Number Needed to Tweet: Podcast with Charlie Wray

Eric: Welcome to the GeriPal Podcast! This is Eric Widera.

Alex: This is Alex Smith.

Eric: Alex, who do we have in our in-person studio audience?

Alex: In our in-person studio audience we have Charlie Wray, who is Assistant Professor of Medicine here at UCSF, and he works here at the San Francisco VA, and he’s a Hospitalist. He’s also a social media editor at the journal of Hospital Medicine, right?

Charlie: That’s right.

Alex: Welcome to the GeriPal Podcast, Charlie.

Charlie: Thanks, guys.

Eric: Welcome! Before we talk about, the title again was, for this podcast is, Number Needed to Tweet? Is that right?

Charlie: That’s right.

Eric: We always ask all of our guests for a song for Alex to sing.

Charlie: Yeah, so looking at Twitter, you have a little bird as their little icon, so I tried to think of a band that had a bird in it. Thought about The Black Crowes, one of my favorite bands growing up as a kid. And I think one of the songs, if I was ever stuck on a desert island and could only listen to one song for the rest of my life, I think this one might be one of them. Which is, She Talks to Angels, by The Black Crowes.

Eric: Nice! We should do that. Ever heard of Desert Island Discs, it’s an old BBC show? Where they ask people, what would you bring to a desert island?

Alex: If you could only listen to one thing, or one disc for the rest of your life, what would it be?

Eric: There was one with Dame Cicely Saunders.

Alex: Wonder what she said? That’s good.

Eric: Before we go more on a tangent, you wanna give us a little love?

Alex: Little bit of Black Crowes here. Terrific choice. [Singing]

Eric: I could tell Alex likes that song because he did the extended version in the beginning. That was fantastic.

Alex: It’s too good to do a short snippet!

Charlie: You should keep going.

Alex: I even cut it a little bit!

Eric: This entire podcast is just gonna be that song. Over and over again.

Charlie: That’s fantastic. That’s great. Great job, Alex.

Eric: So, Number Needed to Tweet. Charlie, how did you get interested in social media, and especially social media and academics.

Charlie: Great question, and I get this question quite frequently. I think it sort of stems back to when I was a resident. I was a good resident, I was sitting at home, I’d be reading these really interesting articles that I would find really fascinating. My wife, who’s a pediatrician, was a resident with me, I would sort of lean over to her and I would say, “Check this out! Look at this. This is really cool.” And she would give me this really sort of disdainful look of like, I don’t care. And she would literally say, “I don’t care.” So I would be left with reading things that I found really interesting and I wanted to share it with people, and I could share it with my co-residents, but just not at all hours of the day, of course.

And I was on Twitter, and then I sort of noticed, hey other people are doing this. Other people are sharing the things that they found interesting. So I started posting articles that I found interesting, along the way, people would respond. So it was a way for me to sort of have a conversation with people about medical topics that I found really interesting. I noticed that it was a place where I could put my voice out there, but I could also listen to other people along the way. So it was a good give and take. So that’s when I discovered it. Then, just like as most people get into it, you just start off slow, then you get more and more and more involved over time. That’s how I kind of got involved.

Alex: So let’s bring it to the contemporary conversation. I remember in your talk about this, and you give grand rounds recently with this same title, you said that there are a number of barriers to people using social media. Physicians and other clinical providers and health care professionals, in particular. Could you talk a little bit about that?

Charlie: Yeah. So there are a few things that I think people find somewhat intimidating. The first is the overall intimidation factor, the idea of like the whole world is listening to you as you’re trying to throw your voice out there. So I think people get intimidated by that idea. Is the idea of it taking too much time out of their lives. I think a lot of people already, your mental bandwidth is already is sort of stolen from your work to your home life. And this is one extra aspect that I think people try to add into their lives and I think they fear that it might sort of take over their lives in some regards.

And a lot of people have asked me about that. So how do you balance your social media work with the things that you’re sort of doing? And it just takes a little bit of will power, I think, just like anything else. So I think people becoming overwhelmed with it is another issue that I think people sort of run into along the way.

Alex: Yeah. It’s one thing we hear quite often, Eric and I actually just did a teaching session for the new palliative medicine fellows about social media and palliative care. And one of the major barriers that they brought up was, how am I going to find time for this with all of the other things that I have to do, and I’m trying to cut back on screen time?

