Too Much Twitter

Dr. Uri Ginzberg has an interesting post regarding the use of Twitter as a tool in medical practice. (Those of you who are unfamiliar with Twitter can refer to this video. It’s an excellent explanation of what it is.)

In his post, he proposes that Twitter can be an excellent medium of communication between healthcare professionals and patients. It can, for example, inform nurses and patients about your whereabouts and activities. It can also provide you with the ability to participate in “micro-consults” with patients.

It’s an excellent idea, but I think it will cause more problems that it will solve.

I don’t know about you but I wouldn’t want to be burdened with consistent updates from my patients. Yes, I say burden. It’s one thing to receive a call or two everyday, another thing to get tweets several times a day. Some of you may think I’m exaggerating, but how many patients to you want to keep tabs on with Twitter anyway? Just one or two? The more patients you follow on Twitter, the more stressful your life will become.

Getting tweets like “I’m having lunch with my aunt” from a friend is not like reading “@geekydoctor I’m not feeling well today” from a patient. In the former, there is no expectation of a reply. The latter necessitates action, and failure to act may constitute negligence. True, if the patient has your cellphone number he can just call or SMS you. But my point is — given the ease of posting updates — patients will be less likely to filter out minor events. Next thing you know, you’ll be getting tweets from anxious patients regarding every bowel movement, every episode of “pins and needles,” every spike in blood pressure, every little tremor.

If you’ve seen Bruce Almighty, you’ll remember the scene in which he starts to hear prayers. It’s going to be something like that, only a bit scaled down. Do you really want to play God 24-7?

What will constant patient updates do to a doctor’s decision-making algorithm? Doctors learn to filter out unnecessary bits of information. Too much information and the decision-making process might break down. In Blink, the writer Malcolm Gladwell uses the example of Dr. Brendan Reilly’s experiment in Cook County Hospital, in which he proves that a 4-step decision algorithm is sufficient in the diagnosis and management of acute coronary events. Taking into account too many factors — in the case of Cook County, more than the four factors in the Goldman algorithm — into consideration was proven to be a less efficient way of doing medicine. Will taking into account what you know from cumulative tweets be any different?

Even if you’ll be able to filter out relevant tweets, there is a reason why the doctor-patient relationship has boundaries. Being able to know each and every symptom at the very moment they happen can theoretically give you an advantage as a physician, but at what cost? Dr. Antonio Dans, one of my mentors, always talks to us about physicians “burning out.” Constantly monitoring tweets from patients will rob you of time and, sooner or later, wear you down.

I might be wrong but I don’t think Twitter will be a useful tool for medical practice. Patients will benefit more from patient communities (like PatientsLikeMe) and forums. And for doctors, let’s concentrate on services with some promise, like online office applications (Google Docs, Zoho) and EMR (Google Health, Microsoft HealthVault).