Peter Chin-Hong, MD, MAS, is a professor of medicine, Academy-Endowed Chair for Innovation in Teaching, director of the Pathways to Discovery in Clinical and Translational Research program, and director of the transplant and immunocompromised host infectious disease program at the University of California, San Francisco. His Twitter handle is @PCH_SF.

Tweets in the time of Zika (or Ebola or cholera)

I was excited by the prospect of restarting my blog after a hiatus. I queried my editor. He wanted me to be topical, but novel — male-to-female transmission of Zika maybe? Zika as a sexually transmitted infection? I perused the published scientific literature — zilch; then The New York Times, my perennial go-to source for pre-published medical news — there, but a bit thin. So I almost reluctantly turned to Twitter. I had been introduced to Twitter by a Harvard Macy (@harvardmacy) Institute course that I had taken over the summer, where I was assigned (in a homework, peer encouragement sort of way) to begin tweeting. After all, the course leaders exalted, health care professionals — not just millennials — need to be on social media for myriad reasons.

By the time I was done with the Twitter search (#Zika), Zika had spread to Florida and Singapore and back again, we discovered that mosquitoes spread Zika to eggs via vertical transmission and there were further reports of Guillain-Barré syndrome and the congenital effects associated with Zika. Pregnant women began turning up positive for Zika in Florida. All at breathtaking speed. So after starting and stopping and starting back again in staccato style, I went back to the drawing board.

I decided to write about tweeting in a Zika time instead. Being relatively new to this whole world of information retrieval, I thought it would be better to ask a diverse group of more experienced colleagues (the medical “Twitterati” so to speak). Edward R. Mariano, MD, MAS (@EMarianoMD), is chief of anesthesiology at the VA, Stanford Medical School. Steven A. Pergam, MD, MPH (@PergamIC), is director of infection control at the Fred Hutchinson Cancer Research Center, University of Washington, Seattle. And Catherine R. Lucey, MD (@CatherineRLucey), is vice dean for medical education (ie, education czar), and chief architect of our new BRIDGES curriculum at the University of California, San Francisco School of Medicine.

What are the limitations of traditional medical information sources for clinicians today? Does anyone still read journal articles?

Pergam: While getting to read journal articles is a key part of learning about new emerging pathogens, many of these papers are not immediately available, behind pay walls (ie, not open science), or not current enough for evolving outbreaks. It takes so long for things to get published that often by the time a paper is in press, it is no longer relevant — particularly when dealing with outbreaks.

Lucey: I think that the conventional journal publication cycle is way too long for our information age. What we really need is a new disease alert that goes out in multiple journals — a quick synopsis (perhaps like either the NEJM perspectives or the JAMA patient info pages) for all physicians with the most up-to-date info.

Figure 1. Medical educators engaging with educational technology at ASM Microbe 2016 in Boston.

Source: Peter Chin-Hong, MD

How then do you realistically keep up with emerging issues like Zika beyond journal articles to stay current? Do you have a “news feed?”

Mariano: I’m very partial to Twitter because it serves as my “news feed” for current events, medical news, and other topics that I’m trying to learn more about, like leadership.

Pergam: More recently I have used Twitter. The immediacy of data and reporting from worldwide experts, local media and physicians on the front line of many of these diseases is incredibly valuable. I retrieved early Zika news from Micronesia, outbreak data from South America, and information on clinical outcomes. Experts from the CDC and the academic community (such as Peter J. Hotez, MD, PhD, [@PeterHotez]) have been crucial for me in advising travelers (patients and staff), and giving me early insights into local preparations. I can also link to people working closely on the science in the Zika field — it keeps me abreast of diagnosis, clinical complications and studies addressing treatment and prevention.

Lucey: What I currently do is follow both the general medical journals (NEJM, JAMA, Annals of Internal Medicine and Science), but I also get a lot of info from the lay press (The New York Times) and Twitter feeds from journals.

Are there any disadvantages to these Twitter feeds?

Pergam: The downside to Twitter is that such instant reporting can lead to reports that are not accurate, or results that are overblown/inaccurate — so it is important to take news with a grain of salt. It is important to be wary of limitations, but I have found high value in the speed of epidemic news through Twitter, and reviewing Twitter has become a part of my clinical workday. 

Lucey: I don’t stop there (at Twitter), but often that prompts a new search for more information.

Who should doctors follow on Twitter and on social media in general?