Charlie: Right.

Alex: Isn’t this going to make the problem worse?

Charlie: Right. I think that’s a fantastic question. And this is the way I rationalize it, and I will put the emphasis on the word rationalize it. My time on social media, I’ve really tailored my stream, I’ve tailored what I listen to and what I pay attention to, to be following medical individuals and medical topics. So, my rationalization is that, when I’m on there, I’m kind of working at that point in time.

Alex: Yeah.

Charlie: I am keeping my pulse on the medical community, trying to figure out, what are people talking about? What’s new in research? What’s new in med ed? And that influences my work. So part of me rationalizes as my time on social media as part of my work at this point in time.

Alex: And I think that’s what we generally do, as well. We focus on using social media, Twitter in particular, it’s really a professional focus for us. And we save time, actually, by letting others kind of crowdsource. Like, what is the thing I should be reading, because everybody else is talking about it? And then contribute to that with our own individual take.

Eric: Right. Do you find that helpful, too?

Charlie: The crowdsourcing?

Eric: Yeah.

Charlie: Absolutely. The thing I try to convey to people is, I’ve read hundreds of articles that I never would have found on my own. From journals that I just don’t subscribe to, that I don’t even know exist. That have sort of come my way because somebody highlighted it along the way and said, “Check this out. This is really interesting.” So, absolutely. I’ve been exposed to ideas and topics that I wouldn’t’ve found on my own. And it’s certainly influenced my practice and It’s certainly influenced the way in which I think about medicine, as well. So, absolutely.

Eric: What about the argument, who really wants to hear what I have to say? Why should I go on social media, ’cause like, who am I? Who am I to tell people what’s interesting or not?

Charlie: Yeah. Man, I think everybody has a story. I think everybody has something to say. I had that feeling and I still have that feeling. Who am I to say something and anybody just sort of listen to me? But I think everybody has a story. I’ll give my one example.

So, yesterday, we have a patient on my service who required a certain type of diaper, and we didn’t have it here. So, what did I do? I went down to Walgreens and I came back and I got them for him. And I tweeted out, because I thought this was an interesting idea of, what are special things you’ve done for your patient, to keep them in the hospital and to keep them happy? Tweeted that out there just to sort of say, what do people do? And I had, I think, 40 or 50 comments already about what people are doing to sort of keep their patients in the hospital. I found that they have a story. I think everybody has a story to tell and bring to that conversation. I was completely enlightened by almost every single one of them. I think it just shows the good in the world with that example.

Alex: Terrific. So we’ve talked about some of the main barriers, and you’ve talked a little bit about reasons to do this. Could you give us a little bit more about reasons to do this? Maybe first starting with people who are in clinical practice but not researchers.

Charlie: Good one. So for the individual who is not a medical educator or a researcher, I think one of the areas that you can really benefit from social media is using social media, again, as keeping your finger on the pulse of what is happening out in the world. Because I think a lot of clinicians end up sort of operating within their bubble, within their institution, doing their own thing. Then, once a year they’ll come out of that bubble. They’ll go to a national conference. They’ll hear what’s sort of going on. And then they go back into their bubble. Yet I’ve often times argued that social media is a way to sort of stay outside that bubble constantly. From, what trials are coming out? What do people think of outcomes from these trials? And these are things where I think, as individuals, we can think about them, but I’m not an expert on a lot of these things.

So I think hearing how other people sort of interpret the new medical literature, I think is a great way for people to, again, sort of extend their boundaries and not be just sort of insulated. So I think as clinicians, it’s a great way to just hear what other people are doing and or practicing.

Eric: Yeah, I agree. I think there’s a lot of different types of social media, too. So, just podcasts, I listen to Curbsiders a lot, great podcast. Just to stay up with internal medicine topics. And sometimes, like, I loved their hyponatremia topic.

Charlie: Yeah!

Eric: Oh yeah it was great!

Charlie: Joel Topf gave that one. And he’s fantastic, absolutely.

Eric: It was as amazing.

Alex: As amazing as hyponatremia can be.

Eric: It was. It was great. But like, learning from all different types of whatever. If you like the audio component, listen to podcasts. Or Twitter for short, bite-sized stuff. Or blogs if you like the reading. There’s another one that came out on the New England Journal, I think it was the New England Journal, about just sharing stories and the importance of just sharing stories.

