How to Save Time Doing Healthcare Social Media: A Primer for Physicians

Followers, friends, and colleagues of mine often think that I spend HOURS doing social media everyday; reading, writing, and posting to all the various social media outlets I participate in including Blog (the one you are reading), Twitter, Facebook, YouTube, Google+, and LinkedIn.

Nothing can be further from the truth.

Beyond writing blog posts which does take time... I probably spend about 30 minutes daily reading and sharing. My reading lists typically is from customized Twitter lists I have created following users I find particularly interesting and helpful for my purposes to gain ideas to write about as well as share information that I feel may be of interest to my own followers, mainly on Facebook and Twitter.

Subscribing to RSS feeds can also be used, but I find customized twitter lists easier.

And I automate nearly everything when it comes to sharing to save time.

Here are my workhorse applications I use to save me time: Hootsuite, IFTTT, and bufferapp.

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Hootsuite

Rather than using Twitter whose interface I find clunky and inefficient, I use Hootsuite which combines all my customized Twitter lists as well as my other social media accounts all onto one concise, clean, and efficient web interface. They also have an iPhone and iPad app.

Any tweets or shared links I encounter, I can easily post to any other social media account all automatically from within Hootsuite so I don't waste time going to each individual websites for posting purposes.

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IFTTT

I also extensively use a service from  IFTTT (IF This, Than That) which allows for easy-to-create macros that automatically creates a customized action whenever I do some action. For example, I created a macro (known as recipe in IFTTT) whereby whenever I post something on twitter, IFTTT will automatically repost on LinkedIn... instantly and invisibly. You can create as many macros (recipes) as you want. Automatic responses can occur to over 47 social media accounts (Blog, LinkedIn, Facebook, YouTube, instapaper, email, tumblr, yammer, etc)

So theoretically, you can post once on twitter... and IFTTT will automatically repost the same information on all the other social media services instantly.

Of course, IFTTT can do more than just repost, but that's what I mainly use it for.

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bufferapp

Lastly, I use bufferapp. This nifty website will send out tweets at designated times that is user-specified. All the user has to do is "fill" the bufferapp bucket with the information you want tweeted.

So monthly, I will fill the bucket with up to 30 tweets I want sent out twice per day during business hours when tweets typically are noticed.

For a Physician, When is the Best Time To Tweet or Publish a Blog?

According to professional bloggers and tweeters, timing of content publication is important in order to maximize getting noticed and shared. From a general topics viewpoint (not healthcare specific; data taken from here):

• 4PM Eastern is the best time to Tweet
• Friday is the best day to Tweet
• 9AM Eastern is the best time to Facebook share
• Saturday and Sunday are the best days to Facebook share
• In the morning is the best time to blog
• Publishing a different blog article multiple times throughout the day is better than once per day

However, I've always wondered if such "rules" similarly apply to healthcare content as by their very nature, people tend to search a problem after seeing their doctor or seeing/reading it on the news.

Ever since I've been monitoring my website statistics starting in 2005, I've noticed some undeniable trends of "when" website activity occurs which presumably reflects "when" healthcare keyword searches occur.

For any given 24 hour period of time (graph shown below is for Nov 14-15, 2011), my ENT practice website got THE most activity between noon and midnight; peak activity being from noon - 3PM.

On a weekly basis (graph shown below is for Mon Nov 14 - Sun Nov 20, 2011), the greatest activity is Monday thru Wednesday after which web traffic drops off almost 50% by Saturday before bouncing back up 100% on Monday.

Such statistical fluctuations have been true for the past 5 years I've been tracking this stuff.

Now I certainly can't explain the "why" this phenomenon happens without more google analytics data from more healthcare websites, but I certainly can take advantage of this knowledge as it pertains to ENT problems (though I suspect that what is true for ENT is true of other health problems when it comes to web traffic).

How can I take advantage of this knowledge?

People are CONSTANTLY adding to the content found on the web, all vying for the attention of eyeballs. Being the first is important as it seems to me that google values original content (not copies that appear later), but just as important is "when" the content first appears as one would like to ride the wave of when healthcare keyword searches occur.

