[Bertalan Mesko] [Webicina]
[The 2.0 Doctors: What is S/he Using?] [Dr. Bertalan Mesko]
Good morning, everyone.
Thank you very much, that is, for the great introduction.
As many has presented you many examples of social media,
as a doctor coming from Hungary, let me tell you a real story of a Hungarian doctor
who used social media in the most efficient way.
I think this is the best example of doctors and social media.
I'm talking about this guy here.
His name is Tamas Horvath.
He's an Ear, Nose, Throat Specialist in Budapest,
and he just opened a clinic called ENTHouse.
About 2 years ago, he saw one of my presentations, and he decided to start using
all the social media resources.
So he started using Reddit, Flickr, YouTube, Facebook--everything.
But he had a strategy.
After 6 months, he stopped and tried to evaluate the results,
and after that, he only kept on using 3 of these resources.
So now, he has a blog in Hungarian. Here it is.
Whenever a Hungarian patient does a search for an ear, nose, throat symptom or diagnosis,
they will find his blog in the first place.
He has a Twitter page in English to be able to contact professionals from around the world
in order to keep himself up-to-date easily, and he has a Facebook page in Hungarian--
a fan page for the clinic.
Now he told me that after 1 year, now 50% of his new patients find him
through these social media resources.
It takes him about 30, 40, 50 minutes a day to update these free resources,
but that's how it works for him.
He had a good strategy, and he spent time with that, but now it works for him.
He finds new patients through these free resources.
In the first steps of my presentations, I like to emphasize something, some lines.
First, I believe that social media is really changing medical communication.
Let me show you one example for that.
I guess you know this guy. His name is Conan O'Brien.
He is a famous U.S. television star, and NBC fired him last year, so it meant that
he didn't have healthcare coverage for some time.
So on Twitter, he sent a message to his followers saying that,
I no longer have healthcare.
Could someone show this picture to a dermatologist and get back to me?
He attached this picture.
This is a mole, but really nothing serious. Here it is. Just a mole.
But a U.S. physician replied to him on Twitter saying that, "I'm a hermatologist,
but looking at that, I give you 7 months. Don't worry. That's a really long time."
So communication between patients and doctors is really changing these days.
The second point I would like to make here is that social media is the same as
Web 2.0 is the same as the internet.
There is no physical difference.
We just come up with new expressions, new buzzwords for these things,
but we are talking about the internet, and we're talking about just new tools for communication,
but nothing more.
We don't have to overhype these things these days.
My third thing here is that, we still have to stick to evidence- based medicine,
and we have to use the evidence-based approach even in social media.
I have an example for you about this as well.
I guess you know Google Trends on which you can see which search queries--
search terms are more famous like Lady Gaga or Brittney Spears.
Now at Google they found out about 3 years ago, that if there are more and more
search queries for flu symptoms in a U.S. state, then there is probably a flu outbreak
in that specific state.
So they came up with Google Flu Trends which tried to estimate--to predict,
the flu outbreaks in those U.S. states based on the number of search queries
for flu symptoms.
I believe that's a great idea. We all like that.
Many of us use that.
They presented this on several conferences, and then at the end of last year,
a new study came out from the University of Washington concluding that
Google Flu Trends is not as accurate as CDC national surveillance programs.
So it's colorful, it's interactive, it's social media, but it doesn't work.
That's how simple it is.
If we check PubMed, we can see hundreds of publications focusing on
using Twitter or Facebook, blogs, other resources in medicine,
so we have to stick to the evidence-based approach even when talking about social media.
I thought today I should--Denise asked me to present you
my favorite apps, solutions, resources,
so I thought I should use a sequence of thoughts
and show examples in each of these spots.
So I will use this sequence.
When we search information, we find the information,
then we use that for collaboration crowdsourcing--I will talk about it in detail.
Then we create an online presence on different platforms.
That's the sequence I'm going to use right now.
So let's start with first, search.
Here are the best steps--best resources--best solutions I use day by day everyday.
First search, let's focus on Semanctic search.
In the old form of the internet--was about browsing the web, surfing on the web.
If social media is about searching the web, then the future of Web 3.0, let's call it that,
will be about semantic search--finding content.
For this, I believe the best resource right now is WolframAlpha.
Let's say that I would like to calculate my patient's body mass index.
