An easy introduction to Twitter

“It’s like being delivered a newspaper whose headlines you’ll always find interesting.” ~ Twitter

Yesterday I was at a conference in Brisbane, organised by the Australasian Medical Writers Association. I met some interesting people and learned a lot about writing from speakers like Dr Justin Coleman and Ben Harris-Roxas.

Interestingly, many speakers mentioned Twitter. Social media are essential if you want to bring a health message across. Twitter is also a great tool to connect and collaborate with others and learn new things. It’s my favourite social media platform.

Twitter seems a bit daunting in the beginning, but it’s really easy to use. After reading this post, which should take you no more than five minutes, you will be ready to take the plunge.

Getting started

Because of the limited character count of 140, Twitter is called a microblogging platform. The social media giant describes itself as an information network made up of 140-character messages called tweets. A tweet is the expression of a thought or idea. It can contain text, links, photos and videos. Millions of tweets are shared in real-time, every day, all over the world.

Twitter egg head
Make sure you upload a profile picture, or Twitter will give you the default egg-head. You will get more followers if you use a good picture of yourself (and preferably not the dog or the cat).

You can read the tweets of people or organisations you follow in your timeline, and your followers can read your tweets, click on any links or hashtags you have included in your messages, or they can retweet your tweets, which means that they share your messages with their followers. I’ll explain it in more detail below.

You can use twitter from your phone, computer or tablet.

To get started, first sign up at twitter.com or directly from the app on your phone or tablet, and choose a public Twitter username (also called a Twitter ‘handle’). The user name is always preceded by the @ symbol. I recommend to use your own name or business/practice name, but any available name is fine.

I picked @EdwinKruys, and Twitter has assigned this Twitter URL (or web address) to me: https://twitter.com/EdwinKruys. Twitter users will see your preferred name next to your Twitter username. This is how my names appear: ‘Dr Edwin Kruys (@EdwinKruys)’. It doesn’t matter if you use capitals or not.

You may want to register a few variants of your name or business name. I have also registered @DrKruys and @DrEdwinKruys.

Here are a few examples of Twitter user names:

Next, you will have to set up your profile. Make sure you add a profile photo or Twitter will give you an egg-head. For professional accounts I recommend a 400×400 pixels close-up photo of your face – not the dog, cat, flowers or a stethoscope. Fill out a short description of yourself and a link to your website or blog.

If you like you can add a background header photo (recommended dimensions are 1500×500 pixels). Once you’ve done all this, start following people. See who others follow and follow the interesting people, organisations and businesses.

Click here for my list of Australian GPs on Twitter.

Twitter lingo

There is a bit of Twitter lingo you need to learn, but it’s easy. Let’s start with hashtags. A hashtag is any word or phrase preceded by the # symbol. Conferences and television shows often use a hashtag, e.g. #GP15Melb. Hashtags are also used for advocacy campaigns, like #AHPRAaction, #ScrapTheCap and #CopayNoWay.

A hashtag is like a label added to your tweets to better file and retrieve messages with a certain topic or theme. It doesn’t matter where you place it. And you can add a few hashtags if you like, although two is probably ideal. When you click on a hashtag in someone’s tweet, you will see all other tweets containing the same word or topic.

Here are some other Twitter buzzwords:

  • Tweet: A Twitter message
  • Tweeting: the act of sending tweets
  • Tweeps: Twitter users
  • Favouriting a tweet: this indicates that you liked a specific tweet
  • A follow: someone following your Twitter account. You can see how many follows (or followers) you have from your Twitter profile
  • Home: your real-time stream of tweets from those you follow, also called a timeline.
Social meidia in general practice
Tip: Have a look at the new Social Media Guidelines from the RACGP. It’s a good summary of the pros and cons of social media, including the AHPRA advertising and social media policies.

Your first tweet

When you compose your first tweet, you could write something like:

“Hi there, I’m new on Twitter. Still figuring out how this works.”

