"The Social Network" from Upstate Medical University's Alumni Journal, Spring 2011

the social network B y R e n é e G e a r h a rt L e v y

It used to be enough to just practice good medicine.

Today’s doctors are challenged not only to stay current in their fields, but also to adopt new technologies and to “brand” themselves via social media.

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n December, 2010, orthopedic surgeons Brett Greenky, MD ’84, and Seth Greenky, MD ’83, launched a blog.

The physicians are brothers who specialize in joint replacement, both partners at Syracuse Orthopedic Specialists. With topics such as “Boning up on Osteoporosis,” and “Blood Conservation During Joint Replacement Surgery,” the blog is intended to be another vehicle to offer information to patients.

“More and more, patients are getting medical information from digital media,” says Dr. Brett Greenky. “Blogs are an increasingly popular way of having an informal conversation with patients, a way of getting medical information to the public and cutting through some of the complexities.”

The Greenkys may be on to something. Consider Kevin Pho, MD. In 2004, Pho, an internist in private practice in Nashua, New Hampshire, launched a blog to discuss breaking medical news. At the time, he had no grand expectations about the endeavor.

Today, Pho’s blog, KevinMD.com, averages 310,000 page views per month, making him one of the nation’s premiere physician bloggers. Pho is regularly sought out for commentary in national media and as a presenter at medical meetings. His online presence has expanded to popular social networking sites Facebook and Twitter, where he has 30,000 followers.

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One of those is Bob West, PhD, SUNY Upstate associate professor of biochemistry and molecular biology, and a staunch proponent of the use of social media in medicine.

“In this day and age, with all that’s possible on the Internet, health care is just way behind the curve compared with other industries,” he says, particularly when it comes to the use of social media. “If you’ve got physicians sealed off behind private walls, is that really helping the patient? It’s kind of a defensive mode.”

Two years ago, Dr. West started an elective in the College of Medicine that explores what he describes as “two opposite poles revolutionizing medicine.” The first is the Human Genome Project and its forthcoming genomic information. The second is the use of social

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Professor Bob West, PhD, and medical student Aaron Stupple ’12 advocate physicians using social media professionally.

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media. West believes both are already changing medicine in ways that require a retooling of the training of our future physicians.

In an attempt to get students on board with this cultural change, he launched an elective for medical students in fall 2009 called “Personalized Medicine.” Seven students enrolled, and when the course ended, several of those students formed a student organization, Innovate Upstate, to continue discussion of the same topics informally. When the course was offered in fall 2010, West had 40 students.

“When you get students excited about something, they spread the word,” he says.

Personalized Medicine includes an attempt to prepare med students for the state of medicine where the Internet and wireless mobile services combine to create a new

picture of health care. The course explores ways physicians can use social media, such as Twitter, Linkedin, and Facebook, web tools like blogs, and medical applications for SmartPhones.

It’s a matter of communication and convenience, but it’s also about “branding” the physician. “By using blogs and Twitter, one can present what they have to offer as a physician. It’s a way to get the word out about what they’re doing, what’s different, and what their recommendations are,” says West. “Doctors may think they don’t want to do this, but ultimately, I don’t think they’re going to have much choice.”

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“Doctors may think they don’t want to do this, but ultimately, I don’t think they’re going to have much choice.”

— Bob West, PhD

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est discovered the power of social media in healthcare as a patient. “I’ve had some back surgeries and have gone through pretty much what anybody who’s gone through something chronic has,” he says.

“There is a whole world of patient advocacy on the web,” he says. “With all the medical information available, patients have become much more sophisticated about their diseases. They are educating themselves, communicating with each other, and then educating each other.” That puts different demands on physicians, who he believes should join the conversation.

One method is Twitter, to which West is a recent convert himself. Last April, once the crunch of his firstyear Molecular and Cellular Principles of Medicine (MCP) course came to a close, he seized the opportunity to learn the medium. Long a reader of blogs relating to the field of genomics, he could see that his fellow “genomocists” were communicating rapidly with each other via Twitter. “I realized that to participate fully, I needed to be on Twitter,” he says.

Although many people connect the social network with the musings of “celebrities” such as Ashton Kutcher or Kim Kardashian, West says Twitter is a communication network that allows better access to other people of similar interests.

West, who already has 1,300 followers, mostly uses Twitter to share links to papers that are important to his work. “It’s a very generous community of sharing,” he says.

And once users discover mutual interests, they often connect outside of Twitter. One example is West’s relationship with medical futurist Kent Bottles, MD, which first developed via Twitter. Dr. Bottles, a pathologist by training who is now an independent health care consultant and national advocate of the use of social media in medicine, visited Upstate in February to speak to West and interested students, many of whom follow him on Twitter.

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“You make a blog. Then you tweet about your blog— it’s an engine to get people to look at your blog. I’ll tweet about my blog posts and as I have more followers, they see I have a new post and they go look at it. Then they tweet about my blog posts and new people discover it. If my blog post was interesting enough to share, that person probably has interests in concert with mine, and the next thing you know, you connect with some person who’s working on something you’re working on.”