I can grab my calculator and do that calculation, or I can go to Google,
and do a search for BMI--body mass index and the weight and the height of my patient.
It will give me calculators where I can go and put the same information
again, again, and again.
On WolframAlpha, I do a search for BMI and the height and the weight of my patient,
and it gives me BMI in the first place.
It visualizes the result because it understands the information I'm looking for.
I can also do searches for serum levels.
I have an adult male patient with this creatine level.
It gives me the reference distribution, the range--it understands my question.
I can look for blood pressure data, public health data, epidemiology, whatever I want.
They have thousands of just medical examples, or we can also ask questions
to the audience--to the search engine such as, am I too drunk too drive?
It will ask me back, the number of drinks I had, my gender, the weight, and so on
and try to tell me that based on my preferences, I probably should drive or should not drive.
So we can talk with the search engine--that's the semantic feature of it.
We also need Personalized search engines in medicine and healthcare.
Here is one--Sciencerollsearch.com, on which we can choose which database
is going to search in.
If I need only WHO information or just drug databases, or just MedScape,
I click on those and I search only in those databases.
I am doing PhD in clinical genomics, so I need to find the most famous papers,
the latest papers about genetics day by day,
and it's quite hard to find those just by looking at titles and authors.
So they came up with the Face search function. It's a plug-in.
It means that that they assign faces to papers.
If the paper was just published a few weeks--few months ago, the face is young.
If the publication was published in a high impacted journal, then the face will smile.
So when I look at hundreds of papers, hundreds of faces, I just have to spot the youngest,
most happiest faces, and I find the papers I'm looking for.
Another here is Wikipedia, it's very close to my heart.
I've been an administrator on English Wikipedia for the last 6 years,
which means that this project is very close to my heart.
I always tell my students that if you do research on any topics,
Wikipedia might be the best resource to start with because it gives you a good global
picture, but you should never finish you're research with Wikipedia because it's not
the most credible one.
We have hundreds of medical editors at Wikipedia,
and they work on now to insert medical references to medical entries.
We have enough entries, but we don't have enough references in those articles.
So if you're open to join us, please come and help us with this project.
We also have a manual style for medical and drug-related articles.
I will talk about in later in detail.
The second point I had is to--after searching information, let's find it.
We've got information.
I believe that after these years in social media, we have now credible resources
focusing on medical content--WebMD, Healthline, hundreds of them.
But what about social media resources?
What if I want to find a good cardiology blog?
What if my patient wants to find a good diabetes Facebook group or slideshow or
So somehow we have to curate social media for free for patients and physicians as well.
That's what Webicina does for free in 17 languages.
It means that we have plenty of topics--80 medical topics, conditions and specialties.
And if you take a look at one of these topics such as cardiology and social media,
you find the best blogs, podcasts, Facebook groups, YouTube channels,
all the social media resources focusing on cardiology,
and each resource was selected by professionals or by e-patients.
It also let's you know about the reasons why this selection, why this resource,
was selected in the database.
We also found out that we have to help people follow these pieces of information easily.
So we came up with a Personalized news engine.
I think that's the simplest aggregator in the world. That's called Personalized Medicine.
On Personalized Medicine, you can see in each topic the most famous, best quality,
medical journals, blogs, news sites, Twitter users, YouTube channels--all the social media
resources in a simple customizable way in 80 medical topics--here is oncology.
You will see the best resources on this topic.
You can also import PubMed feeds, PubMed search queries with 1 click,
without even registering on the site,
and then we made it available in 17 languages which means if you click on the German flag,
the platform will be in German, and the resources, journals, blogs, Twitters,
YouTube channels will be the best German medical resources.
We have Japanese, Chinese, Dutch, French, and so on--17 languages,
and we'll have 25 by the end of this summer.
So we try to come up with the best selections about social media for patients,
physicians, and pharma, for free for everyone.
Regarding still information, if you want to get information for that, I use RSS--
Really Simple Syndications. I guess many of you use RSS as well.
When I tell the physicians I'm talking to I use this solution to keep my self up-to-date,
they let me know that they check 1, 2, 3 journals a week in the library.
When I tell them I check 300 blogs and journals a day in about 10 minutes,
they don't believe me.
But that's how it works.
So we use RSS in many platforms.
When we found the information, we should use that for collaboration crowdsourcing.
You know the latest trendy buzzword of these years.
First I present you my example on Twitter.
