My Hematology/Oncology Grand Rounds at Memorial Sloan-Kettering Cancer Center 2/4/14

I was honored to be asked by ASCO President Dr. Cliff Hudis (@cliffordhudis on Twitter) to give Grand Rounds at Memorial Sloan-Kettering Cancer Center in New York on the topic of social media, on Tuesday Feb 4 at 8:00 am EST. The title of my talk is "Connectivity, Collaboration, and Disruption: Social Media and the Oncologist." As I did with the last few talks I've given, I created a special hashtag "#msk_hcsm14" which I will use to create a live Twitter stream that I hope more than a few people will follow and respond to during the actual presentation. Also, using Tweetdeck, I pre-scheduled a series of tweets with the hashtag to be posted during the presentation, containing many of my references and few additional links to extend the talk. While I don't really think anyone will be fooled into thinking that I am live-tweeting in the middle of my presentation - not that I and others haven't thought about it - I find this a fun and educational technique to try to jumpstart online dialogue. And after the session is over, I will create a Storify of the collected tweets to share with the audience.

I know a few MSKCC doctors on Twitter, but I don't know how active they might be during the presentation. I don't think the level of interactivity you see at large meetings like #ASCO13 or #MedX is very common at smaller sessions like this, but there is always a first time!

So if anyone is reading this, feel free to join in the online Twitter conversation starting about 7:45 am on Tuesday 2/4/14. Be sure to save this hashtag and spread the word. Thanks.

#msk_hcsm14

Addendum 2/6/14:

I have posted my slides for my talk to SlideShare.

The Storify for the hashtag #msk_hcsm14 is here.

Spread the word and keep the convo going!

My 12/4/13 talk at Johns Hopkins - "Social Media for Professional Education and Patient Engagement"

Today I was honored to be able to give a talk at Johns Hopkins on the topic of healthcare-related social media. This was a joint seminar of the Cancer Outcomes and Health Services Research Interest Group and the Johns Hopkins Welch Center for Prevention, Epidemiology, and Clinical Research. I set up a Twitter feed in advance using the hashtag #cohsrig13 and prescheduled a series of tweets to go out with links to references for some of my slides. The audience was engaged and enthusiastic, and several of them live-tweeted my talk - which I strongly encouraged of course.

I created a Storify with all of the tweets from today associated with the #cohsrig13 hashtag here. 

I've prescheduled tweets when I've given talks before, and I think it's a potentially effective way to share references realtime and encourage interaction. I've never done a Storify before this but it's incredibly simple and seems to be useful for archiving this type of event. Let me know what you think.

Podcast: Practical Guidance in the Use of Social Media in Oncology

This week we posted a podcast for ASCO's Journal of Oncology Practice on the topic of social media in oncology practice. This was based on an article that was published September 2012 in JOP, co-authored by several members of the Integrated Media and Technology Committee from ASCO. I currently chair that committee and was honored to be included as an author. Three of the article's contributors joined me for a stimulating 45-minute conversation about the power (and perils) of using social media from the viewpoint of an oncology professional, incorporating as well how a professional society like ASCO employs these tools. My guests were Dr. Don Dizon (@drdonsdizon), a medical oncologist at the Massachusetts General Hospital Cancer Center specializing in women's cancers and female sexual health, Dr. Mike Thompson (@mtmdphd), a medical oncologist in community practice in Wisconsin with an interest in hematologic malignancies and clinical trials, and Claire Johnston, Social Media Manager for ASCO.

You can listen to the podcast here on the JOP website, or this link will bring you to the iTunes store (you can also just search "Journal of Oncology Practice" on iTunes and find it that way). Also, please take a moment to read the full JOP article.

The conversation was wide ranging and covered many important points, including:

• Why social media has become such an important form of communication in health care these days and the different ways physicians might use social media (patient care, health messaging for a lay audience, and professional networking/knowledge-sharing)
• What are the special considerations for social media in the field of oncology in particular, compared with other medical specialties
• What issues are raised when patients try to engage with their physicians using social media
• What basic themes and principles we learned by examining the social media policies from about 35 other organizations ranging from the AMA to different hospitals and medical centers
• What role social media plays as a member benefit and a communication/engagement tool for a professional society like ASCO
• What special precautions must be kept in mind if you are using social media to spread the word about a clinical trial and improve recruitment

Hope you take the time to download the podcast and listen to it at the gym or driving to work! Your feedback is always welcome, either here or on the iTunes page.

Social tool or social isolation?

