Medical Doctors on Twitter – How and Why

Medical Doctors on Twitter How and why MDs tweet

Dr Anna Tereszkiewicz

Renata Drozd

Beata Dziedzic

Twitter

A tool of personal communication used to share daily life narratives.

It offers many forms of communication and its used in various areas of professional communication.

Twitter in health communication

Twitter is used by medical doctors, public health departments and health care institutions.

It is used for the purpose of branding, marketing, patient education and dissemination of information about medical practice and health care.

Aims, materials and methods of the study

The analysis of MDs profiles and content of tweets.

10 MDs profiles (the highest popularity).

1520 tweets.

The analysis focused on the purpose of tweeting, the function and content of hyperlinks, audiovisual elements and discourse properties of tweets.

MDs profiles

2 important aspects: self-presentation and impression management.

The details of the MDs profiles included:

I. Information on professional practice (specialization and position held)

II. Links to MDs homepages or blogs, to the websites of societies and institutions in which MDs are involved

III. Disclaimer

IV. Personal information (e.g. hobbies)

Self-presentation

Associated with the authors authenticity and reliability.

Helps to: I. create a credible and reliable profile II. establish MDs position in the professional

community III. gain credence IV. expand MDs network of relationships with

professionals and patient communities

Impression management

Includes visual information (profile and background photographs) and textual information (personal information, updates).

MDs photographs serve to confirm and enhance the owners professional identity (usually close shot, direct gaze and wearing a doctors coat or a surgeon's gown).

Tweet content and function

3 forms of tweets:

I. Updates (43%)

II. Addressed messages (32%)

III. Retweets (25%)

Also tweets from Twitter chats (6%) and conference venues (4%)

Updates

Tweets disseminating popular science and health-care oriented articles from mass media, science-oriented, medical research news and academic journals.

Lets eliminate the stigma of cancer --> Dont blame patients for their disease http://ow.li/paR41

Tweets with health tips. Oct 3 Tweet-a-Day for Breast Cancer. Vitamin D good for

bones what about cancer? Find data at: http://ow.ly/pudgz

Tweets with personal life posts. Noticed today Ive got quite a bit more gray hair. Ah, well:

Ive considered it a race between graying & accelerating baldness

Addressed messages

Tweets with replies addressed at other MDs, institutions, patients and ordinary users.

Tweets with social comments and acts of politeness (thanks, wishes, compliments, etc.).

@user Heard you did a great job in SWOG social media meeting. Thanks! Had conflict with breast working group

Tweets that involve exchange of information and opinions, clarification of information and exchange of experiences.

@user no, common serum tumor markers are CEA, CA-125, CA19-9

Retweets

Tweets published by health-institutions, organizations, societies and other MDs.

Tweets disseminating news and information. RT @user: ALK-positive NSCLC patients story opens eyes,

9/13:58 CAP TODAY http://www.captodayonline.com/alk-positive-nscls-patients-story-opens-eyes-913558

Tweets recognizing the expertise of other MDs (often accompanied by comments evaluating the forwarded message).

Helpful. RT @user: User, MD, discusses mgmt of adverse events (AEs) from treatment w/immunotherapies http://flip.it/hV8sk

Tweets from Twitter chat

They offer a floor for discussion for different audiences (professionals and non-professionals).

The analyzed tweets were found in chats about health care and social media, breast cancer and lung cancer, among others.

Of my #ovariancancer patients this week, 100% had a delay in diagnosis. Raising awareness is such a priority. #gyncsm

Conference tweets

Tweets disseminating news on conference presentations or updates on the research discussed on the conferences.

Tweets involve comments evaluating the presentation, questions directed at speakers and participants and self-promotional messages.

Tweeting from WE CAN breast/cervical cancer advocacy conf in Uganda. #bcsm followers, share support of our African sisters on #WECANAfrica

Linking patterns

29% of the updates contained hyperlinks.

Their primary function is to provide extra information and refer the reader to further external materials.

Linked source Percentage Rhetorical function

Medical society/organizations

websites and blogs (e.g. ASCO)

24% Disseminating information

Dissemination of medical

knowledge

Community formation and

integration

Promotion

Medical journals (NEJM, JAMA) 22% Dissemination of information

and knowledge

Crediting medical discoveries

Referencing and citing

Mass media (Reuters, New York

Times, Washington Post, etc.)


Popularization of medical

knowledge

Promotion of healthy life-style

Increasing public awareness of

health matters

Medicine-oriented websites

(e.g. Oncology Tube, Health

Day)

14% Dissemination of information


knowledge

Promotion of healthy life-style

Other MDs personal homepages,

blogs

11% Community formation and

integration

Crediting information

Organizations/institutions with

which MDs are affiliated (MD

Anderson Centre)

7% Promotion

Enhancing credibility

Identity management

MDs homepages, blogs 5% Self-publicity


Identity management

Other 2% Disseminating news

Humour

Captions annotating the links

Their main function is to abstract the content of the linked text and/or provide the tweeters evaluation of this content.