I've been building a medical community on Twitter for 5 years now.
I try to find those people who I share interests with.
Then I use this community to ask questions, and when I was a medical student
3 years ago, we had a very strange case at the clinics.
A 16 year old boy with an acute pancreatitis for the 6th time in his life,
at the age of 16.
Professors--they tried all the tests, but they couldn't come up with 1 potential diagnosis,
so I thought as I have thousands of medical followers, let's ask them this question.
We had this case, what do you think?
I thought I might get a few answers, but the truth is that, I received more than 200 replies
in 1 day's time.
We had a lively discussion.
We had medical librarians from around the world, patients who had this disease,
physicians from around the world, medical lawyers, reporters, and so on.
By the end of the day, we came up with 1 diagnosis.
I mentioned that diagnosis at the next days grand rounds at the clinics,
and it turned out to be the diagnosis.
The story was featured in New York Times because the reporter, Claire,
also took an active part in the whole discussion.
So we had all the stakeholders from around the world focusing on 1 very complicated
issue for 1 day's time,
and they could come up with the diagnosis at the end.
That's how I believe crowdsourcing should work.
My second example is about Google Docs.
I guess many of you have used Google Docs to publish papers collaboratively.
I did that twice in my life.
I have never met my co-authors, but we met online somewhere on Twitter or blogs,
We worked on Google Docs, and I think we published a paper then we were ready with that.
That's how Google Docs works.
But there's a good example of a hospital using that for managing clinical workflow.
It's the Southeast Medical Center in the U.S. and they use Google Docs to
manage the workflow.
They have 1 Google document different columns for different doctor rooms,
different rows for different time slots, and color codes--the patient was roomed,
the patient was discharged and so on.
They can also leave messages from the front desk, from the nursing area.
It's a private document. Only those people can access it who have accessed with.
They can write simultaneously in the document, and all the versions will be stored
It's archived totally.
That's how a real collaborative software should work for free, of course.
Again, collaboration and crowdsourcing. Let's get to virtual meetings.
Many of you might think that Second Life, a virtual environment,
is now just out of the question. It's not.
It is the education of the golden age.
About 3 years ago, we started organizing medical meetings there, case presentations.
This is the Ann Myers Medical Center. I'm sitting right here in my scrubs.
We have professors from the U.S., medical students from Brazil, Peru, Germany,
We have virtual patients.
In these cases, in these meetings, professors who I invited presented their favorite cases
through text files, blood counts, radiology images.
We can listen to cardiac murmurs through simulations. It's a great solution.
So we have our own online presence,
but Second Life has some technological barriers, so we had to find a better solution,
a free solution, which means that if I want to organize a meeting with you
in the virtual world of Visuland, I can invite you with one link, and in 25 seconds,
you will be in the virtual world without doing anything.
No downloading, no registering to anywhere.
That's how Visuland works, and it's free for everyone.
Regarding still crowdsourcing, I use FriendFeed for my scientific activities.
FriendFeed is similar to Twitter.
We can share messages, links, videos, and so on,
text files, and one of my colleagues started finding co-authors through FriendFeed,
He asked this question on FriendFeed and he got several replies,
and 1 year later, they published a paper in this periodic journal.
That's how it works. You can now find co-authors easily in this scientific network.
I have 1 more thing, but don't tell please anyone.
When I want to find a--I need a paper. I don't have access to it.
Then I used the References Wanted group on FriendFeed and people--
scientists from around the world help each other out with this solution.
But don't tell anyone about this.
The fourth thing I mentioned was the online presence.
After these things, I collaborate, I search, I find information, I want to have an online presence,
for my own personal activities or for my practice, my hospital, that's my decision.
Blogging has been a major issue in my life.
For the last 6 years, I've been blogging medically.
I have an English medical blog and a Hungarian one.
I've won some blog awards for that.
I have 4 million readers.
Blog became the major platform for my online activities.
It actually became my online CV.
If you do a search for my name in Google, you will find my blog in the first place,
and I'm quite happy about that because it contains my real CV, my slideshows, projects,
all the opinions, activities I have online.
So I'm pretty proud of that and whenever you do a search for my name,
you will find that in the first place.
For some other physicians, blog is even more important.
For Arnold Kim, who was a nephrologist in the U.S.,
he left his practice for professional blogging about Macintosh products and developments.