Charlie: Right.

Eric: Using social media. Especially for people who may not have a lot of colleagues that they’re working with.

Alex: Right. People who are in rural areas may not feel a part of a community. You may be the only palliative care provider in the region. But you can connect over social media with other people who are. Well, how about the research folks now? What’s the reason to do it for the researchers? Because I am a researcher. I publish and I’m done, right? Isn’t that it?

Charlie: Yeah.

Alex: No?

Charlie: Right. So I have a nuanced viewpoint on how researchers should engage with and on social media at this point. So, 10, 15 years ago I think the paradigm was, you wrote your paper, you sent it in. It was published. It was printed. It went out. Everybody walked out to their mailbox and picked up the newest issue of JAGS and read Alex’s paper. But we don’t flip pages anymore to find information, we scroll on the computer screen at this point. My argument at this point is you spend, on average, people spend months to years on a single paper. You submit it. It’s sent out there. And then, who reads it? There’s been studies that show, on average only 10 people are ever going to read your article. Half of all articles, only three groups of people are going to read them. The authors, the editors, and the reviewers.

Alex: That is sad.

Eric: And the author’s mom.

Charlie: And the author’s mom, right. Right. And the author’s mothers will, of course, read it. So I feel like you’re doing a great disservice if you just stop at the publication point and don’t help disseminate your research. And I use social media to disseminate my research, my colleagues’ research, research that I think is actually engaging and interesting.

Eric: But as a researcher, aren’t you supposed to be a neutral party that just delivers the facts and let other people deal with all that dissemination and interpretation.

Charlie: Yeah, I wish. I wish that would be the case. But if you’ve ever read a paper, and often times when you read a paper, and you’re like, well why didn’t they think of this? Why didn’t they do that? And what about this? You know, social media allows you to engage researchers on a level that you couldn’t. Again, 10, 15 years ago, certainly you could email them, but very few people probably did that. 30 years ago, you could have written them a letter, but nobody ever did that. But now, when I see a paper written that I think is really interesting, and I have a question about it, and I can find that author out there, I can engage them very quickly on that.

Eric: Yeah, I also just clicking on the Altmetric scores to see what are people saying about this article that just came out. Often times looking through the Twitter timeline for that article using the Almetric score, just to see, how are people interpreting this?

Alex: You had some really interesting statistics in your talk. In fact, there was a study in your talk that you cited about journals that were promoting articles using Twitter alone versus Twitter plus a visual abstract. Maybe we should back up for a second and talk about visual abstracts and what that is. What is a visual abstract?

Charlie: Good question. Visual abstracts are, if you sort of think about a poster presentation at a national conference and look at those posters. If you just took that and made a digital format of that, but with the idea of making it much simpler, only focusing on the sort of the outcomes, the results, and the conclusions, and then using visual cues to sort of help people remember that information. That’s a visual abstract. Visual abstracts were created by a guy, Andrew Ibrahim of the University of Michigan, probably 2 years ago. In the Twitter sphere, they’ve gone gangbusters in the past year and a half. Last I checked, over 70 journals were using them to help disseminate their work. Several institutions use them as well to sort of spread their word as well.

As you mentioned, at the Journal of Hospital Medicine where I help as a social media editor, we’ve been using it for about a year and a half right now, and we’ve noticed anecdotally and empirically that tweets that have visual abstracts that sort of have visual cues with them, do much better, they’re disseminated much further. And Andrew Ibrahim actually did a study in Annals of Surgery that showed that tweets that had a visual abstract with them, were tweeted almost 8 times more frequently than tweets that didn’t have them attached.

Alex: That is impressive. Eric, you’ve done some similar work with JAGS. Do you want to talk about?

Eric: Yeah, definitely. We’ve done visual abstracts. I think the challenge is just from a, like I run the JAGS social media content, is that I don’t have the time to do visual abstracts for everyone, so it’s really trying to get authors to do it. I think the other thing that we’ve seen is it doesn’t just need to be a visual abstract, anything visual. So figures, trying to increase the visual aspects of our posts. Significantly, I think that doubles the amount of people who interact with our content.

Charlie: Right. I think there’s some good sort of behavioral science work that shows that if you don’t catch someone’s attention in something like 30 seconds, you’ve lost them. I think that’s probably dated, I think you’ve got like 5 or 6 seconds nowadays.

