#Doctors20: Impact of Social Media on Medical Practice

My first talk was after lunch on day 1 of the Doctors 2.0 and You conference!

I shared this session with Dr. Carlo Caballero (@carvicab) of Colombia. Carlo is a rheumatologist from the Universidad del Norte in Colombia. He is President-elect of the PanAmerican League of Associations of Rheumatology (PANLAR).

Our moderator was Michael Weiss (@hospitalpatient). Michael was diagnosed with Crohn’s disease in 1984. He is founder and executive director of the Crohn’s disease Warrior Patrol, a charitable foundation that aims to help patients with Crohn’s disease, ulcerative colitis and inflammatory bowel disease. More about Michael here.

As we waited for the participants, I just had to take a picture of the screen showing the title of our session in French!

Sharing my slide deck below. It’s hard to follow though on its own as there are hardly any words on it. So I’m providing my script – which is not an exact transcript of what I actually said that day, because of nervousness. 🙂 But you get the drift.

 

Slide 1. This mural by Filipino artist Carlos Francisco hangs in the lobby of the hospital where I work.  It depicts a babaylan, in Filipino indigenous tradition, a woman gifted to heal the spirit and the body. I always thought of her as some kind of witch, a distant ancestor of the strong women physicians who taught me endocrinology. Yes, my mentors were called endocrine witches by those stung by their acerbic wit during hospital rounds.

 

Slide 2. A decade ago, I took masters studies in health informatics in a pioneering program at the University of the Philippines. As its first graduate in the medical informatics track, it became imperative for me to establish an online presence. In 2008, to honor my mentors, I decided to call myself the Endocrine Witch online.  After several false starts, I began blogging in 2010.  I read books about blogging which didn’t really apply. I neither wanted to become famous or earn money from it. But now this blog has become my living resume. It chronicles the presentations I do, the meetings I attend, the questions I wonder about, things that I learned. Patients have found me through my blog. It is no longer unusual for me to meet a patient for the first time and be told … So you’re the Endocrine Witch! Other health care professionals I’ve never met come up to me at meetings to discuss blog posts I’ve written and slide decks I’ve shared. A few times, some students have asked to have a picture taken with me. Yes, my blog has made me cool in ways I never imagined.

 

Slide 3. I signed up for Twitter five years ago,  of course as endocrine witch. I learned later that keeping the same name across social media platforms was about branding. I just really wanted everything consistent. I  live tweeted the Endocrine Society meeting in San Diego that year as an assignment for an informatics class. Later, I became an official blogger for this meeting. Twitter quickly became my personal learning network. I connected with people from all over the globe with common interests, that I would otherwise have never met. I would not be here today on the invitation of Denise Silber if not for Twitter! Attending Doctors 2.0 this year is also special as I am able to meet in real life some of the people I’ve been following on Twitter. It’s surreal!

 

Slide 4. I opened my personal Facebook account in 2008. Soon after I began receiving Facebook friend requests from patients which I had to turn down. One patient in particular remarked at the end of a consultation, Doc I saw your Facebook profile pic. You looked beautiful. Which made me wonder if she meant to say that my picture was no longer an accurate representation of how I looked currently. Eventually, three years ago, I decided to open a professional Facebook page, distinct from my personal Facebook account as has been suggested by medical organizations. I’d point out this page when patients posted Facebook friend requests. But mostly, this Facebook page was a personal experiment to see if photos with health messages could go viral. I had almost a hundred photos about food choices, eating healthy and walking before I stopped. What do likes and shares really mean in the end? I heard someone say, those are just vanity metrics! Those photos however did get exhibited at the hospital lobby and at a mall for Diabetes Awareness Week. A few doctors have come up to me and said I should continue this project. And maybe I will.

 

Slide 5. I wanted to go to Doctors 2.0 last year because I wanted to meet up with other physicians who saw the potential of social media in healthcare. I’d posted about it and a colleague Dr. Remo Aguilar had said why don’t we hold our own birds of a feather conference in the Philippines. But I felt we didn’t have critical mass to pull that off. At around this time I’d also found Dr. Gia Sison and Dr. Narciso Tapia on Twitter. Gia suggested to have a weekly tweet chat to draw participation from Filipino physicians. We registered #HealthXPH in the Healthcare Hashtag Project of Symplur.  The chat is patterned after the #HCLDR chat where we have a pre chat blog post and three questions to be answered during the one hour of the chat. We’re more than a year old now and the chat generates an average of 7 million impressions weekly with global participants. I’m very happy with this, and some of our regular participants are here at Doctors 2.0. Like Bernadette Keefe (@nxtstop1) and Marie Ennis-O’Connor (@JBBC). But my personal dream is to have more Filipino doctors joining us. To this end I’ve been giving talks about #HealthXPh at different conferences at academe and at medical specialty organizations. A few weeks ago I was at the Asia eHealth Information Network webinar. I am hoping other countries in our region will follow suit. How about HealthXTH for Thailand or #HealthXLK for Sri Lanka? I’m hoping for a ripple effect.