But if you haven’t got many followers, few people will read it. So you could tell someone that you have joined Twitter by adding their username to your tweet. I’ll use my username as an example, but of course anyone’s username can be inserted instead:

“Hi there, I’m new on Twitter. Still figuring out how this works. @edwinkruys

Now I will receive a notification that you have mentioned me, and I may respond, retweet your message or suggest a few people to follow.

If you would put my username at the beginning of your tweet, your message is still public but only those who follow you and me will see the message:

@edwinkruys. Hi there, I’m new on Twitter. Still figuring out how this works.”

If you put something in front of my name, all your followers will see your message (instead of only those who follow you and me):

“Hi @edwinkruys, I’m new on Twitter. Still figuring out how this works.”

Try adding a hashtag and a link:

“Hi @edwinkruys, I’m new on Twitter. Still figuring out how this works. #newontwitter. Read my profile here http://www.mywebsite.com”

You can link to websites, pdf-files, videos etc. The hashtag increases the chance that others with similar interests will read your tweet.

Retweets and replies

A great way to get started is to retweet someone’s message. Ask questions or make some friendly comments to get a conversation going.

A tweet from someone else, forwarded by you to your followers, is known as a retweet or RT. Often used to pass along interesting messages on Twitter, retweets always retain original attribution. Respect the original message and make sure you don’t change the original tweet when you retweet. If you do change it, for example when you delete a few words to save characters, it will become a modified tweet or MT instead of a retweet.

Here is one example of a retweet. Imagine I have just tweeted this message:

“Have a look at this great resource to get started on #Twitter: http://www.linktoresource.com”

You could retweet this – assuming you wanted to share it with your followers:

“RT: @edwinkruys: Have a look at this great resource to get started on #Twitter: http://www.linktoresource.com”

You could also add a brief comment to tell your followers what you think of it or to start a conversation:

“Excellent resource, thanks for sharing! RT: @edwinkruys: Have a look at this great resource to get started on #Twitter: http://www.linktoresource.com”

There are other ways to retweet, for example by retweeting the complete original message without adding your own text, or by retweeting the original message in a box and adding your own 140 character message. Press the retweet button under a message (the two arrows going up and down) to discover the various options.

You can send the same message by replying. Note that, by putting my username at the beginning of your tweet, your message is still public but only those who follow you and me will see the message:

@edwinkruys Excellent resource, thanks for sharing!”

Again, if you want others to see your reply so they can follow our conversation, you need to add something in front of my name, even a full stop will do:

“.@edwinkruys Excellent resource, thanks for sharing!”

Or:

“Excellent resource @edwinkruys, thanks for sharing!”

When you share a resource you have found via someone else, it’s always nice to mention that person:

“Here’s and excellent resource to get started on Twitter: http://www.linktoresource.com – via @edwinkruys

Direct messages, lists and login verification

Use Twitter direct messages to start a private or group conversation with your followers. It is possible to enable a setting to receive direct messages from anyone, not just followers, which may be useful for businesses. Direct messages have no character-limit so you can type as much as you want.

You can add images to your Tweets and even a link plus an image. Although you’re limited to 140 characters, it is easy to get around this by taking a screenshot from a large amount of text and attaching it as an image to your tweet.

Twitter lists are often used to create a group of other Twitter users by topic or interest. Lists contain a timeline of tweets from the users that were added, offering a way to follow individual accounts as a group on Twitter.

There are many third-party apps available to manage your Twitter account(s). I often use buffer to schedule tweets. To avoid getting hacked I recommend using two-step login verification. Have fun!

The no. 1 blogging tip you should always keep in mind

My first blog was a travel blog. Nancy and I were working and travelling around Australia and New Zealand and, like so many others, we blogged about our down-under experience. The audience: Family and friends. Number of daily visitors: 3-5.

In 2004 there was no Twitter, and LinkedIn and Facebook were the new kids on the block. Still, it was good fun. We were passionate about our travel adventures and we enjoyed uploading the pictures we took with our 4 megapixel Sony Cybershot.