Upstate pediatric infectious disease fellow Nick Bennett, MBBChir/PhD, HS ’08, began blogging in 2004, five years before the launch of Twitter. “I spent several years posting online in discussion groups, and when I realized all I was doing was cutting/pasting my answers from previous years, I quit and created the blog, which I set up as an info-portal to combat AIDS denialism, a distressing and vocal fringe movement that is obsessed with saying HIV is harmless and AIDS medications are doing more harm than good,” says Dr. Bennett.

Nick Bennett, MBBChir/PhD, HS ’08, is an active user of Twitter to discuss issues in medicine, particularly related to HIV and infectious disease.

Students in West’s Personalized Medicine course are encouraged to post on Twitter to learn the medium.

Not all of them do, but one who has fully embraced the medium is third-year medical student Aaron Stupple, who as a result of the course is both a regular user of Twitter and has his own blog that explores the possibilities of technological innovation in medicine at Upstate and beyond.

Stupple got started with Twitter. “It was easy to learn.

The next thing you know, I was following all these other MDs. It was like, ‘Wow, there is this whole world out there of doctors talking to each other, sharing everything from recommendations on treatments to strategies for running their practice.’”

Stupple, who heads the Innovate Upstate group, now spends about an hour each morning and evening reading medically-related Twitter and blogs, something he considers vital to his own medical education. “I’m not saying this is better than traditional methods, such as textbooks, but it’s a fact of life,” he says. “We’ve got to embrace this stuff or we’ll just be behind.”

Stupple, who mostly writes about the things that he thinks are important for medical students, explains how it works: 16

Medical futurist Kent Bottles, MD, was a guest on HealthLink on Air during his Upstate visit.

Then came Twitter, and over time, his blog became less and less active. “I haven’t posted anything in over a year,” he says. “I much prefer Twitter to get my ideas out. I initially set out to simply post interesting updates/ advice on infections and outbreaks, but have since got involved in more widespread issues including medical education, the use of IT in healthcare, as well as meeting new people. I had dinner last week with two people I met initially on Twitter—Aaron Stupple and Bob West, along with Kent Bottles, MD.” His epiphany came after his first 1,000 tweets.

“I realized that, far from using it as a way to deliver

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information, I was using Twitter to gather information and meet like-minded people,” says Bennett, who had Texas Children’s Hospital and the New York State Department of Health following him for his tweets, rather than the other way around.

“I currently have about twice as many followers as people I follow, which I take to mean that I’m a net contributor rather than a consumer. I can’t claim to be as popular as Lady Gaga, but I’m sticking with it,” he says.

“Every week I find new people to follow and pick up new followers, and get exposed to ideas and suggestions on how to improve healthcare for docs and patients alike.”

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hile the medical community as a whole may not be as enthusiastic, there’s no doubt there’s a revolution underfoot.

According to a recent survey on Sermo, an online community for physicians, approximately 77.5% of physicians use social media professionally, especially to communicate with colleagues.

In January, the 10 billionth iPhone application was downloaded, a large number of them health related. A month later, the Food and Drug Administration approved

software for mobile diagnostic radiology on Apple handheld devices that allows physicians to view images and make diagnoses from MRI, CT, PET, and SPECT scans from their iPhone or iPad. Days later, the Mayo Clinic launched the Social Media Health Network (socialmediahealthnetwork.org), a website designed to provide access to tools, resources and guidance for organizations and individuals that want to apply social media in health and health care. The site is the offspring of Mayo’s Center for Social Media, a group dedicated to accelerating the adoption of social media for health-related purposes to help improve health literacy, health care delivery and population health worldwide.

“They are on the cutting edge, the gold standard for social web health care,” says West, who serves on the Center’s advisory board.

Prior to the new web site, the Mayo Clinic already maintained several blogs, a Facebook page (which had more than 40,000 fans as of March), a library of YouTube videos, and a Twitter page (with 122,000 followers). The new site is an effort to help others who want to start similar efforts. “They are really doing the world a big favor by sharing what they know,” says West.

Dick Blume, The Post-Standard

Nurse Kimberly Murray and Brett Greensky, MD ’84, look at Twitter prior to Dr. Greenky “tweeting” play-by-play updates while his brother, Seth Greenky, MD ’83, performed knee replaement surgery

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The day of its launch, the site already had two dozen active patient forums, as well as discussion groups for hospital IT professionals that wanted to establish social media programs.

Although Upstate Medical University has no formal social media program or policy as of yet, it does have a presence on both Facebook and Twitter, maintained by the University marketing department. University Hospital CEO John McCabe, MD ’79 says the new electronic medical record system being put in place in the hospital will integrate with SmartPhones, making mobile medicine a reality for University Hospital physicians.

Coincidentally, McCabe started his own blog, McCabe’s Rounds, in December to update the Upstate community on the hospital’s proposed merger with Community General, as well as a forum to congratulate good works. “My audience is really employees,” he says. “Tom Quinn, the Community General CEO, also has a blog.

We saw this as an opportunity to communicate with employees at both places about where those discussions were headed and what was going on.”

