Remember: Social media is social

A few days ago, several news outlets reported on Newt Gingrich's unfortunate turn of phrase about our President. In a speech in Georgia he referred to Obama as "the most successful food stamp president in modern American history." Promptly, David Gregory of NBC News called Newt on the potential racist connotations of this remark, thus precipitating a maelstrom of "liberal media" accusations from the usual suspects (here and here). And so it goes, possibly a careless figure of speech, possibly racially charged code, but everyone is now yelling and screaming about whether or not it was OK to say and subsequently to accuse.

There is a much bigger issue at stake than just the utterance of these words. While they offend me and make me think that they were spoken deliberately to elicit racial tensions, the point is that, in an obtuse sort of a way, they can be defended as non-racial in nature. Unfortunately, the speaker's intention is not the issue any longer, so much as the fact that these words can easily be construed as racially inciting by large swathes of the population. And this is an important point: once squeezed out, much like the toothpaste from its tube, these words cannot be forced back. They will exist in perpetuity and continue to elicit visceral reactions.

Such is the nature of public discourse. Which brings me to the discussion on Bryan Vartabedian's site about the etiquette of healthcare professionals on Twitter. The example of the particular Twitter stream from a healthcare professional who tweets anonymously under a nom de plume, precipitated a spirited discussion (see over 100 comments) about the propriety and professionalism of her messages in this public forum. While many saw her behavior as at the very least undesirable, some MDs and, more concerning, medical students, did not see a thing wrong with her eructations. Furthermore, she responded via Twitter that she was quite surprised by this tongue lashing and did not know what was so offensive in her messages.

But that is just it! Enough readers saw her words as being disrespectful and even contemptuous of patients, regardless of her intent. And this is the crux of the matter: the distance between the output, and its intent, and its interpretation by the listener or reader can be vast, especially when the message is reduced to 140-character snippets. This is why when people lament that communication is the biggest obstacle in all human relations, they are right. And different types of communication deserve different levels of scrutiny.

So, here is my bottom line. Whether we intend to be hurtful or disrespectful in our tweets or racially divisive, as in our political discourse, is immaterial. In an open forum, if we are concerned with being empathic and careful of others' feelings, we should think twice (or more) about what we put out there. Because extending this blogger's thought to all communications, Twitter, like a tattoo, is forever. And everyone is looking.  

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SoMe in medicine: It's about communication, stupid!

My generation of doctors was almost proud of its paternalistic overbearing know-it-all archetype, with the my-way-or-the-highway attitude to patient care. Even today there are inter-specialty fights in medicine that demonstrate these entrenched and seemingly fundamental, albeit willfully exaggerated, differences of opinion and clinical approach. It used to be, and still is to an extent, a badge of honor for an internist to disagree with a surgeon, for a pulmonologist to recommend a course of action diametrically opposed to that suggested by the infectious diseases specialist, and for everyone to disparage neurologists (apologies to my neuro friends). The extent of the discussion with patients as modeled by some of my senior colleagues was to say "You have this, and I am giving you this prescription, and see you in 2 months." And even today, I have observed the best of doctors still respond to a cogent "why?" question from a patient with a "because this is how we do it" answer.

My peers' lack of communication skills is the stuff of urban legends. Yet here we are at what seems like a pivotal moment for so many aspects of medicine -- science, healthcare system, communication technologies -- where effectively communicating outside the profession is a make-or-break proposition. Along these lines, in this BBC documentary Sir Paul Nurse, the head of the Royal Society, examines the societal forces that are coalescing to bring "Science Under Attack." The unifying message that comes out of his inquiry is that other less informed parties with political agendas are co-opting the discussion. Yet there is a distinct lack of the antidote of countervailing communication by scientists in terms that are understandable to the lay public. Nurse's battle cry is that scientists need to do a better job communicating their craft themselves, and not just to each other.

In some ways the prevailing elitism of medicine in the 20th century set the stage for the backlash we are experiencing today. The erosion of trust in the profession, commodification and consequent devaluation of medicine, while multifactorial at their root, could no doubt have been mitigated with better communication. Yet, great communicators rarely choose medicine as the path.

And this brings me to the contentious topic of the role of social media in medicine. For many of the early adopters, the question is no longer "should we", but "how best to." But my sense is, that physicians engaging in social media are still a minority. I am not even sure what proportion of MDs are amenable to communication via e-mail with their patients, though these data may be out there. So, for what seems to me as the majority of MDs who are not sold on e-mail, Twitter, Facebook, blogging or Quora, the value must not be that obvious. This makes me wonder if there are certain unifying characteristics of these docs, one being lack of perceived value of communication outside the profession across all media, including in-person contact.

I am friends with many docs on Twitter and in the blogosphere. The vast majority of them have shown themselves to be patient-centric, knowledgeable and collaborative, the kind of people I would not hesitate to send a loved one to. Yet, this is a skewed sample born out of a selection bias. These are the people who are interested and confident in their ability to communicate outside medicine. These are the people to whom medicine is a humanistic pursuit, where communities of patients and doctors strengthen the discussion of how to transform our system and the patient encounter. My guess is, and this is purely unscientific, that many of those who are skeptical of social media are also skeptical of communication itself, or just do not see the value of it in the equation of providing good patient care within the crushing time constraints of today's healthcare.

So my point is this: before social media tools can be expected to diffuse broadly into the medical community, the value of all communication needs to become clear to physicians in general. At this moment of increasing societal skepticism of science and of usefulness and integrity of the medical profession, against the backdrop of healthcare changes and increasingly unfiltered media noise, willingness and skills to communicate clearly may be as useful to today's doctors as a stethoscope. Once communication becomes the backbone of all medicine, tweets and blog posts are sure to start flowing freely from the fingers of physicians everywhere. And that will be good for the patients, the science and the healthcare system.

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