#Social Medicine – A review of social media and the CanMEDS roles

Dr. Anju Anand, Assistant Professor of Medicine, University of Toronto

January 20, 2017

Posted by Nadine Abdullah, MD, MEd, FRCPC

(Photo credit wordpress.com)

Ready, set, tweet!

What a tweet it was!

Ok, enough bad puns. It speaks to my initial discomfort with the world of social media. If anyone could draw me out of my fear and into a new realm of embracing social media in medical education and patient care, it was Dr. Anju Anand (@thelungdr). We were thrilled to have Dr. Anand speak about social media in the context of the CanMEDS roles. From Medical Expert, to the intrinsic roles of Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional, it touches on every aspect. The take home messages? Social media use in medical education is essential, we must use it professionally, and Twitter is our greatest forum. Here's how (in more than 140 characters):

1) Promote patient care: With the wealth of un-vetted misinformation on the internet, we must engage to make accurate information available. We can communicate directly with individuals or patient groups about a medical topics and provide opportunities to share online resources with them in the office, and at home. Dr. Anand's personal success in the Cystic Fibrosis community is a website which provides accessible, accurate and timely information, educational tools, the latest research, and inspirational stories to the patient community.

2) Promote greater public health: The most industrious use in  I have seen is the dissemination of patient education materials in the form of whiteboard talks. Toronto's own family doctor Dr. Mike Evans is well-known for his YouTube whiteboard talks on behavioural modification for smoking cessation, primary prevention, cancer care, and many more. He calls this "Medical school for the public". He takes stories and engages patients with an active whiteboard illustrating the talk in a multimedia fashion, reinforcing the learning points. Another similar example is University of Toronto's "Healthy Debate" website, which brings easy-to-understand information about the health care system to the public, helping people make informed decisions about their own health. Lastly, behind the scenes, but easy to access, infectious diseases like Influenza and Zika are tracked globally in real time, helping to catch patterns that foresee epidemics, and allowing dissemination of information to local authorities.

3) Promote learning: Faculty and trainees are accessing different tools for reviewing the latest literature and debating evidence. Online journal clubs, like the University of Toronto Respirology and Sleep accredited journal club live tweets their meetings, involving authors who can provide background details to allow critical appraisal of their studies. Blogs like this one disseminate talks to the broader community who share common interests. My favourite - listening to The Rounds Table podcasts hosted by UofT's Healthy Debate, where recent research papers are presented with a critical appraisal and provided a context.

4) Create a global community: Through networking, Dr. Anand shared examples of connections she has made through Twitter with other Cystic Fibrosis physicians and researchers who otherwise would not have met. Barrier-free, open access, instant connection to anyone sharing your clinical, education, or research interest. There is a whole community committed to free and open access medical education on Twitter (#FAOMed). The opportunities are boundless, and imagine the perspectives you have to gain. You can start the connection at a conference. Most now have live tweeting of sessions allowing people to connect.

As the audience engaged in a debate about the potential drawbacks of widespread social media use by trainees, Dr. Anand reminded us of the core principles of responsible use:

1) Maintain professionalism: The rules of engagement are "Don't lie, don't pry, don't cheat, can't delete, don't steal, don't reveal." And avoid all patient-identifying data. Be aware of your regulatory body policies at the local, provincial/state, national level. They share common principles, but some will have unique rules.

2) Own your "digital shadow": Given it's ubiquity, you are bound to find your name somewhere on the internet if you search, and it may not be as you intended. Don't let others speak for you. Set your own stage and be clear in how you want yourself represented to protect your professional identity.

My colleagues took to Twitter to continue a thought-provoking dialogue over the weekend after this talk. While Twitter can be used to disseminate and translate knowledge among health care professionals and patients, how do we ensure the integrity of information, how does this affect research Impact Factors, and what does this mean for print medical journals? One thing is for sure, sharp critical appraisal skills are needed now more than ever.

I admit, I had begun my conversion before this talk, but Dr. Anand solidified my commitment to using social media in medical education. You can follow us on twitter @CEEPAoM. But I remain weary of the potential for addiction and it's effect on mental health. First, if you love information, social media is never-ending. Set your limits. There is an app for purchase that will allow you to access your account for limited hours, similar in concept to parental controls (remember that bag of Doritos - impossible to have just one). Second, there are malicious trolls out there. If you engage in controversial topics, for example tobacco control, be prepared for nasty followers. Block and report them for your own mental health.

Resources:

DocMikeEvans Whiteboard talks @docmikeevans

Healthy Debate hosted by The Rounds Table @roundstable

Evidence-based medicine in the era of social media: Scholarly engagement through participation and online interaction

Twitter's Role in Scientific Publication and Communication INFOGRAPHIC

Melvin, L and Chan, T. Using Twitter in clinical Education and Practice

Ontario Medical Association Social Media Primer

College of Physicians and Surgeons of Ontario Position on Social Media - Appropriate Use By Physicians

Budd L, Fiddler L, Anand, A. Gaining Competence Through Social Media. CMAJ. 2016;DOI:10.1503/cmaj.160255

Bio – Anju Anand, MD

 Dr. Anju Anand is a Staff Respirologist and Sleep Medicine specialist at St. Michaels Hospital in Toronto and Assistant Professor at the University of Toronto. She is also the Education Site Director for Respirology at St. Michaels Hospital. She completed her medical and Respirology training at the University of Toronto and two subsequent fellowships in cystic fibrosis and sleep medicine. Her academic interests revolve around using technology to enhance education and she has been involved in moderating and creating numerous websites for patient education (eg torontoadultcf.com), blogs, e-modules for trainees and for the inception of @respandsleepjc (#rsjc)- an online Royal College Accredited Twitter-based journal club. Her upcoming research involves using Twitter as a tool for educating patients with Cystic Fibrosis online. 

