The nephrologist's guide to Twitter

Twitter is the second largest social network after Facebook. But, though they are often grouped together this is not a Coke and Pepsi type of pairing. Twitter and Facebook are different animals.

The difference stems from a fundamental difference in the construction of the networks. In Facebook, both parties must agree on the relationship. Once you have "friended" each other, you are on roughly equal footing. This mutual agreement to exchange information gives people a sense of privacy that Facebook is repeatedly jeopardizing as they lurch from dorm room experiment to world changing company.

Twitter, on-the-other-hand promises neither privacy nor mutuality. People sign up to "follow" your updates and you can choose to follow them, or not. This changes everything. It allows celebrities to use twitter to broadcast to a wide audience. It also thrives at allowing people to communicate with people they have never met.

It has been said: Facebook allows you to connect with people you already know, Twitter allows you to meet people you want to know.

A more cynical version of this is:

Facebook is where you lie to people you know. Twitter is where you're honest with strangers. @Berci, author of a great Prezi on Twitter in Medicine

The best part of Twitter is that it highly flexible and each user has complete power to customize her experience.

The three fundamental things anyone needs to know to get started on Twitter are:

1. Who to follow
2. What to do
3. What to say

Who to follow
I would categorize who to follow in various slots. I will highlight people I think are important to follow, not because I believe in what they say but because they illustrate an angle to Twitter that helps the neophyte understand the medium. Favstar.fm is a service which tracks the most popular tweets. It is a good tool to see the best of what a person is capable of Tweeting.

@BurbDoc (FavStar) provides a few lessons. The first he is the quintassential example of unprofessional behavior on Twitter. Burb is a primary care doc who has been driven over the edge by the inanity of suburban America and a primary care system disrespected by clueless patients, arrogant specialists, absurd insurance companies, immoral drug companies, and meddling bureaucrats.

Typical NSFW Tweet from @BurbDoc

BurbDoc does not use his real name on his Twitter account. There is no way he could use his real name and Tweet with the style he uses. There are long debates on the merits of anonymous tweeting. I'm a firm believer of tweeting with your name, it will remind you that you aren't scrawling graffiti behind the high school but posting a permanent billboard on the road called Google. Sign your name and you will be more careful with what say. And you never are as anonymous as you think you are.

@DrVes (FavStar) is a professional medical blogger. He is an Assistant Professor at the University of Chicago and blogs at Casesblog.blogspot.com. He is a prolific tweeter covering a broad swath of medical news each day. DrVes is broadly followed and well respected among Twitter doctors. Typical tweet:

@KidneyNews (favstar)is the primary twitter account of KidneyNews, the magazine of the American Society of Nephrology. It may seem similar to @DrVes as it is a continuous stream of kidney stories. The primary difference is that DrVes custom crafts each tweet. KidneyNotes is a bot that automatically posts links to every post from a host of kidney focused blogs. If you want to keep a finger on the pulse of the renal blogosphere this is an easy way to keep up. Pacale Lane, a Pediatric Nephrologist, runs the KidneyNews twitter feed. She also has an individual twitter account at @PHLane (favstar)

Similar to KidneyNews is @TheKidneyGroup (favstar). This nephrology group has established an exemplary social media presence in nephrology. They have active Facebook and Twitter feeds. The tweets usually contain stories about transplant or quirky stories of scientific advancement. The feed doesn't seem to be managed by a doctor, but rather an enthusiastic employee (spouse?) of the group.




If you want to skip the ASN middleman you could follow the top renal blogs directly:

• @RenalFellowNetwork (favstar)
• @nephrondemand (favstar)
• @eAJKD

Also you can consider following the blog authors personal accounts:

• Matt Sparks of eAJKD and one of the guys who stepped up after Nate died and saved Renal Fellow Network, tweets from @nephro_sparks
• Simon Prince of Uremic Frost tweets at @simonprince (favstar)
• Joshua Schwimmer is the patriarch of renal blogging, he started KidneyNotes on March 7, 2005. He currently blogs at InfoSnack and tweets at @joshuaschwimmer (favstar)
• Robert Provenzano is a polymath: clinical nephrologist, anemia researcher, VP of Davita, former president of the RPA and expert in Accountable Care Organizations. He blogs at Accountable Kidney Care Collaborative and tweets from @DrBobPro
• Fahim Rahim, a nephrologist, who hosts a radio call-in show, House Call, and tweets at @skibum4eva