While most of my colleagues at Hopkins are aware of my social media activities, and I did give a shortened version of my 2012 UC Irvine Grand Rounds talk Social Media and the Digital Physician at a Hopkins breast cancer conference in November, I usually keep a low profile about what I do on Twitter and this blog. Two to three members of the Hopkins breast cancer group are active on Twitter or have blogs, although most of my group doesn't really participate except perhaps for occasional lurking as far as I know. So I thought it was interesting to share on our breast cancer listserv a tweet I wrote last week about the Albert Einstein College of Medicine's presentation Taking Twitter to the Next Level: A Hands-on Workshop. (Props to my Twitter friends Paul Moniz and David Flores for a great slide deck.) I also linked to Vineet Aurora's (@FutureDocs on Twitter) blog and her Top Twitter Myths and Tips. That led to a little discussion among our group about the (perceived) time commitment required for social media. Here's my reply:

OK, I’ll bite (and if everyone else on this listserv find this tedious, I’m sorry and I promise not to make this a soapbox)…

First of all the time issue, I agree if you spend a lot of time on social media at the expense of things that you should be doing like time with family or exercising, that’s not good. On the other hand, like Antonio said, I think we all waste a lot of time aimlessly online, web-surfing to things peripherally related to professional or personal interests – at least that’s what I would do 10 years ago. With Twitter, you follow a group of people and/or organizations, generally those that share some of your interests or in whom you find something appealing, useful, interesting, quirky, etc.,  that then bring content to you via their tweets. Not talking about this replacing purposeful use of the Internet like looking up a specific clinical/scientific question, doing research, etc. which of course I still do as much as ever. But when I want to stay up to date or let myself become exposed to ideas, news stories, articles in journals I don’t regularly read, policy statements, etc. Twitter is a great way to do it. When do I do it? In the morning at 6:00 a.m. before my wife is up and the paper gets here, when I’m eating lunch for 20 minutes at my desk, scattered times during the work day, and right before I go to bed.  The great things about Twitter is it’s always on, and you can read it for 1 minute or 30 at a time. And I post on Twitter sporadically during the day. When I am reading something online be it a JOP/JCO article, someone else’s blog post, a news story – be it medicine, science, informatics, a personal interest like certain types of music – I click the Tweet button on my iPhone and share it.

Now creating something more than Twitter does take time. Like I said in my talk, I do a monthly podcast interview for Journal of Oncology Practice for ASCO where I interview authors of articles. That’s social media but it’s more organized and formal within my volunteer work at ASCO, so that’s not for most people. And having started my own blog this year, that takes a lot of time to do it well. I’m still feeling my way, and realize there is no way I am going to be able to write blog posts every day or two, but so far I have come up with a tiny bit of a following in the past 6 months by posting a few times a month and getting lots of people to read my blog and share the posts.

Re the question of whether social media is a transient distraction aimed only at youth, that train has left the station – it ain’t. It’s a worldwide cultural phenomenon that has touched every industry, nation, social class, etc. Do you all as clinicians, scientists, or other healthcare professionals need to do this to remain relevant for your jobs and for your personal lives? Maybe not yet, but I am of the belief that is changing fast. While we are somewhat protected as being members of the Johns Hopkins community in that our institution has a vibrant social media presence for us, I would submit that by not at least sampling it as an individual, you are missing out on a lot. I also believe you are missing a lot of opportunities for networking and professional growth. That part has been amazing.

In addition to the slides I linked to below, also take a look at this link for a quick view of Twitter by another academic physician:  http://futuredocsblog.com/top-twitter-myths-tips. Or follow the blog of someone like Dr. Bryan Vartabedian at www.33charts.com for a real visionary. Or, ahem, follow me on Twitter (@rsm2800) or read my blog.

[puts soapbox away and resumes normal life]

So as I was thinking about social media communities and health care professional engagement, I came across this provocative opinion piece in this morning's Washington Post, "Why do we still know so little about Adam Lanza? Because he lived in the cloud." It looks like it's freely available, so it's worth a read if you are able to endure another story related to the horror of the Connecticut shootings. The central thesis of the piece is that one of the reasons we seem to have learned so little about the shooter is that his interactions were essentially all virtual - because they could be. The author goes on to cite experts on both sides of this issue, those that claim that the availablility of virtual communities and social networks promotes social isolation in the real world and those that claim just the opposite. 

This article is interesting but purely speculative, since the police report on the Newtown massacre hasn't been released yet, and to date there is little confirmation of any of this. I'm not suggesting by juxtaposing my earlier comments about the importance of Twitter to healthcare professionals and patients that there is any connection with psychopathic shooters at all. But I do think this - we need a lot more research to understand how social networks and connections work in healthcare and medicine. While I admit I am an enthusiast and see the potential promise for improved health outcomes, professional connection leading to collaboration, and a breaking down of barriers between physicians, researcher, and patients, like any cultural phenomenon there is a dark side that needs to be illuminated, studied, channelled into something better (if it can), or parts of it walled off if it can't. I know that in addition to the concern about the time commitment and misperception of purpose (i.e., Twitter is only for 20-somethings talking about what they had for breakfast) these are reasons why some of my colleagues assiduously eschew social media for now. I am just concerned that the honeymoon between healthcare-related social media (aka the Twitter hashtag #hcsm) and early adopters like me might be winding down. The existence and promise of a phenomenon is not sufficient to justify its continued promulgation in something as important as patient care and research. I do believe that we will ultimately conclude that #hcsm is a tool and communication channel worth using in healthcare, medicine, and science. But we better get to work examining and proving hypotheses about it before another Washington Post columnist starts some darkly-tinged speculation on what we having been doing so far with it.

