Social Media in Clinical Practice by Bertalan Meskó [Book Review]

13 09 2013

How to review a book on Medical Social Media written by an author, who has learned you many Social Media skills himself?

Thanks to people like Bertalan Meskó, the author of the book concerned,  I am not a novice in the field of Medical Social Media.

But wouldn’t it be great if all newcomers in the medical social media field could benefit from Bertalan’s knowledge and expertise? Bertalan Meskó, a MD with a  Summa Cum Laude PhD degree in clinical genomics, has already shared his insights by posts on award-winning blog ScienceRoll, via Twitter and Webicina.com (an online service that curates health-related social media resources), by giving presentations and social media classes to medical students and physicians.

But many of his students rather read (or reread) the topics in a book instead of e-learning materials. Therefore Bertalan decided to write a handbook entitled “Social Media in Clinical Practice”.

This is the table of contents (for more complete overview see Amazon):

  1. Social media is transforming medicine and healthcare
  2. Using medical search engines with a special focus on Google
  3. Being up-to-date in medicine
  4. Community sites Facebook, Google+ and medical social networks
  5. The world of e-patients
  6. Establishing a medical blog
  7. The role of Twitter and microblogging in medicine
  8. Collaboration online
  9. Wikipedia and Medical Wikis
  10. Organizing medical events in virtual environments
  11. Medical smartphone and tablet applications
  12. Use of social media by hospitals and medical practices
  13. Medical video and podcast
  14. Creating presentations and slideshows
  15. E-mails and privacy concerns
  16. Social bookmarking
  17. Conclusions

As you can see, many social media tools are covered and in this respect the book is useful for everyone, including patients and consumers.

But what makes “Social Media in Clinical Practice” especially valuable for medical students and clinicians?

First, specific medical search engines/social media sites/tools are discussed, like (Pubmed [medical database, search engine], Sermo [Community site for US physicians], Medworm [aggregator of RSS feeds], medical smartphone apps and sources where to find them, Medical Wiki’s like Radiopaedia.
Scientific Social media sites, with possible relevance to physicians are also discussed, like Google Scholar and Wolphram Alpha.

Second, numerous medical examples are given (with links and descriptions). Often, examples are summarized in tables in the individual chapters (see Fig 1 for a random example 😉 ). Links can also be found at the end of the book, organized per chapter.

12-9-2013 7-20-28 Berci examples of blogs

Fig 1. Examples represented in a Table

Third, community sites and non-medical social media tools are discussed from the medical prespective. With regard to community sites and tools like Facebook, Twitter, Blogs and Email special emphasis is placed on (for clinicians very important) quality, privacy and legacy concerns, for instance the compliance of websites and blogs with the HONcode (HON=The Health On the Net Foundation) and HIPAA (Health Insurance Portability and Accountability Act), the privacy settings in Facebook and Social Media Etiquette (see Fig 2).

12-9-2013 7-40-18 berci facebook patient

Fig. 2 Table from “Social Media in Clinical Practice” p 42

The chapters are succinctly written, well organized and replete with numerous examples. I specifically like the practical examples (see for instance Example #4).

12-9-2013 11-19-39 berci example

Fig 3 Example of Smartphone App for consumers

Some tools are explained in more detail, i.e. the anatomy of a tweet or a stepwise description how to launch a WordPress blog.
Most chapters end with a self test (questions),  next steps (encouraging to put the theory into practice) and key points.

Thus in many ways a very useful book for clinical practice (also see the positive reviews on Amazon and the review of Dean Giustini at his blog).

Are there any shortcomings, apart from the minimal language-shortcomings, mentioned by Dean?

Personally I find that discussions of the quality of websites concentrate a bit too much on the formal quality (contact info, title, subtitle etc)). True, it is of utmost importance, but quality is also determined by  content and clinical usefulness. Not all websites that are formally ok deliver good content and vice versa.

