Friday, December 07, 2012

Guest Post: Physicians Beware on the Twittersphere

The following is a guest post by William Dillon, MD, a relatively new cardiologist to Twitter. He describes his experience with a recent patient-doctor interaction on Twitter that sounds an important message.   -Wes
Thank you for hosting my response to a recent blog post by Carolyn Thomas at Ms. Thomas is a well respected medical blogger with an emphasis on cardiac care and women’s cardiac issues in particular.  She has certainly helped many patients and been a great advocate for women’s cardiac issues.  We recently had a 3-Tweet interaction that lead to her writing a blog about me. Though Ms. Thomas made excellent points about patient privacy issues and the use of Twitter in general, I feel that her words justify a clarifying response.

Let me introduce myself. I am an interventional cardiologist and new to using Twitter. Two areas of focus for me in the last 18 months have been radial artery catheterization and heart attack care. Social media was recommended as a vehicle to get the word out on heart attack care.  My state, Kentucky, ranks a dismal 49th out of 50 states for MI mortality. I aim to improve this.

The problem started after a particularly challenging and successful radial artery catheterization procedure. I tweeted that “Radial cath is like playing golf. You must do it often to be good. Some will never be good at it no matter how hard they try.”

Without going into the nuanced details of radial vs. femoral artery catheterization (already a controversial topic for interventionalists), Ms. Thomas responded with a thoughtful question of her own: “But how do heart patients being practiced on know if their interventionalist falls into the 'never will be good' category?”

This was one of the first times anyone had ever interacted with me on Twitter, so I tried to help. I am used to helping total strangers; that’s what we do everyday in treating acute heart attack patients.

But in retrospect, maybe I should have remembered mom’s advice: “Don’t talk to strangers!” Ms. Thomas wanted to know how patients know if their physician falls into the “never-will-be-good” category. Because I did not know Ms. Thomas, nor that she had had prior personal experience with a radial artery catheterization, I was left at a conversational disadvantage because of the loss of context that is inherent to 140-character interactions on Twitter. Unfortunately, the answer to Ms. Thomas’ question leads to a thorny area—the truth. As Gloria Steinem famously said "the truth will set you free but first it will piss you off."

The truth here is simple: it’s not easy to know if your physician is good. This is a complex issue, and surely not suitable for Twitter. Engaging on this medium on this topic was a mistake. I learned from it. But let’s be honest about a few things: most honest proceduralists would agree that a cath lab nurse or tech has valuable inside knowledge. These folks have first hand experience and interact with a variety of physicians on a daily basis. They know. The problem of course is that the general public does not have access to the inside scene. However, it surprises me that most patients research toaster ovens more than they do which physician to see.

But even if they did research their doctors it would be hard to sort out the best. Here’s why: Though all physicians complete certain minimum standards and maintain competency through continued medical education, that’s a low threshold. The credentialing process at hospitals weed out incompetent docs, but it is far from perfect or nuanced. It's like grading tests on a pass-fail scale.

Outcomes measures—if they existed—would also be flawed. If our procedure outcomes were scrutinized, you could be sure that high-risk patients would not have many willing doctors.

All cath labs have a Director that should be reviewing complications. Peer review also has merits, but that's tough to accomplish in the real world as well.

Back to the tweets.

Ms. Thomas said: “It never occurred to me in ER in mid-MI to ask, by the way is this guy any good?” I continued to try to explain. Again a mistake on Twitter. I recommended asking EMS to take you to the best center during an MI. This is actually a crucial comment and a vital step to surviving a heart attack. Call EMS! The best treatment is a percutaneous coronary intervention (PCI) done at the nearest center with around-the-clock coverage. EMS providers know which hospitals perform PCI for AMI and will direct patients to those centers.

After this last tweet I got uncomfortable with her line of questioning and elected to stop responding. Unfortunately, the damage was done.

What have I learned from this? I realize that one needs to be careful with comments placed on social media. While Ms. Thomas has likely helped many patients through her blog, my comments were greatly misconstrued. It was certainly not my intention to cause such a furor. I am stunned how a 3-tweet interaction can lead to such a defaming and inflammatory blog response from someone I have never met with, spoken to or interacted with beyond a total of 400 characters. A reputation is a lifelong and daily building process. To have it torn apart in a very public way is extremely damaging and upsetting.

I hope that something positive could come of this. Already I have learned and am sorry for any controversy I have caused. But I would like to sound a warning to patient advocates and physicians alike. If what we all want in healthcare is more truth and transparency, tearing down those who dare to speak, to join the conversation, surely will not help.

William Dillon, MD


Anonymous said...

I sympathize with Dr Dillon. Reading his post, it is clear that he stumbled in to a social media pitfall in an attempt “to help”. As he states, he is “used to helping total strangers; that’s what we do every day in treating acute heart attack patients”. I do not doubt the truth of this statement and wish him well in his efforts to reduce the mortality rate from MI in Kentucky.
Ms Thomas however, was justified in teaching Dr Dillon an early lesson in the reach of social media and I was glad to see that he acknowledge the specific lesson learned regarding patient confidentiality. He should have ended his response there. The other lesson he did not learn is the need to understand that rarely does the reader share your exact same perspective. Her comment; “In case this actually was a thinly veiled criticism of your lesser colleagues, Dr. Dillon, please try not to do this on social media any more. It just comes across as unprofessional and arrogant”, is a good example of this. It does come across as a bit arrogant and it opened the door for her paragraph questioning who is responsible for reporting physician incompetency. Given that we are all guilty of dancing around that impossible to address issue, he should have ended his blog after the second paragraph.

Anonymous said...

Don't worry. You did okay. And it's a black-hole topic. I'm a woman, a (relative) patient activist on the issue of cardiac devices, and I think you can trust readers to judge you over time by your intentions (though these can be difficult to communicate!). Hang in there and Be You.

Anonymous said...

Too bad. Ms Thomas just got a reality check. No apologies to her or really any "colleagues" of the Dr either.

IMHO, no clarifications necessary from the Dr either.


Tom B said...

I find the entire situation to be extremely unfortunate on multiple levels.

In the first place I have the highest respect for William Dillon, M.D. and his efforts to improve STEMI care in Kentucky.

Secondly, it's a sad day when an interventional cardiologist can't compare a radial cath to golfing without being accused of arrogance.

Third, thanks to situations like this, we have less transparency in health care.

It reminds me of the response I got from another cardiology blogger when I asked about inappropriate ICD shocks and why we don't do a better job with programming. He said, "that's more truth than Twitter can handle."