page: http://www.asco.org/about-asco/social-media or just link to the Symplur page itself. I've reached out to Dr. Katz to inquire about his thoughts on the idea and welcome your thoughts as well!

Thank you again. I appreciate your insight.

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