New to Twitter? Do these things first:
Habla Español? ===> Guía de Redes Sociales en Anatomía Patológica
1. The first and most important thing to do is be sure you have a profile pic. This is the MOST important thing. Upload a professional headshot pic if you have it. If you don't, just smile and snap a selfie. Seriously. Stop reading this and do it right now. If you don't have a profile pic, no one will follow you as they will think you are either a spam/fake account or someone who rarely uses Twitter.
2. Update your profile to give a bit of essential bio info. Wait...did you upload a profile pic yet? If not, go back to step 1 and do that. I'm not kidding! It's important! Ok, so back to updating your profile/bio...It doesn't have to be fancy. "PGY-2 Pathology resident at Mayo Clinic" would be totally fine, for example. You can always change it later as often as you like. If medical professionals don't know you are a pathologist (or radiologist, or surgeon, etc) or even a doctor, they are less likely to follow you. Who would you follow: @crazycatlady73 or @CatLoverMD? See, you can still keep it fun and personalized but professional at the same time. I'm more boring, so I'm just @JMGardnerMD.
3. Follow 10-20 pathologists (or whatever your specialty or interest is). Twitter is most fun when you follow others and have your own followers. That is when interaction and discussion and retweeting starts happening. And then Twitter finally makes sense and it all clicks! Looking for other pathologists? Check out my list of most of the pathologists on Twitter: https://twitter.com/JMGardnerMD/lists/pathologists. I have lots of other lists, too (see below). My friend and colleague, Dr. Sanjay Mukhopadhyay, also has a great list to get you started: https://twitter.com/smlungpathguy/status/1033141259735584768?s=21. Also, look at who I'm following or retweeting or who other people you follow are following or retweeting...those may be people you are interested in following. Also follow the major pathology organizations...most of them are on Twitter.
4. Make some tweets and retweets. A new Twitter account with 0 tweets or only 1 tweet looks inactive. No one wants to follow an inactive account. Take a pic of a cool case and tweet something about it "Dermatofibroma shows characteristic collagen entrapment #pathology". Find some tweets you like (just click the #pathology hashtag to see all recent tweets about #pathology...I promise you will find something cool) and then retweet those to your followers. "But I don't have any followers yet!" you may protest. Guess what happens when you retweet one of my tweets? Twitter notifies me. And then I notice you, and I see that you are a brand new pathologist on Twitter so I follow you. And then I see that you tweeted a nice pic of a dermatofibroma, so I retweet that to my followers. And guess what they do? They notice you and some of them follow you, too. See how this works? Try to tweet 1 new pic and a few retweets (sharing tweets from others with your own followers) per day at first just to get used to it. That will take 5 minutes max. I think after your first 100 tweets, most people begin to get the hang of how Twitter works. So don't give up!
5. Read this awesome "tweetorial" about getting started on pathology Twitter by Dr. Sanjay Mukhopadhyay:
Ready for more in depth info? See the rest of the social media guide (including more Twitter info) below.
This page represents the personal thoughts and opinions of Jerad M Gardner, MD regarding the use of social media for pathologists and other doctors. Although much of my social media experience centers around my specialty of pathology, many of the ideas and issues discussed here will also be pertinent to physicians and healthcare workers from any field of medicine. This page is based on my personal experiences and is by no means official or exhaustive, nor is it necessarily the correct way to do things. A lot of people ask me questions about this topic, and I often give presentations on it, so I am merely attempting to compile my answers and main talking points online in the hopes that some readers will find it useful. I'll try to continue to update this page as often as I have new things to share. - Jerad
For those who have limited past experience with social media, these websites might be useful to explain the basics of the major social media sites:
Specific examples of how I use social media on a professional level. The possibilities are endless, but this might spark some ideas that you can run with.
- I created discussion groups focused on dermatopathology and bone and soft tissue pathology on Facebook. I started these so that I could share interesting cases and teach others. But to my surprise the membership on both groups exploded and pathologists from around the world started sharing their own teaching cases with each other. The groups have 21,000 and 18,000 members, respectively, as of April 2016.
- When I need to find a clinical photo or photomicrographs of a rare entity for a presentation, I post a request on my pathology-related Facebook groups. With thousands of members receiving the message, I am usually able to find even rare things within a day or so.
- Organize multicenter research projects, particularly when the project requires collecting a series of rare cases. My view regarding initiating collaboration via Facebook or twitter is this: it's no different than emailing a list of your colleagues to see if they have an example or two of X disease so you can all collaborate on a research project. This is not research just scouting for potentially interested parties. It's just potentially SO much more powerful than email as you can reach so many people from all over the world in a short time. Once you find interested parties, then you get an IRB together, have them mail cases to you or share images, and do the project like normal within the confines of the IRB.
- Share links to pathology related articles including recent journal publications. Debate and discussion over new data and findings is robust and can be had in real time on Facebook, a situation I feel is far superior to the old style of writing a letter to the editor to debate a paper.