As a medical  librarian I pay particular attention to the search part, discussed in chapter 3 and 4.
Emphasis is put on how to create alerts in PubMed and Google Scholar, thus on the social media aspects. However searches are shown, that wouldn’t make physicians very happy, even if used as an alert: who wants a PubMed-alert for cardiovascular disease retrieving 1870195 hits? This is even more true for a the PubMed search “genetics” (rather meaningless yet non-comprehensive term).
More importantly, it is not explained when to use which search engine.  I understand that a search course is beyond the scope of this book, but a subtitle like “How to Get Better at Searching Online?” suggests otherwise. At least there should be hints that searching might be more complicated in practice, preferably with link to sources and online courses.  Getting too much hits or the wrong ones will only frustrate physicians (also to use the socia media tools, that are otherwise helpful).

But overall I find it a useful, clearly written and well structured practical handbook. “Social Media in Clinical Practice” is unique in his kind – I know of no other book that is alike-. Therefore I recommend it to all medical students and health care experts who are interested in digital medicine and social media.

This book will also be very useful to clinicians who are not very fond of social media. Their reluctance may change and their understanding of social medicine developed or enhanced.

Lets face it: a good clinician can’t do without digital knowledge. At the very least his patients use the internet and he must be able to act as a gatekeeper identifying and filtering thrustworty, credible and understandable information. Indeed, as Berci writes in his conclusion:

“it obviously is not a goal to transform all physicians into bloggers and Twitter users, but (..) each physician should find the platforms, tools and solutions that can assist them in their workflow.”

If not convinced I would recommend clinicians to read the blog post written at the the Fauquier ENT-blog (refererred to by Bertalan in chapter 6, #story 5) entiteld: As A Busy Physician, Why Do I Even Bother Blogging?

SM in Practice (AMAZON)

Book information: (also see Amazon):

  • Title: Social Media in Clinical Practice
  • Author: Bertalan Meskó
  • Publisher: Springer London Heidelberg New York Dordrecht
  • 155 pages
  • ISBN 978-1-4471-4305-5
  • ISBN 978-1-4471-4306-2 (eBook)
  • ISBN-10: 1447143051
  • DOI 10.1007/978-1-4471-4306-2
  • $37.99 (Sept 2013) (pocket at Amazon)
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Medical Black Humor, that is Neither Funny nor Appropriate.

19 09 2011

Last week, I happened to see this Facebook post of the The Medical Registrar where she offends a GP, Anne Marie Cunningham*, who wrote a critical post about black medical humor at her blog “Wishful Thinking in Medical Education”. I couldn’t resist placing a likewise “funny” comment in this hostile environment where everyone seemed to agree (till then) and try to beat each other in levels of wittiness (“most naive child like GP ever” – “literally the most boring blog I have ever read”,  “someone hasn’t met many midwives in that ivory tower there.”, ~ insulting for a trout etc.):

“Makes no comment, other than anyone who uses terms like “humourless old trout” for a GP who raises a relevant point at her blog is an arrogant jerk and an unempathetic bastard, until proven otherwise…  No, seriously, from a patient’s viewpoint terms like “labia ward” are indeed derogatory and should be avoided on open social media platforms.”

I was angered, because it is so easy to attack someone personally instead of discussing the issues raised.

Perhaps you first want to read the post of Anne Marie yourself (and please pay attention to the comments too).

Social media, black humour and professionals…

Anne Marie mainly discusses her feelings after she came across a discussion between several male doctors on Twitter using slang like ‘labia ward’ and ‘birthing sheds’ for birth wards, “cabbage patch” to refer to the intensive care and madwives for midwives (midwitches is another one). She discussed it with the doctors in question, but only one of them admitted he had perhaps misjudged sending the tweet. After consulting other professionals privately, she writes a post on her blog without revealing the identity of the doctors involved. She also puts it in a wider context by referring to  the medical literature on professionalism and black humour quoting Berk (and others):

“Simply put, derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves. Those individuals who are the most vulnerable and powerless in the clinical environment – students, patients and patients’ families – have become the targets of the abuse. Such humour is indefensible, whether the target is within hearing range or not; it cannot be justified as a socially acceptable release valve or as a coping mechanism for stress and exhaustion.”

