VTODs on Twitter

Replies to This Discussion

Permalink Reply by Dr. Dan L. Fortenbacher on June 7, 2009 at 1:42pm

Hey Nate,
Thanks for taking the lead on Twitter. I'm curious how to utilize the Twitter network too. So far it seems like a good resource for informing folks about events. Good example could be announcements about Childrens Vision and Learning Month in August. Possibly Twitter would be a good way to let folks know.

• ▶ Reply

Permalink Reply by Nathan Bonilla-Warford, OD on June 8, 2009 at 9:18pm

Well, as I see it Twitter is sort of the outpost network for the message. So the website/blog is the central focus and twitter makes connections with people with similar missions and aggregates all of it, thereby get the message out to more people.

I am still at the early stages with the ChildrensVision account. IF COVD wants to make an official one, they can work synergystically.

-Nate

• ▶ Reply

Permalink Reply by Roberto Kaplan O.D., M.Ed. FCOVD on June 11, 2009 at 5:23am

Thanks for the info. I am on Twitter too and it seems to be an invaluable resource for new information and networking. And, we are already connected I guess!

• ▶ Reply

Permalink Reply by Dr. Leonard J. Press on June 11, 2009 at 6:54pm

From Today's NY Times
June 11, 2009
Doctor and Patient
Medicine in the Age of Twitter
By PAULINE W. CHEN, M.D.

I blog, I tweet and I use Facebook. And as I recently told a medical colleague, social media has been an enormously useful tool in my work.

“I can barely keep up with e-mail,” he snorted back. “I’m not about to open up that black box.”

About 15 years ago, during my residency and just as the first blogs were starting up, I took care of a patient in his mid-40s whom I’ll call Eddie. In a waiting room filled with elderly patients crippled by vascular disease, Eddie looked out of place. Until you looked closer at his fingers and toes. Parts of them had been amputated.

Eddie suffered from Buerger’s disease, or thromboangiitis obliterans, an illness that causes clotting and inflammation of the blood vessels of the hands and feet. Considered an “orphan” disease because of its relative rarity, Buerger’s disease compromises the blood supply to a patient’s fingers and toes. Eventually these patients, who are usually men in their 20s to 40s who smoke, develop excruciating pain, severe ulcerations and gangrene. And more often than not, they must undergo progressively higher amputations.

There is no cure for Buerger’s disease; the only way to slow the process is to quit smoking. Therein lies the tragedy. For unknown reasons, patients who suffer from Buerger’s disease are profoundly addicted to tobacco, far more so than most smokers. It is nearly impossible for them to quit.

Eddie wanted desperately to quit. Over the two years that I cared for him, he tried at least a dozen times. But his already challenging task was made even more difficult by his isolation. Eddie lived alone, estranged from his family, with friends and co-workers who grew increasingly unsympathetic to his plight. “They don’t understand why I keep smoking if I keep losing fingers,” he said to me one afternoon. “They just don’t understand how hard it is for me.” Moreover, because his disease was so rare, he had no community of fellow patients to turn to in his town or at our hospital.

But his visits to the clinic always seemed to cheer him up. He responded, it seemed, to my encouragement, and each time he left, he renewed his vow to quit smoking. But weeks would pass and his enthusiasm would wane. If I contacted him by phone, his momentum might continue another few days, but finding a mutually convenient, quiet moment to talk on a regular basis was exceedingly difficult. I tried scheduling frequent follow-up appointments, but Eddie lived over an hour away from our hospital and could not afford to keep missing work.

Eventually, Eddie lost another two fingers, the front half of his left foot and his entire right foot. The youngest man in my waiting room soon became confined to a wheelchair. At the end of our last visit, I stood in the clinic hall watching him inch away from me in that chair, pushing off the ground with the remaining stump of his left foot and grasping at the wheels with hands that had become mitts.

I thought about Eddie and other patients I have cared for who might have benefited from more frequent contact when I spoke with my colleague about social media and the patient-doctor relationship. I wondered if Eddie would have felt a little less isolated and perhaps been able to quit smoking if I had, for example, texted a word of encouragement to him every few days, interacted through blog comments, or directed him to an online community of people who were dealing with the exact same disease.

A survey released today by the Pew Internet and American Life Project reports that 61 percent of Americans go online for health information, and the majority of them have turned to user-generated health information. But a quick scan through peer-reviewed journals reveals only a handful of articles, and no evidence-based guidelines, to guide doctors on the use of social media. It is unclear whether such engagement adds to or detracts from a therapeutic patient-doctor relationship, and clinicians are unsure about what constitutes good standards of care and professional responsibility on these platforms. For example, should doctors give out diagnoses or prescribe treatment on Facebook or a blog? If doctors and patients communicate on Twitter, is a doctor liable if she or he misses a patient’s tweets about the acute onset of shortness of breath?

Dr. Sean Khozin, who blogs and can be found on Twitter @SeanKhozin, is an internist and founding member of Hello Health, a paperless “concierge” practice based in Brooklyn that utilizes e-mail, instant messaging and video chat for coordinating care. “There are so many layers of bureaucracy between health care providers and patients,” Dr. Khozin said. “We can use social media to coordinate care with patients and with different specialists, all using the same platform. I can monitor my patients, and they can also use these tools to become empowered through a better understanding of their own disease state and active engagement.”

