What happens when a highly respected physician, noted for his ferocious passion for evidence-based medicine, writes a blog post denigrating physicians who use twitter? What if that same vociferous defender of science and the scientific process doesn’t actually have a twitter account, or any intention of having one?
If you’re guessing that the irony of the situation was noticed and commented upon, you would be correct.

On April 4, Milton Packer, MD, a renowned cardiologist at Baylor Scott & White’s Heart & Vascular Hospital in Dallas, published a post on his Revolution and Revelation blog at MedpageToday.com. That’s not unusual; Dr. Packer has been blogging at MPT for almost a year at this point, and posts regularly. April 4th’s post, “Do You Practice Twitter-Based Medicine,” proved to be a controversial one. That’s also not unusual; Dr Packer is a man of strong opinions, who isn’t afraid to ruffle a few feathers. Past headlines, for example, include “Does Anyone Read Medical Journals Anymore? Milton Packer wonders whether authors are wasting their time,” “The Fake Hypertension War: Medical politics and mud fights,” and “Are Researchers Who Work With Industry Always Evil?”
That kind of open and honest voice is welcome, especially in the at-times-overly-polite and deferential culture of medicine. And Dr. Packer generally has the creds to back up his strong opinions; after all, the man “was a founding member and former President of Heart Failure Society of America. His research on the treatment of heart failure led to him being awarded the Lewis Katz lifetime achievement award in cardiovascular research.” Wikipedia: Milton Packer
Dr. Packer’s “Twitter-Based Medicine” post, though, appears to have differed substantially in that regard; Dr Packer has made it clear that a) he has never had a twitter account, and b) he does not intend to.
It seems that Dr. Packer did some poking around on twitter in an attempt to understand its appeal. His assessment:
“Many people who are professional cynics (or perhaps are clinically depressed) send out messages of dark disparagements, typically based on uninformed stereotypes. Their message: “Don’t believe what you read, but above all, you should believe in what I say …Others revel in expressions of self-congratulations — essentially, look what I have done! … If Twitter is your primary source of reliable and up-to-date medical and scientific information and discourse, then you practice EBM — emotion-based medicine. More precisely, you practice self-declared expert-based medicine. In reality, you practice opinion-based medicine.”
Excerpted from “Do You Practice Twitter Based Medicine” by Milton Packer, MD
The readers of this blog will undoubtedly know that, while what Dr. Packer’s anecdotal observations certainly hold true for some percentage of tweeting doctors, it is a far from the whole story – as tweeting doctors were quick to note. As of this publication, there are 29 comments on Dr Packer’s post; a few from doctors who, like Dr Packer himself, don’t have a twitter account and feel comfortable mocking their peers who do. Most are thoughtful posts from those who respectfully offer alternative opinions. But the real conversation happened on twitter itself. Over the ~11 days following the post’s publication, it was referenced in the MDigitalLife Health Ecosystem over 500 times by nearly 300 unique authors – the vast majority of whom were physicians.
Additionally, it inspired a post from Bryan Vartabedian, MD (Author of The Public Physician and one of my favorite blogs; 33Charts.com) entitled, “The Twitter Education of Dr Milton Packer.”
Doctor V has been teaching skeptical doctors about the virtues of social media for more than ten years, so he clearly knows whereof he speaks. The post makes several key points that have served to win over thousands of those skeptics, including: “Like hallway conversations, understanding and assumptions about research may be incorrect,” “Twitter is only as evidenced-based as the content it references,” “Any information stream is only as good as what you allow in,” “Public conversation and knowledge creation are not mutually exclusive,” and perhaps most importantly, “Medical leaders have a responsibility to understand modern communication.” If you google Milton Packer, that post is now on the front page of his Google Search results.
It will surprise nobody that I do not share Dr. Packer’s assessment of the value of twitter (in fact, I was one of the commenters on his post). But aside from my personal experience and 9 years of study of the physicians in this space, what strikes me as perhaps most compelling is a finding from an as-yet-unpublished research project that has surprised even me — that close to 50% of doctors in the Mayo Clinic and Cleveland Clinic’s cancer centers are now on twitter. That is staggering. IMHO, it is an indication that the future physician is going to look a lot more like Ed SchlossWestby FisherToniya Singh or Martha Gulati than like the Milt Packer we see today – and that distinction has little or nothing to do with their respective ages. However, based on the fact that Dr Packer is now an award-winning blogger, I am guessing that the value of social media is beginning to become apparent to him – and I have a feeling that we’ll see Dr Packer joining the conversation on twitter before too much longer. What do you think?

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