My (informal) social media policy

I use social media - mostly Twitter and this blog - to share content (journal articles, news stories, blogs, tweets, pictures, videos, etc.) that I find interesting and worthy of dissemination. For Twitter, I often make the decision as to its worthiness at the moment I am reading it, so it is usually unfiltered and spontaneous. However:

• Sharing it does not mean I endorse it, agree with it, or necessarily believe it represents a balanced or carefully researched viewpoint.
• RT in Twitter does not mean I endorse the tweet or the link contained in the tweet. It just means I think it is something my followers should see.
• "Favoriting" a tweet does not mean I approve it; usually it just means I intend to read it later. Sometimes I RT or marked a tweet as a favorite only for note-taking purposes.
• If I share it, I usually will have read the linked article completely enough to understand the main points and general concepts the author(s) intend to convey. However, there are exceptions - I may RT something that looks particularly interesting or provocative without reading it in detail, but usually only if I am familiar with the source.
• Since tweets are only 140 characters, it is often difficult to convey nuance or detail, and read out of context are by definition prone to misinterpretation.

My audience is both a professional audience (other physicians or healthcare/IT specialists) and a lay audience (patients). Whenever I tweet or write a blog post, I do not intentionally create the content exclusively for one audience or the other. I recognize there is a lot of overlap in interests, and I believe that is a good thing.

Sometimes I will link to articles that require a personal or institutional subscription to view the full text, or as some call it, articles that are behind a "paywall." I do regret that all of my readers will then not have full access to what I am sharing, but that is the reality of publication today. I'm not going to wade into that discussion here, but I will say that I recognize current business models mean that many journals can't stay afloat financially without advertising directed at paid subscribers. Sorry folks. 

I will not share any patient-specific information, and certainly not anything that would run afoul of HIPAA. Patient privacy is a sacred trust for physicians, and protecting that is my highest priority.

Moreover, while I may share some perspectives and experiences surrounding patients I have encountered, I will do so in a general way, and individual patients should not be able to identify themselves. I realize that it is still possible to reveal enough information in a scenario or vignette to violate privacy without including a patient-specific identifier, so I won't do that.

If I do share a vignette or patient story, it will be a conglomeration of multiple patients or it will be otherwise fictionalized so that an individual won't be able to identify him- or herself. The exception would be if I chose to share a specific patient story with the explicit permission of that patient.

Tweets or blog posts do not represent medical advice. Any interactions I may have with individuals on this blog or Twitter are of a general nature about the health condition but not your health condition. These interactions do not constitute a doctor-patient relationship. You should always consult with your personal physician for questions about your health.

My blog posts and tweets are my opinion only and not that of any other person or organization. They do not represent the opinion of the Johns Hopkins University School of Medicine (my employer) or the American Society of Clinical Oncology (where I volunteer). I am not speaking on behalf of Hopkins or ASCO. I do attempt to honor the social media policies of both organizations, however.

While some have advocated that physicians and other professionals have completely separate social media accounts for their personal and professional uses, I don't totally agree with that (who has the time). I have one blog (this one) and one main Twitter account (@rsm2800). I do use LinkedIn for professional contacts and Facebook on occasion for keeping in touch with friends. However, on LinkedIn I generally only accept connections from people with whom I have a prior or existing business relationship, and I only accept friend requests on Facebook from personal friends.

I am honored to have my patients read my blog or follow me on Twitter, but I do not practice medicine using social media. If you are a patient and you need to contact me about a specific health concern, please DO NOT do so on those channels since I cannot guarantee your privacy or assure you a timely enough response. (At the time of your visit, we will discuss the best way of reaching me or my office - a phone call is always the safest and most direct.) Also for reasons of privacy - yours and mine - I do not accept LinkedIn connection requests or Facebook friend requests from existing or past patients. 

I enjoy being visible on social media and interacting with Twitter followers and readers of this blog, but that doesn't mean I am available 24/7. I have a demanding job and like everyone else I need to tune out at times, not think about work, not read email etc. Some of those times I may still be on social media, so you may see me there even if I am not in the clinic, answering email, etc. If I have any email unavailability longer than an overnight or a weekend, I will use my Out of Office message so you can know when that is. For my Hopkins patients, there is always an oncologist on call 24/7, who can be reached by calling my office number day or night, so if I am not around, someone else covering for me will be.

And finally…

Remember that the strength of social media is its immediacy and accessibility, and the content shared is often spontaneous and unpolished. The ideas may be further developed by sharing and interaction (RT's, blog comments, etc.), and that means that the tone and conclusions may evolve. Pediatrician and social media expert Dr. Bryan Vartabedian calls this "public thinking," and I would agree with his premise that physicians are starting to have an obligation to connect and spread ideas in this very transparent and public space. But by definition, that makes social media a much different communication channel for me as a physician than traditional ones - interacting one on one with a patient in the exam room, publishing in the scientific literature, or speaking at a conference. So while I will always endeavor to make the content I share publicly on social media accurate, timely, and relevant, readers of this blog and my Twitter stream must appreciate the differences between the traditional and social channels. And it is important to do both well!

