This is the key concept from a series of talks that I presented at several national and international meetings in 2011-2012 (CSACI, AAAAI and WAO) - TIC, Two Interlocking Cycles:
- Cycle of Patient Education
- Cycle of Online Information and Physician Education
The two cycles work together as two interlocking cogwheels (TIC).
Cycle of Patient Education (click here to enlarge the image). An editable copy for your presentation is available at Google Drive:
Cycle of Online Information and Physician Education (click here to enlarge the image). An editable copy for your presentation is available at Google Drive:
The first presentation was during the annual meeting of the Canadian Society of Allergy and Clinical Immunology (CSACI) and brought a lot of engaged, useful, and interesting questions. Feel free to use the images in your own presentations with credit to AllergyCases.org.
The two cycles work together as two interlocking cogwheels. Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:
Products of the Cycle of Patient Education: EQUALS
- Energized patients and health staff
- Quality of life is improved
- Understanding of patient condition is improved
- "Affinity" - better physician-patient relationship leads to increased referrals to the practice, e.g. 2-5 new patients per week per physician, increased revenue
- Lower rate of ER visits, hospital admissions, phone calls
- Savings for patient and health system
What is Return On Investment (ROI) of Cycle of Patient Education?
Calculated ROI:
- 2 new patients per week who come to the clinic directly from the blog/Twitter account
- $500 reimbursement for 2-3 visits (initial visit and 1-2 followup visits)
- 50 weeks x 2 patients = 100 new patients per year
- 100 patients x $500 = $50,000 per year
The best interest of the patient is the only interest to be considered
The purpose of the cycle is not to make money. As the Mayo Clinic CEO pointed out recently, Mayo Clinic intends to be the leader in social media in healthcare but this is not about competitive advantage, it is about the patient. The best interest of the patient is the only interest to be considered. Social media makes the union of forces more broadly practical than at any time in human history.
Social media for physicians: Do I really need to be on Twitter, Facebook and YouTube?
(the text below uses the specialty of allergy and immunology as an example, an edited version was published on the website of the World Allergy Organization where I write a monthly column)
It certainly looks like social media is taking over the world. Facebook is a “country” with more than 750 millions citizens. Twitter has more than 250 millions users. Google+ is the fastest growing web service and history and reached 25 million users in just one month after its launch. As an allergist, you may ask yourself, “Where is my place in all this? Do I have to be on Twitter? Do I have to use Facebook and YouTube to stay relevant?” The answer is yes.
With the recent update of Google called "Search Plus Your World", individuals, physician practices and organizations without social media presence will be pushed further down the page of search results. That means, unfortunately, that if your practice does not have a strong social media presence, when patients/physicians search for a health topic, they may not see the quality results they deserve.
Number of Tweets Predicts Future Citations of a Specific Journal Article
Twitter is becoming essential for both authors and publishers of scientific literature. Highly tweeted journal articles are 11 times more likely to be highly cited than less-tweeted articles. Top-cited articles could be predicted from top-tweeted articles with 93% specificity and 75% sensitivity. A "twimpact" factor is proposed that measures uptake and filters research resonating with the public in real time (Med Internet Res 2011;13(4):e123. http://www.jmir.org/2011/4/e123).
You can be a physician and a social media superstar at the same time
Social media can provide a focused and time-efficient learning experience. Sharing relevant medical news with patients is just a click away. The paramount is to protect patient privacy at all times and to comply with your employer and professional organization guidelines. You can be a physician and a social media superstar at the same time. Here is how in 3 easy steps.
1. Use of Internet to learn and stay up-to-date
- Web feeds (RSS and Atom) work great for for targeted updates from journals, websites, and allergy/immunology news. RSS stands for Really Simple Syndication and consists of updates pulled from a particular website whenever something new is published. RSS feeds can be separated in different categories, e.g. asthma, allergic rhinitis, etc. Web-based RSS readers (Google Reader, Feedly, Flipboard) function as “inbox for the web”. You can get all sources delivered in one location - a web-based reader
- Blogs and Twitter accounts. A selected list of high-yield blogs and Twitter accounts of board-certified allergists/immunologists includes: @JuanCIvancevich (Juan C. Ivancevich, Buenos Aires, Web Editor of the World Allergy Organization), @wheezemd (Michael Blaiss, MD, Past President of the American College of Allergy, Asthma, and Immunology), @DrSilge (Robert Silge, MD, allergist/immunologist, Salt Lake City, Utah), @AllergyNet ( John Weiner, allergist, clinical immunologist, Melbourne, Australia), @MatthewBowdish (Matthew Bowdish MD, allergist/clinical immunologist, Colorado), @allergydoc4kidz (Stuart Carr, allergist/immunologist, Canada), and the author’s own Twitter account at @Allergy.