Professional blogging

Four years later we settled down in Western Australia and started a business. A blog became part of the new practice website.

In the early days the blog attracted 20-30 visitors per day, but after a while the number grew to 40-60. Connecting the blog to the practice social media accounts made a big difference. I learned a lot about content – what works and what doesn’t.

In 2013 we decided to move back to Queensland and I left the practice. I began to focus more on my Doctor’s bag blog (it’s good to see the Panaceum blog is still very much alive).

Keeping a blog going is hard work. There is no ‘easy way’ to do it. The competition is fierce and as there are many great bloggers out there, it’s not that simple to get noticed.

I really enjoy blogging – which helps of course. I am fortunate to work in an industry that’s a constant source of inspiration.

Slowly the visitors number started to climb to 80-100 per day.

The struggle

But just as I thought my blog was taking off, writer’s block hit me hard. My creativity was gone. I didn’t blog for a while. The longer I didn’t post anything, the more attractive the thought of deleting my WordPress account.

English is not my first language and I often struggle to find the correct words. So, I argued, why not save myself the trouble and stop blogging altogether?

One evening I was reading an article about writer’s block. It was the break-through I needed. The author, Jeff Goins, simply said: “You overcome writer’s block by writing.” His message was short & sweet: It doesn’t matter what you write, as long as you get going.

That’s what I did and somehow it worked. Before I knew it, the inspiration was back and the blog ideas started flowing again.

The first time my daily visitors number reached 1K, I couldn’t believe it. I thought it was a one-off, just luck, but last month over 15,000 people visited Doctor’s bag.

Although I want people to read my posts, it has never been my goal to get more visitors – nor do I think the hit counter is a measure of success. I enjoy producing content that makes others think. If it leads to change – even in the smallest way – I’ve reached my goal.

There will always be people with more writing talent, better posts and more followers, so I try to keep Bill Gates’ words in mind:

“Don’t compare yourself with anyone in this world… if you do so, you are insulting yourself

But there is one thing that is more important than anything else…

The best tip

The one thing that determines success in blogging, and in many other ventures in life, is perseverance. It is important to follow your passion. If you enjoy writing, the best tip I can give you is: Don’t give up.

Everybody has a story to tell, so keep writing. You will get better at it and people will find your blog.

Picture from my first travel blog in 2004, dropped off at Lizard Island, North Queensland, with food, water, tent & map.

How social media is changing the healthcare landscape

How social media is changing the healthcare landscape
Image: Pixabay.com

There seems to be a significant growth of social media usage in the Australian healthcare industry.

In the past years we have seen surprisingly influential social media campaigns, like AHPRAaction, ScrapTheCap, InternCrisis, and very recently NoAdsPlease. These campaigns not only rally for better health care policies; they also signal a shift towards more transparency and accountability.

Characteristics of the social media campaigns are:

  • They spread quickly and generate a lot of media attention
  • The participants are very passionate about their cause
  • They are often supported by different groups including consumers
  • They may or may not be supported by professional organisations
  • They are very effective.

At the same time other social media movements, like FOAM (free open access medical education) are gaining momentum. Again, these grassroots initiatives are driven by passion – a powerful force. It won’t take long before health care professionals can do their continuing professional education via free social media sources.

I don’t think many professional and health care organisations are ready for these changes – yet they are coming whether we like it or not.

Psychiatrist and blogger Dr Helen Schultz is a social media enthusiast. Helen was involved in the successful AHPRAaction campaign. She believes social media skills are important for doctors: “I feel in the next 6-12 months there will be even more awareness of the need for doctors to know how to use social media professionally, but also how to use it to your advantage, building your brand, your platform and your voice.”

“The time has passed where we can be complacent and think patients will listen to us just because we are doctors,” she says. “We are largely absent from health debates currently, and others educate about health which may not always be necessarily evidenced based. In addition, we must claim our social media real estate, ie own our domain names and twitter handles to prevent others pretending to be us.”