+++++++++++++++++++++++++++++++++++++++++++++++++

[UPDATE 1/2/2015]

On 12/3/2014 I became a full-time employee of the American Society of Clinical Oncology (ASCO), meaning that my previous employment at Johns Hopkins has ended. My position at ASCO is Senior Director, Quality and Guidelines and Medical Director, CancerLinQ. From time to time, I will continue to update this blog, Perspicacity. I remain active on Twitter at @rsm2800. The views I express on any and all of my social media channels are personal views and do not necessarily represent the views of ASCO. I am not speaking on behalf of ASCO. As noted above, "retweeting" or "favoriting" on Twitter does not mean I endorse the content of the tweet. "Following" another user on Twitter does not mean I agree with the positions or policies of that person or organization. And tweets/blog posts never represent medical advice.

USA Today article on #bcsm weekly tweetchat

Kudos and thanks to Liz Szabo (@LizSzabo on Twitter) from USA Today for her 10/23/12 article "Breast cancer survivor group is a social movement" about the weekly breast cancer social media (hashtag #bcsm on Twitter) tweetchat and online support group.  Co-founded by two breast cancer survivors/bloggers Jody Schoger (@jodyms) and Alicia Staley (@stales) a little over a year ago, the group has blossomed into a vibrant community of support for breast cancer patients and their families, caregivers, friends, and many other interested folks. If you're unfamiliar with the lingo, a tweetchat is a virtual meet-up on Twitter at a specified time, often repeated weekly or at some other interval, around a predetermined hashtag, which is a type of metadata. The conversation is often organized around questions or topics posted by the moderator, although tweetchats are by definition unstructured and free-flowing. Here's a more detailed explanation. 

The USA Today story emphasizes the power of the community that has arisen out of this online gathering. While it seems improbable that meaningful interaction could really occur over the exchange of 140-character tweets, that is exactly what happens, and the online conversation is deeply-nuanced and powerful. I have been honored to be a guest expert on #bcsm, and I frequently join in the conversation, which occurs most Monday evenings at 9:00 pm Eastern time.

I appreciate Liz Szabo allowing me to be quoted for the article and more importantly for publicizing the existence of the group and the good that it is doing. This is another example of how social media provide opportunities for connection and community that transcends geographical, institutional, and socioeconomic boundaries.

Help me show a group of physicians the power of social media

I'm going to be giving Grand Rounds for the Department of Medicine at University of California, Irvine School of Medicine on Tuesday, October 16, 2012 at noon PDT, as I mentioned in an earlier blog post. The title of my talk is "Social Media and the Digital Physician - #UCIMedGrandRounds." Since it would probably be a wee bit too challenging to try to livetweet my talk while actually giving my talk (I'm good, but not THAT good), I decided to pre-schedule a series of tweets using HootSuite with the #UCIMedGrandRounds" hashtag, to be posted during the talk, roughly correlated to the topics I am covering at the time. I fully plagiarized this idea from @colleen_young, who pulled this off in spectacular fashion I am told at the 2012 #Med2 conference in Boston - props to you!

So I am hoping that my Twitter community will join in the fun next Tuesday 10/16 at noon Pacific time. Please follow the #UCIMedGrandRounds hashtag that day, and "wave" to the audience by introducing yourselves to them via Twitter. I'll send out a few reminders at the start of the talk. While I don't know how social media savvy my physician audience will be, since it's an academic medical center I suspect that penetration of Twitter may be fairly minimal. I am hoping we can generate a little buzz by showing them the power of connection and interaction that we find in social media. Maybe we will get a few converts! Thanks.

I'm on BlogTalkRadio 9/26/12 5PM EDT with Dr. Richard Just

I'm honored to be asked to appear on Internet radio with San Diego area oncologist and social media triple threat Dr. Richard Just, Wednesday 9/26/12 5:00 pm EDT for a 30 minute chat ranging from social media for oncologists to breast cancer. You can listen in live here. And be sure to check out Dr. Just's lively Twitter stream with the handle @chemosabe1 (wish I'd thought of that one) and blog JustOncology.com.

The Virtual Choir

[This weekend, while trying to work on my Department of Medicine Ground Rounds talk at UC Irvine for next month ("#UCIMedGrandRounds – Social Media and the Digital Physician"), I've been listening to some soothing Eric Whitacre pieces with hopes that it would inspire me to get most of my slides done. Not sure that is working yet, but it inspired me to share a blog I did for ASCO Connection earlier this year about artistic vision, collaboration, and illness.]

In a previous life I used to be a church musician. I started piano in the 1st grade, and since I attended a pretty traditional parochial elementary school, it was natural to gravitate in this direction. Over the years I’ve been involved in church and school choirs as a pianist, organist, singer, arranger, composer, and conductor, and I did this in high school, college, med school, and beyond, as recently as about four years ago. Lest you confuse me with someone with real talent, let me say I was never classically trained and I would probably embarrass myself pretty badly today if I tried to perform anything complicated. But I’ve long maintained my love for classical choral music, both sacred and secular, and I’ve always greatly enjoyed listening to choral works on my iPod.