Now he makes 5x as much money as a professional blogger working 3 hours a day
than as a physician working 8, 10 hours a day.
I believe he's still sees patients, but as a hobby, nothing more.
He's now a professional blogger.
And then negativism, boy, I always have one.
This guy is Dr. Flea. It was his pseudonym.
About 5 years ago, he was one of the most famous rock star medical bloggers.
He blogged under his pseudonym, and he made jokes of his patients day by day.
But it turned out that he got sued in real life, a malpractice lawsuit.
He was a pediatrician anyway in California,
and he kept on blogging about the whole lawsuit.
He made jokes of the attorney, the judge, the patients,
but the attorney found that this blogger might be that doctor in the court.
The next day he asked him. He had to say, "Yeah, this is my blog."
He lost the trial, not because of the malpractice,
but because sharing information about the lawsuit on his blog.
That was the only reason to lose a trial.
For one year, he was vanished from the whole blogosphere.
After one year, he gave an interview to this blogger, and to me as well,
and he said that he survived a shark attack, and he has one advice for new medical bloggers,
please do not blog anonymously.
That's only one field--in sports, in politics, you can do whatever you want to.
But in medicine and healthcare, you have to take the responsibility for what
you're writing online.
I always tell my students about that, and they have to act like that in the online world as well.
Well, after having an online presence, we can use these online services on YouTube.
We can have a page for our practice on YouTube page--that's a plastic surgury practice.
We can have a Facebook page--It's Hello Health practice, private practice in the U.S.
So we can have many platforms to use for.
For example, here are the platforms I'm using.
I have a smartphone. I'm an Android user.
I use many applications day by day.
I also know about other examples used by my physician friends from around the world.
Now we can upload any medical slides, any kind of content on our phones,
iPhones and Androids.
We can attach an alcohol breathalyzer to the iPhones.
There is now a blood sugar content device for the iPhone as well.
There is the Best Application of the Year Award was given to Siri last year.
It's Siri on iPhones. It's Vlingo on Androids.
It works like that.
I tell my phone, my application to get me a cab.
It knows my GPS location. It tries to find an online cab ordering service.
And it will try to order a cab to my exact location.
The developers have many examples for entertainment, cinemas, finding a steakhouse,
and so on, but they didn't have at least one example in medicine and healthcare.
So I thought I should come up with some of these such as
make an appointment at the Mayo Clinic, connect me to a cardiologist now,
or call an ambulance to my exact location.
That's how Siri works.
In Australia, where there are hundreds of kilometers between patients and hospitals,
doctors, GPs can use smartphones for performing ultrasound examinations,
and by this, they can send the results wireless to the hospital where it can get analyzed
in high resolution and can decide whether the patient should go to the hospital--
should travel for hundreds of kilometers or not.
My last example for smartphones here is my favorite application which I use day by day.
It's called Layar.
It was developed by Martin in the Netherlands.
It's an augmented reality application.
I can see the world through the camera of my mobile phone.
It means that it connects the online information to the things I see online.
If I grab my phone right now, I can see who is using Twitter right now in the audience.
In the Netherlands, they came up with 1 plug-in. It's called AED4EU.
It's for finding old semi-automatic defibrillators easily by GPS locations.
Dutch authorities upload a data, semi-automatic defibrilllators GPS data,
and when people look into their cameras, and there is an emergency in the streets,
they can check that in this direction in a 100 meters, there is 1 automatic defibrillator
which I need right now. That's how simple it is.
And then tablets. Denise mentioned iPads for other device applications.
I use a Samsung Galaxy Tab myself.
It actually changed the way I receive information day by day.
I use many applications on this Galaxy Tab,
which means I have medical applications, some of them free, some of them are not.
I use social media on this because it's about getting information
as fast as possible, so I can reply to these tweets, Facebook messages, and so on,
so I use that to keep myself up-to-date in medicine and healthcare,
as well as in social media.
So I mentioned search, information, crowdsourcing, then online presence,
I want to conclude that social media can be your friend.
I wanted to say it can be a doctor's friend, but it can be a friend for patient's,
for policy makers and for pharma as well.
If you use them the right way, it's strategy
because without strategy, it's absolutely useless.
And then I thought I should come up with one final conclusion about
what to do now for doctors--Doctors 2.0--
and I thought that there is one thing to do for them, and that is education.