- Podcasts for allergy and immunology education represent mobile-based MP3 files and services with automatic subscription. Free podcasts/videocasts are provided by COLA Allergy (ACAAI, http://childrensmercy.org/content/view.aspx?id=5979), Journal of Allergy and Clinical Immunology (AAAAI, http://jacionline.org/content/podcast), and World Allergy Organization (http://journals.lww.com/waojournal/Pages/podcasts.aspx).
- Persistent searches for topics of interests in allergy/immunology. You can subscribe to RSS feeds for "persistent searches" in PubMed and Google News for the topic of your interest, e.g. “oral immunotherapy for food allergy”.
- Text-to-speech (TTS). You can use text-to-speech to listen to journal articles at a later time. The text-to-speech programs convert the the text of a journal article into an MP3 file. A free program is Balabolka (http://cross-plus-a.com/balabolka.htm).
- Clinical cases and practical questions are available from the World Allergy Organization Journal, AllergyCases.org (disclaimer: the author is the founder of the website), AAAAI Ask the Expert (http://aaaai.org/ask-the-expert.aspx).
2. Use of Internet and computers for patient education
- Patient education diagrams - web- and iPad/tablet-based diagrams are well-received by patients and doctors in training. The the author's survey at the allergy clinic of the University of Chicago showed a 95% patient approval rate for iPad use for patient education. The diagrams used in the study are available here: Diagrams for Patient Education.
- Videos for patient education can be viewed on tablet or netbook. The videos can be streatmed from the physician's website or downloaded locally. Targeted videos can be used for patient education before and during the visit, for example, “what to expect from your visit at the allergist office”, “how to use an inhaler”, etc. There is a continuum of education - start at the office (tablet or netbook), then continue at home (web-based videos and selected educational brochures and links).
- Ready-made patient education brochures can be printed from allergist's website. A custom-made search engine can generate brochures on demand, e.g. Medline Plus.
3. Use of Internet to promote your practice and collaborate
- Start a website for free (WordPress.com or Blogger.com). Start a Twitter account and professional Facebook page for your practice.
- Setup persistent searches for your name/practice on Google, Twitter, etc. and subscribe to RSS for automatic updates. You can address questions and concerns whenever they arise.
- Use Google Docs for research collaboration, creating diagrams for patient education, office calendar, and spreadsheets.
Risks of social media use by physicians
Physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just as they would in any other context. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content first to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities (Source: AMA Policy: Professionalism in the Use of Social Media, 2011).
12-Word Social Media Policy by Mayo Clinic: "Don’t Lie, Don’t Pry, Don’t Cheat, Can’t Delete, Don’t Steal, Don’t Reveal" (http://goo.gl/1Jwdo).
Advice for Physician Who Use Social Media for Professional Purposes
- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA, e.g. never publish any identifiable information without patient permission
- Consider using your name and credentials on your blog and other social media accounts
- If your blog is work-related, it is better to let your employer know.
- Inquire if there are any employee social media guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
Summary
Social media is here to stay and is fast becoming the dominant way of information consumption and sharing for the general population and patients. Allergists have to be on social media to stay relevant and to provide meaningful service to patients.
The author can personally confirm the benefits of the approach outlined above. Dr. Dimov has used social media for professional purposes for more than 7 years while on staff at Cleveland Clinic and the University of Chicago. During that time his websites have had more than 8 million page views and attract daily 16,000 RSS subscribers, 9,000 Twitter followers and 2,600 visitors.
There are other physicians who are even more popular on social media and make the stats above look minuscule. You can be one of them. It benefits both your patients and your professional life.
RSS bundles of medical news
You can use the following RSS bundles to subscribe to medical news items. The bundles are exported from my personal Google Reader page. They update automatically several times per day. When in Google Reader, just select the ones that you find interesting and share them on Twitter. Feel free to add your own comments to some of the tweets.
Top Twitter Doctors
This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:
Related reading
Should oncologists 'prescribe' accurate web sites in combination with chemotherapy? Ann Oncol. 2011 Nov 22.
How to Prepare For and Execute An Online Presence - by Howard Luks, MD http://goo.gl/zsg3m
What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging
Patients directed to online tools don't necessarily use them: 25% checked website vs. 42% read same material on paper. Am Medical News, 2012.