A few years ago, while browsing the iTunes store, I discovered a composer and conductor named Eric Whitacre, who has had a somewhat meteoric rise to fame and international acclaim in this genre. He has an interesting personal story. He grew up in rural Nevada in the ‘70s-‘80s and attended UNLV, not exactly known as a powerhouse for classical music. As he tells it, even though he could sing, he couldn’t read music when he started college. On a whim, he joined a college choir and almost immediately had a transformative experience with the music and the blending of voices that led to a BA in music, then a Masters at the Juilliard School, and over the next 20 years lavish praise, fame, and multiple awards as a prolific composer and conductor of choral and symphonic music. I’m sure it doesn’t hurt that, now at 42, he is described as “boyishly handsome” and is an articulate and passionate speaker. His music is known for its dense harmonies, dissonance, and unusual rhythms. I find it very beautiful and challenging. But what I really found fascinating was an experiment he started in 2009 with something called the Virtual Choir. It’s probably easier to watch this 11-minute “TED Talks” video, which went insanely viral last year, than read my summary, but I will try to be brief. It seems that a young girl sent him a fan video on YouTube of her singing the soprano part to one of his pieces called Sleep. He was struck by the tribute, and he recognized the purity and sweetness of her artistry. He then had an inspiration about how to harness the creativity of multiple other would-be performers who might be singing to their video cameras and uploading to YouTube, hoping to create something beautiful that would make them famous. So what he did was to put out a call, using social media, encouraging singers all over the world to video themselves singing one of the parts of his work Lux Arumque. He ended up receiving almost 200 hundred videos from a dozen countries. Then with a collaborator, he assembled his Virtual Choir into a single video, with himself conducting these virtual voices, and the results are, well, astounding. He went on to produce Virtual Choir 2.0, with over 2,000 separate singers from dozens of countries, and then just this week released the video of Virtual Choir 3.0, with 3,746 singers from 73 countries performing his work Water Night. I know you are busy people, but take 30 minutes out of your evening to view all three of these videos. Even if you are not a fanboy like me, the artistry is remarkable, and the music sublime and exhilarating.

So what in the world does this have to do with medicine, oncology, or ASCO Connection? As I followed this story, it struck me how there are some parallels with health care and the experience of illness. In the Virtual Choirs, Whitacre and thousands of others with the common interest of choral music were coming together to share an artistic vision and create a larger work. While each singer was recording an individual vocal track in the privacy of his or her own bedroom, there was an undeniable social connection. The need to connect with other people who share our interests and experiences is one of the strongest forces of our humanity. And I see this every day in the practice of oncology. Yes, this is the era of personalized medicine, but so many of our patients have a fundamental need to connect with other patients and families that are going through the same thing they are, a need that we as health professionals can’t possibly fill. People need to learn from each other in a social and collaborative fashion, and the wonders of the Internet and the explosion of so many social media channels today have enabled this to a degree never before possible. Much research has confirmed this, and while patients will usually come to their physicians for the authoritative voice we have, they still need to process this knowledge through the filter of other people. As oncologists, we would be foolish to deny this reality, and I would maintain that a much greater good could come from our efforts to facilitate it, if not harness it for a larger purpose.

But for us as physicians, it’s more than simply allowing patients to share their war stories and their tips on dealing with treatment, with some type of blind but vaguely disapproving eye. I think this social urge is a greatly underutilized resource for discovery. Think of the whole concept of patient-reported outcomes. As physicians, we know or should know that we generally do a lousy job in assessing the patient experience of illness. In our field this very pointedly is the patient experience of treatment toxicity, fear of the disease process, and loss of control. The data are so much better when we let patients tell their stories directly. And think how easy it would be to enable this with all of the simple and widely accessible technologies available today, like YouTube and cell phone texting. As investigators, we could create our own Virtual Choir of our patients, individually and collectively, contributing content that we can amass and analyze for trends and causality. Think how simply elegant an experimental design could be. Say we wanted to know the temporal trend of patient-rated bone pain following a Neulasta injection. Sure, we think we know this from existing clinical trial data, but mostly it’s what we’ve asked our patients to tell us. What if we told every breast cancer patient getting dose-dense AC starting on day 2 of each cycle to text an integer value from 1-10 corresponding to their level of bone pain to 11435? And what if the data were displayed real time on a website that refreshed every ten seconds with all other participants’ results, so that people feeling lousy in their homes that night could see other peoples' scores and know they weren’t alone? I would predict that this collaborative content creation would enhance study compliance like no $25 Starbucks gift card ever could. And if instead of a Virtual Choir of 2,000 or 4,000, we had tens of thousands of patients doing the same thing? Talk about Big Data! Yes, our current broken clinical trial system can’t support something like this. But I believe we can figure out a better way to harness the power of social media, collaborative data creation, and the patient voice to overcome these barriers and transcend our current maddening limitations.