- I often share links to my soft tissue pathology Youtube teaching videos, links to my dermpath teaching cases on dermpedia.org, or my dermpath and soft tissue path tweets (Twitter: @JMGardnerMD ) on my Facebook feed. This allows me to share my new pathology-related content with a broader audience (not all of my friends use Twitter or are subscribed to my Youtube channel, but the majority of them use Facebook.
- Build personal relationships with pathologists from around the country and the world (networking)
- Colleagues may not know my email but they know how to message me on facebook. I get FB messages all the time about a variety of things from professional colleagues (research projects, consults [sans patient info of course], invitations to be a guest lecturer or to present a course, etc).
- Follow and interact with patient advocacy groups. This is an awesome experience and is very rewarding! I've published about this: How Angiosarcoma and Facebook Changed My Life. If you want more info about pathologist interaction with patient support groups on Facebook, watch these videos on my YouTube channel:
- Share dermpath and soft tissue teaching “pearls” with my followers
- Build recognition of my name and my areas of diagnostic interest and experience
- Connect with other pathologists and clinical colleagues
- Follow and interact with patient advocacy groups. Again, very rewarding.
- Tweet to Senators and Representatives regarding pathology-related legislative issues
- Great place to share pics of interesting cases. Many of my friends who don't use Twitter do actively use Instagram, so it gives me a chance to share my posts with a wider audience. On Instagram, I am @JMGardnerMD. I find that my Instagram posts get many more likes than the same pic posted on Twitter. Instagram is robust: as of February 2017, I have 27,000 followers on Instagram vs 8,900 on Twitter and 9,100 on Facebook. I've been using Instagram for less than 2 years!
- LinkedIn is more of an online CV than an interactive social network. It is cool in that your colleagues can write recommendations and public reviews of your performance (you get to approve which are displayed on your profile) and can verify that you have experience in various knowledge areas.
- Overall, it is a good place to display where you work, what you are publishing, what committees you are on, etc. It does that much better than Facebook or Twitter.
- But it's not very "social" as social media platforms go. My advice is "set it and forget it". Set it up so if someone wants to get your background info or to get in touch with you, they can. Allowing people to message you via LinkedIn is a great way to be available but without having to disclose your personal email address to the whole Internet). But after it's set up, you don't need to check it very often.
- Post soft tissue & dermatopathology pathology teaching videos: https://youtube.com/user/JeradMGardnerMD. These can be live videos recorded from a mounted microscope camera, screen recordings using digital virtual pathology whole slide images (WSI), or screen recordings of a powerpoint presentation. I've used all of these techniques and the results are great. I constantly get requests to create more videos. These take time to make but are worth it. At first I edited my videos a lot to make them very polished and professional. It took forever. Now I just record them and post them with little or no editing aside from splicing multiple clips together or trimming the end or beginning of a video. Perfect is the enemy of good. I find that even though I talk quickly, stumble over my words sometimes, and go on tangents, my YouTube viewers still tolerate my flaws and enjoy my videos.
- I have heard multiple requests from viewers, especially in the developing world, to get more pathologists to create teaching videos and share them on YouTube. I plan to make a guide giving detailed steps about how I create and post videos on YouTube and detailing what equipment I use to try to help facilitate that. Stay tuned.
- Video record lectures I give in person (I just use my iPhone and a small tripod...not perfect but it works) and then post on my YouTube. Let's a much wider audience see lecture. Also, allows you to have something to reference if you are writing a paper in the literature and want to refer readers back to more detailed info in a lecture you gave. I reference my YouTube videos all the time when I'm writing papers about social media.
- I just started using this recently (2017) because my med students all seem to use it. I'm not very good at it yet, and it seems more confusing than other social media platforms that I use. But then again, I said that very same thing about Twitter and Instagram when I first started using them. On the bright side, failing at my early attempts at Snapchat got me noticed by Buzzfeed.com, who published an article about me: https://www.buzzfeed.com/crystalro/this-teachers-snapchat-photo-will-make-people-who-feel-old-s. So that was pretty cool. More info on Snapchat once I get the hang of it.
Periscope - give pathology lectures to a worldwide audience
Periscope is a useful tool for freely sharing your lectures real-time to anyone who wants to watch worldwide. Presenters and viewers only need internet/data connection and a smartphone. See paper on this topic by Maren Y. Fuller, Sanjay Mukhopadhyay, and me: Using the Periscope Live Video-Streaming Application for Global Pathology Education: A Brief Introduction.
Examples of Periscope lectures (recorded and later published on YouTube):
- How to Jumpstart your Pathology Career via Social Media
- Pathology Research via Facebook & Twitter
- Lung Pathology slide seminar by Dr. Sanjay Mukhopadhyay
Similar live video broadcasts can be done with YouTube Live and Facebook Live. Facebook Live has been used with great success to share live video from lectures at USCAP Interactive Microscopy courses in Palm Springs:
- USCAP: Jason Hornick's Soft Tissue Pathology course
- USCAP: Wendy Frankel's Gastrointestinal and Liver Pathology course
A list of links to pathology Facebook groups. If you create a new group and want me to link to it here, just leave a message with the link on my talk page (or message me on Facebook).