The Infectious Nature of Classical Music

Dr. Dan Petrescu, Division of General Internal Medicine, University Health Network

January 10, 2017

Posted by Nadine Abdullah, MD, MEd, FRCPC

The Scene of the Death of Mimi, from Puccini’s opera “La Bohème”
(Photo credit AllPosters.com)

This week, Dr. Dan Petrescu dimmed the stage lights to take us on a beautiful journey through opera and infectious diseases. Two seemingly divergent topics paired naturally as he expertly guided us through Four Acts – a metaphor for the theme. The beautiful aesthetic of watching and listening to operatic clips in a darkened hospital auditorium in the middle of our busy clinical work day and high-stakes meetings slowed us down, and allowed us pause to listen, breathe, alert our calming senses, and quiet our activating fight-or-flight reflexes. A stark departure from the typical noon medicine rounds on infectious diseases.

To begin, Dr. Petrescu introduced us to the influence of magical thinking in understanding illness. We saw how delirium and febrile hallucinations preceding the death of a child were believed, at the time, to be an assault afflicted by a supernatural being, depicted in Schubert's Opus 1, a musical rendition of Johann Wolfgang von Goethe's poem Erlkönig.

From delirium, we moved on to syphilis and tuberculosis. Mental illness has long been portrayed in music and art, but who would have thought to look for infectious diseases? Learning about the historical context of opera story-telling to understand the societal perceptions of illness in various eras gave us deeper understanding into how communities have stigmatized disease throughout history, such as TB and syphilis. Violetta in Verdi's La Traviata was portrayed glamorously as a thin, pale, diaphoretic, debutante consumed by tuberculosis and sensuous desire, at centre stage surrounded by admirers, on the verge of nuptials. In contrast, we felt the squalor and isolation of Mimi in Puccini’s La Bohème amidst the poverty of her bohemian, disenfranchised and forgotten artists, taking her last breath. The critical event that shaped the latter portrayal was the scientific influence of bacteriology, and the discovery of Mycobacterium tuberculosis as the infectious agent causing consumption, and the airborne means of transmission leading to a shift from admiration, toward isolation and stigma. On a simplistic level, we can use this to illustrate where infection control and isolation practices in public health were born. But on a deeper level, can we use this study in contrast to better understand our community of patients and see illness through their eyes, and see what it means to them? Where the stigma comes from and why they may not align with our proposed treatments?

Reminiscent of how close reading of literary passages is taught in narrative medicine to heighten the listening, observation, and critical thinking skills of healthcare professionals, the study of opera can be seen as another form of close reading. Ranging from discussing music and composer history, to uncovering illness perceptions and biases, to the concrete analysis of key transitions, instrumental voice and themes to indicate mood and meaning, the opportunities to make opera relevant to medicine are immense. And just as one need not be an English major to incorporate narrative medicine into practice, musical training is not a requirement for one's medical practice to benefit from the study of music and opera. It is so commonplace that many medical humanities courses and programmes have emerged throughout North America, combining the study of arts and humanities with medicine. Our very own Drs. Linda and Michael Hutcheon, from the University of Toronto Departments of English and Medicine were early leaders, lecturing internationally on opera and medicine.  It is no wonder that many of us in the audience were classically trained musicians, and why the majority of medical school applications that I read have Royal Conservatory of Music Certification alongside the competitive GPA and volunteer hours.

Infectious disease as portrayed in the arts may now be more obvious to me, but what about other illnesses, like cancer? Verdi's portrayal of tuberculosis resembles that of Susan Sontag's description in Illness as Metaphor, whereas in her historical review, cancer was abhorred, despised, and people were considered to be stricken by dread and shunned. Is this stigma what persists in some communities today, the ones from which emerge the protests: "Don't tell mom she has cancer?" As though receiving the diagnosis would lead to her death, independent from the disease process itself.

The audience was engaged again this week, stimulated, and the inevitable question was indeed answered in closing the talk: Why does paying attention to opera matter in medicine? Opera is a classic, overly indulgent and melodramatic characterization of all that is the best and the worst of human nature and relationships. It is a rich backdrop for delving deeply into people's motivations and choices, a study into human psychology. In health care, one of the professions most reliant on understanding human nature, this deeper understanding of opera can engender empathy, and strengthen our doctor-patient relationships. Dr. Petrescu left us with some of his wisdom. Humans have long sought to understand life and death, illness and misery, and have found meaning and expression through the arts and music. Opera is a rich genre that heightens our senses to the knowledge of the time. The doctor-patient human relationship suffers if we don't step back and listen.

Resources:

Sontag, S. Illness as Metaphor. Vintage Books, 1979

Hutcheon, L and Hutcheon, M. Opera: Desire, Disease, Death. U of Nebraska Press, 1996

A complete medical education includes the arts and humanities

Opera and Medicine Bodily Charm: Living Opera

Physicians in opera - reflection of medical history and public perception

Bio – Dan Petrescu, MD

Dan Petrescu is a graduate of the Internal Medicine and Infectious Diseases training programmes at the University of Toronto. He currently practices both Internal Medicine and Infectious Diseases at Markham Stouffville Hospital and is a Clinical Assistant in the Division of General Internal Medicine at Toronto Western Hospital, attending on the CTU. He takes a special interest in the interaction between the humanities and medicine and has given presentations across the GTA on topics ranging from interesting clinical cases, to classical music as it relates to Infectious Diseases, to the history of vaccines and anti-vaccination movements.