My Twitter Journey

Aaron T. Gerds, MD, MS
Assistant professor of medicine in the Hematology and Medical Oncology department at the Cleveland Clinic Taussig Cancer Institute

My journey to Twitter was not my idea. A few years ago, the chairman of the Cleveland Clinic Taussig Cancer Institute, Brian Bolwell, MD (@BrianBolwellMD), realized that social media could play a vital role in our efforts to care for patients. Along with members of our media department, he saw that Twitter, which at that time allowed us a measly 140 characters to share our thoughts, could be a useful tool for reaching patients, communicating with colleagues, and increasing the visibility of our institute.

There was an internal push to get our cancer physicians tweeting. Members of the media department started holding half-hour training classes for doctors – both a basic Twitter 101 course and a more advanced course about increasing your visibility and creating more meaningful conversations.

It was a great resource, but – don’t tell my boss – I largely ignored the rush to create a Twitter handle.

It wasn’t until I was at the 2014 ASH Annual Meeting, sitting in an education session next to Naveen Pemmaraju, MD (@doctorpemm), and Laura Michaelis, MD (@lauracmichaelis), that I realized the value of Twitter. They were both live-tweeting their thoughts about the presentation, taking part in real-time dialogue with those in the room and around the world. Afterward, we started discussing how they use Twitter to get information about what’s happening in the field.

Twitter isn’t just for millennials, I thought. It’s a way to get up-to-date information about developments in my field and to hear what colleagues think about them.

That was the inspiration I needed. I signed up for an account right then and there.

Finding Your Community

When I ask physicians why they aren’t on Twitter, the most common answer is “I don’t have time for that.” Many of our colleagues don’t view it as a vital part of their practices, so spending time on it seems like a waste. Their default response is, “Leave it to the millennials.”

But, Twitter doesn’t need to take up your whole day. I’m not a user who sets aside dedicated Twitter time, but I fit it in here and there. During the downtime before a meeting, when people are still trickling in, I’ll scroll through my feed. When I’m reading through Blood or scanning PubMed, I’ll comment on an article that piques my interest. It’s an easy way to start a conversation about new information that I find interesting without disrupting my day.

The perceived time commitment can be a huge stumbling block for people hesitant to join the ranks of tweeting physicians. I would argue, though, that it can save time.

It’s our duty as health-care professionals to stay up-to-date on the latest advances in our field, but that’s a monumental task. There is so much medical literature published every day, some research has estimated that if a person wanted to read every piece of literature pertinent to one’s field, it would take more than a decade.

Now, if only there were a place where everybody in your field was looking through the literature, commenting on what he or she finds meaningful, and sharing it with all interested parties …

Twitter really started taking hold for me when I recognized its value as a tool for curating information. You can make Twitter work for you. As with any social-media platform, there is a lot of noise and chatter on Twitter. To me, it’s people who post, “Hey, look at my paper on this,” without offering any follow-up, who distract from meaningful conversations we want to incite.

I eventually found that to use Twitter effectively and make it a valuable part of your professional life, you have to find your community. For example, as a specialist in myeloproliferative neoplasms (MPN), I follow a group of hematologists, patients, and advocacy groups that tweet with the hashtag #MPNSM, or “myeloproliferative neoplasms social media.” The members of this community are all interested in new developments in our field, and we’re all there to start discussions about what these developments might mean for our patients and practices.

With the #MPNSM group, I found a community of people who are interested in having the same conversation I want to have. I’ve been on threads where we’ve had double-digit replies about an individual paper or finding – why it might be important, why we need to pause before we implement the results of the research, and what the next steps for the research should be.

Many, including Joseph Mikhael, MD, MEd (@jmikhaelmd), have dubbed it “the ultimate peer review.” If information is available online, anybody can view it and anybody can comment on it. It’s not just “Reviewer 1” and “Reviewer 2” assessing the information; literally anyone with an internet connection can give you an opinion.

Tweet Like Everyone’s Watching

Condensing information was my gateway, and I quickly found more uses for Twitter beyond filtering the latest and greatest from PubMed. It became a new outlet for interacting with colleagues and patients, and even bringing attention to various issues that I felt were important.

However, with that kind of visibility comes great responsibility. Social media’s predominance in our personal and professional lives is a doubleedged sword: Everyone can see your activity, so you can reach a huge audience with your message and you can pull information from large swaths of the population. That also means that people can see any negative interactions you’re having, as well.