Overall, the holy grail is to come up with great original content, be the first to publish it, but publish it at the right time.

Great, Original Content

Good content is king and #1 in the priority of getting noticed. If your content stinks, being first and when you publish won't matter.

Be the FIRST to Publish

I can't prove it and I don't have supporting evidence for it, but it seems that google does prefer content that appears "first" over copies that appear later. The prime example is Associated Press articles that are syndicated and re-published over a wide variety of different newspaper websites throughout the world.

If google encounters the same exact article 100 times, how does it rank one over the other?

I suspect, it ranks based on two factors:

1) "Popularity" of the website publishing the content
2) Being the first to publish

Obviously, an individual only has control over timing. Take advantage of it.

WHEN to Publish

Though being the first to publish is important, the timing of when to publish is also extremely important. It's almost like surfing... You want to be the first to stake out a place to ride a wave... but you need to be where the waves are.

Given the dramatic... but consistent... fluctuations in healthcare web activity, it is better to wait and publish when people are actively searching. It is more likely to get noticed and hopefully shared, emailed, liked on facebook, tweeted, etc. Going viral is the goal all content publishers dream of.

So, WHEN is the golden moment to publish?

It is around 11AM on Mon, Tues, and Wed based on my limited data.


Conclusion

Now, do I even follow my own advice?

Not necessarily... I tend to go with the "be the first" rule regardless of the time, not because I feel it more important than the timing of publication, but it's just that I have so much other things to do (like taking care of patients), that if I come up with an idea to write about, I just publish it and not worry too much about timing.

BUT, if I do have a moment, I WILL tend to publish things timed between 11AM and 3PM during the week.

Home Allergy Shots

DISCLAIMER: This post is not meant to condone or promote allergy shots to be given at home. It is meant to promote discussion and make patients aware of the issues involved.

Allergy shots, unlike medications like claritin and flonase, offer patients with significant allergies a way to potentially be cured of their misery without the need for daily medication use. However, there is a small, but substantial risk for anaphylaxis and even death with allergy shot administration. After all, a patient is being injected with the very substances that cause their allergies. As such, many allergists will allow allergy shots to be administered ONLY within a medical setting. Also, the American Academy of Allergy Asthma and Immunology (AAAAI) specifically forbids allergy shots to be administered at home.

Furthermore, the allergen extracts used to make the allergy vial serum used for allergy shots carry a black box warning on the medication package insert:

"This product is intended for use only by physicians who are experienced in the administration of high dose allergy injection therapy, or for use under the guidance of an allergist. Allergenic extracts may potentially elicit a severe life-threatening systemic reaction, rarely resulting in death. Therefore, emergency measures and personnel trained in their use must be available immediately in the event of such a reaction. Patients should be instructed to recognize adverse reaction symptoms, be observed in the office for at least 30 minutes after skin testing or treatment, and be cautioned to contact the physician's office if symptoms occur. Standardized glycerinated extracts may be more potent than regular extracts and therefore are not directly interchangeable with non-standardized extracts, or other manufacturers' products. Patients with cardiovascular diseases and/or pulmonary diseases such as symptomatic unstable, steroid dependent asthma, and/or those who are receiving cardiovascular drugs such as beta blockers, may be at higher risk for severe adverse reactions. These patients may also be more refractory to the normal allergy treatment regimen. Patients should be treated only if the benefit of treatment outweighs the risks. Patients on beta blockers may be more reactive to allergens given for testing or treatment and may be unresponsive to the usual doses of epinephrine used to treat allergic reactions. This product should never be injected intravenously."

The downside of allergy shots is that they are given 1-2X per week not just for a month or two, but for YEARS. If shots are given only within a medical facility, the patient must commit a significant amount of time, travel, and gas in order to complete a shot series. There is also the time missed from work. In essence, the patient must approach allergy shots like a part-time job.

Given all this... what are the actual risks of anaphylaxis and death from allergy shots?

VERY small...

In one Mayo Clinic study on 79,593 immunotherapy injections over a 10-year period showed the incidence of adverse reactions to be less than two-tenths of 1 percent (0.137 percent). Most of the reactions were mild and responded to immediate medical treatment. There were no fatalities.

