Medical Doctors on Twitter How

and why MDs tweet

Dr Anna Tereszkiewicz

Renata Drozd
Beata Dziedzic

Twitter
A tool of personal communication used to
share daily life narratives.
It offers many forms of communication and
its used in various areas of professional
communication.

Twitter in health communication

Twitter is used by medical doctors, public
health departments and health care
institutions.
It is used for the purpose of branding,
marketing, patient education and
dissemination of information about medical
practice and health care.

Aims, materials and methods of the

study
The analysis of MDs profiles and content of
tweets.
10 MDs profiles (the highest popularity).
1520 tweets.
The analysis focused on the purpose of
tweeting, the function and content of
hyperlinks, audiovisual elements and
discourse properties of tweets.

MDs profiles
2 important aspects: self-presentation and impression
management.
The details of the MDs profiles included:
I.

Information on professional practice (specialization

and position held)
II. Links to MDs homepages or blogs, to the websites of
societies and institutions in which MDs are involved
III. Disclaimer
IV. Personal information (e.g. hobbies)

Self-presentation
Associated with the authors authenticity and
reliability.
Helps to:
I. create a credible and reliable profile
II. establish MDs position in the professional
community
III. gain credence
IV. expand MDs network of relationships with
professionals and patient communities

Impression management
Includes visual information (profile and
background photographs) and textual
information (personal information, updates).
MDs photographs serve to confirm and
enhance the owners professional identity
(usually close shot, direct gaze and wearing a
doctors coat or a surgeon's gown).

Tweet content and function

3 forms of tweets:
I. Updates (43%)
II. Addressed messages (32%)
III. Retweets (25%)
Also tweets from Twitter chats (6%) and
conference venues (4%)

Updates
Tweets disseminating popular science and health-care
oriented articles from mass media, science-oriented,
medical research news and academic journals.
Lets eliminate the stigma of cancer --> Dont blame patients
for their disease http://ow.li/paR41
Tweets with health tips.
Oct 3 Tweet-a-Day for Breast Cancer. Vitamin D good for
bones what about cancer? Find data at:
http://ow.ly/pudgz
Tweets with personal life posts.
Noticed today Ive got quite a bit more gray hair. Ah, well:
Ive considered it a race between graying & accelerating
baldness

Addressed messages
Tweets with replies addressed at other MDs, institutions,
patients and ordinary users.
Tweets with social comments and acts of politeness
(thanks, wishes, compliments, etc.).
@user Heard you did a great job in SWOG social media
meeting. Thanks! Had conflict with breast working group
Tweets that involve exchange of information and opinions,
clarification of information and exchange of experiences.
@user no, common serum tumor markers are CEA, CA-125,
CA19-9

Retweets
Tweets published by health-institutions, organizations,
societies and other MDs.
Tweets disseminating news and information.
RT @user: ALK-positive NSCLC patients story opens eyes,
9/13:58 CAP TODAY http://www.captodayonline.com/alkpositive-nscls-patients-story-opens-eyes-913558
Tweets recognizing the expertise of other MDs (often
accompanied by comments evaluating the forwarded
message).
Helpful. RT @user: User, MD, discusses mgmt of adverse
events (AEs) from treatment w/immunotherapies
http://flip.it/hV8sk

Tweets from Twitter chat

They offer a floor for discussion for different
audiences (professionals and non-professionals).
The analyzed tweets were found in chats about
health care and social media, breast cancer and
lung cancer, among others.
Of my #ovariancancer patients this week, 100%
had a delay in diagnosis. Raising awareness is
such a priority. #gyncsm

Conference tweets
Tweets disseminating news on conference
presentations or updates on the research
discussed on the conferences.
Tweets involve comments evaluating the
presentation, questions directed at speakers and
participants and self-promotional messages.
Tweeting from WE CAN breast/cervical cancer
advocacy conf in Uganda. #bcsm followers, share
support of our African sisters on #WECANAfrica

Linking patterns
29% of the updates contained hyperlinks.
Their primary function is to provide extra
information and refer the reader to further
external materials.

Linked source
Medical society/organizations
websites and blogs (e.g. ASCO)

Percentage
24%

Medical journals (NEJM, JAMA)

22%

Mass media (Reuters, New York

Times, Washington Post, etc.)

