Compassion, #COVID19, and @Twitter

No one listens, learns, or changes their mind when they are being attacked. As healers, we know this. We deal with patients and families all the time who don’t understand or are so traumatized that the last thing we would think of doing is yelling at them as we try to help them on their journey to health.

We’ve all seen the videos of mobs of people without masks rushing to get to the front of a crowd to hear @realDonaldTrump. We’ve all seen the photos of people in crowds at bars, parties, and on college campuses with no one wearing masks. If you are tempted to think this is ok, I have two things I’d like to share…

It’s not about you.

I totally agree that, as an adult, if you want to not wear a seatbelt, you have that right. But you don’t have the right to drive drunk and kill or injure someone else. If you want to drive 80 miles an hour on your ranch and ignore safety, go for it! But if you want to speed and run stop signs on our shared roads, that’s not ok. Why? Because the person you hit with your car could be a family member or friend… and they will unquestionably be a neighbor (because we are all neighbors).

Masks are about compassion.

If you come down with COVID19, it’s also not just about you. If you do get sick with COVID19 (and I hope you don’t), it’s not about “getting over it” like a cold. You could have a lifetime of consequences… but if it was just about you, that would be your choice.  But that’s not how this works.  If you are COVID19 positive (with or without symptoms), you can infect your elderly family member, the kid next door who is on chemotherapy for cancer, the nurse who takes care of you when you go, frightened and alone (since no one will be allowed to stay with you), to the hospital.

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Since my new friend on Twitter asked me about the science, I’m happy to help with some of what we know:

  1. Masks decrease the spread of COVID19 in a community.
  2. Masks do not cause low oxygen levels.
  3. Masks do not cause an increase in carbon dioxide.
  4. COVID can be spread for up to 6 days before you develop symptoms.
  5. There are people who have the virus, can spread it to others, but never develop symptoms.
  6. The virus is small, but it travels on droplets (that’s how others get infected) – and that’s why masks work. (That’s also why it’s not cool to put on masks made of lace, gauze or other things with holes)
  7. We can’t rely on herd immunity, unless we think its ok to have up to 2 million dead Americans.
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p.s. I changed how I interact with folks on social media after I listened to Nadia Bolz Weber’s interview with Megan Phelps-Roper on her podcast, The Confessional. Megan Phelps-Roper was a member of the Westboro Baptist Church who became the voice of her family on Twitter, spreading their particularly venomous message. But a funny thing happened … there were people on Twitter who, instead of yelling at her, responded to her venom with compassion and curiosity… and it changed her life.

Twitter for Physicians

I was asked to speak today on using Twitter in medical education at the 44th annual meeting of the American Pediatric Surgical Association. I used Status Present, an incredibly cool software designed by Fred Trotter.  As I talked using these “slides”, they were tweeted at the same time.  It’s interesting to me that using this technology felt like a return to the era before Power Point, when talks were given by following “talking points” rather than slides.  It’s not going to be applicable to all talks, but this was really fun!

Twitter in #meded for #pedsurg – a presentation which will be live tweeted and will then be posted on my blog wellnessrounds.org

I blog and microblog (Twitter) because I am a teacher. #meded

Once you learn the details (easy) Twitter becomes a new platform to teach (and learn) #surgery

Why don’t more #physicians use Twitter?

4 reasons #physicians don’t use Twitter 1/4: “I don’t get it” Link to my post on Blogging, Microblogging and Time

Twitter is NOT email.  Twitter is NOT Facebook.

The best word to describe Twitter is “ephemeral”

Twitter is the surgeon’s lounge.  Walk in.  See who is there. Eavesdrop or join the conversation. Leave when you want.

4 reasons #physicians don’t use Twitter 2/4: “I don’t know how”

Two steps to start on Twitter.  1/2: Pick your @name (handle). Short is better.  Professional is essential. How To Choose a Good Twitter User Name

Two steps to start on Twitter. 2/2: Dive in. Follow a few people, then look at who they follow. Getting Started on Twitter

#hashtags can be a specific event or topic (#pedsurg) or for fun #ihaveglutealischemia How To Use Hashtags in Twitter

Retweet = repeating the conversation you heard in the surgeon’s lounge.

