Advancing Medicine in 140 Characters or Fewer

Sept 11, 2017 | David L. Fischman, MD, FACC,
and Michael P. Savage, MD, FACC

On the eve of Election Day 2016, Twitter was determined to be the largest source of breaking news with a reported 40 million tweets. Donald Trump's fondness for Twitter was evident throughout his presidential campaign and the election may have inadvertently given spark to a form of social media that was stagnant for several years and on the verge of collapse. Twitter was created in 2006 as an online news and social networking service. It was the brainchild of four computer programmers who wanted a new way to send texts on their cellphones. Despite what preconceived notion there may be about Twitter, it is not just a way to tell your friends what you ate for lunch. It has evolved into a powerful communication tool with great potential for medical applications.

Figure 1: Comparison of Twitter Data for ACC.17*, European Association of Percutaneous Cardiovascular Interventions** and American College of Physicians Meeting 2017***
(Source: Symplur LLC)

Information Graphic
Information Graphic
Information Graphic

* #ACC17
** #EuroPCR
*** #IM2017

Twitter has gone beyond its 140-character limit to include photos, video, links to journal articles and even polling options. These capabilities position Twitter as a primary means for the instantaneous dissemination of news. It is this capability that also makes it a prime use in academic medicine. It was no more evident than at the American College of Cardiology's 66th Annual Scientific Session and Expo (#ACC17) where in the span of three days, over 47,000 tweets and almost 232,000,000 impressions occurred among 15,000 Twitter participants. An average of 861 tweets occurred per hour (Figure I). Twitter helped disseminate real-time breaking news of scientific research and updates on cardiovascular care by thought leaders to thousands who were not in attendance. ACC.17 was a clear demonstration of how Twitter allows clinicians, educators and researchers to communicate with one another.

In addition to bringing medical conferences to the physician, Twitter can bring the world of academic medicine closer together. It allows individuals to reach one another and discuss their research interests online rather than in-person at conferences. Twitter can help connect investigators across institutions to share and vet ideas providing for instantaneous feedback and validation of one's work. It can also serve as a tool for recruiting patients for clinical trials, as well as a means to engage practicing physicians and educate the public regarding treatment and advances in medicine.

The perceived quality of a journal is currently determined by its impact factor, the measure of frequency of which the average article in a journal has been cited in a particular year. It is conceived that within the foreseeable future, a journal's impact factor will be determined not only by the number of times it is cited in the literature, but also by the frequency of which the article is mentioned or referenced on Twitter. At the least, it will bring attention to articles that may go unrecognized and uncited. Tweets have been shown to predict highly cited articles within the first three days of article publication.

Twitter has become a way for academicians to disseminate and promote their work to a much broader audience, beyond the subscription ranks of a particular journal. For the non-academician, Twitter has become an important resource to keep up with medical literature in real time. It also allows the reader to serve in an important capacity as a post-publication peer reviewer providing critical commentary, putting the author and journal's reviewers on notice.

Cardiologists on both sides of the Atlantic Ocean have clearly shown a fondness for Twitter as demonstrated by SYMPLUR analysis (Figure 1) and its use has been encouraged by the ACC and the European Cardiology Societies. However, this is not true for all meetings and organizations. At this year's American College of Physicians Annual Scientific Session (#IM2017), the presence of Twitter was barely noticeable. Although not a forum for breaking scientific research like ACC.17, academicians were providing updates and clinical pearls in internal medicine to an international assembly of physicians. Yet when it comes to Twitter, a pin dropping could be heard within the walls of the conference center. Was this a missed opportunity to share knowledge and foster a dialogue about best clinical practice?

Just as Twitter has the power to promote, it has the power to punish. At this year's American Diabetic Association's (ADA) Annual Meeting, attendees were specifically asked to remove tweets of presenters' slides due to perceived copyright infringement. This created a social media furor for the ADA, with the focus of the ADA hashtag causing the Twitter ban and not the science being presented at the meeting. Despite the many perceived benefits of Twitter, it appears that certain organizations and a significant population of the health care profession remain wary of engagement. Is it the term social media that frightens physicians from participating? Is there a certain lack of control that professional organization are not willing to engage?

As we have witnessed with many things in medicine, including government regulations, health insurance reform and electronic health records, physicians have been slow to become engaged with change and often struggle to catch up. The same will be true for social media if we do not take the time to explore how it can help us in our individual roles as practicing physicians, educators and researchers. It is imperative that our professional organizations recognize the emerging power of social media and help us in this journey by leading the way as the ACC has.

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This article was authored by David L. Fischman, MD, FACC, and Michael P. Savage, MD, FACC.