15%

Medicine-oriented websites
(e.g. Oncology Tube, Health
Day)

14%

Other MDs personal homepages,

blogs

11%

Organizations/institutions with
which MDs are affiliated (MD
Anderson Centre)
MDs homepages, blogs

7%

Other

2%

5%

Rhetorical function
Disseminating information
Dissemination of medical
knowledge
Community formation and
integration
Promotion
Dissemination of information
and knowledge
Crediting medical discoveries
Referencing and citing
Disseminating information
Popularization of medical
knowledge
Promotion of healthy life-style
Increasing public awareness of
health matters
Dissemination of information
Popularization of medical
knowledge
Promotion of healthy life-style
Community formation and
integration
Crediting information
Promotion
Enhancing credibility
Identity management
Self-publicity
Enhancing credibility
Identity management
Disseminating news
Humour

Captions annotating the links

Their main function is to abstract the content of
the linked text and/or provide the tweeters
evaluation of this content.
They are also persuasive and informative.
Is your physician's electronic medical record
system selling your info to drug & device
companies? http://bit.ly/1dyXR43 h/t @user
[Original headline: The hidden cost of free EMR
systems]

Multimedia
Among the analysed tweets (1520), only 120
posts include an audiovisual element.
Audiovisual content
Photographs of posters and
conference slides

Frequency
22%

Photographs picturing other

MDs at conferences

7%

Photographs picturing the

self at conferences

5%

Medicine-oriented videos,
graphics, cartoons,
photographs of medical
equipment, medicines
Personal-life photographs
Other (news, humorous
memes)

48%

8%
14%

Rhetorical function
Information dissemination
Popularization of medical
knowledge and research
Community formation and
integration
Crediting medical discoveries
Self-publicity
Enhancing credibility
Identity management
Disseminating information
Popularization of medical
knowledge
Promotion
Identity management
Disseminating news
Humour

Discourse patterns
Tweets by medical practitioners are seen as hybrids of
professional, public, institutional and private discourses
(Myers 2014).
Stance-taking the expression of authors stance:

I.

in institutional and professional discourse, it helps to

establish and communicate professional expertise;
II. in private and popularizing discourses, it helps to
establish ones authority, but also engage and attract
addressees.

Implicit evaluation
Sharing a link or retweeting without the users
comment. Retweeting may indicate the authors
agreement with the claim presented in the
message, or may trigger a conversation.
RT @user: Smaller, flexible trials mean more
options for patients & faster scientific answers:
http://mobile.reuters.com/article/idUSBRE98P05
N20130926

Explicit evaluation
Involves expressions of both attitudinal and
epistemic stance.
I. Positive evaluation
II. Negative evaluation
III. Expressions of feelings and emotional
reactions

Positive evaluation
attitudinal markers highly subjective and strongly
evaluative expressions concerning the value, importance
and accuracy of the tweets:
I.

adjectives + noun phrases (adjectives premodifying nouns

indicating the type of content being evaluated)

Excellent review by @user: How can social media improve

oncology care? http://ow.ly/oDARZ
Cool video from Iceland. MT @user: Really creative
http://huff.to/GJIF92 "This Road Leads to Breast Cancer
Awareness"

II.

verbs (frequent use of subject ellipsis, due to space restrictions;

sometimes followed by a justification of the opinion)

@user Agree. I do not deny medicine is a business but how we

operate and what we need to achieve require the highest ethical
standard
III.

a single yes

Yes! RT@user: @user It is reasonable that #empowered pts can do

research on their own & introduce it to their docs? #lcsm
IV. an interjection
Ugh MT @user: Pts discouraged about cancer clinical trials: ~60%
by oncologist & ~50% by family physician http://ow.ly/psYbB

 epistemic stance (particularly frequent in Twitter chats)

I.

first person pronouns + verbs indicating stance (verbs tend to be

modified)

@user @user I actually think that EMRs do more harm than good at
this point. http://bit.ly/19TMIJJ
II.

inclusive we (often followed by modal and semi-modal verbs,

expressing deontic modality)

We need to improve the speed of trial enrollment process. Or come

up with a totally new enrollment process
III.

statements made by MDs about the current and desired state of

affairs in health care

Medical care needs to begin with reforming pt-doctor

communication @user #MedX

Negative evaluation
evaluation in which MDs directly or indirectly reject the validity of
others views; it helps them enhance their professional authority and
credibility.
MD says apps with skin pictures can mitigate shortage of dermatologists.
http://bit.ly/16C3mJx > Dubious. In derm, context is key to dx...
adversative conjunction but (helps to reduce the force of the opinion)

To clarify, I'm a big fan of involved pts, but I see some who exemplify why
it's great, & some who highlight why many docs resist. #s4pm
negation (may indicate that the author follows the opposing view)
@user It's not easy--needs partnership between doctor and pt, and pt
also has to do part to tell good story #MedX

Expressions of feelings and emotional

reactions
(both positive and negative) can be seen as a
wish to establish solidarity and create or maintain
bonds with others.
Excited to join the faculty of George Washington
University and looking forward to working with
@user!
Sad/frustrating. MT @user: For me, it's more
about fighting insurance to cover trials vs. finding
them hasn't been issue. #lcsm

Conclusion
Main purposes of tweeting:
I. Dissemination of knowledge and information
II. Knowledge translation between experts and
the public
III. Interaction and discussion of health issues
IV. Self-promotion