Chapter 25: Exploring Uses of Social Media
Dr. Fisch talks about his fascination with social media and his attempts to introduce its creative use at MD Anderson to communicate more effectively with patients and the public.
Dr. Fisch talks about his introduction to Twitter and his efforts to use it in healthcare, beginning with the Community Clinical Oncology Program. He explains why ASCO now has a Social Media Working Group. (Dr. Fisch serves on that committee.) Dr. Fisch explains the impact that social media can have on individuals and institutions and stresses the importance of making education about social media part of medical curricula. He states that MD Anderson has made some headway in this area, and he lists the consequences of not keeping up.
Dr. Fisch next talks about his involvement in a clinical trial that proposed to use social media to increase patient enrollment. He contributed to the grant, which the South Western Oncology Group has funded.
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History of Science, Technology, and Medicine | Oncology | Oral History
Michael Fisch, MD:
I would even say in my own career that the interface of social media and medicine is another sphere altogether. It’s not a medical sphere, but communication, you know, communication and media. It is part of what’s important, right? People want to eliminate cancer in Texas, the nation, and the world. To do that, you need to have some of the principles and practices of public health, and some of that involves communication with diverse communities, not just talk within the medical community, but interacting with the lay public and starting a dialogue and seeing what could be done, and engaging the public, the patient community, and the lay public, the people who are unaffected but interested in preventing cancer and interested in seeing their family members get good care.
Tacey Ann Rosolowski, PhD:
When did you first kind of realize that social media was going to be an interesting tool?
Michael Fisch, MD:
Well, I’ll take you back one step further and tell this story. It started, I think it’s 2005, for me, where I had the sense—I actually kept seeing things in clinic, and I thought if my patients were better prepared before they got into clinic, if I wasn’t having to start the curriculum right there, it’d be better, like if they knew something even before. So I thought, how could you get more people—the general health literacy or cancer health literacy elevated so that people came into their clinic visits with a little bit more to start with. I was thinking about that general issue, and this is at a time when the radio show [Car Talk] Click and Clack, the car guys, was popular. So I was thinking about the car guys, and, first of all, I’m not really into cars. I don’t know much about cars. I’m not a car aficionado. And I wasn’t religiously listening to every show, but I’d hear that show and I would listen to it. In the course of listening to the car guys, I ended up learning things about cars. So I would say that my car literacy, how car guys think, how they diagnose things, how basic things work, I was becoming smarter about cars with no intention for that, because the car guys were able to bring their reasoning as car guys into my midst by having the show that was a little bit light and entertaining, and I was willing to listen to it, and I was getting car-literate through it. So I thought, “We need the Click and Clack of cancer.” And I thought, “Well, how do we do that?” I’d been to a faculty development workshop where a guy named Christopher Avery, who’s sort of an executive coach, leadership guy, he had written a book called Teamwork is an Individual Skill. So he had his book and he was here. Janis Apted and her wonderful Faculty Development group had him there. And I remember very keenly one specific thing in this Christopher Avery lecture. He said, “How many of you have ever been part of a bad team?” My hand shot up. “Yeah, I’ve been part of a bad—.” You know. And he goes, “How do you know it was a bad team before you got there?” And it’s like, “Oh.” The hand goes down. That was a good hook. But I thought, wow, so Click and Clack of cancer means sort of palliative care, general oncology, and then like a normal guy who could ask—you know, talk to me like I’m a two-year-old. So what does it mean to be staged for cancer? And a very logical, reasonable, very mature way of thinking about personal responsibility, somebody like him and somebody like me, we could be the Click and Clack of cancer, although I don’t claim to have that kind of entertainment skill. I’m not a professional radio host, and I’ve never done anything like that. So it’s not that I felt like I had skills like that that I didn’t have, but I thought something like that. I was almost thinking not like this is what I want to be, but this is something that should be, and I wish somebody would do it. It doesn’t have to be me, but then nobody will begin to even understand it unless we’re willing to do something or show them. You know what I mean? Excuse me. [recorder is paused]
Tacey Ann Rosolowski, PhD:
All right. We are back recording again after about a ten-minute break, and you were talking about becoming the Click and Clack of—
Michael Fisch, MD:
Yes, so this idea of Click and Clack of cancer. So I tried to pitch that to MD Anderson, that let’s do a radio show, an MD Anderson radio show, and we want to call it “The Cancer Guys.” Click and Clack of cancer was just a way of describing it, but we’d be “The Cancer Guys,” and it could be Christopher Avery and me. But it didn’t matter to us; it could be anybody else. But we needed “The Cancer Guys.” So then we went and bought web domain cancerguys.com, cancerguys.org, and put together a logo, and we tried to pitch it to Communications. I went to Sarah Palmer [phonetic], was her name at the time. She has a new last name. But Sarah Palmer, head of Communications, and Steve Stuyck, executive leader from Communications, and our whole Communications group, and pitched “The Cancer Guys.” They were very entertained by this and it was interesting, but in the end, no action plan. Again, I don’t know, sometimes you pitch things, you don’t get a specific answer, “We’re not going to do anything, and here’s why.” But you just, “Thank you for coming,” and no thread of follow-up. So, just shared some information with them. So then I tried to pitch it to ASCO, and actually got invited to go to Alexandria, the new ASCO headquarters area. I guess it was in Alexandria. It was in the D.C. area. I don’t know if the new ASCO headquarters was in place then. It might have been the old ASCO headquarters. But I went to D.C. area, the Cancer Communications Committee, and they flew Mr. Avery and I there.