- Breast Pathology
- Bone/Soft Tissue Pathology
- Gastrointestinal GI Pathology
- GI, Liver, and Pancreatic Pathology
- #GROSSOGNOSIS: Gross Diagnosis
- Gynecologic and Obstetric Pathology
- Head and Neck Pathology
- Path Hits
- Pathology Job Opportunities (USA and Canada)
- Pathology Laboratory - tips & tricks (technical info and troubleshooting for histology labs)
- Pulmonary Pathology
- Surgical Neuropathology
- Surgical (Anatomic) Pathologists
- Surgical Pathology - Hints Tips Clues
- Uropathology (genitourinary pathology)
Pathology Residency & Fellowship Programs on Social Media
This awesome list was originally compiled in May 2019 by Lacey Durham (@laceydurham), a medical student at Texas A&M College of Medicine (Class of 2020). I converted it into an editable public file on Google drive (that way if your program's info is missing, you can easily add it to the list):
Thanks for your hard work on this, Lacey!
Twitter 101 for Pathologists
So you've decided to join Twitter...now what? Twitter is a bit different than Facebook, and it takes some time to get used to the rapid fire paste, the abbreviations, the #hashtags and @usernames and how to use them. Don't worry, it's worth it!
1. The first thing to do is be sure you have a profile pic. This is the MOST important thing. Twitter accounts without profile pics look like they are either rarely used or a fake account...not the kind of user that anyone else would like to follow. I use a professional headshot photo for mine so others can see what I actually look like. I would recommend that everyone does that (unless they prefer to remain anonymous) rather than use a pathology image or picture of your cat. For fun pics like that, you can add them to your background image rather than your profile pic.
2. Update your profile bio to describe yourself. You only get 160 characters so you must be brief. You can change this whenever you want, so don't worry about making it the most clever thing you have ever written right now. Just be sure to indicate that you are a pathologist (or med student/resident/doctor) and say a bit about yourself. Here is what mine currently says (February 2017): "Pathologist (dermpath & sarcoma). Deputy Editor-in-Chief: @ArchivesPath. Social Media Chair: @TheUSCAP & @ASDPTweets. Fellowship Director: @DermpathUAMS."
3. Find others to follow. Twitter seemed kind of pointless to me when I thought it was just all about me thinking of things to tweet. But once you start following others, replying to their tweets, retweeting and favoriting their tweets, and interacting with them, then the real power (and fun) of Twitter quickly becomes apparent. Here is how to find other users to follow on Twitter:
- You can start by following me: @JMGardnerMD. I retweet a lot of things from other pathologists on Twitter. If you like those tweets, you can just click to follow those @usernames in my retweets. Also, if you click on the list of people I follow, you will find many pathologists, patient advocacy groups, medical organizations, etc, and some of these might be of interest to you. If you think someone looks interesting, follow them. You can always unfollow them later if you don't find their content of interest to you.
- I also keep various lists of Twitter users subdivided by areas of specialization or interest: https://twitter.com/JMGardnerMD/lists. I try to keep them updated and add to them regularly. You can subscribe to these lists and they will show up on your account under the settings tab/lists. If you want to be added to one of these lists, message me on Twitter @JMGardnerMD. Here are some lists that might be of interest to you:
- Top 10 Pathology Twitter Accounts to Follow
- Once you follow a few people and find that you really enjoy the kinds of content that they tweet, look at the list of who they follow and who follows them. You will find many good twitter accounts to follow that way. Also, when you first follow someone new, twitter often pops up several other recommendations of similar accounts for you to follow. I find lots of good people to follow via Twitters recommendation.
4. Start tweeting! New users often wonder what they should say. The easiest way to get started is to click the retweet button on tweets from others that you like. Retweeting will share that persons tweet with all of your followers. You can retweet as much as you like. As long as you are sharing good content, your followers will be happy! The other easy way to get started is to tweet a pathology picture with a short description. Pathologists on twitter LOVE to see tweets of cool pathology pictures. My most popular tweets are almost always pics of cool cases.
5. If you are curious to see how many people have seen an individual tweet or want to get stats about which of your tweets are most popular each month, be sure to sign up for Twitter Analytics. It's a free service offered by Twitter. You just have to sign up for it. Go to https://analytics.twitter.com, log in with your Twitter log in info, then authorize Twitter Analytics for your account. Going forward, you will be able to click the "View Tweet Activity" button (little bar graph symbol at bottom of your tweets) to see impression info. You can also go to analytics.twitter.com (best on your computer not smartphone, in my opinion) to see more granular data. It's pretty cool. I highly recommend it. Note: if you have multiple accounts, you have to log in to Twitter Analytics once for each account to activate it for each.
1. What are #hashtags and how do I use them?
Here is a guide: [] to get you started.
