What can surgeons learn from patients?

I’m going to be on a panel at the American College of Surgeons 96th Annual Clinical Congress on October 5 in Washington, DC. The session title is pretty provocative: To Tweet or Become Extinct?: Why Surgeons Need to Understand Social Networking and my part of it uses the “e” word that I recently tried to swear off: The E-patient is In: How Social Networking Can Make You A Better Surgeon.

This is a different audience for me — all M.D.s, no “civilians” — so I have been preparing for it with special care.

Last week’s Mayo Transform symposium offered me a chance to learn from surgeon Catherine R. deVries, M.D. and from critical care specialist/anesthesiologist Alice A. Tolbert Coombs, M.D. I learn every day from surgeons who use social media, such as Howard Luks, M.D., and trailblazing docs who aren’t surgeons, such as Kevin Pho, M.D.

My reading list has included a review of the 2008 Archives of Surgery article, “E-mail Access and Improved Communication Between Patient and Surgeon,” and the great discussion we had about it on this blog. I also re-read Joanne Disch’s essay in the Journal of Participatory Medicine, “Participatory Health Care: Perspective from a Nurse Leader,” about her experience in a collaborative cardiovascular surgery work environment, as well as Bill Claxton’s monster post about how he – a patient – helped develop a surgical plan to treat his cancer. One book I read in preparation for this panel was Sherwin Nuland’s The Soul of Medicine (here’s an NPR interview if you are audio-inclined).

In the spirit I try to bring to all my work, I’d love to open up the discussion early and bring in insights from anyone who would like to share.  Can social media make someone a better surgeon? What evidence would you present?  What stories would you tell?

Alternatively, why does social networking matter for surgeons? As one person said to me, “I didn’t pick my surgeon for his communication skills, I picked him because of he’s the very best at this procedure!”

Enlighten me on any side of this you care to take.

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Comments

33 Responses to “What can surgeons learn from patients?”

  1. Susannah Fox says:

    OK, yes, I just posted, but I already have to add this article to the must-read lineup:

    When Patients Contact You via Social Media – 9 Pointers, by Bryan Vartabedian, MD (aka @Doctor_V)

    http://33charts.com/2009/10/9-things-to-consider-when-patients-contact-you-via-social-media.html

  2. Sani Yamout says:

    Susannah,

    I’m a first year pediatric surgery fellow (general surgeon specializing in pediatric surgery), I find social media to be a very powerful tool for spreading information that I gather along the way as I proceed through training.

    Surgical training consist mainly of acquiring operative skills and surgical knowledge. The later part is mostly by reading and research, as well as personal day to day experiences that you cannot find in books. Social media allows me to express and share what to me is the synthesis of what I have read and how I saw it applied in real life. This is beneficial to both myself and, I hope, surgeons of similar interest and levels of training who read my posts.

    Also, it’s fun!

    • Susannah Fox says:

      Sani,

      Thanks so much (and I’m looking forward to being on the panel with you)!

      I understand very well how social tools can be useful for professional development. I use them the same way in my field – to find new insights, to synthesize my observations, to debate concepts with farflung colleagues, to spread my findings further than any press release could reach. I often say I am a better researcher because of social tools (my favorites are blogs and Twitter).

      What do you hope to learn from patients? Or colleagues outside your specialty?

      By the way, I don’t have a stake in the outcome of this discussion – I am just hoping to get a better understanding of the impact of technology on health care in general (and for the purposes of our panel, surgery in particular).

      Other people should jump in – if there is another doc out there with a perspective or a nurse, caregiver, patient who would like to share what they have seen, whether for good or for ill.