The doctors involved do not make any effort to explain what motivated them. But two female anesthetic registrars frankly comment to the post of Anne Marie (one of them having created the term “labia ward”, thereby disproving that this term is misogynic per se). Both explain that using such slang terms isn’t about insulting anyone and that they are still professionals caring for patients:

 It is about coping, and still caring, without either going insane or crying at work (try to avoid that – wait until I’m at home). Because we can’t fall apart. We have to be able to come out of resus, where we’ve just been unable to save a baby from cotdeath, and cope with being shouted and sworn at be someone cross at being kept waiting to be seen about a cut finger. To our patients we must be cool, calm professionals. But to our friends, and colleagues, we will joke about things that others would recoil from in horror. Because it beats rocking backwards and forwards in the country.

[Just a detail, but “Labia ward” is a simple play on words to portray that not all women in the “Labor Ward” are involved in labor. However, this too is misnomer.  Labia have little to do with severe pre-eclampsia, intra-uterine death or a late termination of pregnancy]

To a certain extent medical slang is understandable, but it should stay behind the doors of the ward or at least not be said in a context that could offend colleagues and patients or their carers. And that is the entire issue. The discussion here was on Twitter, which is an open platform. Tweets are not private and can be read by other doctors, midwives, the NHS and patients. Or as e-Patient Dave expresses so eloquently:

I say, one is responsible for one’s public statements. Cussing to one’s buddies on a tram is not the same as cussing in a corner booth at the pub. If you want to use venting vocabulary in a circle, use email with CC’s, or a Google+ Circle.
One may claim – ONCE – ignorance, as in, “Oh, others could see that??” It must, I say, then be accompanied by an earnest “Oh crap!!” Beyond that, it’s as rude as cussing in a streetcorner crowd.

Furthermore, it seemed the tweet served no other goal as to be satirical, sardonic, sarcastic and subversive (words in the bio of the anesthetist concerned). And sarcasm isn’t limited to this one or two tweets. Just the other day he was insulting to a medical student saying among other things:“I haven’t got anything against you. I don’t even know you. I can’t decide whether it’s paranoia, or narcissism, you have”. 

We are not talking about restriction of “free speech” here. Doctors just have to think twice before they say something, anything on Twitter and Facebook, especially when they are presenting themselves as MD.  Not only because it can be offensive to colleagues and patients, but also because they have a role model function for younger doctors and medical students.

Isolated tweets of one or two doctors using slang is not the biggest problem, in my opinion. What I found far more worrying, was the arrogant and insulting comment at Facebook and the massive support it got from other doctors and medical students. Apparently there are many “I-like-to-exhibit-my-dark-humor-skills-and-don’t-give-a-shit-what-you think-doctors” at Facebook (and Twitter) and they have a large like-minded medical audience: the “medical registrar page alone has 19,000 (!) “fans”.

Sadly there is a total lack of reflection and reason in many of the comments. What to think of:

“wow, really. The quasi-academic language and touchy-feely social social science bullshit aside, this woman makes very few points, valid or otherwise. Much like these pages, if you’re offended, fuck off and don’t follow them on Twitter, and cabbage patch to refer to ITU is probably one of the kinder phrases I’ve heard…”

and

“Oh my god. Didnt realise there were so many easily offended, left winging, fun sponging, life sucking, anti- fun, humourless people out there. Get a grip people. Are you telling me you never laughed at the revue’s at your medical schools?”

and

“It may be my view and my view alone but the people who complain about such exchanges, on the whole, tend to be the most insincere, narcissistic and odious little fuckers around with almost NO genuine empathy for the patient and the sole desire to make themselves look like the good guy rather than to serve anyone else.”

It seems these doctors and their fans don’t seem to possess the communicative and emphatic skills one would hope them to have.

One might object that it is *just* Facebook or that “#twitter is supposed to be fun, people!” (dr Fiona) 

I wouldn’t agree for 3 reasons:

  • Doctors are not teenagers anymore and need to act as grown-ups (or better: as professionals)
  • There is no reason to believe that people who make it their habit to offend others online behave very differently IRL
  • Seeing Twitter as “just for fun” is an underestimation of the real power of Twitter

Note: *It is purely coincidental that the previous post also involved Anne Marie.