Helen has taken it upon herself to organise a social media workshop for doctors and managers, and she has invited me to speak about blogging. Helen: “On the back of the success of the AHPRAaction campaign – and because I was so inspired by my colleagues around Australia, I thought we had to meet and put our heads together about how doctors can use social media in Australia to join health debates and run really successful campaigns.”

Some excellent speakers presenting at the workshop: Ms Dionne Kasian-Lew, Dr Brad McKay, Ms Jen Morris, Dr Jill Tomlinson, Dr Amit Vohra, Ms Mary Freer, and Dr Marie Bismark. Dr Mukesh Haikerwal is guest of honour.

Social Media by the Sea is a full day interactive workshop with practical tips and insights from the experts about their successful use of social media, whether it be as a blogger, advocate or part of campaign building. Time: Saturday, 15 November 2014. Place: Peppers “The Sands Resort”, Torquay, Victoria. Send email.

Blocking social media at work is not the answer

Restricting social media usage at work is sometimes done out of fear. “We don’t want our staff to be distracted.” And: “They shouldn’t waste their time on social media.” Other understandable reasons may include perceived cyber risks or the cost of excess data usage.

An organisation that blocks social media sites may send out one or more of the following messages:

  1. We don’t trust our staff
  2. We don’t really understand what social media is all about
  3. Even though consumers are using social media for health purposes, we’re not really interested

In most cases decision makers are probably unfamiliar with social media and may see it as a threat.

Why staff should have access

Here are five reasons why health care staff should have access to sites like LinkedIn, Twitter, YouTube, Blogs etc:

  1. Social networks are powerful learning tools for staff
  2. Social media are increasingly used as health promotion tools (such as embedded YouTube videos)
  3. Shared knowledge accessible via social media will assist staff in finding answers and making decisions
  4. Interactions with peers and thought leaders can increase work satisfaction (and will contribute to staff retention)
  5. Participating in social media and other new technologies will raise the (inter)national profile of an organisation

When it comes to cyber security, I believe there are alternatives that are more effective than blocking social media access including upgrading and updating operating systems, updating antivirus software, improving backup procedures, clever password management and online safety training for staff.

A simple social media staff policy also goes a long way.

AHPRA’s guidelines: Can someone tell me what just happened?

The Australian Health Practitioner Regulation Agency now says in its new guidelines that practitioners can be fined if patients post online testimonials praising the clinical care they received.

Last Friday, it seemed as if AHPRA had backed down on the harsh regulation. But is this really the case?

What does AHPRA say?

First of all, here’s a quote from the current guidelines:

a review (…) that states ‘Practitioner was quick to diagnose my illness and gave excellent treatment’, is a testimonial which references clinical care and is considered in breach of the National Law.

The guidelines also state that health practitioners must take steps to remove unsolicited testimonials appearing on any (social media) website not under their control. However, last Friday the medical board put out a media statement on the AHPRA website saying this:

The advertising guidelines apply to testimonials in the context of advertising (…) there is a clear difference between advertising – which requires an intent to promote the health services – and unsolicited online comment over which practitioners do not usually have control (…). The Board recognises that practitioners are unable to control what is written about them in a public forum.

The full statement can be found here.

3 unanswered questions

Indeed, this sounds a lot better than the official advertising guidelines – the medical press have used the words ‘backflip‘ and ‘backdown‘. However, the guidelines have not been updated, which leaves the following three questions unanswered:

1. If a patient posts a comment on my Facebook page stating that I gave excellent treatment, this is still considered in breach of the National Law according to AHPRA’s guidelines and I may be up for a fine if I don’t delete this friendly post. Will I be able to defend myself by referring to the media statement posted on the AHPRA website on 7 March 2014? If AHPRA is serious, the guidelines should be changed in accordance to their statement.

2. Health professionals need to know why our feedback about exactly this issue has not been taken on board in an earlier stage. The first draft guidelines appeared in 2012 and health practitioners were not impressed. The rules were already clear: we knew that testimonials in advertising are a no-go (and I don’t mean unsolicited Facebook comments from patients) – and of course this applies to websites, social media, the classroom, the elevator and anywhere else.