We’ve had countless examples from entertainment, politics, and pop culture: Anything you put online is there for all eternity. I’ve certainly fallen into the trap of having unproductive discussions through Twitter. So now, when I’m getting ready to send something out to my followers – and, really, anyone with an internet connection who might happen across my profile – I listen to the voice in the back of my head that tells me, “Patients and colleagues may see this.”

I didn’t even realize how many of my patients were on Twitter until Elaine Schattner, MD (@ESchattner), a health-care advocate and former physician who has a large Twitter presence, suggested I take a look at my followers list. I was totally shocked to see how many non–health-care providers were on it. My audience was much different than I thought and discovering that has made me a more effective communicator.

My advice is to tweet like everyone’s watching. Don’t post something you’ll regret. Still, I think we should be embracing patients on social media, rather than shying away from them. I had the pleasure of participating in a Twitter chat with patients through #MPNSM, where we live-tweeted for over an hour, answered tons of questions from participants, and had thoughtful conversations with them – not to mention with the hundreds more who were probably following the conversations but not writing in. It reminded me of the patient symposia we hold at our institute; patients can come in and listen to lectures from experts in the field. But, through Twitter, we were able to do it live, organize it quickly, and deliver it to anyone who searched the hashtag.

Patients and Privacy

There is a distinct advantage to opening lines of communication through Twitter: When patients enter the doctor’s office, there is an unmistakable hierarchy; in that formal setting, patients may feel uncomfortable asking certain questions, or may forget to ask the questions they wanted to ask. Interacting with patients on Twitter removes some of that formality. People may feel more comfortable having virtual conversations outside of the confines of the doctor’s office or clinic.

As many advantages as it provides, there are undeniable limitations of using Twitter as a platform for patient interaction. I get tweets from people identifying as MPN patients who ask me for my thoughts about a treatment or for a second opinion. Of course, I can’t perform a full history and physical over Twitter, so it’s impossible to make a fully informed evaluation. However, I can provide general information and steer them to various resources.

We also are governed by patient confidentiality and HIPAA laws, so the transparency and informality inherent to social media is often at odds with the patient protections built into the U.S. health-care system.

Interacting with a Twitter avatar, rather than an “in-real-life” patient, means I can’t perform “the eyeball test” that clinicians rely heavily on in day-to-day practice: When you walk into a room and start talking to patients, subtle, nonverbal communication cues can give you a sense of what they do, how active they are, and how their disease has affected their lives. These are factors we consider in our treatment discussions; they’re also things you can’t discern from virtual patient interactions.

My strategy is to give patients as much information as I can, but I can only explain so much through 280 characters and limited background information. If I can’t answer a question in the context of Twitter, I’ll respond with, “That’s a great question and an important topic. I have a hard time answering that question, but you and your doctor can discuss it.”

In some cases, I steer people toward one of my colleagues in their region who can give them more in-depth information or direct them to a nearby clinical trial center if they have questions about investigational treatments.

Obviously, Twitter is never going to take the place of an actual face-to-face, physician-patient interaction, but it certainly augments what we do. If we keep it professional and recognize the limitations of this type of interaction, it only makes sense for hematologists to leverage this platform to reach our intended audience. Also, many of our patients are likely already on Twitter – shouldn’t we join them?

Hematology Hashtags

Nervous about signing up for a Twitter account? Dr. Gerds offers some advice for overcoming your fears.

Log on and show up.

“As the saying goes, ‘Ninety percent of success is showing up.’ Social media platforms are incredibly intuitive, so just by being there, you can pick up a lot of information about how to use it to your advantage.”

Take inspiration from those you follow.

“You don’t have to tweet a lot at the beginning, but start following people and look at the conversations they’re having. Notice what sticks out to you when you’re scrolling through the feed, or what type of content started a conversation.”

Ignore people with an agenda.

“Finding a good community means weeding out people who log in to Twitter with a malicious agenda. The best strategy I found is simply not interacting with them. If someone tries to provoke you, just move on. While scientific debate is healthy, getting into that kind of heated entanglement is not to your benefit or the benefit of anyone who is viewing your social media feed.”

Inject your personality into what you tweet.

“Don’t be a Twitter robot. Feel free to add a personal touch to your tweets. In a series of tweets, I posted my entire bowtie collection. And many people follow the progress of the tomatoes grown by John Leonard, MD (@JohnPLeonardMD), all summer long!”

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