Filter Twitter conversations by making or following “lists” How to Create and Manage Twitter Lists

Twitter 101:  @name, follow @whoeveryouwant,, retweet what you like, follow (and unfollow) as you like, make lists  #havefun

4 reasons #physicians don’t use Twitter 3/4:  “I don’t have time”

Twitter is not email. You don’t have to read it all (you can’t).  #lesstimethanyouthink

Minimizing wasted time on Twitter: 1) Make lists 2) Follow specific #hashtags

4 reasons #physicians don’t use Twitter 4/4: “I don’t think it will help me”

5 ways Twitter helps #physicians. 1/5 Breaking news. @cnnbrk @msnbc_breaking @BBCBreaking

5 ways Twitter helps #physicians. 2/5 Medical (and other) emergencies. @CDCemergency @Houston_Weather @BCMHouston @TexasChildrens

5 ways Twitter helps #physicians. 3/5 Following meetings and thought leaders @APSASurgeons @AmerAcadPeds @BAPS1953 #pedsurg

5 ways Twitter helps #physicians. 4/5. Efficient way to follow journals & journal clubs. @NEJM @JAMASurgery http://bit.ly/10W3Q17

5 ways Twitter helps #physicians. 5/5 Discovering important information in your field or other fields.

Ex: @JAMA Surgery Comparison of #CT scan and #Sestamibi for #parathyroid localization bit.ly/ZrZeMu #PTH #endocrinesurgery

Twitter is particularly powerful for #physicians in #meded

Twitter links #physicians to #meded topics, resources and people

Ex (tools for #meded)  @amcunningham Electronic Clinical Logs/Portfolios for students lnkd.in/_vJPBM

Ex (resources) @bnwomeh Get free copy of ‘Paediatric Surgery: A Comprehensive Text For Africa’ at #eAPSA2013 reg desk img.ly/uuDF

Ex: (GME info) @TheNRMP Match Results Statistics for Pediatric Surgery & Pediatric Hem/Onc ow.ly/kBVAg ow.ly/kBVCS

Ex (meetings) @BrianSMcGowan Please join our #eapsa2013 conversation 2-4 PMET via Twitter – as we help pediatric surgeons embrace #SoMe! #hcsm #meded #eapsa2013

Twitter is an important tool for #meded

You can’t stay with a rotary phone in a smart phone world… especially if you teach. #Meded

“When medical students see an attending with a newspaper they think it is quaint” @LouiseAronson #DontBeADinosaur

Blogging, Microblogging, and Time

I have become so enamored with Twitter that I have been writing less for this blog…. which got me thinking….

doctor-twitter

Both my Twitter account and this blog serve the same purpose – to  serve as a “tool kit” for medical students, residents and practicing docs.  But it’s really interesting how different they are in accomplishing this goal.

Twitter is the equivalent of  the “surgeon’s lounge” – comments about interesting things you’ve seen or heard, showing people something in the news, or short pieces of advice.   Writing for a blog is more like sitting down in a quiet space with a colleague to discuss a topic, work on a project or give advice.

There is one important aspect of Twitter that is particularly interesting for physicians. If there is serious breaking news, Twitter will probably hear it first.   A good example is how the CDC uses Twitter. It can also be used to update everyone in a medical school or hospital.  Another interesting use of Twitter for physicians is “tweeting” medical meetings.

There is a learning curve for all social media.  Twitter, in particular, can become a remarkable time waster with little benefit.  If you are a busy student, resident or physician and want to use Twitter efficiently, here are some ideas that might help

  • A busy resident told me that he uses Twitter only for the news.  He gave up reading the newspaper and watching CNN to follow them on Twitter.  He reads the headlines and uses the link to read only the articles that interest him .
  • It’s not Facebook.  Anyone who starts tweeting about where they are going to get coffee gets “unfollowed” immediately.  For busy professionals, Twitter is not the best way to connect with friends.  It is, however, a fantastic way to connect you to communities, causes, issues, etc.  The way this is done is with hashtags (markers for a common theme).   For example, people interested in medical education use #meded.