  3. Howard Luks says:

    First off… I hope you will forward me a copy of deck, I would love to see it. I’m impressed the the ACS is even interested.
    Why is social media important to physicians…hmmm
    -they are online whether they know it or not and people are discussing them/ and their institution. The bare minimum effort in any soc media program should be geared towards reputation mgmt and controlling the message.
    -patients are online…. and increasingly so as time moves forward. Like big business has learned… you need to be where your customers are.
    -Humans are innately social
    -Health Care is Social
    -Even Physicians are social, they discuss cases with colleagues, they look for a shoulder to lean on when they witness a horrible tragedy. etc/ Bringing this online is simply an extension of that as the 800 Million or so on FB, TW, U-tube, etc already know.
    -FEAR… physicians fear the unknown and there is a need for clear guidance about boundaries, etc.
    -Physicians need to know that being *active* in social media does not need to mean interacting with one particular patient… but it starts as an outreach to inform, encourage and educate their potential patient base, etc.
    -Many of us simply do it for the “greater good” with no expectation of an ROI.
    Since they will ask… what is the risk of not engaging online…. perhaps obsolescence in 5-7 years (lots of eyeballs will roll at that :-))

    Show them what @Jenssmccabe has been able to accompish, what @textandshout working on and they should begin to get it… show them the work being done at MIT http://goo.gl/h7RN and their eyes should start to return to normal focus and their ears might perk….

    Look fwd to getting a copy of the deck… good luck!!! You’ll be brilliant!
    Howard

    • Susannah Fox says:

      Howard, I may just call a lifeline and put you on speaker phone for this panel!

      I’m picking up signals from you and other surgeons (via email, tweets & DMs) that this will be a skeptical, smart group of people who want the bullet, not the bull**** (not that I think anyone wants the latter, but you know what I mean).

      Very psyched for this challenge – thanks for the encouragement to dive in further.

  4. Susannah Fox says:

    Philip Glick, the panel moderator, tweeted a link to the following book this morning:

    Forgive and Remember: Managing Medical Failure
    by Charles L. Bosk

    http://www.press.uchicago.edu/presssite/metadata.epl?mode=synopsis&bookkey=3622913

    You can preview it on the site, which describes it as “the definitive study of the training and lives of young surgeons.”

    Looking forward to digging into it!

  5. Martin Young says:

    There are a few ways for surgeons to use social media.

    One is in a completely non-surgeon fashion – as a private individual with private and non-professional thoughts. Just hope your bosses and patients like this part of you.

    Second is in a self promoting manner – like “I did three parotidectomies today and have never had a complication.” That is just plain dumb, and looking for trouble.

    Third is in reaching out to other doctors’ patients – also not permissable, and is akin to interfering.

    Fourth is to promote links to good research and patient information. Probably a good idea, but again “What’s in it for me?”

    Even as an eDoctor, I’m not sure what role social media has for me on an open platform!

    On a limited or closed platform, i.e. doctor – patient – funder or insurer – hospital – surgical supplier – that is a whole different story with unlimited potential!

    • Susannah Fox says:

      Thanks, Martin! I think you just laid out a few of the reasons why many people (including surgeons) don’t see the point of social media – clear downsides, unproven upsides.

      What do you think about closed social networks for doctors?

      Here’s a panel discussion from Health 2.0 Europe which I found pretty interesting (esp. the part when Daniel Palestrant of Sermo says he never heard of his British counterpart before that day – ouch):
      http://www.health2con.com/2010/08/16/physicians-and-online-communities/

      How about VuMedi, a surgeon-only video-sharing website, which was suggested to me by Nicole Johnson (@nicoleljohnson)?
      http://www.vumedi.com/

  6. Martin Young says:

    If you can imagine a version of Facebook for healthcare, where a person’s profile is their health record, but is only viewable by permission, and the ‘Friends’ are service providers of all sorts – doctors, hospitals, surgical suppliers, each with public profiles, and communication can go back and forth in this medical social network, imagine what this would do to drive down costs!

    This is my vision of the medical future.

  7. Mary Jane says:

    I know from my own personal experience — that social media can help you, the average individual, in amazing ways. I am speaking here mostly about support networks and the internet. As a bereaved mother, similar to e-patient Dave, email and the internet enabled me to have a worldwide support network that frankly kept me alive through the black whole of a mother’s grief.

