The surgeon and social media: Twitter as a tool for practicing surgeons

Social media is user-generated content in the form of written stories, infographics, pictures, or videos that are shared via the Internet and that promote engagement, sharing, and collaboration. These tools use mobile and Web-based technology that create highly interactive platforms where individuals and communities may participate in an exchange of information. Many people find Facebook, a popular form of social media, to be a good way to keep in touch with family, friends, and colleagues; others watch videos on YouTube; and, perhaps most prevalently, people use Twitter to get bites of information about people and topics of interest to them. Nonetheless, some surgeons have yet to actively use social media and integrate it into their practices. This article offers the uninitiated some insights into how social media works, specifically Twitter, and how it can work for them.

Twitter basics

Twitter is a specific social media service that allows you to share information in the form of a tweet, which may contain a maximum of 140 characters. At press time, Twitter announced it was considering a move to stop counting photos and links in its character limit, which would give users the opportunity to compose longer messages. Twitter can be accessed via a user’s computer, tablet, or smartphone.

New users can register via the Twitter website and by clicking on “sign up” or by using one of the many Twitter applications (apps) that are available for download via iTunes or Google Play. The following are examples of popular third-party Twitter apps:

• Twitterrific 5, Tweetbot 3 (iPhone only), Echofon Pro, and Osfoora 2 are examples of apps that are popular for Apple products.
• Carbon for Twitter, Fenix for Twitter, HootSuite, plume, Talon for Twitter, and Tinfoil for Twitter are some of the most popular apps for Android devices.

When signing up, you are prompted to choose a username. The only requirements for usernames are that they be unique, limited to 15 characters or less, and not contain the words “Twitter” or “admin.”

Once registered, give careful consideration to the image you want to present to the Twitterverse. As a health care professional, the content of a Twitter profile can be extremely important because it is indexed by major search engines and easily discovered by coworkers, family, friends, and patients.

Your profile picture can speak volumes about you. When a user first joins Twitter, the default profile picture is an egg. “Hatching” the egg by uploading a picture is important, as it adds to your profile’s credibility and personality. In other words, if you’re going to take the time to set up a Twitter account, take the time to include a photo. Your profile picture can be modified to reflect the image you want to project. Having trouble getting started with Twitter? Check out the Twitter Help Center.

Twitter—a news and networking tool

In the fast-paced world of surgical practice and training, it can be hard to keep up with current events and information. Twitter is a valuable resource for news, often providing real-time updates on what is happening around the globe. Not only can you, a physician, share perspectives and ideas, but you can also obtain information on new literature, conferences, and best practices related to a variety of specialty topics.

Twitter also is an effective means of networking with other users who share your interests. Once an account is established, you may search for institutions, organizations, and individuals with which you want to connect. Whenever you decide to “follow” individuals, agencies, institutions, media outlets, and so on, the content they post will appear on your Twitter feed. To start following another user, click the “Follow” button next to the user name or on the person’s or institution’s profile.

Once you start following others, take the opportunity to scroll through your Twitter feed before you start tweeting to observe how others in your area of expertise use the social media tool. It is not uncommon for an individual to follow multiple users without posting any original content.

As you become more proficient in using Twitter, you will likely find that following journals that appeal to your interests can be a good way to keep up with recent research, as virtually all of these publications post tweets highlighting upcoming abstracts and articles. These journals, or any collection of Twitter handles, can be grouped into a Twitter list, allowing a user to quickly browse the latest research or related posts/content.

As a new user, it is easy to start building connections by retweeting (RT, done by clicking the Retweet icon) or replying (clicking the Reply icon) to other tweets. Once the Retweet function is selected, you will have the option of retweeting or quoting the tweet. An RT simply reposts the tweet from your username, also known informally as a user’s Twitter handle. Quoting a tweet posts the same tweet as a slightly smaller version of the original with any additional comments you choose to include. Once you RT the square arrow changes from gray to green. Choosing to RT or quoting a tweet enhances your visibility in the Twitterverse. (In terms of Twitter etiquette, it is generally considered poor form to copy someone’s tweet and simply put RT @username in front of it.) (See Figure 1, below, for an annotated tweet.)

Another way of fostering communication with others on Twitter is to include people in your tweets using their Twitter handle, @username. By including other people in a tweet, your message will show up in their notifications feed. You can also show your support for a tweet by clicking the small heart icon. Once you like a tweet, the heart will change color from gray to red. This is equivalent to “liking” a post on Facebook or giving someone a virtual thumbs-up or high-five.

To get the most out of your Twitter experience, avoid setting your account to private. Private accounts cannot be quoted, retweeted, or tagged, severely limiting the benefits of participation in the platform.

Twitter journal clubs

As previously noted, one way to stay current with newly published content is to participate in Twitter journal clubs. Users can also have access to journal clubs by simply “lurking,” which in this context means the user follows the clubs without tweeting or participating. One example of a Twitter journal club is the International General Surgery Journal Club, @IGSJC, which a group of academic surgeons started in 2014. The group hosts monthly Twitter journal clubs to discuss recently published articles with a guest author who also is on Twitter. Each journal club lasts for two days to allow asynchronous conversations about a selected article. The journal club activity is tracked by including #IGSJC in all tweets.