In Dr. Khozin’s practice, that engagement occurs on a secure site, as patient privacy remains a major concern with all forms of social media. But on platforms such as Twitter and Facebook, where privacy is more difficult to insure, those concerns also extend to physicians. “On the one hand it is really good to see the human side of your doctor on a site like Facebook,” observed Dr. Daniel Sands (@DrDannySands), a physician at Beth Israel Deaconess Medical Center in Boston, Mass., and a consultant with the Cisco Internet Business Solutions Group, as well as co-author of the first set of guidelines ever published on using e-mail in patient care. “On the other hand,” Dr. Sands continued, “maybe letting your patient get too close isn’t always good for the therapeutic relationship.”

Taking on the responsibilities of yet another form of communication can also be onerous for physicians, many of whom already feel overburdened by multiple demands on their time. “Physicians are really busy,” Dr. Sands said. “In our current health care environment, the only commodity they have is time. Doctors don’t want to introduce new technologies of unknown value, which is why many were hesitant about e-mail. Something like Twitter is going to take longer to accept because the value proposition is even hazier.”

Still, there continues to be anecdotal evidence regarding social media’s potential to strengthen the patient-doctor bond. “One way I see that power is through education,” said Dr. Christian Sinclair, a physician for Kansas City Hospice who has created a palliative care network through his blog and Twitter (@ctsinclair). “I can help to inform the public, I can put the knowledge I have out there. And if there are patients or families who need this knowledge, I can help them because of this network.” Dr. Sinclair has, for example, helped individuals he has met through Twitter connect with local hospices, a process he believes was expedited by Twitter’s particular platform.

And social media can also help patients and physicians widen illness support networks, which in turn can augment the patient-doctor relationship. Health care providers have long known that patients with chronic or life-threatening diseases benefit from support groups made up of people who can sympathize and empathize with them. But such support is difficult for physicians or hospitals and clinics to cobble together when patients and families are physically isolated or homebound, or when they have an orphan disease like Eddie’s.

“With social media,” Dr. Sands observed, “we can aggregate across space and across the world and create a safe environment for support. Although there may be only 10 people in greater New York with a certain disease, there may be 250 people across the world.” Dr. Sands recalled guiding a patient to the Association of Cancer Online Resources, a social network of online communities for patients and families. “That was the most important advice I ever gave him. It was an information prescription.”

Social media platforms can turn 10- or 20-minute doctor’s visits into an ongoing dialogue, where sources of information and, potentially, support are continually available to the patient and the doctor. “Platforms like Twitter can be powerful if doctors are a lot more active in disseminating their expertise,” Dr. Khozin said. “Patients are being bombarded with information online, but I don’t think all that information necessarily empowers them. You also need expertise.”

Social media has kept me connected with colleagues and a few former patients, allowed me to stay up-to-date with certain health care and medical education issues, and helped me to keep abreast of Web-based resources that might be useful to those I care for. It has also taught me a tremendous amount about the experiences of patients and caregivers, information I’m not sure I would have had access to had I not been engaged online. Although I am far from a savvy user, I have come to think of social media like I do any other test, instrument or procedure; it’s extremely helpful in some situations, and for some patients, and less so in others.

A few days ago, staring at a blank screen and thinking about this column, I tweeted: Working on column on social media (spec. Twitter, Facebook, blogs) and patient-doctor relationship. Any opinions?

Minutes later I began to receive replies, including this one from @achronicdose:

Knowledge from patient-peers thru social media *can* mean more helpful talks w/ dr; dr. p.o.v. helpful for patients to read.

Doctor or patient, you are never alone in the twitterverse or blogosphere; there is always someone who is willing to offer some help or lend some support. It’s a world that I think might have made all the difference for a patient like Eddie.

Join the discussion on the Well blog, When Your Doctor Is on Twitter.

• ▶ Reply

Permalink Reply by Nathan Bonilla-Warford, OD on June 17, 2009 at 1:04am

Fresh Eyes on Social Media

Here's today's Social Media Insider originally published in MediaPost

If you think you've read everything you need to know about social media, maybe you should get your eyes checked. When you go, with any luck your optometrist will be Nathan Bonilla-Warford, O.D. in Tampa, Florida, as he can teach you a few things.

Nathan reached out following last week's column about my optometrist uncle, who said my article was posted on an optometrists' forum. His email signature included links to his Web site, Yelp listing, Facebook page, and Twitter account, and he later revealed he's a blogger too. I thought his practical experience as a business owner grappling with social media should be shared with others. Here's an exclusive interview with Dr. Bonilla-Warford.

Social Media Insider: How did you decide to tweet? What's it doing for you?

Dr. Nathan Bonilla-Warford: Another optometrist turned me on to it. Because I blog, it was a no-brainer. It gets my message out about news and events. Twitter has led to new patients and new sales. Now that I have been tweeting for a while, I truly see Twitter (social media more generally) as "The Chamber of Commerce for our generation."