    Been in the administrative side of health care now for 25 years and work closely with physicians. The older ones are like me — having steered away from the computer until it was mandatory for them to learn it for their job. It is fast becoming that way.

    Physicians have/are moving from handhelds (their first experience with technology use for their jobs) to the internet.

    The biggest motivators for surgeons to be e-savy are: 1)timely (immediate) access to evidence based medicine; 2)better ability to talk to their patients who in increasingly large numbers are coming to their appointments with e-info 3) ease of use of the hospitals’ electronic health records and physician tools 4) continuing medical education credits -some hospitals are going for medical education credits for their physicians to learn how to manipulate e-medical records 5) will be needed for them to continue to be certified — as the Specialty Boards are reguiring them to work on quality improvement efforts which rely upon use of computers and 6) in a closed network or through email having the ability to relate to their colleagues across the country quickly AND in depth.

    Not alot of use outside the internet really except last but not least is the fact that surgeons, like us all, have children and grandkids who “talk” on the computer, through FACEBOOK, etc. Through use of those social networks they will be able to keep in touch with their family AND see more family pictures.

  8. The links below may be of interest:

    1. Reaching out for patients: public relations and events with real results
    http://www.ncbi.nlm.nih.gov/pubmed/20094963

    2. Time to Tweet?
    http://www.ncbi.nlm.nih.gov/pubmed/19606626

    3. Social Networking Among Upper Extremity Patients
    http://www.jhandsurg.org/article/S0363-5023%2810%2900005-5/abstract

    4. Analysis of Healthcare Social Networking sites and applicability in Macedonian e-society
    http://ieeexplore.ieee.org/xpls/abs_all.jsp?arnumber=5533629&tag=1

    5. Promoting Clinical Competence Using Social Media
    http://journals.lww.com/nurseeducatoronline/Abstract/2010/05000/Promoting_Clinical_Competence_Using_Social_Media.15.aspx

    6. Talking about your health to strangers: understanding the use of online social networks by patients
    http://www.informaworld.com/smpp/content~db=all~content=a925192542~frm=titlelink

    7. ‘Friending’ Your Patients
    http://nurse-practitioners-and-physician-assistants.advanceweb.com/Archives/Article-Archives/Friending-Your-Patients.aspx

    8. Everybody’s talking about it: social media is giving providers new ways to communicate with families, prospects, and other key players.
    http://www.ncbi.nlm.nih.gov/pubmed/20394274

    9. Twitter opens a door to Iowa operating room
    http://www.physorg.com/news171121774.html

    10. Tweeting, posting, and yammering: the role of social media in the OR
    http://www.ncbi.nlm.nih.gov/pubmed/20333817

    11. Reflections on surgery in its relation to the patient, to social media and to scientific research
    http://www.ncbi.nlm.nih.gov/pubmed/13854276

    12. Tweeting From the Operating Room
    http://well.blogs.nytimes.com/2009/07/09/tweeting-from-the-operating-room/

  9. Susannah Fox says:

    I am fired up by Bryan Vartabedian’s half-time speech/field guide – he had so much to say he skipped the comments and went straight to this awesome post:

    http://33charts.com/2010/09/how-to-speak-to-physicians-about-social-media.html

    Feeling grateful & energized – thanks, Bryan!

    (Quick note: I am heading to a friend’s landmark birthday party today & through the weekend so I’ll be offline, but looking forward to catching up with the discussion on Monday!)

  10. [...] V was responding to a request from Susannah Fox, Associate Director – Digital Strategy at Pew Internet & American Life [...]

  11. [...] been a great discussion about physicians, patients and social media. In her post What can surgeons learn from patients?, Susanna Fox helps fire up the discussion before her talk at the American College of Surgeons [...]

