Twitter: What’s the use?

As orthopedic surgeon Joel Wallskog, MD, surveyed the operating room at Aurora St. Luke's Medical Center before performing bilateral knee surgery, he spotted one addition to the usual crew: a hospital public relations staffer at a computer, posting Dr. Wallskog's surgical play-by-play live from Milwaukee onto the world of Twitter.

Given how the social media Web site has burst onto the national consciousness over the past few months, you probably know of Twitter but might not know what it's all about.

Twitter is a Web site that also can be accessed on a mobile device. People can create an account to share their thoughts, 140 characters at a time, to other Twitter users who sign up to "follow" that user's "tweets." Registration is free. Twitter accounts start with an "@" sign, and are promoted as "@username."

Physicians are among those jumping onto Twitter. If nothing else they want to see what the hype is about, or what the purpose is of blasting short, random thoughts to whoever opts to listen.

Most users, physicians and otherwise, don't tweet for very long. Data that the Nielsen Co. released in April found only about 40% of users were active a month after creating an account.

Doctors who keep tweeting stick around because they find it can be useful. Physicians most often use Twitter as an extension of their Web presence, a patient communication site, a marketing tool or a virtual water cooler with their colleagues. Or, maybe a combination of all four.

"I recognize the power of having a community," said Bryan Vartabedian, MD, (@Doctor_V) pediatric gastroenterologist at Texas Children's Hospital and assistant professor of pediatrics at Baylor College of Medicine. "I didn't realize when I first went on Twitter that there is a lot of strength and a lot of power in having these sorts of connections."

Aurora Health Care, parent of Aurora St. Luke's Medical Center, is one of a handful of hospital systems that have detailed surgeries on Twitter. It's an inexpensive and easy way to connect with patients, and potential patients, and perhaps get a little media buzz.

Jamey Shiels, social media director for Aurora (@Aurora_Health) who helped organize Dr. Wallskog's twittered surgery in April, said traditional advertising does not result in a two-way conversation. It's more of a push, he said. The hospital saw Twitter as "an opportunity to move to a one-to-many conversation."

The procedure Aurora decided to tweet was not randomly selected. It was a new, less-invasive approach to bilateral knee replacement, using customized tools created from virtual images of the knee. The marketing team thought the novelty factor alone might draw some attention.

It did.

Aurora reported more than 180 questions and comments in reply to the 250 tweets posted during the surgery. At least 75 of its messages were forwarded, or sent as "retweets," by other Twitter users. This expands the reach to other groups of followers.

The hospital's surgery tweeting was profiled on ABC-TV's "Good Morning America" and got a mention on "The Oprah Winfrey Show." Within a week after the surgery, the number of Twitter users following Aurora grew from 930 to 2,240. By mid-June, that number had passed 3,900.

Within a month of the surgery, Dr. Wallskog saw at least 10 new patients, all potential candidates for the surgery. Dr. Wallskog suspects the seed has been planted, and as the year unfolds, more new patients will come for a consultation as a result of Twitter.

While several hospitals have established a presence for marketing purposes, few physicians are using Twitter for that. At least not yet.

Peter Beck Kim, MD (@doccottle), a family physician in Costa Mesa, Calif., said he started twittering as a way of connecting with other physicians interested in health IT issues. He can see himself eventually using Twitter as another way of interacting with patients, but not enough people are on yet.

"I think there's more out there [on Twitter] than not," Dr. Kim said. "But overall, in terms of my patient base, I wouldn't say it's a tiny minority, but it's a minority."

As the number of users grow there will be a larger pool of local users to connect with, he said.

Extension of a Web presence

Gwenn Schurgin O'Keeffe, MD, (@DrGwenn) a Massachusetts pediatrician who is CEO and editor of the Web site PediatricsNow, already had a pretty devoted Web following. She decided to join Twitter earlier this year as a way of extending her Dr. Gwenn brand.

Dr. O'Keeffe has made contacts through Twitter that have expanded her work as a writer and media source. Now she's weighing the question of how many contacts are too many.

While some Twitter users look for a core group of people who share similar interests, others join with the goal of having as many followers as possible. "It's like a big sales pitch," she said. "You can't filter out the noise from the real conversations."

But, the ability to reach thousands in one place is the real power of Twitter, said Wesley Young, MD (@DrWesYoung), an emergency physician in Honolulu. He's already seeing the benefits of getting your name onto as many platforms as possible, including blogs and Web sites, as well as Twitter.

Part of Dr. Young's practice involves conducting virtual visits through a telemedicine service started by Boston-based American Well and Hawaii Medical Service Assn., a Blue Cross Blue Shield-affiliated plan. One online patient said she chose him from the list of available physicians because she recognized his name from Twitter. "That is a foreshadowing of things to come," Dr. Young said.

Patient communication

Dr. Kim said he sees an increasing number of patients in his practice using smart phones to send text messages and surf the Web. While Twitter use has not yet reached critical mass, he intends to be on the cutting edge and use the site to communicate with patients who are interested in it.

"As an added service, I definitely think it can have an appeal if you are trying to market yourself as a physician saying, 'I will give you Twitter updates on things of interest to you [if] I find a health-related article' or 'I will give you a real-time update if I am running behind,' " Dr. Kim said.

But until local patients reach that critical mass, many physicians are using Twitter to communicate with anyone looking for information.

Dr. Young believes it should be the goal of every physician to educate the masses — and Twitter is a good tool.

"One method of providing health education is through electronic media, which can multiply, if used properly, a single individual's efforts to promote healthy life choices," he said.

This ability to reach thousands of people with one message also can useful in times of public health scares. The Centers for Disease Control and Prevention and other health organizations have turned to Twitter to help educate people about A(H1N1) flu, spread information and curb misinformation.

Unfortunately, Dr. O'Keeffe said, the Twitter-using public doesn't always differentiate qualified expert advice from unreliable chatter.

Dr. Vartabedian said he saw a number of physicians stepping in during the flu scare to "provide some sound balance to what was really, on Twitter, an amazing amount of hysteria." He sees local physicians, whom the local public knows and trusts, assuming that role more and more in the future.

Virtual water cooler

Physicians tend to gravitate to other physicians in most social networking mediums, and Twitter is no exception. But there are few curbside consults here. Besides the obvious privacy issues related to posting on a very public forum, there's limited dialogue opportunity within the 140-character limit. What you often find is the virtual version of office banter and the occasional sharing of links to useful resources.

"Most of the physicians I follow are not twittering as doctors, they are twittering as people who are doctors," said Dr. Vartabedian. "They talk about medical things and they link to medical things, but they aren't talking from a position of authority."

Many physicians believe embracing Twitter is just a part of practicing medicine in the 21st century and that, either in its present form or something similar to it, Twitter will be around for a long time to come. Others are not so sure.

"I think the chips are still out," Dr. O'Keeffe said. "It's kind of like an election where we're not going to see the results for a while."

Dr. Wallskog is an undecided voter.

He agreed to the tweeting of one of his surgeries because the idea was "quite unique and novel."

But a few weeks after the surgery, he found he hadn't used his Twitter account much.

"I'd love to say I'm regular twitterer," Dr. Wallskog said. "I am interested in kind of exploring it. It's just I don't have that much time to use that stuff."

The print version of this content appeared in the July 6, 2009 issue of American Medical News.

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