Clinical Editor's Corner: Kern

The Use and Abuse of Social Media in the Cath Lab

Morton Kern, MD, MSCAI, FACC, FAHA
Clinical Editor; Chief of Medicine
Long Beach VA Medical Center
Long Beach, California;
Associate Chief Cardiology,
University of California, Irvine Medical Center, Orange, California
On Twitter: @drmortkern

Morton Kern, MD, MSCAI, FACC, FAHA
Clinical Editor; Chief of Medicine
Long Beach VA Medical Center
Long Beach, California;
Associate Chief Cardiology,
University of California, Irvine Medical Center, Orange, California
On Twitter: @drmortkern

I learned something new recently. Did you know that the average person has five social media accounts and spends about an hour and 40 minutes browsing these counts every day, accounting for 28% of total time spent on the Internet? In Britain, the English are slightly less digitally obsessed, spending an hour and 20 minutes each day (courtesy of Dr. M. Chadi Alraies — see below).

Social media has become a ubiquitous part of our daily life and in particular, involves how we in cardiology and the cath lab exchange experiences, educate, discuss, notify, and create forums for information exchange. Just so we are on the same page, social media is defined as forms of electronic communication (such as websites for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content (such as videos) (Table 1). If you have a modern cell phone, you have access to social media and, whether we like it or not, are exposed to and influenced to various degrees by what we see on social media. At the American College of Cardiology (ACC) Annual Scientific Sessions in March 2019 in New Orleans, I was honored to be asked to participate in a debate on the pros and cons of social media. Dr. Martha Gulati, Chief of Cardiology, University of Arizona, Phoenix, Arizona, took the role of the proponent position on the benefits of social media. I took the role of a skeptic as to its value (although I am on Twitter @drmortkern and Facebook) (Figure 1).

The session had quite a lively discussion, bringing a wide disparity of views from both panelists and audience members. Although I am a relatively infrequent user of social media, I have a basic understanding and high curiosity, because my 30-something-year-old daughter has educated me to just above a beginner’s level. Having participated in the discussion and read a great article on the subject1, I thought this might be a good opportunity to share with our cath lab colleagues and others some of the important concepts and comments that highlighted the use and abuse of social media as it might apply to our workplace.

One of the best explanations of social media for those who are not familiar with it comes from an article by Drs Parwani, Choi, Lopez-Mattei, Raza, Chen, Narang, Michos, Erwin, Mamas, and Gulati, all members of the ACC interest group focused on social media and its opportunities in cardiovascular medicine. Their paper1 clearly summarizes the basics of social media, and its uses in education and advancement for the individual cardiologist and overall research (Figure 2). Social media is useful in creating new cardiovascular networks and communities. It is applicable for journals and conferences to notify users about recent events or publications. It has the capability for promotion of cardiovascular health initiatives. At the end of the article, Parwani et al also list suggestions for social media best practices.

The Pros of Social Media

At the 2017 Cardiovascular Research Technologies (CRT) meeting in Washington, D.C., Dr. M. Chadi Alraies, MedStar Washington Hospital Center, Washington, D.C., and Dr. Sheila Sahni, David Geffen School of Medicine, UCLA, Los Angeles, California, presented and later published2 probably the most comprehensive description of social media, describing its importance in medicine, and use in learning, educating, promoting work, and for personal branding and networking (Figure 3, Table 2).

Differences Among Social Media Platforms

Numerous social media platforms are available to the individual such as Doximity, Snapchat, Twitter, LinkedIn, YouTube, Facebook, Instagram, etc. As social media users, we do not need to be conversant in all, but we should be aware that many of our professional societies, colleagues, and fellow team members will be a participant in at least one or more of these platforms. While I may be dating myself as an outmoded old guy, I use Twitter, as do many of my professional colleagues, along with a couple other modalities (e.g., Facebook and Instagram) to keep appraised of different cath lab techniques, publications, meetings, and opinions. Some media are better than others at graphic display (Instagram), notifications (Twitter, Facebook), or conversations (Twitter, Facebook) [Note: These are my own assessments. Others may disagree. MK].

Using social media helps learners by highlighting journal activities, society and organizational meetings, and by transmitting opinions from experts in the field. Social media often involves peer-to-peer and colleague collaboration and discussions. Many of our most prestigious scientific journals have and continue to make their content known through these media.

Twitter as a Search Engine and for Remote Meeting Engagement

Something shown to me by Drs. Alraies and Sahni was that Twitter can function as a search engine to look up particular topics of interest such as drug-eluting stents or left atrial closure, and allow you to see instant results. Social media has the ability to enhance participation in scientific meetings, either in person or remotely, through polling and livestreaming. The use of social media at such meetings can engage colleagues in debate or support public health care messages. Providing scientific meeting updates, updates, learning, and engagement at these meetings are just some of the benefits of the social media platforms. It is now easy to conduct online polls to get immediate feedback from peers and colleagues interested in a controversial topic. Opinions can be quickly solicited via social media by using methods such as Twitter polls to see current thought on a critical subject, presentation, or procedure.