Tacey Ann Rosolowski, PhD:
Michael Fisch, MD:
I think Bob Mayer was—I don’t know if he was ASCO president, but he might have been the person who was in charge of that committee. One of my colleagues, Roy Herbst, was there. I remember Roy because he still to this day when he sees me, he’ll go, “Hey, it’s the Cancer Guy,” and he just remembers me pitching this thing. The committee was very intrigued by what we were talking about, and some ASCO staffers and other people thought that’s something that maybe ASCO should do, but I think that a lot of the other members of the committee who were academic colleagues thought it sounded like sort of self-promoting MD Anderson faculty or just sort of a self-aggrandizing opportunity that ASCO shouldn’t have a part of. And part of it was also a fear thing, of, well, if ASCO sponsors “The Cancer Guys” and these two guys start talking about cancer, what if they say stupid things? What if they say things that ASCO doesn’t agree with? It reminded me of like if you were being the Baltimore Orioles radio announcer. Jon Miller and Joe Angel, I think, were favorite announcers of mine when I was growing up, and sometimes I’d listen to the Orioles or Harry Kalas with the Phillies. But you realized that these guys were calling a game and they were basically hired by the Phillies or at least approved by the Phillies or approved by the Orioles, but nobody could expect every description of every play to be the official position of the Baltimore Orioles or the Philadelphia Phillies. So you had to let your announcers be announcers that worked, in general, consistent with what the organization would hold up, but that the listeners would know that they’re just some guy calling the game. If you want some official ASCO statement about something, you need to find the official ASCO statement guideline about something. Otherwise, ASCO’s just sponsoring some dialogue, trying to improve the cancer health literacy. But hard for people to wrap their head around, and so in the end, I tried a few times. I went that one time personally. I tried them once and again two years later, and it never took flight. But it was the same premise that became this social media thing. Because I think it was—I don’t know. I’m trying to remember exactly when Twitter started, but, I mean, Twitter, like, didn’t exist at all until, what, 2008 or so?
Tacey Ann Rosolowski, PhD:
Michael Fisch, MD:
I mean, this was pre-Twitter period, and I didn’t get started on Twitter until—and it says right on my Twitter account, because it gives you kind of your born-on date. But I think mine was like February of 2011 or something like that. I think that’s when it was. But it was right after the Arab Spring. I remember seeing the stuff happening at Tahrir Square and all these tanks in Tahrir Square. You’d see on the news, photographs of tanks they said that they got from Twitter, and I was trying to understand how does that happen? So some Egyptian citizen is taking a photograph on their smartphone, and then somehow the national news is seeing the photo. How do they get that from their smartphone on the national news. How’s that work? And then sort of understanding, oh, the photograph then gets turned into a—put on the web, shrunk into a bitty link, and then contextualized into 140 characters of other description of some tweet, and then how do they find it? So you tweet it, but how do they find it? And then I realized that hash tags were kind of indexing, right? So somebody would say “Tank in Tahrir Square, #Jan 30, #Egypt,” and then if you’re NBC News, even though you don’t know that citizen at all, you have no reason to follow them, and you didn’t know they existed on the planet, but you’re just following a stream by #Egypt and that day, and then you just look at what tweets are coming from all the world on that, and then some of those tweets have pictures, and then you can put together the pictures and you can confirm that this story holds up, that these pictures are consistent and that we’ve decided that this is true, and then you can report it. I thought that is unbelievable. So basically, each of these people has more or less their own version of CNN. They are like a reporting outlet to the world. Even if they’re not individually followed, they could be found as reporters. And then I thought, well, we should do that in healthcare, right? That’s the Click and Clack. The Click and Clack of cancer can start to affect health literacy by using Twitter, and it doesn’t cost you anything. So I started to try to do that, and I started to do that for our CCOP, and at one of our CCOP meetings, I think maybe in the spring of 2011, I started to describe Twitter and try to get people to start tweeting things about our studies and things about things we care about: healthcare disparities, cancer care, symptom control, cancer control. One of the people who came to our CCOP meeting at the time, Michael Thompson [phonetic], Mike was one of our fellows at MD Anderson, and I’d worked with him in the LBJ Clinic, and he’s just an amazingly talented individual. He has an MD/PhD and was just a top-performing fellow and had gotten ASCO Young Investigator’s Award and ASCO Career Development awards. But he had taken a road less traveled and went into practice in Waukesha, Wisconsin, in a community oncology setting and turned away all kinds of other academic job opportunities. But he wanted to academize. He wanted to have an academic career from a different platform, and he is and has been extremely successful at doing exactly that, sort of free agent, teaming up with former colleagues at Mayo Clinic and other places. But anyway, so Mike was there, and he took to this and he set up his Twitter handle. He’s @mtmdphd, Mike Thompson, MD/PhD. And my Twitter handle, @fischmd. So we started to share stuff just with each other. But he’s been enormously successful, so he’s now one of the preeminent tweeters in oncology, and he’s done many great things. He started tweet chats