June 18, 2018 | by John Infanti

“What should my first tweet be?”

It’s a question John Barbieri, MD, was thinking about just after he created his account on the social media platform. The Dermatology chief resident decided to take the plunge and sign up with the goals of building a network, learning more about the latest from other researchers in his field, and promoting his own work. These specific inspirations were echoed by all of the doctors interviewed for this story as they started out on social media, but the challenges they face can be very unique to their profession.

Finding an Audience

The first hurdle is the same for everyone, from doctors to doormen.

“In the beginning, no one’s listening,” said Jules Lipoff, MD, an assistant professor of Clinical Dermatology, who joined Twitter two years ago. “It’s important to engage and not just to tweet and follow people, because you need to work your way into the community so people can find you.”

Finding an audience is a universal challenge for anyone getting their social feet wet, but it’s especially true when your target is a specific field of medicine. Several doctors note that one key strategy is to interact with your institution or specific center. That can involve projects that are specifically geared toward digital platforms like Penn’s Center for Digital Health, and it can also be specific to an area of work, as in the case of the newly-launched @PennMedBenchmarks, which is focused on basic science.

There don’t seem to be any reliable statistics that break down doctors who are active on social media by specialty, but anecdotally, the physicians themselves say it’s clear.

“Dermatology is not as active as some of the others,” Lipoff said.

It may not come as a surprise that oncology, by contrast, has a sizeable presence on Twitter. As a result, clinicians and researchers who tweet about cancer can find their audience far more quickly. Charu Aggarwal, MD, MPH, an assistant professor of Hematology-Oncology in Penn’s Abramson Cancer Center, joined Twitter earlier this month on the first day of the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, the world’s largest cancer research conference. Within a day and a half, she had 200 followers.

“It was spur of the moment; I didn’t join just because of ASCO,” Aggarwal said. “It just took off. I’ve had so many people mention to me that they saw what I wrote.”

That visibility can be both a blessing and a curse for anyone on social media, but it’s especially true for doctors who may have knowledge of private patient information or unpublished research data. One wrong tweet, even by accident, can lead to serious problems.

“The thing about Twitter is that you need to focus,” said Abigail Tripp Berman, MD, MSCE, an assistant professor of Radiation Oncology who has been on Twitter since January 2017. “It’s like adding another job, and not one that’s insignificant. You need to think about who you’re going to follow and prioritize what you’re going to tweet about, which will help you find your niche.”

Once that happens, it can lead to incredibly meaningful engagement. Deeper conversations about the medical profession and society no longer only happen in break rooms and at happy hours. As the #ILookLikeASurgeon hashtag shows, they’re also happening out in the open on social media.

Spreading the Word

Like all users, doctors on social media have the opportunity to share ideas with others who work in their intellectual space. For some, that means direct interaction with leaders in the field.

Aggarwal notes there’s been a push from many department chairs, mentors, and division chiefs to encourage early-career scientists to be more active as a way to gain visibility within their field. It’s a concept that’s been around for a long time – think How to Win Friends and Influence People by Dale Carnegie – but now it’s easier than it has ever been.

“Early in your career, you can connect with these leaders, even if they’re not at your institution,” Berman said. “They get to know you a little bit. Otherwise, you’d have to travel across the country to a meeting and hope to get some time with them in person.”

Lipoff points out that Twitter is unique among social media in this way.

“Theoretically, it’s very democratizing, because anyone can interact with anyone no matter how rich or poor or famous or unknown you are,” Lipoff said, noting that it’s a different ballgame than what typically happens on other platforms. “Facebook is very siloed, and my feed is dominated by groups I follow and baby pictures posted by people I know. I’m not interacting with strangers there or using it for work.”

In addition to networking, Twitter provides a streamlined opportunity for doctors to keep up with the latest research in their field. It’s especially critical with so much new information coming out on a daily basis.

“I learn things from following friends and co-workers that I may not otherwise see,” Barbieri said.

“Twitter also provides commentary,” Berman added. “You don’t just get the research highlights. You also get to see how the rest of the field is talking about it, and you get that in 280 characters.”

Beyond the small, easily-digestible nuggets of information, Twitter also has the advantage of moving faster than traditional publications.

“Academic writing is on such a delay, whereas Twitter is real-time and gives academics a way to get engaged,” Lipoff said.

It also helps doctors find potential partners for collaboration. Lipoff makes a point to engage with others at Penn who may be doing related work just a few buildings away, something he says helps him “tap into our academic capital.” Aggarwal said the first people she followed were people she’s worked with in the past, cementing existing relationships.

“You can also get a sense for whether or not an idea may generate any buzz,” Barbieri said.

Self-Promotion, With a Catch

It may seem to go without saying that social media can also act as a tool for promoting one’s own work, but that’s not exactly true. Many of the doctors I spoke with mentioned the stigma around the perception that someone is patting themselves on the back, and Twitter super-users often advise that touting only your own work isn’t enough – to engage and build an audience, you have to be part of the industry-wide conversation, sharing news from outside your own walls. But even if the culture of academia was more open to it, some people just aren’t naturally inclined to self-promote.

“The trouble with that approach is that oftentimes great work doesn’t reach the public,” Lipoff said. “If it was important enough to research, it’s important enough to share, and Twitter is the perfect vehicle.”

This direct contact with the public represents a whole new world for medicine, especially for clinicians. Until now, it’s never been so easy to directly contact your doctor between appointments or for a potential patient to research a doctor’s opinions on social issues before choosing to make an appointment. Not all doctors make those opinions public, but authenticity is key to running an effective social media account. On top of that, some of those interests and opinions come out naturally, whether it’s a passion for Boston sports in Barbieri’s case, or screenwriting, a side-passion of Lipoff’s.

“I’ve had people reach out to ask for medical advice, and it can become dangerous to put something that can be misinterpreted out there,” Aggarwal said.

“Can I follow a patient?” Lipoff wondered. “Even if I do, I certainly can’t acknowledge that they are a patient.”

“It gets complicated, so I’d rather just avoid it entirely until we have clear guidelines on how to handle that,” Berman said.

Aggarwal also mentioned the potential impact her opinions might have when she tweets about specific research. It’s easy to imagine a scenario in which a study is presented at a medical meeting, experts are unimpressed with the results, and the negative reaction has a ripple effect financially on shareholders in whatever treatment is being tested. That kind of real-time feedback couldn’t happen without social media, and it has the power to lower a stock or alter whether a grant is awarded.

Engage

With so many opportunities to benefit and such industry-specific risks, the decision of whether to join at all is one that needs to be thoughtfully considered. But from Twitter rookies to social media mavens, proponents say it’s worth it to engage.

“It’s something where you have to think about when in your day you’re going to do it, but the nice thing is that you can do it from anywhere,” Berman said. “Treat it like you would treat your career. Put some thought into it.”

Lipoff is more direct in his advice.

“Have no fear,” he said.