Doctors, why aren't you on twitter yet?

Our presence as doctors online is no longer optional. This is a lesson the college of obstetricians and gynaecologists (RANZCOG) learnt on January 2. The Australian Doctor posted this, and the internet exploded:

Unfortunately, as RANZCOG had no media presence and very few actively tweeting fellows, there was no one to rebuke the claims that the college was 'sexist, misogynist and ignored trainees human rights'. RANZCOG is actually the college that allows the most flexible training regime for doctors becoming parents - but on twitter, as in real life, you can't defend yourself in a conversation you've declined to participate in. The best summaries of the events are here by Dr Eric Levi and here by Dr Nikki Stamp.

We've all seen the dangers of using of social media, but to me this highlights the risk of not using it. Whilst there are many 'guidelines' available, very few do anything to convince doctors to join the conversation.
A few of these guidelines include the AHPRA guideline, this 2011 MJA article, and the RACGP guideline (the only one of which, actually alludes to the benefits of social media)

I am a GenY doctor, which I define as doctors who are in training between the years of 2005 and 2025. More than 90% of GenY's log into social media every single day and we've never gone a day as a doctor without our mobile phones. But despite social media's huge role in our lives, it is almost non-existent in medical education, with just one lecture in all of my training which involved someone reading out the 'social media guidelines'.
In my opinion, this isn't teaching, this is risk management. Afterall, how can you teach something as living and breathing as social media with something as rigid as a guideline? 

Guidelines seem to at worst insult our intelligence, and at best state the obvious. 'Don't post photos of yourself doing illegal things' and 'Don't post identifiable information about patients' are covered by common sense. I once saw a poster in a hospital that said 'Never post anything related to work online'. What does that mean? Don't mention medicine?
I have friend in IT who would say that it's impossible for two doctors to talk about anything other than medicine when they get together. So then, is it best to avoid Twitter and if we do use it, not post about medicine?
This is where the guidelines betray us. They imply that extreme caution and ideally abstinence from social media is the best course of action. I disagree entirely. 

Let me tell you about twitter-

Last week I participated in a robust discussion about why we hate using the word 'acopia' in reference to frail patients presenting to ED. This topic was passionately debated between a geriatrician, a palliative care physician, a med reg, 2 GPs, a medical student, an anaethetist, an ED reg, 2 paramedics and a surgical HMO. We all walked away having learnt new phrases, new skills and new ideas to improve our care.

The night before we discussed mental health in doctors. A week before we discussed opiate rotation in palliative care. Other recent discussions have included euthanasia, the review to MBS, when to have children during training, antibiotics in septic joints and bullying in medicine. 

Every time I log in to Twitter I am presented with a discussion on par with a National Conference Panel. If we don't know an answer, we tag in someone who does. Doctors from every speciality and every country are represented, as well as nurses, administrators, allied health and researchers. 

The benefits don't end there. I recently wrote a blog that was read over 20,000 times, just from sharing it on twitter. Another time I was contacted by the editor of a state newspaper to ask if they could publish a blog I'd read on twitter. I was also contacted via twitter to speak at a conference. 

I often read journal articles long before any of my work colleagues because they've been posted on twitter by the doctors in that speciality. Imagine social media where whilst 'wasting time online', you got caught up on all the latest evidence based practices - that's what twitter is. 

I read tweets from frustrated patients who want such simple things from their doctors. I read the frustrated tweets of colleagues in different departments and have discussed many times what each speciality want to hear in a referral. I really think these things make me a better doctor. 

If I were allowed to teach med students or doctors how to use Social Media, I'd have everyone make a twitter account with the following for homework then meet again after a week. 
  • Start off your account by adding a photo and a bio (see below)
  • Follow 5 new health professionals per day whose timelines interest you
  • Retweet something at least 1 tweet per day
  • Tweet 1 original tweet that includes a link per day
  • Contribute something to a medical hashtag or participate in a 'tweetchat' like #hpm or #nephjc
  • Ask a question and participate in the discussion that follows
I suspect this would teach them more than a rigid guideline could. I'd also give them my post 'Dr Ash's Twitter rules'

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