Healthcare hashtag project

Medical hashtages on hashtags.org

  • It’s not email.  You don’t have to read them all.  If you have a minute, skim what’s there, but don’t worry about the rest.  Twitter is supposed to be ephemeral.

If you aren’t on Twitter and want to get started here are a few links to help: Newbies guide to Twitter from cnet.com, Twitter 101 from twitter.com, Twitter tutorial

On last (but incredibly important) thought. Using Twitter (or any social media) is different if you are in medicine. Every company has guidelines about using social media.  In medicina, we have a standard for how we can discuss what we do that is different than the rest of society.   Here’s some rules that will keep you safe.

  • Do not (ever) discuss a patient, post a picture of a patient or put anything online that could identify a patient.  This is the law (HIPAA) and it is our ethical and professional obligation.
  • Do not give medical advice via social media.  If you are contacted by a patient that you are really worried about, the only thing you can do is tell them which office/hospital to go to or where to call.
  • Do not put negative comments about a colleague or institution on social media.  If you need to ventilate, find a friend and go out somewhere.  Think of social media as the “microphone in the elevator”.  Don’t put anything online that you wouldn’t want someone in the future to “overhear”.  Digital = permanent.

One of the best guides on the use of social media in medicine comes from Austrialia and New Zealand.  It has some very illustrative scenarios and is beautifully (and succinctly) written.  If you are in medicine and using social media, it’s well worth the time to read this document.

Can Facebook Hurt Your Career?

There have been a lot of recent posts on the web about social media use by physicians.  It’s very, very important to think about the ethics and the risk of using Facebook, Twitter, etc if you are a physician or a physician in training. The internet lives forever… things you post now may come back years from now when you are applying for a job.   I’ve posted previously about using Facebook and other social media, but there are other, more comprehensive summaries on the web.  Take a minute and read about some of the horror stories – it may protect you!

Link on shockmd.com to a video and pdf from the Austrailian AMA

Guidelines on using social media from the American Medical Association

Facebook and Other Social Media

Social media, like Facebook, is an important way to keep in touch with friends and not feel so isolated when you are in medical school and your residency.   It’s a wonderful tool, but it can backfire if you don’t realize some of the pitfalls.

Unlike high school and college, once you are in medical school, you are part of a profession.  (Yup, from the moment you start).  So there are a few important rules you need to know about using Facebook or any social media network.

1.  Never friend patients or their families.  This is an important rule to follow.  Even if they are the nicest people in the world just make up your mind now that the answer is “never.”   Once you are in practice, you may choose to use social media by developing a page for people to “like”… but don’t do it while you are in training!

2.  Beware changing privacy rules.  Facebook in particular is notorious for changing who can see what.  You need to check – often.   Everything on your Facebook page should be “friend only” .

3. Make sure you know what other people can find out about you on the Web.  Residency programs routinely use search engines to screen for “red flags” in applicants.  This is even more true once you finish residency and are looking for a job.   So, periodically, do a search on yourself.  You’ll need to make sure there is no misinformation out there and do whatever it takes to get it corrected.

4.  Never post unprofessional photos or comments. You are not in college anymore.  Think about what you have on Facebook now (and what you will put on in the future).  Is there anything you wouldn’t want the Dean of Students or your Program Director to see?  Do you really want people to see the disparaging comment you made about a professor or attending?  Take it off.  It’s not professional.

5.  Never put ANY patient information on Facebook.  Part of being a professional is knowing the rules.  Patient confidentiality is protected by law… and by the ethics of medicine.  Never, never, never  (in case it wasn’t clear – that means NEVER) put ANY information about a patient on Facebook or any social media…

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