Social Media Use for Patient Education

In some regions of the world, general clubs and chats on cardiovascular disease topics have become useful for educating both patients and care providers. Platforms such as Facebook Live have been used in academic practice and discussions. Twitter and other similar platforms have been able to expedite information exchange. Of course, any time patient information is discussed online, we must be aware of the HIPAA rules protecting our patients’ confidentiality.

Downsides of Social Media

When I was asked to discuss the pros and cons during the ACC panel session, I listed them in an old-fashioned format, with a pen and paper, a device that rarely runs out of battery, never needs to be recharged, is relatively inexpensive, and is always available, unlike some of her more modern media platforms. In my own handwriting, I listed the following 8 things I consider critical to the discussion of social media (Figure 4):

  1. Social media is here (whether I like it or not, and I think I do).
  2. It has its limitations as a communication tool, but it can reach huge audiences.
  3. Its major functions appear to be marketing and notifications. It is used to share opinions and (presumed) facts.
  4. (Anyone can be a) media expert? No qualifications needed to be a Twitter maven.
  5. Social media posts are not peer reviewed, are not vetted science (and may be inaccurate).
  6. Discourse may not advance science (or may be frankly rude).
  7. Social media will not get you grants.
  8. Social media will not advance your scientific career goals (but will advance your visibility on Twitter; see #4).

My major concern about using social media is that at times, it is a true waste of time. Moreover, the information exchange can become unreliable, personal, or unhinged. In presenting clinical material, personal or patient information may be overlooked. We should adhere to the rules of privacy and protected health care information law. However, there are no ways to enforce these or any other rules on the Internet. As a consequence, it is not rare for one to witness the dark side of social media, presenting as biased, untrue, unfair, and/or unvetted diatribes substituting as facts, making the platform substance propaganda, rather than news.

My Suggested Rules and Best Practices for Social Media

  1. Do not violate HIPAA or the General Data Protection rules of the European Union.
  2. Use common sense and avoid being rude. Remember your tweet is a permanent record of your thought and will stay with you wherever you go.
  3. Comment when you think it adds to conversation or to support a position, but keep it professional. Don’t say something you wouldn’t want to see printed on the front page of The New York Times.
  4. Don’t spend too much time when you have real things to do.

What Are # and @ Used For?

For those new users, it is confusing to be in the dark about the symbology of the social media world.  For a bit of clarity, here are what the # and the @ mean if you don’t already know. A hashtag (#) is a word or phrase preceded by a hash sign (#), used on social media websites and applications, especially Twitter, to identify messages on a specific topic that can then be searched. Whenever a user adds a hashtag to their posting, that word and the post are able to be indexed by the social network and become searchable/discoverable by other users. A hashtag archive is consequently collected into a single stream under the same hashtag. For example, adding or searching for the hashtag #RadialFirst allows users to find all the posts that have been tagged using that hashtag and people (@drmortkern) who are interested in or who have participated in this topic. The @ sign is used to call out usernames in tweets. People will use your @username to mention you in tweets, send you a message, or link to your profile. A username is how you are identified on Twitter, and is always preceded immediately by the @ symbol (Figure 5).

The Bottom Line

Twitter, Facebook, and other social media platforms have changed the way we see our world. Social media will be the way we communicate, educate, notify, and share our views across wide groups of users, particularly in the cardiovascular space. Corporate, university, business, and personal branding provides the ability to display your profile, contact information, and likes/dislikes, as well as promote your research, clinical expertise, practice and institutional clinical programs of special note.

I hope this short review on social media is helpful. I thank Dr. Alraies and Dr. Sahni for sharing their CRT presentation with me. Finally, be safe and have some fun out there in the Twittersphere. 

Disclosures: Dr. Morton Kern reports he is a consultant for Abiomed, Abbott Vascular, Philips Volcano, ACIST Medical, Opsens Inc., and Heartflow Inc.

  1. Parwani P, Choi AD, Lopez-Mattei J, Raza S, Chen T, Narang A, Michos ED, Erwin JP 3rd, Mamas MA, Gulati M. Understanding social Media – opportunities for cardiovascular medicine. J Am Coll Cardiol. 2019 Mar 12; 73(9): 1089-1093. doi: 10.1016/j.jacc.2018.12.044.
  2. Alraies MC, Sahni S. Why cardiologists should be on social media - the value of online engagement. Expert Rev Cardiovasc Ther. 2017 Dec;15(12):889-890. doi: 10.1080/14779072.2017.1408408.