- Cycle of Patient Education
- Cycle of Online Information and Physician Education
The two cycles work together as two interlocking cogwheels (TIC).
Cycle of Patient Education (click here to enlarge the image). An editable copy for your presentation is available at Google Drive:
Cycle of Online Information and Physician Education (click here to enlarge the image). An editable copy for your presentation is available at Google Drive:
The first presentation was during the annual meeting of the Canadian Society of Allergy and Clinical Immunology (CSACI) and brought a lot of engaged, useful, and interesting questions. Feel free to use the images in your own presentations with credit to AllergyCases.org.
The two cycles work together as two interlocking cogwheels. Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:
Products of the Cycle of Patient Education: EQUALS
- Energized patients and health staff
- Quality of life is improved
- Understanding of patient condition is improved
- "Affinity" - better physician-patient relationship leads to increased referrals to the practice, e.g. 2-5 new patients per week per physician, increased revenue
- Lower rate of ER visits, hospital admissions, phone calls
- Savings for patient and health system
What is Return On Investment (ROI) of Cycle of Patient Education?
Calculated ROI:
- 2 new patients per week who come to the clinic directly from the blog/Twitter account
- $500 reimbursement for 2-3 visits (initial visit and 1-2 followup visits)
- 50 weeks x 2 patients = 100 new patients per year
- 100 patients x $500 = $50,000 per year
The best interest of the patient is the only interest to be considered
The purpose of the cycle is not to make money. As the Mayo Clinic CEO pointed out recently, Mayo Clinic intends to be the leader in social media in healthcare but this is not about competitive advantage, it is about the patient. The best interest of the patient is the only interest to be considered. Social media makes the union of forces more broadly practical than at any time in human history.
Social media for physicians: Do I really need to be on Twitter, Facebook and YouTube?
(the text below uses the specialty of allergy and immunology as an example, an edited version was published on the website of the World Allergy Organization where I write a monthly column)
It certainly looks like social media is taking over the world. Facebook is a “country” with more than 750 millions citizens. Twitter has more than 250 millions users. Google+ is the fastest growing web service and history and reached 25 million users in just one month after its launch. As an allergist, you may ask yourself, “Where is my place in all this? Do I have to be on Twitter? Do I have to use Facebook and YouTube to stay relevant?” The answer is yes.
With the recent update of Google called "Search Plus Your World", individuals, physician practices and organizations without social media presence will be pushed further down the page of search results. That means, unfortunately, that if your practice does not have a strong social media presence, when patients/physicians search for a health topic, they may not see the quality results they deserve.
Number of Tweets Predicts Future Citations of a Specific Journal Article
Twitter is becoming essential for both authors and publishers of scientific literature. Highly tweeted journal articles are 11 times more likely to be highly cited than less-tweeted articles. Top-cited articles could be predicted from top-tweeted articles with 93% specificity and 75% sensitivity. A "twimpact" factor is proposed that measures uptake and filters research resonating with the public in real time (Med Internet Res 2011;13(4):e123. http://www.jmir.org/2011/4/e123).
You can be a physician and a social media superstar at the same time
Social media can provide a focused and time-efficient learning experience. Sharing relevant medical news with patients is just a click away. The paramount is to protect patient privacy at all times and to comply with your employer and professional organization guidelines. You can be a physician and a social media superstar at the same time. Here is how in 3 easy steps.
1. Use of Internet to learn and stay up-to-date
- Web feeds (RSS and Atom) work great for for targeted updates from journals, websites, and allergy/immunology news. RSS stands for Really Simple Syndication and consists of updates pulled from a particular website whenever something new is published. RSS feeds can be separated in different categories, e.g. asthma, allergic rhinitis, etc. Web-based RSS readers (Google Reader, Feedly, Flipboard) function as “inbox for the web”. You can get all sources delivered in one location - a web-based reader
- Blogs and Twitter accounts. A selected list of high-yield blogs and Twitter accounts of board-certified allergists/immunologists includes: @JuanCIvancevich (Juan C. Ivancevich, Buenos Aires, Web Editor of the World Allergy Organization), @wheezemd (Michael Blaiss, MD, Past President of the American College of Allergy, Asthma, and Immunology), @DrSilge (Robert Silge, MD, allergist/immunologist, Salt Lake City, Utah), @AllergyNet ( John Weiner, allergist, clinical immunologist, Melbourne, Australia), @MatthewBowdish (Matthew Bowdish MD, allergist/clinical immunologist, Colorado), @allergydoc4kidz (Stuart Carr, allergist/immunologist, Canada), and the author’s own Twitter account at @Allergy.
