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.


  1. Lauren: Excellent post & great summation of the issues! I'm happy to identify myself as "Tweeter c." My initial concern about live tweeting was my penchant for trying out "new" ideas and presenting unpublished material at conferences. Yes, it is the case, that these ideas and material are public once one opens one's mouth. However, they are usually shared with a relatively small group of people. When there is live tweeting, those ideas and material reach a multitude of individuals. So, will my sanctioning of live tweeting result in my being more circumspect in what I present at conferences? Perhaps, although I am not sure at this point. I hope I will say what I want to say and let the chips fall.

    Again, thanks for the great post and your contribution to the #SLpeeps.


    Brian Goldstein

  2. Really enjoyed reading this, I find it sad that some people don't see the benefit of live tweeting! It's been very much encouraged in my nursing experience from #CNO2012, #FNFAC2013 and #NHSExpo. The way in which twitter informs healthcare us so great, surely sharing information from a conference with colleagues who can't be there is a good thing!

    I for one look forward to reading your live tweets in the future :)

  3. Hello Lauren, thank you for your thoughtful blog post which serves to further one of the major benefits of the debate which was to highlight the existing guidelines for respectful live tweeting of conference material. I do not believe that the debate was about the ethics of live-tweeting or not live-tweeting. Rather the issue is about ethical processes for live-tweeting. If my intercession led some observers and participants in the debate to think a little about the presenter’s perspective then I am satisfied. I am happy to be identified as Tweeter a and am pleased to see that you agree that EvidenceLive provided an excellent example of the way that live tweeting should be conducted. Furthermore, this sort of scientific conference where scientists are freely sharing their own scientific discoveries is a perfect context for live tweet discussion among participants and nonparticipants alike. The debate that you refer to arose in the aftermath of a misunderstanding that occurred when a state-conference participant provided a live tweeted continuous summary of two workshops presentations. This is a different context that I believe provides many opportunities to violate the intellectual property and moral rights of the speaker, cause harm to reputations when attributions are not clear, and result ultimately in the spread of misinformation. For myself, I would love to see twitter conversation about any presentation that I might give but I would be horrified to see a summary of what I was trying to convey when you can easily find what I say in my own words in my self-posted conference handouts, published articles, books, blog, and yes, in my own twitter feed. What is most wonderful about twitter is that all of us, no matter who we are, get to speak for ourselves in our own voices. Susan

  4. Dear Lauren, congratulations on being a tweeter and blogger extraordinaire. I am just learning blogging. In fact, I think this is my first comment on a blog.

    While you are awaiting our results on twitter research for student slps and academics alike, (Hemsley & Phelan Uni of Newcastle) here is a link to a document I'm using when reporting on results (we're not collecting tweet data yet).

    Tweeter b

  5. Great post Lauren! Thanks too for linking to our blog on social media at academic conferences (I should just point out that, thought we'd like to be @CochraneUK, that name's taken by an individual, so we tweet as @UKCochraneCentr - no e!).
    You make lots of good points but I was particularly struck by your comment that you felt reassured by the number of people tweeting from Evidence Live, which served as a sort of verification of tweet content, and the fact that you trusted the tweeps as people who were interested in high quality evidence.
    Something we found reassuring about social media coverage of our Anniversary Symposium, for ourselves and hopefully for all who joined in,was that we had set up and publicized guidelines, as you've mentioned here, and had asked all our speakers whether they were happy for people to tweet the content of their presentations, take photos etc. We'd recommend this simple course of action to anyone organizing their own event.

  6. Lauren this is a great post. I'm pleased the debate on twitter helped spark interest, concern, and guidelines for you.

    I agree completely with this quote from your post "put simply a reader shouldn’t believe everything they read." Twitter is no different from any other point-of-view reporting. I don't believe everything I read in a blog post, in the paper, or in a magazine.

    When my live-tweeting sparked the debate on twitter, I was stunned the debate even occurred. It seemed obvious to me I was typing MY tweets which reflected MY understanding of the presenter. Anything that was a true direct quote I tried to place in quotes.

    One of the difficulties was that I didn't realize some people would argue with tweets. For myself, when I read other's live-tweets, I make comments to the person tweeting, as clarification, but I would never consider making a scientific argument with that individual. Obviously that would be better served by speaking with the presenter directly; OR presenting it as a question which can be asked of the presenter to gain clarification.

    For many who are live-tweeting the purpose is multi-fold. First, it helps me stay awake and focused on the presentation, I'm not just attending, I'm participating. Second, it serves as my notes for the presentation, I chirpstory the tweets so I can find and review them at my leisure. Finally, it serves as a way to get information "out there" and generate interest in a particular subject or presenter.
    One of the arguments against live-tweeting was that blogging should be used instead. While I agree, blogging is a fantastic way of sharing information, it doesn't take the place of live-tweeting. Blogging is a timely process and can't be done while actually attending the conference. If I wait to blog I don't have access to the presenter to gain clarification, the opportunity to ask questions, or the immediate feedback. What I do have is MY interpretation of the presentation...and that's it.

    On both days that I live-tweeted, I was able to ask clarifying questions based on questions the people following the live-tweet asked. While I deeply regret the debate on twitter, I am not a bit regretful about live-tweeting. I know that my tweets helped reach an audience who otherwise would not have ready access to information - OR - wouldn't have had the interest in finding the information. If even one person who was unfamiliar with the presentation topic decided to look for more information based on my live-tweets, it was a success.

    In reality, that is all a live-tweet is...a sharing of information.

    Presenters cannot control what happens with the information once it is presented. I have attended many a class where professors have returned with handouts and their interpretation of that material - which is now in the form of lecture notes, etc. Is this 100% the presenter's information - of course not.
    I fully recognize that many presenters will not want their conferences live-tweeted. I do believe that we should be respectful of those few. However, I would caution that most presenters have no idea when they are being live-tweeted and therefore should plan on presenting with the idea that they will be live-tweeted. Secondly, I would caution that many (including myself) would seriously reconsider attending a conference where live-tweeting was not allowed. Gag-orders should not be used lightly.

    I believe we are quickly coming to an age where presenters will need to accept live-tweeting, social media, etc. is here. Failure to do so may well result in being considered obsolete.