Alex: Yeah, less.

Charlie: So I think the visual cues are a great way of trying to do that.

Eric: So I think this does create one of the things that people are worried about is, again, as my role as a neutral party of disseminating facts versus am I like a newspaper editor that just wants to throw out the flashiest, catchiest title to bring more people into reading my article? How do you balance that?

Charlie: Yeah, that’s a fantastic question. I think as a scientist, as someone who attempts to remain as objective as possible, whenever I do a post a visual abstract or anything to that notion, I try to remain extremely true to the study. And we, at JHM, have sort of come up with a policy where I don’t change the wording. I don’t take anything from the author, or rather, I don’t extrapolate from their paper, and we use exactly what they have presented to us. So we’re not trying to build up a paper, and we’re not trying to sell it by any regards, we’re just trying to present it in a visual formatting that people will hopefully engage in sooner and quicker.

Alex: Yeah, that’s a great perspective because this isn’t about sensationalism. The goal isn’t dissemination for dissemination’s sake. It’s about clear communication of the essential findings of the article to as many people as possible. And by doing it clearly using visual abstract and means that are quickly accessible to people, you may draw in more people to do that research. But that doesn’t mean crossing that line into sensationalism and just for the sake of getting hits on your Twitter feed.

Charlie: Right. It’s a slippery slope, certainly. But we try not to fall down that slope.

Eric: What about for educators? Is there a role in social media?

Charlie: Absolutely. And I will use you guys. Eric, I used you in my example in my talk a little bit, and many of the sort of program directors and fellowship directors here at UCSF. The primary modality that I think educators and mentors, which I’ll sort of group in here, is how to support your students, your mentees along the way. And there is nothing better than highlighting their successes out there. I think people feel that nice sort of, it’s the virtual pat on the back from your mentor if they post your work. If they post a picture of you standing next to your poster, or of you on graduation day, or the good work you’re doing in the clinic. It’s just a fantastic way, I think, to support your trainees. And I think medical educators, and the ones who I’ve seen, do it really well, often use that as a way of doing that.

Alex: People feel honored and respected and important when you take a picture of them alone, and then when you take a picture of them and then disseminate it on social media, they really feel acknowledged. And it’s pretty simple to do.

Charlie: It really is.

Alex: But it’s very meaningful for your mentees.

Charlie: Absolutely. I’ve seen other folks do this a lot. If you’ve got a substantial following and you have been deemed a clinical connoisseur, somebody who is sort of good at clinical messages, people will follow you for your academic knowledge. So there are a few guys I can think of off the top of my head who are really good at interpreting and reading EKGs, so they are always posting tidbits and facts about how to be a better interpret EKGs. So that’s another way in which you could sort of feed information, I think, to your learners through sort of asynchronous ways and through the nontraditional ways of teaching as well.

Eric: Any other reasons why we should be more involved as physicians or clinicians? Because we’re busy with our clinical lives. Any other reasons why we should get involved?

Charlie: Yeah, this is something where I’ve gone back and forth on this over the past several years. And I think we should be involved. Don Berwick wrote an article in JAMA about a year ago, sort of really advocating that we’re at a point where physicians for many, many years have not really had a voice, either socially, even in a lot of the medical debates. And he had this just very poignant article with the idea like, how do we get involved as physicians, and how can we do it? And if you sort of look at all the options that we have, are you going to call your senator, are you going to sort of get involved, are you going to go to Washington or anything like that? And probably not.

But it’s as simple as sort of tweeting something out for something that you believe in, be it patient advocacy, be it of health policy, be it a clinical issue. I think that’s just one way of getting your voice out there and being heard and being acknowledged as a physician. I think a lot of people have argued we’re not as vocal as we could be, and I think this is just one extra avenue in which we can.

Alex: Yeah, one extra avenue, and it’s part of our professional responsibility. I’d say as a profession, we have a responsibility not just to care for our patients but also to think about the larger health policy context in which that occurs, and advocating for policies that promote good care for our patients.

And we can do that through social media. And we can also counter misinformation that’s disseminated via social media, such as death panels, which first appeared on Sarah Palin’s Facebook page. So we need to meet that misinformation where it occurs, and disseminate thoughtful, appropriate, accurate information about what our services are and polices that promote them.