- Podcasts for allergy and immunology education represent mobile-based MP3 files and services with automatic subscription. Free podcasts/videocasts are provided by COLA Allergy (ACAAI, http://childrensmercy.org/content/view.aspx?id=5979), Journal of Allergy and Clinical Immunology (AAAAI, http://jacionline.org/content/podcast), and World Allergy Organization (http://journals.lww.com/waojournal/Pages/podcasts.aspx).
- Persistent searches for topics of interests in allergy/immunology. You can subscribe to RSS feeds for "persistent searches" in PubMed and Google News for the topic of your interest, e.g. “oral immunotherapy for food allergy”.
- Text-to-speech (TTS). You can use text-to-speech to listen to journal articles at a later time. The text-to-speech programs convert the the text of a journal article into an MP3 file. A free program is Balabolka (http://cross-plus-a.com/balabolka.htm).
- Clinical cases and practical questions are available from the World Allergy Organization Journal, AllergyCases.org (disclaimer: the author is the founder of the website), AAAAI Ask the Expert (http://aaaai.org/ask-the-expert.aspx).
2. Use of Internet and computers for patient education
- Patient education diagrams - web- and iPad/tablet-based diagrams are well-received by patients and doctors in training. The the author's survey at the allergy clinic of the University of Chicago showed a 95% patient approval rate for iPad use for patient education. The diagrams used in the study are available here: Diagrams for Patient Education.
- Videos for patient education can be viewed on tablet or netbook. The videos can be streatmed from the physician's website or downloaded locally. Targeted videos can be used for patient education before and during the visit, for example, “what to expect from your visit at the allergist office”, “how to use an inhaler”, etc. There is a continuum of education - start at the office (tablet or netbook), then continue at home (web-based videos and selected educational brochures and links).
- Ready-made patient education brochures can be printed from allergist's website. A custom-made search engine can generate brochures on demand, e.g. Medline Plus.
3. Use of Internet to promote your practice and collaborate
- Start a website for free (WordPress.com or Blogger.com). Start a Twitter account and professional Facebook page for your practice.
- Setup persistent searches for your name/practice on Google, Twitter, etc. and subscribe to RSS for automatic updates. You can address questions and concerns whenever they arise.
- Use Google Docs for research collaboration, creating diagrams for patient education, office calendar, and spreadsheets.
Risks of social media use by physicians
Physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just as they would in any other context. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content first to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities (Source: AMA Policy: Professionalism in the Use of Social Media, 2011).
12-Word Social Media Policy by Mayo Clinic: "Don’t Lie, Don’t Pry, Don’t Cheat, Can’t Delete, Don’t Steal, Don’t Reveal" (http://goo.gl/1Jwdo).
Advice for Physician Who Use Social Media for Professional Purposes
- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA, e.g. never publish any identifiable information without patient permission
- Consider using your name and credentials on your blog and other social media accounts
- If your blog is work-related, it is better to let your employer know.
- Inquire if there are any employee social media guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
Summary
Social media is here to stay and is fast becoming the dominant way of information consumption and sharing for the general population and patients. Allergists have to be on social media to stay relevant and to provide meaningful service to patients.
The author can personally confirm the benefits of the approach outlined above. Dr. Dimov has used social media for professional purposes for more than 7 years while on staff at Cleveland Clinic and the University of Chicago. During that time his websites have had more than 8 million page views and attract daily 16,000 RSS subscribers, 9,000 Twitter followers and 2,600 visitors.
There are other physicians who are even more popular on social media and make the stats above look minuscule. You can be one of them. It benefits both your patients and your professional life.
RSS bundles of medical news
You can use the following RSS bundles to subscribe to medical news items. The bundles are exported from my personal Google Reader page. They update automatically several times per day. When in Google Reader, just select the ones that you find interesting and share them on Twitter. Feel free to add your own comments to some of the tweets.
Top Twitter Doctors
This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:
Related reading
Should oncologists 'prescribe' accurate web sites in combination with chemotherapy? Ann Oncol. 2011 Nov 22.
How to Prepare For and Execute An Online Presence - by Howard Luks, MD http://goo.gl/zsg3m
What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging
Patients directed to online tools don't necessarily use them: 25% checked website vs. 42% read same material on paper. Am Medical News, 2012.