Figure 1. An annotated tweet

The criterion for articles selected includes work that is recently published, peer reviewed, and relevant to the field of surgery. Journal club articles are offered through open access (available to download for free) by publishers for the month of the journal club. In August and December 2015, two articles published in the Journal of the American College of Surgeons were included in the International General Surgery Journal Club and were available for discussion in the Twitter-based forum. And, for the first time in Twitter history, the International General Surgery Journal Club partnered with JAMA Surgery to offer continuing medical education credit for participants.

Glossary of useful terms

The Twitterverse has its own language, as illustrated by a few terms defined earlier in this article. The following is a brief list of terms with which new Twitter initiates should be familiar:

• The @ sign: The @ is used to call attention to a topic or individual. It is also a way to “mention” other users or attribute content to a particular user or users. For example, “hello @pferrada1” is a greeting to a particular user that will show up in the person’s Twitter notification feed.
• Block: If you block a Twitter user, that account will be unable to follow you or add you to their Twitter lists, and you will not receive a notification if they mention you in a tweet.
• Direct messaging: You can send and receive private messages, but only among people whom you follow and who follow you back.
• Hashtag: People use the hashtag or pound symbol # before a keyword or phrase (no spaces) within a tweet to categorize those messages and to help them become more searchable to other users. For example, #IGSJC is used for all tweets made during the monthly Twitter journal club.
  A hashtag can be used to live tweet conferences. An example of this is #ACSCC15, which was the hashtag used for the American College of Surgeons (ACS) Clinical Congress 2015. When you click on a hashtag, you can see all other tweets containing the same keyword or topic.
• Like: Show your love for tweets by clicking the small heart at the bottom right corner of the tweet. Likes are saved to your profile and can be looked at from your profile page. This function also allows users to see what other people are liking.
• Lurk: To follow a thread of tweets without tweeting.
• Modify tweet: This function is somewhat outdated and involves quoting a tweet, but slightly changing the content. You would use this function to announce you have corrected a typo, added or removed information, or clarified information from a previous tweet.
• Reply: This function is found at the bottom left of all tweets. By clicking reply, a new tweet is generated with the person who authored the original tweet. Note that this tweet will show up only on the Twitter feed of the individual to whom you are replying, as well as anyone who follows both you and the original author. For example, the reply, “@RASACS great link, thanks for sharing!” will be sent to the Twitter feed of the @RASACS account and anybody who follows you and the Resident and Associate Society (RAS-ACS). If instead you include a period or space before the reply, such as, “. @RASACS great link, thanks for sharing!” then all of your followers will see the tweet regardless of whether they also follow the @RASACS account.
• Retweet: You can use this feature to share a tweet posted by another user with all of your followers. Some users will copy the tweet and insert RT @username to the beginning of the tweet instead of hitting the RT button, but this has become a less acceptable way to share someone else’s tweet.
• Tagging: On Twitter, you have the ability to tag people in pictures. Since tweets allow only 140 characters, the number of people whom you can mention is limited. One way to include more individuals in a tweet is to tag them in a picture. Pictures generally get more visibility than text-only tweets. The number of people who can be tagged in a tweet is limited to 10.
• Thread: A series of tweets by multiple users connected to a general topic, usually by a hashtag.
• Tweetation: A citation or link to a journal article found within a tweet.
• Username or Twitter handle: The login name users select for Twitter.

Real-time collaboration

Although primarily an online social networking tool, Twitter is increasingly used to disseminate scientific information. For example, attendees at scientific meetings often use Twitter as a means of stimulating and engaging in further dialogue about presentations and papers. Not everyone has the interest or opportunity to pose questions at meetings, but it is possible to foster a virtual discussion on Twitter. While the speaker presents data at a panel session or meeting, a full discussion can occur on Twitter related to the information being relayed by the presenter, which allows for additional questions to be raised and discussed. These conversations can lead to an expansion of the research, future collaboration, and improved dissemination of the work. In fact, live tweeting at conferences using the assigned conference hashtag could become a powerful recruitment tool to bolster an organization’s membership as well as future meeting attendance.

Professionalism and Twitter

Users, particularly physicians, should remember that all tweets are public. Anyone with Internet access can find your tweets. Once you start tweeting or posting on Facebook, expressing views or content in an unedited manner can become almost second nature. Keep in mind, however, that once your message is out there it is nearly impossible to completely erase it from the Web. It is important to set a professional example for both colleagues and junior physicians on social media, and that includes ensuring patient confidentiality at all times. A popular rule of thumb is a 12-word social media policy: “Don’t lie, don’t pry; don’t cheat, can’t delete; don’t steal, don’t reveal.”

Conclusion

Twitter is an influential tool because it offers opportunities to share ideas. This influence is especially apparent when ideas are shared by enough people to motivate others to action. Social media platforms like Twitter can generate increased interest in a topic and enhance the legitimacy of a wide range of ideas and perspectives. In other words, there is “power in numbers.” How many people can you reach in a classroom or in a meeting—20? 300? How about sharing your ideas with 30,000 people in an instant via a hashtag discussion on Twitter?

Consider that someone on the other side of the world might be experiencing the same issue that you have at your hospital, and they have found a solution. Twitter offers an endless supply of crowd-sourcing opportunities. Once you establish a network of academic surgeons, you have the ability to tweet a question and get instant answers. If you’ve found better ways to do things, whether solutions for increasing efficiency or improving outcomes, wouldn’t you want to share your experiences with your colleagues? You can. It is just a tweet away.

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