Eric: But it’s hard enough just being a good clinician. Now you’re adding all of these other things that I should be doing.

Alex: Eric! If Trump can do it, you can do it!

Charlie: Why aren’t you awake in the middle of the night tweeting, Eric?

Eric: Occasionally I am. No, but I’m serious. I think this is the big challenge, is that just over the last, I finished med school in 1998, there was very little talk about quality improvement, and now we’re supposed to be quality and safety experts.

Alex: You finished med school in 1998?

Eric: No, I started med school in ’98. So I guess 2002. Alex and I were in the same graduating class. Sorry, I lose track of time. But even like 2002, how many times did we hear being quality and safety experts? That was not part of our med school training. And as the years came up, it just seems like, in the last 15 years, now I have to be experts in all of these different things. And now you’re telling me I got to be an advocate too. Like, what the hell.

Alex: Yeah, life’s hard man. Being a doctor is hard.

Charlie: It sounds like I think there’s a lot of stuff on burnout out there that maybe you should look into.

Eric: I’ll work on that. #burnout.

Charlie: I don’t have a great answer. I struggle with it as well. I have a full-time job just like you guys. I have kids and family at home that I would love to spend more time, and this certainly adds something extra to it. But I find a way to fit it in, and I think it’s somewhat possible.

Eric: Yeah, and I think of actually going back to the burnout literature is actually finding that meaning in one’s work is exceptionally important to prevent burnout. And advocacy, safety, all of those things could actually add to one’s wellness rather than distracting.

Charlie: Right. Yeah, it comes back to one of the things that I often sometimes say about Twitter and social media. So I think one of the fallacies is that a lot of people sort of enter into social media and think, the goal should be getting the greatest number of followers that you possibly can. That’s not what I do. To me, it’s about finding your culture, finding your following, finding your group. Because the other reason that I actually find social media engaging and helpful in my life is I can find people who are struggling with life and work just as well as I am. And so sometimes you’re like, “Man, I just had that paper rejected again.” And I scroll through my Twitter feed and everybody else is talking about their papers they got rejected. And it’s just, it again, it expands my community outside of the folks who I have sitting right next to me. And that’s helpful in my life.

Alex: And it’s Bob Senter who I think is at UAB, likes to say, he has his own blog and he tweets quite often. He likes to say, “I do this social media stuff at the interstices of my day.” Very medicalized analogy there. The little spaces in between, in between meetings, during lunch break, just flip to it and re-tweet and have a take on this. Posting, “I’m bringing diapers back from Walgreens for my patient. What are you doing for your patients?” That takes like a minute.

Charlie: And that’s how I utilize it just as well as I’m sure you guys are.

Eric: Alright, you’ve convinced me. I should go on social media. What do I do? Where do I start?

Charlie: So, there’s an unfortunate term, but people use it frequently. So, do you lurk? So you get on, you set up your account, and what I oftentimes tell people is just hang out. Follow, find 10, 15, 20, 30 people that you know at some national level and start to follow them. See what they’re saying. See how they’re actually saying those things. And they will re-tweet people or follow people or give you hints as to whom you should be following. And you will just start following individuals along the way. And it was once told to me that it takes about a year for someone to get really comfortable in social media, from just lurking to posting original tweets. And at first I was like, “Nah, that’s too long.” And then after about a year, I was like, “no, that’s about right.” It took me about a year to build up the courage and sort of do it. And you’ll find your voice, you’ll find the topics that you want to be known for. And then you’ll find your group and I think find your tribe in there. But I think it just takes time.

Alex: Yeah it takes time.

Charlie: How about you guys? I mean what do you … you guys are out there, what do you guys do? Or how would you recommend-

Alex: We do a little podcasting and blogging and tweeting-

Charlie: You may have heard of our podcast.

Alex: But, yeah we do a lot of stuff.

Eric: The thing is that I think the fun part has been that we’ve always … it’s such a low barrier to try, that if you fail, who really cares?

Charlie: Yeah.

Alex: Yeah.

Eric: And from doing our blog to being on Twitter, to doing these podcasts, like our initial podcast was with a really bad microphone and my computer and that was about it. So the entry barrier was exceptionally small. And that was true for our blog too. And I think it’s helped me, academically progress as well. I think most people know me because of the things I’ve done in social media.