Implementing Twitter in a Health Sciences Library

23 11 2010

Twitter describes itself as “a service for friends, family, and co-workers to communicate and stay connected through the exchange of quick, frequent answers to one simple question: What are you doing?” [2].

The “answers” are equally simple, because the tweet (that what is being “said”) must fit in 140 characters. The tweet does not only contain plain text, but can contain short-URL’s which link to webpages, figures and videos.

However, tweets have evolved to more than everyday experiences, and take the shape of shared links to interesting content on the web, conversations around hot topics (using hashtags (#), like #cochrane OR #ev2010 (conference evidence2010)), photos, videos, music, and real-time accounts of a newsworthy event [2]. Furthermore, Twitter is now also used by institutions and companies  for branding, marketing and costumer service. This also applies to libraries, with public libraries leading the way. Health science libraries started twittering  in 2009 and as of 2010 there were (only) 24 of them. In addition, the National Library of Medicine (NLM) and most of the regional National Network of Libraries of Medicine (NN/LMs) have a Twitter presence.  I follow @NLM_LHC and @NLM newsroom, for instance.

The NYU Health Sciences Libraries (NYUHSL) began using Twitter in June 2009. The team, consisting of the Director, the Emerging Technologies Librarian and the Web Services Librarian of the NYUHSL, described their experience with the implementation of Twitter in the latest Medical Reference Services Quarterly [1]

The main aim of their Twitter account was to disseminate topics similar to what was posted on their Web site: news about facilities, resources, handy tidbits, services offered, downtime, events, and staff, as well as breaking news.

What was their approach and what were their main experiences?

  • Claim your name, as soon as you vaguely consider using Twitter!
    In the case of  NYUHSL, their usual library acronym was already taken, so they took a similar name: @NYU_HSL (because of the 140-character limit, it is advisable to use as few characters as possible: this will leave more room when somebody replies to you).
  • They added the library logo as a profile picture and included a link to the library website plus a short “bio”.
  • First the team shared responsibility for posting on Twitter (by logging in into the NYU_HSL account and posting), but this posed coordination problems (like double postings, irregular postings). Therefore it was decided that team members would post according to a schedule. Furthermore there was a 2-week rotation. Any important news was tweeted promptly and interesting news from other Twitter users was occasionally retweeted .
  • Later CoTweet was used. This is a free tool, which -as its name suggests- allows multiple people to communicate through corporate Twitter accounts and stay in sync while doing so. One person is the account owner, who creates and maintains the account and gives other people access to it. The individual members can post to Twitter via the Co_tweet account.  CoTweet uses bit.ly as an URL-shortener, displays some (rudimentary) stats, allows scheduling and archiving of tweets and has some other slick features for corporate Twitter use. (See  this post at News CNET for a comparison between CoTweet and the better known Hootsuite)
  • What I most liked about the paper – besides the description of CoTweet – is the content flow diagram the authors used (adapted below). Posts from their library blog were automatically cross-posted via RSS to Twitter using Twitterfeed, whereas tweets were in their turn automatically posted on Facebook. To this end a Twitter Tab was added to the NYUHSL Facebook fan page. In addition it remained possible to post manually to the different social networking tools and to respond to followers or retweet messages of other users.

  • The team also had to find the right tone for Twitter: the style of tweets is more informal than the style of blog posts. They emphasize the importance of keeping the nuances of different social networking sites in mind when establishing an institutional presence.
  • They promoted Twitter in many ways:
    • A large Twitter mascot (blue bird) with the text: “Follow NYU_HSL on Twitter” was placed on the prominent Web’s site feature bar (see Fig. below). Unfortunately the twitter message only appears when you press “next”. Most users will not do this.
    • Creation of a small poster about Twitter.
    • A word of mouth campaign (in orientation presentations, and a tag line with Twitter account information in e-mail correspondence to students: according to Pew Internet [3] college graduates are among the biggest users of Twitter.
    • description and promotion of the Twitter account in the library’s e-mail newsletter and in blog posts.