We created a full list of pathology hashtags that was published on symplur.com: http://www.symplur.com/healthcare-hashtags/ontology/pathology/
Symplur is a website that tracks use of healthcare related hashtags. It's a great place to see what hashtags are trending. All of the hashtags in the link above are tracked by Symplur so it's easy to see how popular they are at any given time. You can also see which users are tweeting the most using those hashtags. It's a great way to find the most relevant Twitter users for you to follow in whatever subspecialty of pathology you are interested in. Example: Recent #Cytopath Activity on Twitter
2. What are @replies and mentions?
It's important to know how to mention other @users in your tweets. Twitter FAQ explains it best: https://support.twitter.com/articles/14023-what-are-replies-and-mentions.
3. How do I keep up with all of the activity on Twitter?
Once you follow many other users, there will be no feasible way to keep up with all of their tweets. So when I log on to twitter, I don't usually look at my Timeline. Instead, I go to my "Notifications" section. That area shows me any recent activity (replies, favorites, or retweets) to my own tweets, and it also shows me any tweets that others have made that mention me. It helps me keep up with everything better. Then, I will go to one of my lists or click on one of my favorite #hashtags to see recent tweets on topics of most interest to me.
Check out this guide for more ideas: http://computer.howstuffworks.com/internet/tips/how-to-manage-twitter-feed.htm
Nice tweetorial by Laura Pastrian (@DraEosina) about how to bookmark tweets to save your favorites: https://twitter.com/DraEosina/status/1014509122925027328
Other useful articles about Twitter:
4. How do I improve the quality of my photomicrographs for Twitter and Facebook?
The most important things are:
- Use a good camera or smartphone (iphone and other smartphones can take images of comparable quality to most traditional microscope mounted digital camera...use an adapter https://www.youtube.com/watch?v=KzsLNMJxOGU or free hand technique https://www.youtube.com/watch?v=cfd9ViHBlR4. Most of the pics I now share online (and many of the ones I publish in articles and books) are taken by my iPhone, freehand without adapter, via the Morrison technique (perfected and published by my former resident, Dr. Annie Morrison).
- White balance your pics via Enlight app on your iPhone or via photoshop or GIMP on your computer. This is the MOST useful thing you can do and only takes a few seconds. I explain this in detail in my video: How to white balance & watermark pathology images for social media
- Crop your image to the optimal size for the social media platform you are using. The best size or aspect ratio of an image is different for Twitter vs Instagram vs other platforms. Detailed info here:
5. How do I "live tweet" a medical conference?
Eventually, I plan to write a more thorough guide for this. For now, try this:
We recently published a paper in Modern Pathology about live tweeting at the #USCAP2015 meeting and beyond. Our paper includes tips for maximizing the live tweet experience:
- #InSituPathologists: how the #USCAP2015 meeting went viral on Twitter and founded the social media movement for the United States and Canadian Academy of Pathology
6. How do I schedule Tweets (and Facebook posts) ahead of time?
I use Buffer app to do this. Tweetdeck, Hootsuite, and many other apps allow you to schedule tweets. If you are like me, you may sit down and write up 10 tweets at a time but then go for a while where you are too busy to tweet/post. While it is ok to post/tweet all 10 things at once, it is not as ideal has having those 10 posts/tweets released at regular intervals over several days or a week. That helps maximize your views and the reach of your posts/tweets. These apps provide a way to time your tweets or post however often you like. They are also convenient because with many of the apps you can come back later and add your old tweets/posts back into your queue to be tweeted/posted again a few months or so in the future. They are also convenient because you can create one post and have the app share it on Twitter, Facebook, and even Instagram (with some help...not fully automated currently given Instagram policies as of 2/2017). Additionally, Facebook has a scheduling option when posting on a professional page. More info to come on how to use apps effectively for scheduling your posts.
Watermarking your images with your name or Twitter @username is a good idea. Once you post a great pic on the internet, it has the possibility of being widely circulated. It might be shared 100+ times and may even end up on Facebook and Instagram, too. This is a good thing (in my opinion) since the reason I post pathology images is for education, and the whole point of social media is sharing content and interacting with/about it. Most people are not going to intentionally try to "steal" your pics (i.e. - not give you credit), but in the process of sharing, sometimes pics get detached from the original tweet and then no one can remember where the pic actually originated. It's your image. You should get credit and retain name recognition and ownership of photos that you have worked hard to obtain, even if you want to share them and allow others to use them. Also, if someone sees your pic and wants to publish it in a textbook or somewhere formal, they would need your permission first. If they don't know who took the pic, they won't be able to get permission. For all of these reasons, I always watermark my pics with @JMGardnerMD.
How to add a watermark:
1. Once photo is on my iphone, it is very easy to watermark it via an app. My favorite is Enlight because it also has lots of other photoediting abilities such as white balance. EZY Watermark also works well. Not only can you type in your @name for a watermark, but you can also use the mixer tool in Enlight to overlay another image on top of your pic. I keep a simple @JMGardnerMD logo pic with a black background on my phone and then overlay that on top of my pics to watermark without having to type my name out each time (it also allows me to have a visible watermark even when there is no white or light colored area on the slide to type). I usually save pics taken on my scope camera attached to my PC in my dropbox, then move pic to my phone (via the dropbox app, just select pic and save it to your photos), watermark the pic with @JMGardnerMD, then tweet or post it. If I have taken the pic with my iPhone, then it's one less step (and part of why I've started using my iPhone for most of my photos). I have a "pathology" album and a "pathology ready to post album" in Photos on my iPhone. I use that to keep track of where my pathology pics are for ease of posting. For pics that I want to be sure to save and be able to locate long term, I upload these into the dropbox app, put them into a folder, and label it with the diagnosis so it is searchable.