Charlie: Right. Yeah, and getting to one of your points you just sort of mentioned, sort of, if you fail who cares … I think a lot of people sort of worry “well if I send this tweet out and it’s a bad one, what happens? Are people gonna hate me?” I’m like, tweets have half lives of like 3 hours. So if you say something that’s either offensive or wrong, or it just wasn’t something that came out correctly, it’s gonna be gone and in the ether for most individuals, in about 3 hours. And so, you always have the chance to start over after that.

Eric: With a caveat, like, I remember one of Ken Covinsky’s tweets that he sent out once, was around over-the-counter statin use, ’cause it was being considered statins over-the-counter, and he wrote a tweet just saying “NOOOOO” and then he got a call from the New York Times, from Paula Span, to talk about statins over-the-counter. So, you never actually know when that small tweet actually may lead to a much bigger commentary. And we’ve seen that with our blog posts, where it can get picked up, and next thing you know it’s on NPR.

Alex: Yeah when Paula Span was here on our podcast, she said, as far as she’s aware, everyone in the New York Times is on Twitter.

Eric: Yeah, every journalist-

Alex: Every journalist in the New York Times is on Twitter. Because it’s perfect for journalists. These little snapshots of information they can scroll through. And many of our interviews with New York Times, or USA Today, or other traditional media, have come through things that we’ve posted on social media.

Charlie: Right. No, I’ve had the same experience. People have reached out to me, said “I noticed you said this, can you offer a comment?” Or, “what’s your perspective a little bit further?” And it’s good stuff, they’re fun things to comment on and I’ve appreciated that. And I think that’s also to the advantage of social media, is the idea of people are hearing my voice, hearing what I have to say, and I get to comment on it in those more traditional methods as well.

Eric: Why should journals be on social media? You’re doing this for Hospice of Medicine, right?

Charlie: Right. Yeah. There are two numbers that I oftentimes quote for this, so the circulation for, and I use this ’cause I refer back to Andrew Ibrahim’s study. The circulation capacity for the Annals of Surgery, which is a large journal, is I think a little over 1,300 individuals, yet they have over 35,000 followers on Twitter. So, there’s the old Willie Sutton quote of, “why did you rob the bank? Because that’s where the money is.” And if you’re a journal trying to get your voice out there, you gotta go where the people are. And to me, again as I sort of refer back, we don’t flip pages anymore, people scroll through computers so that’s where you have to be.

Alex: You had an interesting metric in your talk about low impact, medium impact, and high impact. And I wonder, where GeriPal fits on that spectrum.

Eric: Of course, high.

Alex: How did you come up with that, and-

Charlie: Oh yeah, so I didn’t come up with it, that’s not a Charlie Wray original, I think that’s a Jonathan Serbino et al., he’s … there’s a bunch of ER docs who sort of came up with this, as you sort of allude to Alex. So how do you, as medical educators, or clinicians, or researchers, how do you sort of measure your impact on social media? And they sort of categorized this. And essentially, low impact you have a certain number of followers, middle impact you have more, and then of course high impact you have a lot of followers. I give you guys high impact, you know I’m not a geriatrician and I actually follow you guys and I enjoy your posts, and that’s good.

Alex: Good answer. Right answer, you can stay.

Charlie: I’m giving you-

Eric: We will not delete this podcast.

Alex: But from here it’s a short hop to, is there anything in it in terms of promotion? Like for people who are in academic settings, is there anything … like, why would I do this rather than write an article for a journal that is the traditional currency of promotion?

Charlie: Yeah. We are currently in the wild wild west of how social media fits into academic promotion at this point in time. There are a few places that I think are starting to recognize this a little bit more. Mayo Clinic is one that is now using social media engagement as a metric for promotion. I don’t know their internal metrics with regards to that, but they are certainly … they’ve been doing this for couple of years now. How do you do this? If you sort of ask some of these guys who’ve been on social media for a while, it’s quantifying your metrics, so if you’re putting your work out on ResearchGate, how many people are following you there? If you’re a medical educator and you’re putting your slides up on SlideShare, how many downloads are you getting there in a year? And you put that into your promotional packet. And granted you just can’t put those numbers out there, I think you have to explain your niche, who your audience is, what your platform is, and what you’re trying to sell. I think that’s the beginning stages of trying to integrate your social media utilization into your advancement. I think over the coming years as people realize social media is a powerful tool, I think it’ll be more and more accepted. How we measure that impact? I think we’re still trying to figure that out.