Whitacre had a vision of musical creation that transcended a single concert hall or venue, and the results were breathtaking. In our field, I believe we are no less creative and passionate. What are the provocative questions we can answer by being as visionary and bold?

Crowdsourcing a title for my grand rounds on social media

A few weeks ago I was flattered to be asked by an old friend from Stanford fellowship days, Dr. Ed Nelson, Chief of the Division of Hematology/Oncology, UC Irvine School of Medicine, to give Grand Rounds  for the UCI Department of Medicine in October 2012, on the topic of "Social media in medicine, now and in the future." Since it's a grand rounds, the audience will probably be mostly physicians, and my expectation is that their familiarity with social media tools and comfort with using them in their professional lives and in interacting with patients probably pretty limited. I could be wrong, but I suspect they are similar to the faculty at most other medical schools. I haven't fully decided yet on how I am going to shape the talk, but I expect I will cover such topics as:

1. General overview of SM tools and applications
2. Statistics on the tremendous growth of SM in healthcare and medicine
3. Examples of best practices from prominent institutions like Mayo Clinic, MD Anderson, Hopkins, etc.
4. Opportunities to use SM to promote enrollment to clinical trials and for other areas of patient engagement
5. Use of social media for sharing medical information with other healthcare professionals and for continuous professional development, which was some of the research I presented at Medicine 2.0 at Stanford in 2011 with Brian McGowan et al

Since I am a believer in the power and inevitability of social media and social networks in healthcare, while still maintaining a healthy skepticism about its utility in clinical practice, I intend to give a generally positive, enthusiastic, and balanced presentation, particularly highlighting my personal growth in this area.

I need a catchy, non-cliched title for my talk, something that conveys the optimism and promise but doesn't sound like a press release from the latest Web 2.0 start-up. So I decided to crowdsource it! Please make suggestions for a title for my Medicine Grand Rounds, either in the comments below or tweet it to me @rsm2800. Thanks!

Inflection points

I've been blessed with many opportunities in life, and while I can't say if I had the chance to replay my career in medicine I would do it exactly the same way each time, I am very satisfied with the path I have chosen (or has been chosen for me). I thought I would explain some of the interesting phases and changes of my career as an oncologist by focusing on a few key inflection points. I realize now, 27 years after med school graduation (geez, that number makes me sound incredibly ancient), how different my career and my family's life experiences would have been if a few of these points had turned in another direction.

The first was when I opened the envelope on Match Day in March 1985 and learned that I would be doing residency in Internal Medicine at UC San Francisco, my first choice. (Trivia question, how many of you remember your rankings for your residency choices in the match? I believe my top 5 in order were UCSF, Yale, MGH, University of Washington, and Case-Western.) While I was very honored albeit very surprised to be accepted into such a prestigious program, at the time I seem to recall my greatest source of happiness was the fact that a good friend and housemate would also be doing his residency in the Bay Area, at the naval base. At that point, I had lived my entire life in Virginia, including college at UVA (where my sister, dad, and grandfather were all alums) and med school at MCV in Richmond (now called VCU). So moving to the West coast as a single person at age 26 and starting the scariest and most intense training of my life was a huge change. How different life would have been if I had matched in a program in the East or elsewhere, considering I then went on to live in California for the next 24 years, met and married my wife there, and raised all three of my kids in Sacramento.

Going to Stanford for oncology fellowship in 1989 was another important inflection point for obvious reasons. Ironically, my first choice was actually Johns Hopkins…except they didn't offer me a slot. Let's see now - Baltimore vs. Palo Alto, hmmm. Guess I landed on my feet. (I love telling this story to Hopkins fellows and residents these days.) Although I went into fellowship assuming I was going to have a career as an academician and clinical researcher, for a number of reasons, mostly personal and family-related, I chose to go into private practice in Sacramento in 1991, where I stayed for the next 17 years. And I might have continued to have a very unexceptional but rewarding career as a community oncologist if it weren't for a few other inflection points. I didn't realize it at the time, but one was in 1995 when I was nominated to be a board member for the Association of Northern California Oncologists (ANCO), the ASCO state affiliate for northern California. I can't even remember if there was an election or not, but serving on the ANCO Board, eventually becoming VP then state society president, afforded me numerous opportunities to understand some of the regulatory and reimbursement issues facing my colleagues and work toward improving our professional lives and indirectly the welfare of our patients. I have no recollection of how I was even nominated, but if that hadn't happened, I am doubtful that I ever would have gotten involved in "medical politics" or anything much outside of my own medical practice in Sacramento.