Here's a description of my organizational system/schema for keeping track of pathology photos on my iphone: https://twitter.com/JMGardnerMD/status/920478004240887808
2. I use photoshop brush tool to watermark. Photoshop is powerful but not user friendly and I still can only do very basic stuff. Once you create a "brush" with your watermark, it's very easy to add the watermark to the photo. But setting up the brush took me about 10 minutes the first time. Here is a nice guide: https://blog.udemy.com/photoshop-watermark/
Where do I start?! There are many potential benefits:
- Help others in the field (It's the right thing to do, and it also builds political capital and goodwill)
- Teaching opportunities
- Build a huge professional network
- International name recognition
- Invitations/opportunities to speak, collaborate on research and other projects, travel as a visiting lecturer, and even give talks ABOUT social media (it's still a niche area that most doctors don't know much about)
More info, see my YouTube videos:
I have a lot to say on this topic. I plan to publish about my experiences sometime soon. I have also released a template version (editable Word .doc) of my entire promotion & tenure packet that I used when I went up for promotion from Assistant Professor to Associate Professor (I was successful, thankfully!); it's available here: https://goo.gl/EHYp79. I gave a webinar for Altmetric about using social media for promotion & tenure; the video is available here: https://youtu.be/aBN8sK5fVfY. My video about how to create a medical CV may also be helpful: https://youtu.be/hVSgwgNw8fQ.
When applying for promotion, I collected metrics from my social media channels to provide objective data about the reach and potential impact of my medical social media posts. If you use Twitter, you can sign up for Twitter Analytics for free. On Facebook, if you post your content via a professional Facebook PAGE (not just your regular account), you will also get free access to analytic metrics. The number of views, shares, people reached, etc are all data points that help prove that your social media posts/tweets are relevant and useful to your followers.
I went a step further and obtained some subjective feedback from my followers, as well. I created a short survey via SurveyMonkey and shared it on Facebook, Twitter, and Instagram. I asked my followers to rate my teaching, my leadership, a few other questions. I asked them to tell me their country and to leave a brief free text comment about how my social media posts help them. In 4.5 days, I received 1100 survey responses from users in 88 countries. The vast majority rated me highly. 1000 people left free text comments. I submitted this data including about 20 pages of free text comments as supplemental data along with my promotion and tenure packet. It serves as additional proof of my reputation, my impact, my leadership, etc...all things the promotion and tenure committee wants to see proof of. See my full survey and results here: https://www.surveymonkey.com/results/SM-VRPSJKLM/.
We have all heard horror stories in the news of politicians, actors, and other famous people getting into minor or major trouble by something they posted on a social media site. While I certainly don’t think we should totally avoid social media or live in excessive fear of making a mistake, being aware of some examples of these mistakes and learning some general guidelines can help us avoid them. Obviously, the more famous and/or “important” one is, the more impact is likely to occur when that person makes a social media gaffe. So at least I feel relatively safe because of that.
Here is my main personal guideline: Be reasonable. Just don’t say ridiculous, hateful, inflammatory, or extremist things on your public social media page. If you wouldn’t want it in the newspaper, maybe you shouldn’t say it online. Remember that even if you have your Facebook set to private, your friends who you allow to see your posts can always take screen shots or copy and paste your posts out into the wide open internet (this has happened many times before). So just think before you post. And don’t post when you are not of sound mind. That means if you have had more to drink than you might have intended to, or when you are angry, or any other reason that might make you less inhibited.
Advice for Doctors on Social Media:
Advice for Nurses on Twitter:
- http://www.ausmed.com.au/twitter-for-nurses/ (great advice not just for nurses but for anyone!)
This site also has some useful guidelines:
Here are some enlightening (and entertaining) links that might be relevant:
Is it ok to post de-identified histologic or clinical pictures on Facebook or Twitter?
I get asked about this so often that Eve Crane and I wrote a paper about it for AMA Journal of Ethics. Read this first. It will answer most questions you will have, and if others question you about this issue, you can now refer them to a published article in the literature rather than to some random website! ;-)
- Pathology Image-Sharing on Social Media: Recommendations for Protecting Privacy While Motivating Education
Tim Allen, MD, JD (a pathologist and lawyer) and I wrote another paper that does a deeper dive into the legal aspects of medical professional use of social media, with a special focus on the sharing of de-identified pathology images.