They are also persuasive and informative.

Is your physician's electronic medical record system selling your info to drug & device companies? http://bit.ly/1dyXR43 h/t @user

[Original headline: The hidden cost of free EMR systems]

Multimedia

Among the analysed tweets (1520), only 120 posts include an audiovisual element.

Audiovisual content Frequency Rhetorical function

Photographs of posters and

conference slides

22% Information dissemination


knowledge and research

Photographs picturing other

MDs at conferences

7% Community formation and

integration

Crediting medical discoveries

Photographs picturing the

self at conferences

5% Self-publicity


Identity management

Medicine-oriented videos,

graphics, cartoons,

photographs of medical

equipment, medicines



knowledge

Promotion

Personal-life photographs 8% Identity management

Other (news, humorous

memes)

14% Disseminating news

Humour

Discourse patterns

Tweets by medical practitioners are seen as hybrids of professional, public, institutional and private discourses (Myers 2014).

Stance-taking the expression of authors stance:

I. in institutional and professional discourse, it helps to establish and communicate professional expertise;

II. in private and popularizing discourses, it helps to establish ones authority, but also engage and attract addressees.

Implicit evaluation

Sharing a link or retweeting without the users comment. Retweeting may indicate the authors agreement with the claim presented in the message, or may trigger a conversation.

RT @user: Smaller, flexible trials mean more options for patients & faster scientific answers: http://mobile.reuters.com/article/idUSBRE98P05N20130926

Explicit evaluation

Involves expressions of both attitudinal and epistemic stance.

I. Positive evaluation

II. Negative evaluation

III. Expressions of feelings and emotional reactions

Positive evaluation

attitudinal markers highly subjective and strongly evaluative expressions concerning the value, importance and accuracy of the tweets:

I. adjectives + noun phrases (adjectives premodifying nouns indicating the type of content being evaluated)

Excellent review by @user: How can social media improve

oncology care? http://ow.ly/oDARZ

Cool video from Iceland. MT @user: Really creative http://huff.to/GJIF92 "This Road Leads to Breast Cancer Awareness"

II. verbs (frequent use of subject ellipsis, due to space restrictions; sometimes followed by a justification of the opinion)

@user Agree. I do not deny medicine is a business but how we

operate and what we need to achieve require the highest ethical standard

III. a single yes Yes! RT@user: @user It is reasonable that #empowered pts can do

research on their own & introduce it to their docs? #lcsm

IV. an interjection

Ugh MT @user: Pts discouraged about cancer clinical trials: ~60% by oncologist & ~50% by family physician http://ow.ly/psYbB

epistemic stance (particularly frequent in Twitter chats)

I. first person pronouns + verbs indicating stance (verbs tend to be modified)

@user @user I actually think that EMRs do more harm than good at

this point. http://bit.ly/19TMIJJ

II. inclusive we (often followed by modal and semi-modal verbs, expressing deontic modality)

We need to improve the speed of trial enrollment process. Or come

up with a totally new enrollment process III. statements made by MDs about the current and desired state of

affairs in health care

Medical care needs to begin with reforming pt-doctor communication @user #MedX

Negative evaluation

evaluation in which MDs directly or indirectly reject the validity of others views; it helps them enhance their professional authority and credibility.

MD says apps with skin pictures can mitigate shortage of dermatologists. http://bit.ly/16C3mJx > Dubious. In derm, context is key to dx...

adversative conjunction but (helps to reduce the force of the opinion) To clarify, I'm a big fan of involved pts, but I see some who exemplify why

it's great, & some who highlight why many docs resist. #s4pm negation (may indicate that the author follows the opposing view) @user It's not easy--needs partnership between doctor and pt, and pt

also has to do part to tell good story #MedX

Expressions of feelings and emotional reactions

(both positive and negative) can be seen as a wish to establish solidarity and create or maintain bonds with others.

Excited to join the faculty of George Washington University and looking forward to working with @user!

Sad/frustrating. MT @user: For me, it's more about fighting insurance to cover trials vs. finding them hasn't been issue. #lcsm

Conclusion

Main purposes of tweeting:

I. Dissemination of knowledge and information

II. Knowledge translation between experts and the public

III. Interaction and discussion of health issues

IV. Self-promotion

Medical Doctors on Twitter – How and Why

Documents

Transcript of Medical Doctors on Twitter – How and Why