And finally, we have to come up with the Key Question: was it all worth the effort?

At the time of writing the NYU-HSL had 66 followers, 27 of which were affiliated with the NYU (others being other libraries and librarians for instance). This is not a very big (target) audience, but I agree with the authors that the definition of success in social media is relative.  There were clear (subjective) benefits, like the low cost, ease of use, low effort to maintain the service on the one hand and the possibility to engage the audience, get user opinions and the opportunity to fix problems quickly on the other hand. Furthermore it’s presence on Twitter enhances the library’s reputation, as the library is making an effort to extend beyond its walls and confirms the role of librarians as technology leaders.

I also agree with the library’s basic principle “to give users as many options as possible to keep current with library news, resources, and services.” In this regard Twitter is a simple and effective method for promotion.

Thus health, medical and other libraries. I would say, if you are not twittering, give it a try and read the reviewed paper [1] for more tips. One of these tips is to connect with other libraries on Twitter as to learn from their experiences.

Credits:  @DrShock dm-ed (direct messaged) me on Twitter to alert me to the paper. Thanks Walter!

References (all assessed 2010-11-23)

  1. Cuddy, C., Graham, J., & Morton-Owens, E. (2010). Implementing Twitter in a Health Sciences Library Medical Reference Services Quarterly, 29 (4), 320-330 DOI: 10.1080/02763869.2010.518915
  2. Mashable http://mashable.com/guidebook/twitter/
  3. Lenhart, A., and Fox, S. ‘‘Twitter and Status Updating.’’ Report: Web 2.0, Social Networking. Pew Internet & American Life Project (February 12, 2009). Pew Internet: http://www.pewinternet.org/Reports/2009/Twitter-and-status-updating.aspx




Friday Foolery #36 : Friends on Facebook

15 10 2010

I found this hilarious South Park video about Facebook Friends on Jud’s Education Emporium.

It was used to illustrate that “friending” doesn’t mean a lot, although in this video it does mean an awful lot to some real-life friends of Stan.

In real life this happens too. See Paul’s “outpouring” on Facebook…..

(relatie=relation(ship))

Paul has a relation (on Facebook)

 





Silly Saturday [32] Do You Know Who’s Watching You?

28 08 2010

Curious to know “who is watching you” then watch the infographic* made by Wordstream.com (a marketing company).

A previous post already addressed privacy problems with Facebook (also showing infographics).  Here is also described how you can reclaim your privacy using a simple bookmarklet.


* At Wordstream I could only find this infographic, which is part of the infographic shown above. The entire infograph was taken from Power of Data Visualization (pdviz.com), and also found at Thoughtpick. Both refer to Wordstream without linking to a particular page.

Related Articles





Reclaim your Privacy on Facebook using a Simple Bookmarklet

20 05 2010

Of all social networking sites, Facebook causes the greatest privacy concerns. Certainly since it has changed its privacy options over time.

In the beginning, Facebook restricted the visibility of a user’s personal information to just their friends and their “network”, but the default privacy settings have become much more permissive, as you can see in the video below.
This short video is based on a visualization made by Matt McKeon and gives only an impression of a work-in-progress
(for up to date info check the original animation at http://mattmckeon.com/facebook-privacy/).

The reason? According Facebook founder Mark Zuckerberg the controversial new default and permanent settings just reflect the way the world has changed, becoming more public and less private (see ReadWriteWeb).

“Default” is the key to the problems. You have to opt out to protect your privacy. However to fully protect your privacy on Facebook, you have to navigate through 50 settings with more than 170 options (see great charts at the NY Times!). Facebook’s privacy policy is longer than the American constitution!!!

Shocked by the results of the ACLU’s Facebook Quiz (see Mashable), I already changed my privacy settings last summer. Doing a simple quiz on Facebook meant everything on your profile (whether you use privacy settings or not), is available to the quiz. Even more worrying, when your friends do a quiz, everything on your profile is made available to the developers as well.

Since the default privacy settings have changed, my settings needed to be adapted again. But where were the leaks in the 170 options?