Here are some additional personal views:
1. Posting de-identified images does not in any way violate HIPAA. People who have argued with me about this usually either don't understand HIPAA, don't understand pathology, or more likely, both. I'm not a lawyer, but HIPAA makes it pretty clear what patient identifiers are: http://cphs.berkeley.edu/hipaa/hipaa18.html. Please note #17 on the list: "Full face photographic images and any comparable images". Histology images clearly do not qualify as that. For further evidence, look at medical journals. Histologic pictures, even of exceedingly rare cases or cases where n=1 are published in print and posted online. Most lay public don't read these journals, but medical journals are PUBLIC not private and can be accessed by anyone willing to pay or use a library. From an ethics/privacy/HIPAA perspective, posting histology pics on Facebook is no different from publishing them in a journal in my opinion.
2. Should we have patient permission to use histologic images, or, on an even broader scale, to use human tissue for teaching or research in any way at all, even if it is de-identified? That is a much bigger ethical and political question that is as yet undefined. Some institutions have their own policies regarding this, but to my knowledge, there is no legal requirement for this currently. Many people seem to think there should be, and this issue is raised and discussed at the end of the book "The Immortal Life of Henrietta Lacks" by Rebecca Skloot (an excellent read by the way: http://rebeccaskloot.com/the-immortal-life/). My personal feeling is that at least for histology images, there is no harm or risk to the patient at all if privacy is protected. Additionally, histology images are not even natural or similar to what tissue looks like in a patient. Cells are not normally pink and purple in vivo...we do that to them in the lab by staining them. I have heard pathologists state that even if de-identified, it is still not ethical to post patient histopathology images without consent. My response is that while I understand their concern, we must realize that taking that point of view will require us to reject the use of almost all existing pathology textbooks and educational materials (as few of those images were used with patient consent since that is not generally required for publishing de-identified pathology images). Clearly, removing those crucial educational resources would be an enormous harm to our field and to our patients. Thus, while I understand that ethical issues are always complex, I believe this is an area where the actual risk to patients by using de-identified images (essentially zero) is offset by the massive benefits to our field and our patients by using these de-identified images for education (and the tremendous risk of harm that would come if we could no longer use any historical pathology images that were obtained without consent).
3. Do opinions given on Facebook, Twitter, or anywhere online count as official consults and put the poster at legal risk? I'm not a lawyer. Perhaps there has been some legal precedent in this area but I am not aware of it (if anyone knows, please send me a link). I feel online comments are just opinions not true medical advice. No doctor-patient relationship or consultant-contributor relationship is created. If the person who posts the images chooses to use comments from a forum to guide their diagnosis, that is their prerogative as a trained and qualified physician. The rules of my Facebook forums at least clearly state that the purpose is educational and that all comments are unofficial and not consults. I think it would be unethical (and foolish) for anyone to quote or cite any comment from a Facebook group in an official pathology report or anywhere else in a patient's chart.
Here are some tips I use to stay out of trouble:
1. I never say "today I saw a case of JXG" or "yesterday I had this really sad case of sarcoma". I never use dates. I might say "I recently saw" but I try to always be vague. Remember, a date is a patient identifier. Will you really get in trouble for saying you saw a basal cell carcinoma today? No, of course not. I see many basal cell carcinomas every day. But I try to be extra safe to avoid even the remote possibility of accidentally revealing patient identity or even appearing to do so. I obey the HIPAA law because I don't want to get in trouble. But I respect the ethical principle of PATIENT PRIVACY because I'm a good doctor and decent human being. HIPAA and patient privacy are related, but they are not identical things. There is a difference (see our article: Pathology Image-Sharing on Social Media: Recommendations for Protecting Privacy While Motivating Education)
2. I usually modify the patient history to varying extents when I post an unknown. If I say "this is a left leg mass from a 20 year old woman" there is a high likelihood that the true age is different by a couple of years, the sex might not really be female, and maybe the anatomic site is not really correct either. I try to always do this as a further layer of protection from any accusation of privacy violation.
3. Food for thought: my personal slide collection contains cases from other countries and also from the USA in years prior to HIPAA. How can anyone know if the case I'm posting is from this week or a recut from a 20 year old block or a case a colleague from another country sent to me.
Personal privacy issues
This is a complex topic. Everyone has different comfort levels regarding social media and privacy settings. I tend to be a pretty open person and will friend someone on Facebook after just meeting them once. But I am also pretty careful about what I post on Facebook and try to avoid saying things that I wouldn’t want to have repeated in public. Some people are very concerned that others not be able to access their FB page. Fortunately, most social media platforms provide multiple adjustable privacy settings. You should read up on this carefully and decide what setting is right for you, especially if you are very concerned about privacy.
Should I have two different accounts for each social media site (one personal, one professional)?
For people who are very concerned about keeping their personal and professional life separate, this might be a good idea. However, Facebook doesn’t think so, and technically it is a violation of their rules to create two accounts and they will potentially close your account if they catch you (I’m not sure how often that happens). The privacy settings on Facebook allow you to have individual settings for what each person sees. So you could friend your department Chair but then set the privacy for that person so that they do not see the majority of your posts. I personally just have one account on Facebook, and I generally allow all of my posts and pics to be seen by all of my friends. But you have to figure out what is comfortable for you.