in myeloma, and he’s very well known to the top people in cancer care. And particularly in the certain areas of focus that he has in myeloma, everybody knows Mike, and they know him because he’s a talented guy and knowledgeable, but also because he’s easy to know through Twitter. All the advocates know him, and the Myeloma Foundation people, and people all over the planet can see things that he’s sharing, because he’s using Twitter kind of like the NBC was using it at Tahrir Square. Sort of that vision of how that could be done has been realized through Mike and through others in social media, but I think we got started basically right around that time, and now ASCO has just basically in the last two months approved the official Social Media Working Group, because people were starting to tweet at ASCO meetings, and then they liked it because there would be, like, millions of impressions about the ASCO meeting. Then last year, for the first time, they had official ASCO tweeters, so they would start to promote a set of people who would be more or less reporters through Twitter. Now they’ve started to formalize the working group so that they would have a formal process, because then some people would say, “How come they get to be ASCO tweeters? I want to be an ASCO tweeter.” Right? So then you have to have some way of managing this and some rules of engagement. ASCO has subsequently, through this informal working group that Mike Thompson and I and others are part of, Don Dizon [phonetic], Robert Miller [phonetic], David Graham [phonetic], a handful of people, have published a social media guidance. ASCO has sort of tips on social media, good social media practice, trying to professionalize social media. It becomes an educational point, too, like if faculty are using social media in a healthy way, in a professional way, then we can help guide our trainees on how to have the right professional way of being in social media, so that bad things can happen if you violate HIPPA through this or if you create an unprofessional impression or if you think that you’re obnoxious persona as a sports fan isn’t really you, it reflects on your professional self. There’s no way to disappear some other social media avatars you have. So people have to understand this stuff, but if there’s no faculty to understand it, then you can’t coach anybody. So it’s become part of a good medical education is to have some people—and the more the merrier—who are mindful of this, can teach it, and can model it and make it part of the new reality. Then within the institution, how does MD Anderson promote itself? You’ve seen in recent years, now Mayo Clinic has developed a social media—what do they call it—a Center for Social Media. So some other places have gone big. Here we can talk about it all day long, but then they go big and at high levels start to resource it and start to ask faculty not to wonder whether they’re doing it, let them get away with it, and try not to make a big deal out of it, sort of like a risk mitigation. “Just don’t hurt us with this and we’ll leave you alone,” versus, “Please do it, do it well, and let’s use it to help the organization achieve its lofty goals.” That’s a different approach. So Mayo has taken a different approach. MD Anderson has come along. Places like the Cleveland Clinic and the Mayo Clinic, again, if you go to the Cleveland Clinic or Mayo Clinic Twitter handle, they have—I don’t know, we can check it now. But they must have 800,000-plus followers, so they are able to send out a signal on their network and communicate things about health information or Mayo or Cleveland Clinic’s way of looking at health that’s very influential. MD Anderson has a version of this too. I think we had, last I checked, maybe slightly less than 30,000 followers. So, a significant gap. So if you’re sort of slow on the uptake of these things, there are consequences in your scope of influence. But MD Anderson is such an amazing place, so we don’t always have to be first out of the gate, we don’t have to win the first quarter of the race, so we frequently sort of hang in the middle of the pack and then we turn on the jets. So I’m always confident that MD Anderson, when it wants to turn on the jets, it’s got massive burst, and it just has to decide it’s time to come out of the pack and just get busy, but we haven’t made that significant burst yet. What happens in the other groups, I think, is in the end they engage faculty to help lead these things, so it’s not like the Social Media Center has no Mayo faculty. It’s faculty-led. It’s not led by a vice president of communications; it’s led by a physician. And then there’s other communications professionals supporting that. But you’re not going to run our melanoma department without a physician. You might have other kinds of people that help make a great team, but provider organizations ultimately, if they’re trying to organize healthcare, get physicians involved, and that hasn’t really happened in social—we don’t have a social media leader here. We don’t have a chief experience officer either. So Mayo Clinic with its social media, Cleveland Clinic, with patient experience, have physicians leads and have parlayed those innovations into big progress that has really helped their scope of influence, helped them move up the rankings in what people trust in healthcare. MD Anderson has always been way high in cancer, but they’re noticing people coming out of the pack that didn’t use to be on their radar in cancer care, and they’re sort of coming up not through massive prowess in some cancer advances, but through unusual channels: patient experience, social media. That’s not that they don’t have anything else going, but those are the things that are sort of getting separation in realms that seem to me really helping.
Fisch, Michael J. MD, MPH and Rosolowski, Tacey A. PhD, "Chapter 25: Exploring Uses of Social Media" (2015). Interview Chapters. 848.
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