Saturday, 30 March 2013

Healthcare Social Media: the return of #Twittergate

Whether you love, hate, or are apathetic towards social media, you will probably agree that it is changing the way in which information is shared and accessed. Healthcare professionals and students alike have cottoned on to the fact that as fun as it is to share funny prank videos and send intragramed (I know – I hate myself too for the anthimeria) photos of their sandwich, social media is a potentially powerful tool which can help further themselves, their profession and patients, e.g. 60% of doctors say social media improves quality of care delivered to patients (hyperlink). Social media has become a well established member of new society; slowly, often reluctantly, academics and professionals join the ranks of millions by signing up and adding their profile pictures to social media sites as they accept social media is in it for the long run.  

For the past week the subject of social media in healthcare (or #HCSM) has fascinated me and I need to tell you why - this ‘need to tell’ probably stems from the social media culture to which I have grown accustom.

A week ago today I was participating in one of my new favourite pastimes; browsing through one of my frequented hashtags, #slpeeps, (the ‘speech and language people’) to see if anyone had posted any current research/videos/resources or had anything interesting to say on Twitter. For the astute amongst you yes this was a Sunday night, and no, I wouldn’t disagree with you considered me worthy of pathos and labelled me 'pathetic'.

It soon became apparent that a new #twittergate row had occurred that day among a few speech and language therapists the other side of the world. I was intrigued, my partner for some reason couldn’t care less. #Twittergate, for those of you who don’t know,  refers back to an argument in October over whether a student had the right to ‘live tweet’ in an academic conference: since the material was not yet published the argument was that it shouldn’t be broadcast to the world (link here).

Back to last week - it seems a speech and language therapist had attended a conference of about a 120 delegates, of the two speech and language therapists there she was the only one live tweeting. Controversy broke out among ‘concerned’ speech and language therapists regarding the ethics of live tweeting at a conference: the speaker’s rights, problems with accuracy and acknowledgment.

Tweeter a: It is disingenuous to say that attribution for words or thoughts is clear in live tweets

And later: Issues with live tweeting are respect for reputations, quality of info, moral rights

Tweeter b: It is quite naive of presenters at any conference to think that tweeters need permission to post something out of context

Tweeter c: I'm going to sanction & encourage [live tweeting] @ my next talk in May

As someone who had never come across live tweeting before (I had only seen a few of the Tweeting Therapist’s live tweets that morning) I could empathise with both sides of the argument. On seeing some of the live tweets that morning I had become excited that I was able to access information from a conference I wasn’t attending the other side of the world and by the fact that the tweeter was not a student SLT but, a fully-fledged SLT; making the information feel a bit more golden-nugget-like. Critical appraisal is integral to my Language Pathology MSc (I am about to begin the final term), I also have an interest in evidence based medicine & practice: of course I wouldn’t take live tweets as gospel, I understand that 140 characters can’t encompass everything that a person has said and can risk being biased or inaccurate however I felt I trusted the source enough to enjoy being fed some information and would follow up any information that interested me by researching myself.  

Perhaps it was trust in my own ability to critically evaluate tweets that lured me into a false sense of security that everybody could and would do the same. I was taken by surprise as I flicked through the intense discussion surrounding the ethics of live tweeting: how and why would anyone be upset with someone for so generously taking the time to share information with us? As I read more from both sides I started to kick myself for not considering the presenter’s perspective: what if someone was to tweet from a lecture that contained unpublished material and some evil academic came along and stole a thesis idea? What if a tweeter had some awful history with a presenter and wanted to tarnish their name? Seriously though I suddenly pictured every lecturer, speech and language therapist, teacher, doctor, nurse, my mam and everyone I had ever heard utter the word shouting it: ‘CONFIDENTIALITY!’ Pretty soon I felt uncomfortable about the idea of live tweeting, being from a profession where the notion of confidentiality is so fundamental I guess this isn’t surprising or such a bad thing to consider, however I wanted to get with the times and love it and felt bad for the criticisms that the Tweeting Therapist had experienced.

My own complete ignorance of live tweeting highlighted to me that discomfort about live tweeting was inevitable as it is part of such a new culture: we are not being able to draw from historical social etiquette on how to behave in these circumstances. I added my two pennies worth and sent a tweet to the original Tweeting Therapist saying that it would be helpful for guidelines to be written on Live Tweeting (by the Royal College of Speech and Language Therapists (RCSLT) or, in this case The American Speech-Language and Hearing Association (ASHA)).  A reply quickly shot back:

Tweeting Therapist: are there clear guidelines on what you talk about when you leave a conf?

She really did have a point. At what point had I begun to think that we lived in a society which prohibited freedom of speech; where guidelines needed to be prescribed for what is appropriate reiteration of information? Other people, including her had argued that the information presented in conferences could be talked about or put in a blog following the conference without this kind of controversy; how, they asked, was tweeting any different or worthy of any more condemnation than those forms of information sharing? Tweets were potentially permanent yes, but if I verbally reiterated something I had learnt in a conference then that fact too could potentially be retained by the listener for an indefinite period.

I went to bed unjustifiably excited by the debate and wanting to find out more to be able to form an opinion. It just so happened that Evidence Live, a ([n] excellent) two day conference on evidence based healthcare, was happening the next day (I found that out via a twitter post). The next two days I spent pretty much glued to my phone following the majority of live tweets from the conference, I was so interested and grateful that people were taking the time to tweet: not only personal views, in fact, rarely personal views, instead tweets comprised quotes from speakers, links to papers cited, slides and pictures from the conference, most tweets were very well referenced and some humour shone through too, which added a sense of intimacy. Although it wasn’t as good as being there it definitely felt like the next best thing. The quality of the live tweets, by professionals and students that I knew had an interest in quality data, meant I felt comfortable about the sources (this of course could be abused).