My recommendation is to have ONE Facebook account for personal/private use, and then to also have ONE Facebook PAGE for public/professional/medical use. A page is similar to a website or blog, but it's free and easy to use. If you have ever "liked" a business or organization on Facebook, then you have seen their page. Create a similar page for yourself as a public individual/personality. You must have a regular Facebook account in order to create and manage a page. Post your medical content on your public page. This serves several purposes:
- Your friends and family can enjoy pics of your kids, dogs, food, etc without having to see gross pathology images from time to time (unless they want to see those, in which case they can like/follow your page).
- Your medical posts can be viewed by anyone online and can be shared. You can cite your posts if you are writing a paper. You can share your posts to multiple pathology discussion groups for wider viewing. You can send links to your posts (maybe you posted a great example of a certain entity and now a resident is asking about that...email them a link to your post on your public Facebook page).
- Patients, professional colleagues, program directors, employers, etc will search for you and find your public page and can interact with you that way. Your personal Facebook account can stay private for family, friends, or for other professionals who you feel close enough with to let them see pics of your kids, dogs, food, etc.
I see many pathologists who use Facebook professionally, but very few of them have public Facebook pages. I only discovered this and started actively using my page in 2015, years after I had been using Facebook professionally. It was a huge discovery. Creating a public Facebook page is the one biggest thing that pathologists on Facebook can do to move to the next level of successful professional social media use.
Twitter is a different story. In general, it is totally fine to have more than one Twitter account. And indeed I do. I have @JMGardnerMD for my medical tweets and @JMGFoodie for my tweets about food and cocktails and other non-medical stuff (the foodie account is no longer in use because I'm running too many other Twitter accounts!). I also help administrate about a dozen other Twitter accounts, too. You can easily switch between different Twitter accounts with a couple simple clicks via the Twitter app on your smartphone.
My Social Media (and related) Publications in the Peer-Reviewed Medical Literature
- MY Fuller, S Mukhopadhyay, JM Gardner. Using the Periscope live video-streaming app for global pathology education: A brief introduction. Arch Pathol Lab Med. 2016 Nov;140:1273–1280. Free PDF
- GM Crane, JM Gardner. Pathology image-sharing on social media: Recommendations for protecting privacy while motivating education. AMA Journal of Ethics. August 2016, Volume 18, Number 8: 817-825. Free Fulltext
- RS Gonzalez, SM Amer, N Ben Yahia, FD Costa, M Noatay, JH Qiao, FG Rosado, Y Rosen, BT Sedassari, RK Yantiss, JM Gardner. Facebook discussion groups provide a robust worldwide platform for free pathology education. Arch Pathol Lab Med. 2017 May;141(5):690-695. Free PDF
- JM Gardner. How angiosarcoma and Facebook changed my life. Arch Pathol Lab Med. 2017 Feb; 141(2):188-188. (Also published in: The Healing Art of Pathology. Editors: Bui & Galagan. CAP Press [College of American Pathologists]. 2016.) Free PDF and YouTube Video
- D Cohen, TC Allen, S Balci, PT Cagle, J Teruya-Feldstein, SW Fine, DD Gondim, JL Hunt, J Jacob, K Jewett, XS Jiang, KJ Kaplan, I Kulac, R Meunier, ND Riddle, PS Rush, J Stall, LN Stuart, D Terrano, E Uthman, MJ Wasco, SR Williamson, RI Wu, JM Gardner. #InSituPathologists: How the #USCAP2015 meeting went viral on Twitter and founded the social media movement for the United States and Canadian Academy of Pathology. Mod Pathol. 2017 Jan 13;(2):160-168. Free Fulltext
- MA Arnold, E Freitag, JM Gardner, CA Arnold. If you are not on social media, here’s what you’re missing!: #DoTheThing. Arch Pathol Lab Med. 2017 Nov;141(11):1567-1576. PDF.