This may sound strange, but another inflection point was when U.S. Robotics introduced the first PalmPilot in 1996 (then called "Pilot"). I was always a gadget freak and had enough knowledge about personal computers to be truly misinformed, but when I saw the first prototypes of these PDA's, I knew I had to have one and use it in my daily routine as an oncologist. One thing led to another, and eventually I became recognized as an expert of sorts, mostly through reviews and columns I wrote for PDAMD.com, ASCO Online, and other websites. So that led to another turning point, in about 2004, when ASCO President-Elect Dr. Sandra Horning, one of my mentors when I was a fellow at Stanford, asked me to chair the ASCO IT Committee. At the time, there were quite a few older, more tech-savvy, and experienced oncologists whom she could have chosen - I've worked with most of them over the past 10 years in ASCO-related IT endeavors - but I am still deeply appreciative of the trust she placed in me. And it is probably true that my experience as an ASCO Committee Chair and my prior position as a state society president contributed to my nomination and eventual election in 2006 to the ASCO Board of Directors.

One of the stranger inflection points was how I became involved in social media. I've shared this in my talks before, but in approximately 2007 ASCO was experimenting with blogs and social networks, and at the time, as Board liaison to the ASCO IT Committee, I was charged with trying to legitimize this and make it more palatable to the ASCO Board. Historically the Board had been hesitant to officially bless something as potentially wild as social media with the ASCO name. Personally, I had a high level of skepticism when this was starting out. And that's how I began experimenting with Twitter, since I knew I had to take one for the team and make it work for myself, if ASCO was going to endorse it.   The rest is history - along with most other professional societies and non-profit institutions, including most academic medical centers, ASCO is widely recognized for its social media presence including its Facebook page, Twitter feed, and the award-winning blog and social networking site, ASCO Connection.  And for me, oddly enough, I find myself doing research and giving talks on social media and medicine, including upcoming Medicine Grand Rounds at UC Irvine in October 2012. If you had told me in 2006 that my last three papers accepted to peer-reviewed journals would be about Twitter and social media, I would have questioned your sanity.

Finally, my current position at Johns Hopkins which I assumed in 2009 obviously was another inflection point, due to a fortuitous combination of timing and having just the right contacts. At the time, I was becoming increasingly unhappy dealing with the business pressures of being a self-employed physician in private group practice, which was squeezing the joy out of medicine and requiring increasing vigilance to counteract some of the local pressures my group was facing. I was thinking I might look at a job with an EHR vendor or perhaps a chief medical information officer position with a hospital system. But I wasn't quite ready to give up clinical medicine yet. Then, in December 2008, I saw an ad in JCO that Johns Hopkins was looking for a clinician in the breast cancer program. Although I wasn't confident I had the credentials they were seeking, I approached Dr. Nancy Davidson, with whom I was serving on the ASCO Board at the time, to learn that, unbeknownst to me, the position was opening up because she was leaving Hopkins to go to Pittsburgh, and they needed an oncologist to take over the load of seeing new breast cancer patients. But even better was when I learned during the interviews that they also wanted someone to assist with the implementation of their electronic health record…and well here I am.

Here's what I learned from these experiences. It's easy to identify the big changes - matching at UCSF in 1985 and being offered the position at Hopkins in 2009 are obvious examples if for no other reason than the sheer geographic upheaval (subject for another blog post perhaps). But many of the inflection points were much more subtle, and I couldn't possibly have anticipated the downstream implications. If some kind soul hadn't offered up my name as an ANCO Board nominee in the mid-1990's, I'm not sure I would have necessarily gone in that direction. If Sandy Horning hadn't asked me to become an ASCO Committee Chair, I'm not sure I would have taken on progressively greater leadership responsibilities in a professional society like ASCO, as I was quite content at the time seeing patients in the community practice setting. And considering I am not a member of the stereotypical Facebook generation, if I hadn't delved into Twitter for the sole purpose of experimenting with it on behalf of ASCO, perhaps today I would be regarding social media as just another cultural phenomenon that does not particularly affect me. It would have been completely normal, expected, and unremarkable for any one of these events to have gone totally in another direction, and my career and family life could have been so very different.

I have been blessed with these wonderful opportunities, for which I am eternally grateful. Part of the excitement of what I do every day is wondering if the next seemingly unremarkable event, collaboration, engagement, or new technology, is going to turn me in some other unexpected direction. Never boring!

Genesis

Don't let the perfect be the enemy of the good.

If I sit through another meeting (usually something related to EHR implementation) and hear that quote, I think I'm going to…well I don't know what I am going to do, since everyone seems to be saying it and acting like they thought it up themselves. But that quote, supposedly paraphrased from Voltaire, partially explains why I have finally decided to put aside all of my reservations and actually go ahead and start a blog. A physician blog is hardly unique or interesting any more, but for me, with my increasing involvement with social media (and some level of visibility), the time is right to do this. To be more accurate, I have already been contributing to a blog on ASCO Connection for a few years now, and even prior to that to one of ASCO's first forays into social media, which was an EHR-focused blog on the Ning platform, which ASCO later migrated to ASCO Connection. I have contributed to ASCO Connection a few times a year, although I definitely feel far eclipsed by Don Dizon, Mike Fisch, George Sledge, and others, who are writing great blog pieces that have helped propel the ASCO Connection site to greater prominence, including a recent national award, a 2012 Apex Award for publication excellence. In other words, even though I was one of the first, these guys do such a great job, they should continue to carry the freight, and I'll probably just continue as a part-timer.