Luckily there is a very simple bookmarklet Reclaim Privacy that can check and fix your profile in 2 minutes (see Mashable.com) It is very easy.

1. First go to Reclaim Privacy and drag the bookmarklet to your web browser bookmarks bar
(in the example I dragged the bookmarklet into Chrome’s bookmarks (upper arrow)

2. Go to your Facebook privacy settings and then click that bookmark (Scan for Privacy, see arrow) once you are on Facebook.

3. You will see a series of privacy scans that inspect your privacy settings and warn you about settings that might be unexpectedly public.
In my case my friends could still accidentally share my personal information. This is indicated by a red sign: “insecure.

4. So I clicked “prevent friends from sharing your data”, and in seconds this was the result:

5. I tweaked the contact information a bit (caution) by changing my contact settings, but I still would allow everyone to add me as a friend (I still have to approve, don’t I?)

Piece of cake!





A Quantitave Study suggests that Twitter is not Primarily a Social Networking Site

13 05 2010

A lot can be said about Twitter, Facebook, Linkedin and other social media. What is the best, the most useful, the most popular the most social (and has the least privacy-issues, hehe Facebook)?

You know I love Twitter. Twitter is a social networking and microblogging service that enables its users to send and read messages known as tweets. The tweets don’t exceed 140 characters, so your message must be very concise. For me Twitter is a very rich source of information and a useful networking site. But it is hard to explain that to others.

Some Most people think that individuals who twitter are just parroting others (hé this is called retweeting, guys!) or are just egocentric bores (“I eat cornflakes for dinner”).

Well, a recent quantitative study by a group of researchers at Korea’s Advanced Institute of Science and Technology suggest that they might just be right. … Or at least their data suggest Twitter may be less of a social site and more of a news site.

According to Haewoon Kwak et al this is the first quantitative Twitter study ever.

The researchers crawled the entire Twitter site and obtained 41.7 million user profiles, 1.47 billion social relations, 4,262 trending topics, and 106 million tweets. They looked at the follower-following topology, looked at the ranking by number of followers and by PageRank, analyzed the retweets and the tweets of top trending topics.

You can read the main conclusions in the power presentation below and their abstract for Proceedings of the 19th International World Wide Web (WWW) Conference, April 26-30, 2010, Raleigh NC (USA). Below the abstract you can also find links to two download files, enabling you to reanalyze the data
Going Social Now and ReadWriteWeb also give a nice overview.

What are their main conclusions:

  • Twitter is not very “social”
    • It is “I follow you”, not “lets become friends” and you don’t have to approve or follow back. Following thus means that you “just subscribe” to the tweets of that person.
    • Only 22.1% of the relationships are reciprocal, thus 77.9% of the relationships is one way, just one of two is following the other. Surprisingly, 67.6% of users on Twitter are not followed by any of the people they follow.
    • this low reciprocity is unlike all other human social networks.
  • For most tweople, Twitter is primarily a source of information, not a social networking or information dissemination platform.
    • The Majority of topics (54,3%) are headline topics
    • Few users reach a large audience directly.
    • The average path length between two people on Twitter is 4.12. This is much shorter than Stanley Milgram’s original experiment uncovering the “six degrees of separation” phenomena.
    • Any retweeted tweet is to reach an average of 1,000 users no matter what the number of followers is of the original tweet.
    • Once retweeted, a tweet gets retweeted almost instantly on next hops, signifying fast diffusion of information after the 1st retweet.

It is a beautiful study that highlights the topological characteristics of Twitter.

One word of caution. Twitter is analyzed as a whole. There are many subpopulations with their own kinetics and goals. So the majority of people may follow the news, and fans may follow a celebrity by the million, but there are (relatively) small niches on Twitter, like health and medicine (or science) that may not follow the same rules.
I daresay (guess) that more people in this niche follow each other and do use Twitter both as a source of information and as as  network for social communication.
But these small niches are outnumbered by others (news sites, CEOs, celebrities).
At least that is my hypothesis.

Who is going to test this??

Many different Twitter birds in a flock

Credits