- M Lepe, JM Gardner. Fine social aspiration: Twitter as a voice for cytopathology. Diagn Cytopathol. 2017 Aug;45(8):705-713. PDF
- E Carlquist, NE Lee, SC Shalin, M Goodman, JM Gardner. Dermatopathology and social media: A survey of 131 medical professionals from 29 countries. Arch Pathol Lab Med. 2018 Feb;142(2):184-190. PDF
- B Madke, JM Gardner. Enhanced worldwide dermatology-pathology interaction via Facebook, Twitter, and other social media platforms. Am J Dermatopathol. 2018 Mar;40(3):168-172. Abstract
- J Isom, M Walsh, JM Gardner. Social Media and Pathology: Where are we now and why does it matter? Adv Anat Pathol. 2017 Sept; 24(5):294-303. Abstract
- M Fuller, XS Jiang, JM Gardner. Social Cytopathology: Building a stronger cytopathology community through social media. Cancer Cytopathol. 2017 Dec;125(12):891-895. Abstract
- EA Mateos, LG Pastrián, LP Andújar, LL Solache, A Zucchiatti, RG Angel, JD Prieto Cuadra, TL Miravalles, R Carvalho, JM Gardner, C Terrádez, E de Álava. La Anatomía Patológica en las redes sociales. Campaña de reclutamiento (Pathological Anatomy in social networks. Recruitment Campaign). Rev Esp Patol. 2018;51:6-13. PDF
- Haller J, David MP, Lee NE, Shalin SC, Gardner JM. Impact of Pathologist Involvement in Sarcoma and Rare Tumor Patient Support Groups on Facebook: A Survey of 542 Patients and Family Members. Arch Pathol Lab Med. 2018 Jan 29 [Epub ahead of print]. PDF
- Oltulu P, Mannan R, Gardner JM. Effective use of Twitter and Facebook in pathology practice. Hum Pathol. 2018 Mar;73:128-143. Abstract
- Gottesman S, Hosler G, Klein W, Rush P, Veprauskas K, Gardner JM. #dermpathJC: The First Online Dermatopathology Twitter Journal Club. J Cutan Pathol. 2018 May;45(5):370-373. Abstract
- Nix JS, Gardner JM, Costa F, Soares AL, Rodriguez FJ, Moore B, Martinez-Lage M, Ahlawat S, Gokden M, Anthony DC. Neuropathology Education Using Social Media. J Neuropathol Exp Neurol. 2018 June; 77(6):454-460. PDF
- Mazer BL, Fuller MY, Lepe M, Reyes-Múgica M, Crane GM, Mukhopadhyay S, Gardner JM. Social media in pathology: Continuing a tradition of dialogue and education. Arch Pathol Lab Med. 2018 Aug;142(8):889-890. PDF
- Gardner JM, Allen TC. KEEP CALM AND TWEET ON: Legal and ethical considerations for pathologists using social media. Arch Pathol Lab Med. 2019 Jan;143(1):75-80. PDF
- Gardner JM, McKee PH. Social media use for pathologists of all ages. Arch Pathol Lab Med. 2019 Mar;143(3):282-286 PDF
- Razzano D, Hall A, Gardner JM, Jiang XS. Pathology engagement in global health: Exploring opportunities to get involved. Arch Pathol Lab Med. 2019 Apr;143(4):418-421. PDF
- McLawhorn JM, Balamurugan A, Gardner JM, Kaley JR, George MJ. Using social media to assess mental health and quality of care among patients with Darier disease: a novel resource for patient advocacy. J Dermatol Nurses Assoc. 2019 March/April; 11(2):79–83. Abstract
My Social Media (and related) Videos
- How to Jumpstart your Pathology Career via Social Media
- Pathology Research via Facebook & Twitter
- The DFSP Partnership: How We Used Internet to Engage Cancer Patient Communities for Research
- Pathologist Involvement in Patient Support Groups on Facebook
- Pathologist collaboration with DFSP patient support groups on Facebook
- DFSP patient questions answered by a sarcoma pathologist
- Impact of Pathologists in Sarcoma Facebook Patient Groups: Survey of 541 Members
- Changing the Public Image of Pathology - Pi Talk for PathoIndia
- ASDP: Social Media
- An ASDP Interview with Jerad Gardner, MD
- How to white balance & watermark pathology images for social media
- Why pathologists should use Twitter & Facebook - SEAP-IAP 2017 Valencia
My Other Social Media (and related) Publications & Resources
- JM Gardner. The social pathologist. The Pathologist. 2015 Feb; #5:18-19. Free PDF
- JM Gardner. Introducing the Pathology Hashtag Ontology. Symplur.com blog, March 2016. Blog Post
- JM Gardner. USCAP's Social Media Committee Rocks! USCAP Open Mind - Summer 2016 Free PDF
- JM Gardner. Annual Meeting 2017 – Social Media Update. USCAP Open Mind – Spring 2017. Free PDF
- Glassy EF. The rise of the social pathologist: The importance of social media to pathology. Arch Pathol Lab Med 2010;134:1421-3.
- Nelson B. Should pathology get more social? A growing movement touts the power of social media for the profession. Cancer Cytopathol 2011;119:291-2.
- Allen TC. Social media: Pathologists' force multiplier. Arch Pathol Lab Med 2014;138:1000-1.
- Fuller MY, Allen TC. Let's have a tweetup: The case for using Twitter professionally. Arch Pathol Lab Med 2016;140:956-7.
- Goyal A, Tanveer N, Sharma P. WhatsApp for teaching pathology postgraduates: a pilot study. J Pathol Inform. 2017;8:6. http://www.jpathinformatics.org/text.asp?2017/8/1/6/201111
The use of social media like Facebook and Twitter by doctors and other medical professionals is attracting a lot of attention. There are numerous articles on this topic. I'll try to post good ones here.
- Physician use of Twitter (discussion of a JAMA article)
- Why doctors should embrace social media (the author, John Madrola, MD, is a great person to follow on twitter: @DrJohnM)
- Go where the patients are: Why this doctor is active on social media by Howard J. Luks, MD - Another leading thinker on physicians and social media
- How to Network with Facebook Groups