Eric: Number of national elections that I’ve influenced.

Alex: Good! Well this is another important issue, because I think a lot of people are afraid of social media because of manipulation of the social media in order to influence the recent Presidential election. And you were asking when you first came in, before we started recording, who purchased this equipment? I just want to make sure that we acknowledge this was purchased by the Russian FSB, and some guy named Putin.

Charlie: Vlady.

Eric: Through multiple shell companies-

Alex: Multiple shell companies.

Charlie: That’s awesome, that’s great, that’s great.

Eric: No, but a lot of people actually stopped using things like Facebook, and actually-

Alex: I cut down on my Facebook … I didn’t delete it but I cut down on my use of Facebook after … I did! I did, and I’m coming back to it slowly.

Charlie: Yeah. My response … When I gave Grand Rounds there was a question that sort of said, was alluding to what you’re getting at there, and my response very much is I kind of act like an ostrich, where I stick my head into the ground, but my hole, again, just contains individuals who, you know, physicians, health policy wonks, medical educators, clinicians, to where all the nasty stuff that certainly exists within social media, I really just put my blinders on and try to stay away from that. So I just try to isolate myself away from those things.

Alex: And any rules or suggestions for people who are interested in posting on social media in terms of stuff you maybe shouldn’t put on there? Or shouldn’t post pictures, tweets, et cetera? Seeing as it’s gonna be cataloged by the net, Library of Congress, for all time.

Charlie: I think if you just follow the general rule that if you’re in a crowded elevator could you say this out loud? Is a general rule that I sort of use. And then, like anything else, as you’re typing out your tweet, read it a couple of times, of course, and then sort of step back and go “how is this going to be interpreted by a general audience?” Or the audience that I’m sort of also aiming at as well. And then of course your photos, I think just being very wary of how things may be interpreted by other individuals. I think is just the larger tenant that I’ve always adhered to, and what I’ve always sort of been taught. And then just the final thing I always tell people is be nice. You know this is a place where I think there’s a lot of vitriol, and I think people can sort of, it can get sort of angry out there at times. But I’ve found that if you’re just nice and cordial people will respond to you much more, I think you’ll get much more engagement.

Eric: Great. Any other last practical tips that you have for somebody who maybe is just starting? In that first year, that you have for them, to dive deeper into this?

Charlie: Yeah. One thing I’ve always sort of advocated for is find a social media mentor, and what do I mean by that, is … I’m not gonna direct message Eric and “will you be my mentor?” But-

Alex: Everyone. If you’re listening to this podcast, direct message Eric.

Eric: I do actually rarely check my direct messages, so just tweet me.

Charlie: Someone’s waiting for that response right now.

Eric: Damn you, Eric! Vitriol!

Charlie: But using Eric as an example, the way Eric expresses ideas, or the way he tweets it, if that sounds interesting to you, watch how he does that for 3, 4, 5, 6 months. And then mimic that in some form or fashion. The other idea is don’t just post a link, tell me what you’re thinking about that link. You know I’m following you because I wanna see how you’re interpreting things, or what you think about that topic. And then the other thing I always say is that you’ll notice if you follow me, I rarely post anything without a photo at this point in time, mainly from what we talked about earlier, so if there’s an article, take a snapshot of that article, throw it out there. Highlight the things that you want people to really key in on. And I think that will engage an audience, people will want to talk to you at that point in time, more so than otherwise. And then just find your voice, and know that it’ll take a little time along the way.

Eric: Great, well I want to thank you for joining us. It was a fascinating discussion.

Eric: Thank you Charlie, that was terrific.

Charlie: This is great guys. Thanks for inviting me over.

Eric: Maybe before we end we’ll do the 3 and a half hour version…

Alex: Yes! 3 and a half hours! That’s what I’m looking for! Extended, She Talks to Angels, Black Crows.

Charlie: That’s awesome, I love it.

Eric: The first 2 hours is just the acoustics.

Alex: All right, here we go. [Singing]

Eric: And with that, I just want to thank everybody for listening, we look forward to having you join our podcast next week, and we’ll also see you on social media.