The fact that there were lots of people tweeting meant that information was more easily verified and reliability more easily judged than if fewer people were tweeting creating an argument for the more the merrier. Further, I was able to directly contact participants via tweets and ask them questions, this is something that could never have happened before social media or the live tweeting age. In total 367 participants generated 1,796 tweets meaning an average of 43 tweets per hour reached participants leading to 7.2 million impressions here's the stats. Conclusion: the information from that conference potentially reached A LOT of people, live tweeting from other conferences would have potential to do the same. As The @UKCochranecentr note in their excellent blog on How Social Media has Transformed Academic Conferences, on its second day #evidencelive was trending on Twitter, reaching almost 30,000 accounts by 10.30 that morning.

I was a live tweeting convert, I could see the arguments against it but as far as I was concerned the benefits far outweighed the cons when done correctly. I wasn’t alone; Evidence Live could be seen as the benchmark

Tweeter b: For #SLPeeps not yet in twitter if you want to see how conference tweeting works have a look at #EvidenceLive for medicos ways #Twittergate

Tweeter a:  good eg of live tweeting; attribution are clear in the tweets; often tweets are clearly personal opinion

In the day between Evidence Live finishing and the (fantastic) RCSLT Student Study Day taking place I posted a message to the RCSLT's facebook page asking what their stance was on live tweeting. Receiving no response within the short timeframe that ensued I decided that unless we were specifically asked not to live tweet from the student day then I would give Live Tweeting a bash and I would use the tweets I had seen at EvidenceLive as my blueprint. 

I needn’t have worried about the RCSLT’s view towards live tweeting; as we entered the room the hashtag #SLTstudentday was on the opening presentation slide and the chair of the council of speech and language therapists took a photo of the room to put on twitter, we were encouraged to tweet away and my anxieties dispelled, further the benefits of social media carried were discussed in a few talks, one student tweeted

Student 1: so many iphones & ipads, great interactive day


@RCSLT tweeted: Our student day is in full swing! Great participation from our delegates, we're enjoying your twittering! #sltstudentday

Example of one of the pictures I tweeted from RCSLT Student Day
Live tweeting was actually invigorating and I felt more engaged with the talks as a result: I was constantly trying to listen for information that I thought would be the most relevant for students or NQPs that were unable to attend, meaning I remained switched on for longer periods than I think I otherwise could have. I felt that I was doing something useful; not just for my own learning but for others' too. 

Despte best efforts, I did feel myself become slightly bias in that I didn’t want to tweet negative information about the job market without adding in a positive;

e.g. I tweeted:  Things might be more positive for NQP band 5s than they have been in recent years but higher banded jobs effected – Derek Munn

Rather than: band 7 and 8 speech and language therapists becoming disbanded during cuts

Also, I found that as tweets only allow for so few characters I had a tendency to tweet negative information using positive language, as this requires fewer characters e.g.  instead of tweeting ‘he isn’t going to bed before 10’ I would choose to tweet ‘he is going to bed after 10’ to save characters. In some instances this slight linguistic amendment could change the meaning of what is being said, future tweeters and readers should beware of this.

We bought T-shirts to support the @GivingVoice Campaign, then we told the world :)

Live tweeting is an extremely valuable tool that professionals, academics and students can use to their own advantage and to help others. With more NHS services likely to be commissioned in the future it is possible that with other social media tools, live tweeting from conferences will have some influence over what politicians, private companies, and the public see and so should be utilised to its full advantage. If the fact that ‘for every £1 invested in speech and language therapy for children with SLI generates a return of £6.43 in enhanced lifetime earnings’ (RCSLT Matrix report, 2010) was quoted in a conference and lots of speech and language therapists tweeted about it at the same time reaching potentially 7 million people, perhaps more people would be interested in the need for the service to be commissioned.

Guidelines on live tweeting would be helpful so that speech and language therapists can go forth and tweet with confidence in future events where maybe there isn’t such an obvious passion for social media involvement and so that presenters know what to expect when they present their data. The Cochrane collaboration gave some guidelines before their 21st anniversary symposium and could be used as a guide in the meantime.

Twitter has certainly blurred the lines between private and public, between the role of a speaker and the role of a journalist, however we should use our newfound elevated status of semi-journalist professional to our advantage and to the advantage of the healthcare profession by sharing as much relevant information as possible with colleagues and the public, including in the form of live tweets.

I feel that a lot of the arguments against live tweeting place much of the responsibility on the tweeter when in real life spoken conversation there is far more emphasis on a shared responsibility of giving and receiving information, my opinion is that this should also apply to social media: put simply a reader shouldn’t believe everything they read.

This discussion will no doubt become more complex in following weeks with the implementation of GMC guidelines that if a doctor identifies themselves as such on social media sites then they must also identify themselves by name; therefore losing anonymity when tweeting. This will come into place on 22nd April 2013. It remains to be seen if the same sort of guidance will be deemed appropriate for Allied Health Professionals.

@NHSsm have weekly chats Weds 8-9pm on how the NHS can use social media to benefit patients and staff

Look out for an #SLPchat in May around the issue of #Twittergate: Live tweeting in conferences.