And let me say a word for and give a shout out to George Sledge in particular. I got to know George a little bit when we were both on the ASCO Board of Directors, and it's not an exaggeration to say he is the real deal - interesting and articulate guy, extremely well read with a broad range of interests, a brilliant scientist and clinical investigator, and as far as I can tell from the outside, a truly compassionate physician. But not only that, he is a great writer and really elevated the content and quality on the ASCO Connection blog pages. (Hey George, I'm not slurping you for any hidden reason, just to make this point.) I frankly don't know how he has the time to create these long and nuanced blog posts for ASCO and for Oncology Times, but they are always a great read. So…I knew I couldn't keep up, particularly with the length. Which is one of the reasons I realized it would be best for me to write my own blog - so here it is. Don't worry, Amy Fries and ASCO staff, I'll still post to Connection, although I will probably post it to this blog first and share.

So here is what I would like to do with this blog and a little more of my motivation for creating this. One of my main purposes is to allow me more space to share ideas than I get in 140-character Twitter posts. People who know about my social media activity of the past few years know that I am active on Twitter, and much to my surprise but also satisfaction, have 2000+ followers and growing (and some aren't spambots). But Twitter is all about quick bursts of information and instantaneous sharing, and not about thoughtful content creation. This blog will allow me to share articles, news stories, and other items I find online, that I am currently sharing on Twitter, but on a blog, you just have more "room." Sentences, not just phrases - what a luxury! And you can write in English, not in SMS-speak (Gr8 articl 2 read abt lng ca - blah blah blah).

Another reason to blog is to engage more with followers, more than what you can do with Twitter replies. I intend to enable comments on the blog and when I feel up to it, respond and engage in dialogue, although I don't have the time for a lot of argumentative back and forth, which is not my style anyway. Social media is always primarily about community and connection; a blog will help facilitate that. And I think it will also help people who read me to understand more of the life and experiences of an oncologist and informaticist (there's that word), particularly someone who has been doing this for 20+ years. Not that I think anyone is particularly interested in me as an individual, but sharing on social media is also about sharing who you are and what values you hold. In another post I will talk a little bit about my career and what led me from the East coast to the West coast and back again, and from private practice to academics. Again, not because I think it is particularly interesting to many people, but it helps define my current perspectives.

[Addendum 3/27/13: Re blog comments, I've learned after 6 months of having a blog that unfortunately a lot of comments are spam. There is a way to filter out a lot of them which I am doing. However, even if you get by the spam filters, I don't intend to publish comments where the primary purpose is advertising a specific service unless it has general applicability. That is true even if you have a legitimate medical practice or service. My blog is not free advertising for you. Sorry.]

Another reason I want to blog is purely selfish. I need to learn to write more quickly. I was an English major in college in a different century, and for all of my career, even in private practice, I have been doing a lot of writing and editing. And I think I am fairly talented in this area, I will say in all modesty. But I am definitely not fast, and the hardest thing I ever have to do is to start a manuscript. I sit and dawdle and waste time on the Internet and a million other things. A blog won't cure me of my procrastination tendencies, but if I am really going to make this work, I have to post regularly, and I don't have hours of extra time to do that. So another example of not letting the perfect become the enemy of the good.

A few other thoughts about what I want this blog to be. I expect I will blog about what I cover on Twitter right now, mostly my professional interests. These, of course, include medical oncology, particularly breast cancer, biomedical informatics and health IT, patient-centered care especially as enabled by consumer health informatics, and healthcare-related social media. I may share experiences about clinical practice, but will never give specific medical advice (that is why you have your own oncologist or PCP, and it ain't me), and I will never blog about a specific patient, at least not in any way that could lead to the identification of an individual. Patient privacy is a sacred trust, and not just because of HIPAA, but because it's what our patients absolutely expect of us. So if I talk about clinical practice, it won't be about what happened that day, but it might be about something long ago, where details have faded, or it might also be a composite of several patients or situations, so that no links to real patients can reasonably inferred.

I am going to try very hard to post a few times a week. I expect that many of my posts might be fairly short, since one of my main purposes will be to share articles or other items that my readers can explore themselves. I think that shorter, more frequent posts will be more effective for what I hope to achieve here, and that practice will certainly be a better discipline than slaving over a 1500 word blog post that takes 3 weeks to write. Again, I'm not going to let the perfect be the enemy of the good, or at least the adequate.

Finally, this isn't going to be pretty, at least not to start. Don't look for clever polls, beautiful graphics, or lots of widgets. I am just starting to play with the Blogger tools, and one of the reasons I chose Blogger over Wordpress was that Blogger is much simpler to configure. It's the words that matter. Sorry, if you want fancy, you will have to read a professional.

So here goes. I can safely say that no one will read this post the day it goes up, since I decided not to promote the existence of this blog until I can convince myself it will happen. But perhaps over time, just like it happened for me with Twitter, a community will develop and maybe I can accomplish something unexpected.