In AHPRA’s udated draft guidelines (2013) the issue of patient feedback vs testimonials had not been addressed, which again led to a storm of online comments as well as another lot of official submissions. See also this post (April 2013). As we know, the final version was published last month and positive patient feedback is not allowed, but then again on Friday the board seemed to think that patient comments are not advertising.

3. As the advertising guidelines are common to all national boards (e.g. dental, nursing & midwifery, psychology etc) we need to know if and how the statement by the medical board will be applied to the other 13 disciplines.

I’m happy with the clarification by medical board chair, Dr Joanna Flynn, and I agree it is a step in the right direction. But it still seems unnecessary government interference, and, after three revisions, the guidelines leave important questions unanswered.

7 online eSafety tips for doctors

It is good to see that social media and eHealth are becoming mainstream topics at national health conferences. At the recent GP Education & Training Conference in Perth (GPET13) I attended two workshops about our professional online presence.

The first one was about the benefits of social media and was attended by GP supervisors, registrars and students. The second one, sponsored by a medical defence organisation, warned about the dangers of the online world, and interestingly there were mainly GP supervisors in the room.

Before I continue I must declare that I was one of the presenters at the first workshop. But it was good to be reminded by professor Stephen Trumble about what can go wrong. His excellent presentation created a lively discussion. Here are seven random points I took home from the workshop:

Tip #1

Doctors should be careful when looking up patients online, eg via Google. In general this is only acceptable if doctors are acting in the interest of patients, for example when trying to find contact information in an emergency.

Tip #2

Privacy settings of Facebook and other social media tools may change or fail, therefore: do not trust these settings. Assume that everything posted online, even in private networks and groups, is public. I have blogged about the elevator test, which is one way to check if something is suitable before posting.

Tip #3

Taking pictures of patients or their body parts is fine as long as the patient has been made aware of the purpose and who will see the picture, has given consent prior to taking the picture and has been de-identified. When doctors publish the picture online, consent must be noted within the publication. If the picture is later used for other purposes, the patient must again give consent.

Tip #4

When doctors collect patient information on their mobile devices, eg when taking a picture with a smart phone or when using a transcription service, these devices must be protected from misuse, unauthorised access, alteration or disclosure. The simple passcode on iPhones is generally deemed insecure (but can be made more secure in the phone settings). If patient information is stored overseas on cloud systems, local security laws apply and they may not meet Australian standards.

Tip #5

Old smart phones, even if factory settings have been restored and the data erased, still contain information. This is of course also true for USB sticks, practice computers, photocopiers with a hard disc etc.

Tip #6

I have blogged about the issues with Skype in patient care. From the handout: “Skype is not recommended for telehealth consultations but has not been deemed ‘unsuitable’. There are privacy, confidentiality and quality issues and many doctors who start with Skype end up upgrading to commercial systems.”

Tip #7

Last but not least: email is not suitable to transfer patient information. Encrypted email is the preferred option.

It is sad that the eHealth practice incentive payments (PIP) by the government are only paid to practices taking part in the PCEHR. As a result costly software, system and security upgrades will not be a budget priority for many practices.

Sources:

  • Online communication for education: risks, responsibilities and rewards. Workshop by Prof Stephen Trumble, Ms Nicole Harvey. GPET 13 Conference, Perth
  • General professionalism online – handout by MDA National
  • Informed consent and Telehealth – handout by MDA National
  • Telehealth tips – handout by MDA National

Social media in healthcare: Do’s and don’ts

Facebook in health care
Image: pixabay.com

‘Reputation management’ was the topic of an article in the careers-section of this month’s Medical Journal of Australia. As I have blogged about reputation management before I was asked a few questions about the way my practice has used Facebook.

I think Facebook and other social media have the potential to improve communication with our patients and colleagues and make healthcare more transparent – if used wisely of course.