 

Slide 6. I’ve always known that there was not enough endocrine-related health information online written in our national language, Filipino. Hence recently I started a new blog written in the Filipino language, called Dok Bru. That’s short for Dok Bruha, which means Doctor Witch. Here I answer commonly asked questions at my clinic.  I’ve used some of my Facebook photos with health messages in the Filipino language here as well.  So all of what I’ve just told you answers the question Denise raised, When does a physician become interested in social media and digital health?

 

Slide 7. In medical school, I was taught to be a five-star Filipino physician. Clinician, educator, manager, researcher, social mobilizer. I believe my participation in social media enhances all these roles.

 

Slide 8. Clinician. Any doctors here? Endocrinologists? Have you ever tried explaining what an endocrinologist is? Endocrinology is the study of hormones. What are hormones? Hormones come from glands. What are glands? It’s quite complicated. Dr. Randale Sechrest says that every product or service has a physical and information component.  The information component helps someone choose a service to access. That information must be understandable, findable and reachable. This applies to the services I provide as an endocrinologist. Do you know what is my most popular blog post with the most comments? It’s that post where I ask, so What’s an Endocrinologist? Many patients have asked me variations of I think I need an endocrinologist, can I see you or your colleague? I am one of only 247 Filipino endocrinologists serving 7,107 islands of the Philippines of almost a 100 million people. I direct them to the website directory of the Philippine Society of Endocrinology, Diabetes & Metabolism. I get the same queries on my Facebook page. I have had patients show up at my clinic and say so, you’re the Endocrine Witch, I hope you can help me! When I see these patients, they already understand what an endocrinologist does and I can spend more time as a clinician on their other concerns.

 

 

Slide 9. Educator.  I teach health informatics in graduate school. I took Internet history and security with Dr. Chuck Severance when I tried Coursera years back. Dr. Chuck tweeted that he was coming to Manila and so I was able to meet him with my students. I also follow Deirdre Bonnycastle on Twitter and learned more about making learning visible through her blog on medical education. Because of these two, I was inspired to make teaching videos for my course on introduction to health informatics.

 

Slide 10. In my informatics class, the students must create a product to make learning visible. For example an infographic to show the development of the field of health informatics in the Philippines. They must then tweet it using the class hashtag mshi and post on Facebook where experts in the field and students alike can provide feedback and engage in conversation. I use a learning management system to blend online and face to face interactions. I am happy to report that last February, the university gave me the President’s award for progressive teaching and learning for this work. The prize money I won helped me get here to Paris.

 

Slide 11. Manager. This is a NodeXL map of our weekly #HealthXPh tweet chat. Those lines are conversations. Those clusters are networks. According to Dr. Charles Boelen, who wrote about the 5-star doctor, the doctor as manager, initiates exchanges of information to make better decisions, and works within a multidisciplinary team in close association with other partners for health and social development. I’d like to believe that the conversations we have on our tweet chat facilitates that exchange of information between our participants who have varying roles in healthcare. At one point, we even had the undersecretary of the Department of health of the Philippines participating.

 

Slide 12. Researcher. Last February, the #HealthXPh team convened the first ever Philippine healthcare and social media summit through a generous grant from the Philippine Council for Health Research and Development. The council approached us to help them set the research agenda for social media and healthcare. At the summit, we had five tracks, all of which have information gaps that can be addressed by research. These are: social media and medical professionalism, social media and health professions education, social media and research, social media and patient stories. The Global Forum on research for health innovation will be in Manila this August. HealthXPh will have a session on social media and healthcare at this meeting.

 

Slide 13. Social mobilizer. We all recognize the digital divide. Skeptics have told me that what I do on social media will not be able to reach my countrymen in what is called GIDA geographically isolated and disadvantaged areas. Access to Internet is also very expensive in the Philippines but since it is the social media capital of the world, access to Facebook or Twitter can be had for only P20 a day, that is about 50 cents. A few months back, internet.org was launched in the Philippines which can give access to Facebook for all. The lower part of the picture is the official Facebook page of the Department of Health in the Philippines. I’m curious to find out if other countries have the same. I have a thesis student working on evaluating this page. Which posts are more likely to go viral? What kind of posts generate more comments? We hope to give feedback to our Department of Health.

 

Slide 14. Let me end with this photo poster I made on leptospirosis which was shared about 20,000 times when it was picked up by several other Facebook pages. A person gets leptospirosis by exposure to rat urine in floods. Symptoms don’t come out until days to weeks after exposure and can be fatal if recognized late. This poster enumerates the symptoms. I don’t know if this poster saved any lives but knowing it could have is enough motivation for me.