I believe that digital literacy must be included in the medical curriculum,
and it's not enough to just talk about this issue.
That's why in 2008, I launched the world's first and still only university course
focusing on social media and medicine
for medical, dentristry, pharmacy, and public health students.
It's in Debrecen and Budapest right now in Hungary.
We have full house each semester--150 students.
One semester is in English. One in Hungarian.
I published the material and slideshows with narration on Med20course.com.
In 10 weeks, I will present this course at a Stanford Summit this September
at the Medicine 2.0 Congress.
I asked students to fill in a survey before and after a course because I want to see
whether their attitude changes during the course--during the 10 weeks.
I asked them about 40 questions.
The first one is, will you meet the expectations of e-patients?
Before, they think they know or they don't know.
After, it's 100% yes.
When I ask them the question, what kind of role would the internet play
in the future of medicine?
They send me 100's of replies.
So I created a word cloud in which you can see the most important words--
increasing, communication, important, information, professional, time management,
so it seems that they realize how important it is to at least know about
the internet latest issues.
They don't have to become tech savvy or social media savvy,
but at least they have to know about these issues when they have such patients.
Have you guessed what was the question here?
Did you like the course?
It was 100% yes, so I guess it's good feedback.
Here's the structure--10 weeks, 20 slideshows, from the basics of Web 2.0 through
medical blogging, Twitter, crowdsourcing, Wikipedia, e-patients, video sites,
science 2.0, collaboration, and Google search engines.
We go through all the important areas and topics in social media and medicine.
I have many cases and patients.
I have e-patients from around the world who send, specifically to my course,
student's personal video messages about how they feel about how medical students
should transform their minds to become web-savvy doctors.
So it's a nice ride every semester, and students seem to be liking it.
There's one more thing that even professionals need.
That's online medical--not content curation, but resource curation.
We have to curate social media resources for them because they use blogs, Twitter,
YouTube, everyday, but they don't always know how to find the best potential resources.
That's what Webicina does on 80 medical topics in 3000 medical resources
in 17 languages.
One more thing here, regulations.
It's not always clear how we can communicate with people with patients, with pharma,
through social media, and I believe that we can wait for the FDA to come up with something
for the next few years.
I'm not really optimistic about that so I thought we should start something.
We should launch a campaign.
So I launched this project this May and June, a joint collaboration that we try to
come up with one open access set of guidelines for pharma using social media.
After this, we will come up with a set up guidelines for medical practices
using social media. For this, I would love to invite you.
I invited about 30 medical bloggers, pharma bloggers, and gurus from
major pharma companies who accepted an invitation, and they are now using and working
on the Google Docs that we set up.
We want to come up with guidelines about how to use Wikipedia as a pharma company,
Twitter, Facebook, blogs, all these resources.
So if you think you would like to contribute to that, please let me know about this.
I would love to invite you to add a Google document with us.
It's a real collaborative process.
You can find it under this address, and you will get access to the Google document
if you send me an email that you would love to participate in that.
So thank you in your interest for that.
I'd like to emphasize one thing at the end.
This is my core message at the end.
I know I brought you many examples--that's my core message.
But I believe the same rules apply for real life as for the internet,
and I mean, I always tell my students, if there are things you would never do in the real world
then please don't do that online either.
That's how simple it is.
If I don't want to discuss my holiday experience with my patient at the grocery store,
why would I do that on Facebook?
Why would I become friends with my patients on Facebook?
I believe that that's how simple it is, but of course in more details.
So social media is not new.
At Stanford University, they did a research on letters sent by people to each other
in the eighteenth century, and they could come up with 1 real huge
circulation of information, a real social network of people sending letters.
Now it's much faster. You know it well. It's much more interactive.
It's archivable. We have social media. We can send tweets in seconds.
And it's even bigger, but the concept is absolutely not new.
One more thing I would like to conclude my presentation with is
that social media is really not about technology.
We can talk about platforms. We can talk about iPads and Galaxy Tabs.
But it doesn't matter. It's just about communication.
I still have to see my patients in real life.
I still have to talk with my patient in real life.
But communication now is different.
I can use Twitter, Facebook, blogs. I can use my mobile phone or laptops or PCs or Macs.
It doesn't matter. It's not about technology.
It's about the concept--the aim, to be able to improve healthcare through social media.
So I hope to, let's tweet in touch.
Thank you for your attention.