Unfortunately the Australian Health Practitioner Regulation Agency (AHPRA) has scared the healthcare community with their social media guidelines. Doctors are now being told by medical defence organisations to be even more careful with social media, but I’m not sure I agree with the advice given.

Do’s & don’ts

Here are the do’s and don’ts as mentioned in the MJA article:

  • “Do allow likes and direct messaging on the practice Facebook page, but don’t allow comments. This will avoid any dangers associated with comments classed as testimonials by AHPRA. It also avoids problems such as bullying that may occur when comments are made about other comments.”
  • “Don’t respond to negative remarks online, as it risks falling into the category of unprofessional conduct if brought before the medical board.”
  • “Don’t befriend patients on Facebook if you are a metropolitan practice, Avant’s Sophie Pennington advises, so as to keep some professional distance. She says that in regional and rural areas it can be unrealistic to have this separation.”
  • “Do link your Facebook page to your website, LinkedIn and any other profiles you have set up online. This will help to ensure that these options appear higher on the search-page listings when others look for your name.”
  • “Don’t google yourself!”

Negative vs positive feedback

I think negative comments online are a great opportunity to discuss hot topics (such as bulk billing and doctors shortages) and to engage with the community in a meaningful way. Positive feedback by patients is wonderful and should not be discouraged, as long as it’s not used as a way to advertise health services.

Health practitioners should be supported to communicate safely online. But not allowing Facebook comments is defeating the purpose of social media.

AHPRA’s draft social media policy

The 2012 draft social media policy by the Australian Health Practitioner Regulation Agency (AHPRA) caused a lot of upheaval. Health professionals expressed concerns it was too prescriptive. Now there’s a new version and the organisation is requesting feedback.

A 76-page consultation paper has been posted on the AHPRA website and it includes drafts of the social media policy, revised Code of conduct, revised Guidelines for advertising and revised Guidelines for mandatory notifications.

It looks like AHPRA has taken the feedback on the earlier version on board. The new draft Social media policy is less prescriptive. Health professionals have to follow strict professional values, no matter if they’re in the elevator at work, the pub, or on Twitter or Facebook.

What does it say?

Most of it is common sense, but I thought these two changes were worth mentioning:

  • Health practitioners are expected to behave professionally and courteously to colleagues and other practitioners, including when using social media (Code of conduct 4.2c).
  • Testimonials on Facebook and other social media networks have to be removed by health practitioners (Guidelines for advertising 7.2.3).

I’ve read all 76 pages but it’s not entirely clear to me what exactly a testimonial is and whether I’m now required to remove my LinkedIn testimonials and endorsements by colleagues from around the world.

Also, it will require some explaining when removing or refusing friendly, unintended testimonials from our patients on e.g. Facebook, and worse, it may even put health practitioners off social media. I won’t mention Google testimonials – they are impossible to remove. It would be great if AHPRA can provide some clarification and reassurance here.

Interestingly, an issue that causes heated debates has not been mentioned, namely anonymous posting on social media networks by health practitioners who are identifying themselves as such, but are using a pseudonym instead of their real name. Some say it’s important for e.g. whistleblowers to be anonymous, others say health professionals always have to be identifiable. But perhaps it’s a wise decision by AHPRA not to open this can of worms.

Good or bad?

The problem with regulations like this is that it increases liability for health professionals and practices already operating in a highly regulated industry – especially against a backdrop of the recent national eHealth developments and the legal issues that health providers are facing when signing up for the PCEHR. Some of the risks are: less innovation and progress, a defensive attitude by practitioners, higher legal and insurance costs, increased AHPRA fees and eventually more costs for patients.

That brings me to the risk management paragraph in AHPRA’s draft Code of conduct, which states that it’s good practice “to be aware of the principles of open disclosure and a non-punitive approach to incident management”. I wonder if AHPRA is going to follow this advice when a practitioner breaches a social media clause. Something tells me that the regulator will follow a punitive approach if we forget to delete Mrs Jones’ friendly Facebook recommendation.