With Twitter you get to see the people behind the business a bit more and, in this day where we are all fed a steady diet of overhyped, irony-dripping marketing, it is nice to see real people. Add local tweetups to the mix and it is awesome, especially for a small business like mine that likes to work in barter when possible.

So I love it. And being the ONLY eye doc in Tampa Bay who tweets, I've got that self-selected demographic all to myself -- for now. And I am taking advantage of it while I can.

SMI: How much time does it take you to manage your social media presence?

NBW: Well, my wife thinks it takes me a lot of time. Really, though, social media is so integrated with other tasks such as administrative and leisure time that it is hard to quantify the time put in. Perhaps 30 minutes a day total, apart from stand-alone marketing time. I don't think of it as taking a lot of time, because it is fun and rewarding. An important note is that this really only applies to maintenance of social networks. Setting up a new presence DOES take time and effort at first, deciding on what image to present, literally and figuratively, and what the written and unwritten rules are of the new network.

SMI: Are any social media channels more important than others?

NBW: I'm not a guru on this subject, but I think it all depends on your goals and perspective. I pretty much see my blog as the central hub of the Web presence and then other systems/networks making use of that content. However, this is changing as I am becoming more active on Twitter. I am starting to dislike Facebook due to all the quizzes and applications, but I know that it is still popular.

SMI: Is it just you managing it? Do you have anyone in your office helping you?

NBW: I have talked about this with other optometrists. Historically, optometrists are not great at delegating. I'm not sure why. I have introduced social media to my office staff and asked them to participate by writing blog posts. I would like to get them more involved and tweet about office events and allow me to focus more on clinical topics, but we are not there -- yet.

SMI: Who's your target audience? Is there a certain demographic?

NBW: The target audience is tricky. Initially and ideally, the target audience is people (specifically mothers) who live in the area and who are patients or potential patients of Bright Eyes. However, we also provide specialty services of infant & pediatric care, vision therapy and orthokeratology, and there is not a large number of these specialists using social media nationwide. So I am simultaneously creating a national and international audience of people who are interested in this niche care.

This has caused me to realize that I have to create different entities to address these audiences, and I am now working toward this, in conjunction with national professional organizations within these specialties. To some degree, I am leading them to it, because they are thinking about the message spreading from more conventional channels.

SMI: What's your advice to other business owners about using social media?

I think that virtually any business could benefit from social media. There is a small, local house cleaning company that I think is doing a great job (@serranocleaning ). I plan on using their services in the future. Ikea opened a new store in Tampa, and they have been the example of "doing it right" with @IKEATampaFans. They listen to tweets and encourage exchange without spam.

So to any business, especially one that deals heavily with human interaction such as sales or consulting, I would say, "Come on in, the water is fine." But do spend a little time dabbling with a personal account to think about what style and approach works for you, before you commit.

I also feel very strongly that businesses should separate their personal and business social media identities. I know others disagree with me on this point, saying, "You are your brand." But I just think it is confusing if you are using your office/business name and then sending a bunch of tweets that have no relation to your core concept. I'm not saying to refuse to show some personal side because that is a good and important aspect, but to keep it relevant to your brand.

• ▶ Reply

Permalink Reply by Dr. Leonard J. Press on June 25, 2009 at 10:09pm

Excellent overview, Nate. I think we're all feeling our way with "the new media", and the time involved is certainly challenging. At one level one might say that the busier we are with day-to-day clinical issues, the less we have to worry about having a presence based on all the time-intensive time involved in this kind of social and quasi-business networking. On another level, it may in short order become the :"expected" way of communication. You certainly are at the vanguard, and I admire your commitment.

• ▶ Reply

Permalink Reply by Dominick M. Maino, OD, MEd, FAAO on August 11, 2009 at 1:47pm

I use Twitter mostly to drive folks to my blog. What has happened lately is that I am receiving a fair amount of email and even phone calls from all over the world about individuals with binocular vision problems....I think this is good...at least so far it has not been overwhelming and I've been able to help a few folks along the way.

• ▶ Reply

Permalink Reply by Ruth Villeneuve on September 9, 2009 at 4:08pm

Hello to all!

I am the new social media specialist for COVD. I will be available in Denver to assist anyone who is interested in learning more about how to use sites such as twitter and facebook to help expand their own practices and spread the word about vision therapy. Please do not hesitate to contact me!

• ▶ Reply

Permalink Reply by Nathan Bonilla-Warford, OD on September 9, 2009 at 4:12pm

Hi Ruth,

I think you are doing a great job with Facebook and twitter! It makes it very easier for myself and others to echo the messages and spread the word. I wish I was coming to Denver to talk more with you about your social media plans for COVD. Unfortunately, I will not be there, as we are expecting my son, due in October.

Keep up the good work!

-Nate

• ▶ Reply

Permalink Reply by Dr. Leonard J. Press on September 9, 2009 at 4:30pm

Hi Ruth,

Welcome aboard! Will look forward to learning more in Denver.

- Len

• ▶ Reply