Drs. Brett and Seth Greenky started a blog about their joint replacement practice.

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n the old days, physicians were the sole provider of medical information. Today, patients often turn to the Internet first. Increasingly, many are using social media for that information, which, as more physicians take part, is making health care more transparent.

According to Pho, “social media encourages a twoway interaction, so it gives patients a voice. Not only can patients look behind the curtain and see what a physician thinks, but they can also respond to it,” he has said.

“There is a lot more interaction, and that barrier between 18

“All of this is just going to mean better communication of health information in any conceivable way you can use your imagination to devise it.”

— Bob West, PhD the patient and health care provider has come down with social media.”

Having a “conversation with patients” was a big impetus behind the Greenkys’ orthopedic surgery blog. Although their practice group already maintains a website with plenty of medical information, they see the blog as complementary to that, a means to help the patient digest the information most important to him or her. It’s also a way to combat the proliferation of inaccurate information online in a world where Wikipedia is taken as a primary reference.

“It’s an ongoing experiment in an open conversation with our patients to increase the level of understanding,” says Brett Greenky. “It can be overwhelming in medicine to stay current on a topic, even if it’s your area of expertise. The patient is at a tremendous disadvantage in this regard to understand things without help. This is a way to sift through some of that and give patients information they can understand and trust.”

The personal nature of the blog format can also provide a glimpse of the physician as a person. For instance, Seth Greenky wrote a post about his first day of work as a joint replacement surgeon at his Syracuse practice.

Although he told the story of a successful emergency surgery, it was also a very personal account of his own insecurities in a new situation.

Social media undoubtedly raises concerns about privacy, both for the patient and for the physician. In November, the American Medical Association created a policy about professionalism in the use of social media.

Its guidelines include: maintaining standards of confidentiality; using privacy settings to safeguard personal information; and maintaining appropriate boundaries of the patient-physician relationship.

While HIPAA concerns are paramount, physicians also need to think about pubic communications from a legal point of view.

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© JOE Generic Photographer ’00

Upstate forensic phychiatrist James L. Knoll, MD, is the author of two blogs, which he uses to “test run” new manuscripts as a creative outlet.

Upstate forensic psychiatrist James L. Knoll, MD, is an FBI consultant and frequent evaluator for state and federal courts. As the author of two blogs, he’s also mindful that his posts can be used by opposing counsel to undermine his testimony. “Depending on who you are and what your profession is, you’ve got to be pretty cautious about what you put on there and how much personal information you reveal,” he says.

Dr. Knoll launched his own personal blog, The Edge Effect, in 2009, as a way to test run draft manuscripts and as an outlet for his interest in creative writing. In June 2010, he became editor in chief of Psychiatric Times, and began blogging principally on that site, which has a far larger active readership. “I try to stay pretty factual to academic or op/ed standards, avoiding speculation or opinion,” he says.

In a post about the Craigslist killer, for example, Knoll wrote about what factual research tells us about doctors who kill. “The idea was to give people who are interested in the case some accurate information about how to think about what they’re reading.”

In addition to connecting with other professionals, Knoll says blogging allows him to express and develop his creative side.

“By and large, physicians often have little time from things having to do with their work, yet they have an active intellectual life and want to engage that,” he says.

Historically, the method of professional exchange was through peer-reviewed journals, which Knolls says is an arduous process, “with no guarantee you’ll get published or that anyone is going to hear you,” he says. “Whereas, if you set up your own blog, you create your own forum.”

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ltimately, creating a forum for information exchange and connection is what social media is all about, and medicine is no exception.

“You have these empowered patients who are pooling resources and making demands in the medical world.

Doctors can do the same thing,” says Stupple. “As physicians, they can pool their resources with others treating the same diseases and use services like blogging and Twitter to say, ‘Hey, here are my recommendations for all you folks with diabetes.’ If it’s published in a really easy format for patients, then patients will want to come to doctors for information instead of each other or to Google.”

A brave new world, perhaps, but West sees an end to the “old-fashioned way” health care is handled. “All of this is just going to mean better communication of health information in any conceivable way you can use your imagination to devise it.” n

The Online Community To read more about the Upstate alumni, students, and faculty featured in this article, check them out on the social web: Nick Bennett, MD/PhD, HS ’08 Blog: http://aidsmyth.blogspot.com/ Twitter: twitter.com/peds_id_doc Brett Greenky, MD ’84, and Seth Greenky, MD ’83 Blog: http://stjosephsortho.blogspot.com/ John McCabe, MD ’79 Blog: http://upstate.edu/blogs/ceo/ James Knoll, MD Blogs: http://wwwedgeeffect.blogspot.com/ http://www.psychiatrictimes.com/blog/knoll Aaron Stupple ’12 Blog: http://adjacentpossiblemed.blogspot.com/ Twitter: twitter.com/astupple Bob West, PhD Twitter: twitter.com/westr Upstate News Twitter: twitter.com/upstatenews Kent Bottles, MD, on HealthLink on Air http://www.upstate.edu/healthlinkonair/podcasts

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