  12. Susannah Fox says:

    Bob Coffield weighed in with more excellent advice, this time from a lawyer’s perspective:

    http://healthcarebloglaw.blogspot.com/2010/09/educating-physicians-about-social-media.html

  13. Susannah Fox says:

    The conference has begun in DC — follow the tweets by searching for the hashtag #acscc10 or follow this list I created:

    http://twitter.com/SusannahFox/acs2010

  14. Simon Lee says:

    I can tell you that picking a good surgeon who has great communications skills matters. Ask any nurse. Typically, a specialist who can communicate effectively with those with whom he/she works will get a quicker referral than one who cannot. I’d bet their patients tend to have better outcomes or at least higher satisfaction rates. Outside of medicine, who do you prefer to be with? Someone who is smart, communicative, friendly? Or someone who is difficult?

  15. Deirdre says:

    I have been talking to med students recently about the concept of social media resources being used for aspects of patient care that they don’t have time for – so the pre-op surgical video site might be shared before hand or an online patient support group might be shared later.

    Even more powerful is the concept of resource sharing that E-patients seem so adept at. Instead of patient to individual doctor maybe we should examine epatient to medical school sharing in some form.

  16. Jackie Fox says:

    Wow, great stuff.
    Right now, what seems the most valuable to me is how social media gives surgeons and patients access to each other’s points of view. Just one example: when I read Sid Schwab’s (http://surgeonsblog.blogspot.com) description of what it’s like to be inside a patient’s and the level of trust it takes, I got the same catch in my throat that I get from really good poetry. I’ve gotten comments from surgeons and family doctors on my blog, so I know it’s going both ways.

    With my “offline” general surgeon and plastic surgeon for breast cancer treatment, my social media use was limited to Googling them after my family doctor recommended them. We have not communicated by e-mail and I have not missed it–it’s all been face to face and over the phone.

    I can’t wait to hear more about this!

  17. Teresa Masters says:

    I no longer must rely on one opinion, internet allows me to venture forth and discover.
    Recognize that we all may learn from one another. The surgeon must understand more than simply removing
    a malignancy, he/she must understand what else is lost.

    Side effects are not only a pharmaceutical problem.

    Teresa Masters

  18. Susannah Fox says:

    Thank you, everyone, for helping me to prepare for the ACS panel today!

    The audience was standing room only (150+ people) and seemed receptive.

    Philip Glick lead off with the results of an ACS member survey: surgeons are not likely to use social media but very likely to use a mobile device.

    Zach Glick gave a step by step tutorial on how to create a Twitter account and at least a dozen surgeons followed it to the letter, down to his suggestion to make “Hello world” their first tweet.

    Since I personally didn’t need the Twitter 101, my favorite presenter was Sani Yamout who spoke about his own experience of using social media to filter the fire hose of medical information he takes in (or would like to take in). See his comment above for more info.

    I gave an overview of U.S. internet use, focusing on how many consumers now use mobile devices to gather, share, and create information online. I related those 3 activities to what surgeons might do: gather (33charts.com was my example of where one might lurk); share (Twitter was my example – and I asked Bryan’s excellent question, “do physicians have an obligation to share?”); and create (Howard’s Orthopedic Posterous was my example). Sermo was my final example, which led me to ask a focusing question: What is your goal? Marketing? Online reputation management? Continuing education? Contributing to public understanding of your specialty? Depending on your answer, you may choose an open system like Twitter/YouTube/Facebook or a closed system like Sermo.

    Rebekah Monson presented the legal POV so convincingly that I wondered if anyone in the room would ever tweet again (even I felt a little apprehensive and I’m not an MD). Her advice is good and important: don’t post personally identifiable patient information online, don’t blog about your malpractice trial, don’t post a picture of you having fun with your cadaver, etc. As she said, the guidelines for behavior are the same online as they are offline, but people tend to forget themselves – or it’s more permanent – online.

    Scott Lind closed out the panel with some great examples of hospitals and practices using social networks. He cited a survey that tagged surgeons as “aloof” and suggested that they needed to take advantage of social media to combat that stereotype.

    By this time we had only 10 minutes left for Q&A, but about half the audience stayed on for another 40! A sample of the questions:

    “Who has time for all this? Interns are the only ones who are allowed to sleep as it is!”