There are other nephrologists who use Twitter as their only online presence. Two examples I like are:

@BrianLee is a nephrologist in Hawaii. He is not a high volume tweeter with a tweet or two every few weeks. He uses Twitter to comment on blogs, spread news stories or celebrate his victories.


He always comes across as professional and well informed. A nephrologist could do worse than model his use of Twitter after Brian Lee.

In this same vein is @KnittingNephron (favstar). She is much more prolific than Brian but since most of the tweets are @ replays they will not show up in your stream, until she drops a bit of renal wit.

Two final twitter accounts that you should consider following. @Skepticscalpel (favstar) is a surgeon who tweets about evidence based medicine, trauma, and medical education. Sharp wit.

Shad Ireland is an athlete on dialysis who is training to swim/bike/run the IronMan Triathlon. He does home hemo and is an inspiring example of what you can do despite dialysis. @IronShad







What to do

Example of a twitter conversation. Read from the
bottom up, click to get a larger, readable copy.

There are three ways to interact on twitter, a reply, a retweet and a favorite. That order is in descending order of engagement. Meaning, if you want a meaningful, interactive Twitter experience, be quick to reply and worry less about favorites.

The simplest to understand is the reply. You see a tweet you appreciate, and you acknowledge it by engadging with it. You direct the message to the author by starting the tweet with their user name: @Kidney_boy to reply to me.


If the reply begins with the twitter handle only people following both parties will see the tweet. This clears out a lot of private chats from your Twitter stream. People that follow just BurbDoc or just me will not see the tweet. People sometimes add a period before the @ so everyone will see the tweet.  

A retweet is a way of saying "I like this." It amplifies the writer's message. Favstar tracks retweets as a way of measuring the popularity or impact of a tweet.

Tweets I have starred

Favorites are a way to honor tweets that you like and it also marks them and collects them so you can review them later. There is no reaction on the public timeline when you favorite a tweet, however people can see what you have favorited by going to your profile page. Stars are not private. Sarah Palin got a bit of heat by making this mistake.

In Twitter for the Mac, each of the interaction functions are just a click away.





Medical Twitter Chats
In addition to the above methods of interaction I suggest exploring some of the regular medical chats that happen a few times everyday.

I like three chats, though I don't participate that often, I always enjoy them when I do. To participate in the chats, search for the HashTag for the chat (#TwitJC, or #HCSM, etc). When you want to add your 144 characters, make sure to append the hashtag so other people can find your comment.

On every second or third Sunday there is the Twitter Journal Club. It is an innovative combination of a website and twitter chat. The organizers post an article and an introduction in the week leading up to the chat. Then during the appointed time the organizers ask pointed questions to tease out the complete story of the article. The discussion uses the hastag #TwitJC. Every other Sunday at 3 pm EST. (7 pm GMT)

Sunday Night from 7-8 pm EST is health care and social media chat. This is the oldest medical twitter chat. It started in 2009. If you want to use twitter to talk about twitter, this is the place for you. The hashtag is #HCSM.

Thursday at 9 pm EST is the MedEd chat. This is one of my favorites. The discussion is lively and generally the people are interesting. Hastag #MedEd.

What to Say
Everyone needs to find his own voice on Twitter. That said, I have a bit of advice. Firstly, remember that everything you say will be permanent and associated with you. Staying quiet initially and watching is a good way to get started. Find people you like and respect and see how they interact on Twitter. Like anything in medicine, imitating respected mentors is a good way to learn.

Probably the best pithiest advice and on how physicians should behave on Twitter comes from the Mayo Clinic and their twelve word social media policy:

Don’t Lie, Don’t Pry
Don’t Cheat, Can’t Delete
Don’t Steal, Don’t Reveal