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Social Media Guide for Pathologists

Revision as of 21:07, 26 May 2016 by Jerad M Gardner, MD (talk | contribs) (added Periscope)
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New to Twitter? Do these things first:

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. 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. 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). 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.

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!

Ready for more in depth info? See the rest of the social media guide (including more Twiter info) below

Overview

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. Additional info related to non-pathology specialties can be found here: Social Media Guide for Physicians. 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


What is social media?

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:

Facebook:

Twitter:

LinkedIn:

Youtube:


Examples of how to use social media professionally

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.

Facebook:

  • 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!

Twitter:

  • 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

Instagram:

  • 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.

LinkedIn:

  • 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.

Youtube:

  • Post soft tissue pathology teaching videos

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.

Video coming soon.

Pathology-related groups on Facebook

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).

Twitter 101 for Pathologists

Twitter profile JMG

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 and say a bit about yourself. Here is what mine currently says: "#dermpath & bone/soft tissue #sarcoma #pathology. Mentor: Dr. Sharon Weiss. Asst Prof & Fellowship Director @DermpathUAMS. T/RT≠med advice. #pathologists"  

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. 
  • 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.            

Twitter FAQ

1. What are #hashtags and how do I use them?

Here is a guide: [[1]] to get you started.

Some common hashtags that pathologists might want to use: #pathologists, #pathology, #dermpath, #GUPath, #GIPath, #pathArt (for pretty artistic-looking pathology pics).

Symplur is a website that tracks use of healthcare related hashtags. It's a great place to see what hashtags are trending. Using those in relevant tweets will increase your visibility among other doctors on Twitter. http://www.symplur.com/healthcare-hashtags/

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

Other useful articles about Twitter:

4. How do I improve the quality of my photomicrographs for Twitter and Facebook?

The most important things are:

  1. 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: ).
  2. 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.

5. How do I "live tweet" a medical conference?

Eventually, I plan to write a more thorough guide for this. For now, I'll post links to good guides that already exist.

How to watermark your photos for posting on social media

NLD

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.

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/

Benefits of social media

There are many potential benefits, and I feel they definitely outweigh the risks (see below).

  • 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)

Pitfalls and risks of social media

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:

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?

This gets asked about a lot. The short answer is: YES. Below is the long answer. I'm not a lawyer, but here are my 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.

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.

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.

Facebook:

Twitter:

LinkedIn:


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.

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.

Useful links related to social media and medicine

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.


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