Mariano: On Twitter, I follow journals, societies, and people with similar interests in medicine. As an anesthesiologist, it’s been especially helpful for me to follow surgeons, surgery societies, and surgery journals as well. Facebook has the most users in social media. Many of the specialty societies and journals also have Facebook pages that you can “like” and have their posts show up on your timeline. LinkedIn is good for finding posts, and some people use the groups to have discussions about topics. I just don’t find it as timely as Twitter.

Pergam: Twitter can be a great way to find open science articles (either pre-print [eg, bioRxiv], open access [eg, PeerJ], or in press papers that aren’t in PubMed) that I would otherwise miss, links to academic blogs, tweets from conferences, or other reporting outside of the traditional print journal experience. There are also some superb medical journalists like Maryn McKenna (@marynmck), Laurie Garrett (@Laurie_Garrett), Julia Belluz (@juliaoftoronto) and Ed Yong (@edyong209) who write interesting updates on emerging pathogens.

Source: Twitter/Peter Chin-Hong, MD

How can physicians use Twitter to train fellows, residents and medical students about epidemics that we have not yet encountered? Is there a place for social media in medical education?

Mariano: Using social media requires training, and it is important to emphasize helpful tools while limiting distraction. Social media offers real-time discussion and opinions from a wide range of participants that predates any peer-reviewed publication. In public health, Twitter has been used to track the flu, Zika and outbreaks of food poisoning. Twitter has also been used for journal clubs that involve people from around the world and can lead to potentially helpful partnerships in learning.

Lucey: In addition to pushing information to physicians and students about emerging epidemics (via Twitter, social media and other sources), I think we need to keep pointing out not just the information about clinical syndromes that these new viruses demonstrate, but also reinforce the basic science concepts that are relevant. For example, I think that by knowing how influenza replicates, it makes total sense why early administration of Tamiflu [oseltamivir phosphate, Roche] is critical.

Pergam: You can’t prepare students for the unexpected, but you can give them tools to be more prepared. If I were to choose one social media tool, I think that Twitter can be a highly valuable way to get engaged in these fields and to learn about new literature, read blogs and hear expert commentary. It is important to spend the time to give trainees some quick do’s and don’ts of Twitter. They need to be smart about how to Tweet, remember HIPAA and privacy issues, and be cautious with what they discuss on social media, but I think it can be a great introduction to emerging infections and epidemics. And for those even earlier in their careers? Interacting with games such as Pandemic can help them learn about how epidemics spread and the need for teamwork in dealing with emerging pathogens. Most importantly, is that anyone entering into or already in the medical field needs to be more engaged with what is going on in the world. Being prepared for epidemics starts with awareness.

Finally, in addition to the people you follow, who do you consider to be your community on Twitter, other subject experts? Who are the “real” people?

Mariano: Twitter is definitely useful for up-to-the-second information on trending topics (even for experts). Zika is one medical example, but there are other world news topics. In my area, the subject of opioid abuse is discussed frequently. The Medicare Access and CHIP Reauthorization Act (MACRA) and Maintenance of Certification (MOC) are other hot topics in the medical community. I also learn a lot from real people and patients on Twitter. Sometimes I participate in chats, and it’s often very enlightening to get the patient perspective in an unfiltered form.

And that is the essence of what Twitter and social media really bring to medical professionals and educators: community. And as I build my own community of other physicians, pharmacists, nurses, medical educators, community activists, patients and advocates, I see value added every day in not only the information I receive but the information I curate and disseminate as well. I thought I had made it when I got a notification that the Infectious Diseases Society of America had followed me. Was it my news feed of emerging climate change-associated infections, or my missives on design thinking in medicine? Or perhaps it was my discussion of donor-derived rabies infection in China that enticed them to put me on their must-see Twitter feed? I was wrong. It was not the IDSA (@IDSAInfo, 8,063 followers) but rather the Industrial Designers Society of America (@IDSA, 27,400 followers), the one with a tagline “Community Matters.” Even better. After all, if I am trying to reach a new community and to bring something new to the table, I was all for it. Indeed, the answer was there all along. I reread the Harvard Macy materials that I had only scanned earlier: We tweet “to connect our alums, our faculty, and our fellow educators. To bring you up-to-date news … To promote the type of inquiry that [we value]. To celebrate the global and diverse community of practice.” That pretty much says it all. Community. Let’s tweet.

For more information:

Twitter tips for beginners:

Disclosures: Chin-Hong, Lucey, Mariano and Pergam report no relevant financial disclosures.