Vascular medicine and social media,highlights from the practice and compensation survey,and the future of vascular medicine training

Guillaume Mahe, MD, PhD; Yogendra Kanthi, MD

Twitter: @GMahe_, @yogenkanthi

Advancements in patient care and longevity over the past century are largely attributed to discovery and innovation in science and health care delivery. Historically, these developments were disseminated through reports in high-caliber medical journals, often meticulously prepared months in advance. Responses from the medical community would be curated, and then published several months after the original report. Technological evolution has expedited and compressed this process. Cutting edge advancements and clinical investigations are now reported by journals on their websites, where internet- and social media-based readership often surpasses print-based readership. ¹ Twitter, a social media platform with > 300 million active users, has become a crucial and accepted means by which ideas are spread rapidly in the medical community. ² In the era of ‘information overload’, Twitter posts or ‘tweets’ are ideas efficiently condensed to 280 characters or less.

Twitter has become a centralized source for vetting ideas, sharing information, discussing health trends, and posing questions and polls regarding controversial topics. Vascular medicine practitioners from different specialties have already adopted Twitter to propose ideas or ask questions, share information, promote evidence-based practices, and discuss issues of clinical and scientific import. The inherently public nature of Twitter has created a ‘democratization of voices’ that breaks down the hierarchies that hinder transparency and open communication. It allows peer-to-peer dialogue between colleagues and trainees, world experts, principal investigators of major trials, cutting edge researchers, and patients in the same forum. ³

Clinical trial results are discussed in real-time, including the insights gained, limitations, and applicability to patient care. Informal polls regularly posted on the platform often reveal gaps in knowledge that support the need for additional studies or consensus statements. This platform has also created vascular learning communities and is a powerful educational tool. Discussions often unveil diagnostic or management skills honed over decades of experience, creating a collective archetype of skills that would otherwise require years of close mentorship and practice to collate. This ‘shared knowledge’ is crucial in a specialty such as vascular medicine, where practitioners from multiple disciplines care for patients with similar diseases.

Some of the most prolific Twitter contributors are leaders in health care, including the Surgeon General (@Surgeon_General), FDA commissioner (@FDACommissioner), clinical trialists, and leaders of subspecialty societies. Vascular medicine is no exception, and leaders in our Society (@SVM_Tweets) are already highly engaged on Twitter. Although they have other avenues to connect with audiences, they continue to use this platform as a means to interact with the vascular community, participate in discussions, and exchange ideas with colleagues. The strength of diversity in our field is clear on this stage, as experts regularly weigh in on discussions related to peripheral artery disease (PAD), venous disease, fibromuscular dysplasia (FMD), spontaneous carotid artery dissection (SCAD), aortic disease, imaging diagnostics, and emerging fields that overlap with vascular medicine, oncology, and rheumatology. Participation and input from the public and advocacy groups further enhance dialogue and strengthen the drive to improve patient care.

Medical journals, including Vascular Medicine (@VMJ_SVM), have also recognized the reach of social media. The Twitter presence of a paper can influence its citation rate. In turn, this may affect the journal’s impact factor. ⁴ Journals have pivoted to routinely disseminate articles of interest to the community through Twitter. Authors will often add commentary and perspective to their own articles, increasing visibility of the subject and highlighting nuances that are important in applying these studies to improve care and research. Use of ‘hashtags’, which are metadata tags that identify messages with a specific theme like keywords (e.g. #DVT, #DOACs, or #COMPASS), help users quickly search for conversations by topic or study name.

In an evolving landscape of technology integration into our professional environments, the incremental value of adopting any new technology needs to be weighed against the time investment and/or potential detraction from other efforts. One recent study identified six key areas where communication via social media may benefit the community: (1) engagement with colleagues and patients; (2) open sharing of information; (3) accessibility of specialized information; (4) social support; (5) improved public health surveillance; and (6) potential to influence health care policy. ⁵ An example of social media impacting public policy was evident recently, when the vascular medicine community mobilized to convince the Centers for Medicare and Medicaid Services (CMS) that coverage of supervised exercise therapy (SET) was essential for patients with PAD. In response to a formal meeting on PAD convened by CMS, representatives from the Society for Vascular Medicine, working with other cardiovascular societies, drafted and submitted a statement to CMS for consideration, which was also published in societal journals. ⁶ Key leaders in vascular medicine publicized this statement by social media and email and also mobilized the vascular medicine community to provide public comments to CME on SET for PAD. The CMS website was flooded with supportive comments from vascular medicine practitioners across the country. As you are likely aware, CMS has since issued a coverage determination in favor of SET in PAD. Surely, rallying the vascular medicine community to advocate for our patients helped contribute to the success of the initiative, and using social media to disseminate CMS’s final decision in real-time provided rapid feedback and spread awareness of the role for SET in patient care.

As with the advent of email, any new means of communication bears some limitations. Inherent to any open communication forum, discussions have the potential to deviate from the initial conversation and can occasionally be difficult to redirect without a moderator. In addition, conflicts of interest aren’t always declared, which can result in the spread of biased information. Health care providers and researchers have the knowledge, insight, and experience to help identify and temper these online deviations from good practices. Simple rules to follow when engaging in Twitter are: (1) respect patient privacy; (2) strive to be accurate; and (3) remain respectful and professional at all times.

Social media in health care is here to stay. The Society for Vascular Medicine and its journal, Vascular Medicine, have dedicated social media editors who work hard to get the message out about the important work of vascular medicine specialists. The Society’s 30th anniversary was celebrated at the 2019 Scientific Sessions. In recent years, this meeting has seen growing engagement on social media, with commentary on large clinical trials, cutting edge research, clinical pearls from experts, and highlighting awardees including the Jay Coffman Young Investigator Award nominees. The initiatives championed by the Society’s Communications, Social Media, and Next Generation committees have increased social media engagement during the annual meeting threefold from 2017 to 2018, and this trajectory is likely to continue with the growing enthusiasm for Twitter (and other platforms) among those at all career stages. As advocates for our patients and for our specialty, if we don’t define vascular medicine in public conversations on Twitter, it will be defined for us by others.