    “How do I elegantly de-friend a patient on Facebook?”

    “Should I let my staff create a Facebook fan page for me?”

    And a few surgeons encouraged their colleagues to jump in, such as this comment, which came from someone who said he spends 30 minutes every morning on Facebook:

    “I’m the same guy publicly as I am privately. I’m friends with everyone in my life on Facebook. My 80-year-old patient is now friends with my high school friends – and I think that’s a good thing.”

    All in all, it was an engaging session and I was honored to be part of it.

    • Philip l Glick, MD says:

      Susannah:

      Again, many thks for your input to make #acs2010 a sro event

      My take on the ACS Survey data was that surgigeons are currently not using ” enough” social media and social networking tools, but based on their use of mobile smart devices, they have the infrastructure to easily increase their use. I see events like #acs2010 as the beginning of an educational process to bring on board more FACS to use SM/SN for cme, cme, pt care, MD-Pt communication/education.

      Only time will tell, but my impression from audience, twitter feed back, ACS staffers was that PS233 was successful. official evaluations still pending. I hope in the near future we’ll be able to see FACS consider and adopt many of the tools we talked about.

      Will continue to follow this subject and your thoughts.

      PLG

  19. Phil Baumann says:

    Very cool –

    I’m sure some of the surgeons would be interested in the newly launched #MDchat, which is a Twitter chat for physicians of all kinds (not just MDs). The first chat was yesterday and was mostly well-received.

    Bryan was luke-warm on the idea, but the overall sentiment that I’ve received was that this is another option for physicians to get more involved.

    If my recollection is correct, I think it was actually surgeons who were among the very first to use Twitter as a matter of fact.

    It’s not for everyone, but some get value out of these chats – probably depends on how the brain is wired. ;-)

    It worked well for RNchat, and we’ll have to give it time for MDchat to see how it shapes up. The site is here:

    http://mdchat.org/

    And the Twitter account is: @MD_chat

    Phil

  20. Gina says:

    I am a healthcare professional and most recently a patient. I am desperate to get an accurate diagnosis on a wrist problem I have. I am a paraplegic and have gone from being independant to needing assistance with all ADL’ . I have a video clip on my cell phone that four physicians and a group of certified hand therapists state they have never seen before. Is there any kind of outlet for me to post this so physicians can view and give me some ideas? The hand surgeon I saw said this would have been good to take to a recent conference he attended in Boston. VuMedic is only for physicians. I am ready to post a reward for any answers!! It is said to be a true trigger wrist without triggerring being caused by any digits. If anyone has any advise, please, please help. Thank you.

  21. Rachel says:

    I’d like to offer a completely different perspective. I believe that we, as patients, have a responsibility to educate our doctors about the healing power of compassion. It is the rare patient who understands that doctors (and particularly surgeons) have very few opportunities to really hear the patient’s perspective. Granted, there are also few patients who have the energy and wherewithal to engage on this level.

    With my background of 24 years of hospice work and years of training new hospice volunteers in compassionate contemplative care of the dying, I made this my challenge when my husband was diagnosed with Stage III colon cancer. He thought this was a hopeless cause originally, but eagerly joined me in educating out doctors after he saw how well they were responding and how grateful they seemed to be with this unexpected and valuable new perspective.

    The story of how we educated our surgeons is here: http://sheddinglightonthecancerjourney.wordpress.com/2010/08/04/compassion-101-lessons-for-a-young-doctor/

    May all doctors grow in compassion. May all patients benefit.

    Aloha, Rachel

  22. Susannah Fox says:

    Update: The bulletin of the American College of Surgeons posted an article about the panel.

    Time to tweet: Social networking for surgeons, by Tony Peregrin

    http://www.facs.org/fellows_info/bulletin/2011/peregrin0211.pdf

    It focuses on the possibilities of surgeon-to-surgeon communication more than I’d hoped it would, but it’s a good summary.

  23. [...] V was responding to a request from Susannah Fox, Associate Director – Digital Strategy at Pew Internet & American Life [...]

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