More than 1 million injections were given without a fatality to 8,706 patients in allergy clinics at Roosevelt Hospital, New York City, between 1935 and 1955.

Worldwide, there were only 35 deaths reported from allergy shots between 1985 - 1993. It has been estimated that during that period there were 52.3 million immunotherapy procedures, making the incidence of fatality less than one per million (0.6692 per million). Data recently compiled by the Allergen Products Manufacturers Association (APMA) estimated the incidence of fatalities to be about three per 190 million annual injections, or approximately one per 63 million injections.

Now compare this to other medical interventions. Approximately 1 in 5000 exposures to a IV dose of penicillin or cephalosporin antibiotic causes anaphylaxis of which more than 100 deaths per year are reported in the United States. Fatal reactions to penicillin have ranged from 0.4 fatalities per million injections to 1 fatality per 7.5 million injections.

One to 2% of people receiving IV contrast (for a CT scan) experience some sort of systemic reaction. The majority of these reactions are minor, but fatalities have occurred in about 1 in 13,000 to 1 in 75,000 procedures in the 1980s (a more recent study has shown a decrease of 1 fatality in 169,000 procedures).

So... the main question now is should home allergy shots ever be allowed?

There are two ways of answering this question.

The first way is to consider any fatality due to an allergy shot (no matter how extremely rare) to be unacceptable, especially when considering the disease being treated -- allergies -- to be a quality of life issue rather than a life/death issue (heart transplant surgery). There is also that black box warning mentioned above.

The other way to view the answer is to consider things in perspective. There are MANY quality of life activities that people perform that has a risk of severe bodily harm if not death. Swimming results in 1,150 deaths per year in the United States alone. There are about 43,000 fatalities per year from car accidents.

Also, if one takes the stringent view that any fatality due to an allergy shot to be unacceptable, than patients should be monitored in a medical facility for not just 30 minutes or less, but 24 hours as late reactions can still occur the following day after an allergy shot! Indeed, in England, patients are required to wait under observation for anaphylaxis as long as ONE HOUR after each and every injection!!! In fact, the one hour observation was an improvement over the TWO hours that was imposed initially. Read more about this here.

So why draw the line at 20 minutes (or more) as recommended by the AAAAI in the United States? It's because the vast majority of severe reactions occur within the first 30 minutes. Beyond 30 minutes, severe reactions become less common (but NOT zero). Well, severe reactions are not very common to begin with... and if allergy shots must be given in a medical facility due to this concern... than should it not follow logically that no matter how rare the possibility, that patients MUST be observed for 24 hours no matter how small the risk of anaphylaxis than?

Why state that allergy shots must be given in a medical facility due to small, but possible risk of severe reaction on the one hand, and than state that there is a small, but acceptable risk of severe reaction after 20+ minutes of observation in a medical facility?

It is just through this thought process that some physicians who provide allergy shots allow home injections. At this time, it is estimated that about 15% of allergists allow home injections (based on a blinded survey of allergists).

IF home allergy shots are allowed (and this is by no means a recommendation or a statement condoning home allergy shots, but just saying in a hypothetical sense), it should be done only in carefully selected patients:

- Are on maintenance regimen (allergy shots are not being increased)
- No significant reactions during buildup and maintenance
- Proper training in administration (just like diabetics are trained to give themselves their shots)
- Epi-pen available and understanding in how to use
- In-office allergy shot with post-injection monitoring for a period of time with every new vial
- Only in adults
- CONSENT signed by patient informing of the risks as well as black box warning



References
Systemic reactions to immunotherapy at the Mayo Clinic. J Allergy Clin Immunol 1997; 99:S66.

The risk of inducing constitutional reactions in allergic patients. J Allergy 1957; 28:251-261.

Deaths associated with allergenic extracts. FDA Medical Bulletin 24, May 1994.

Allergenic extracts used in immunotherapy fatalities. J Allergy Clin Immunol 1997; 99:S67.

Nature and extent of penicillin side-reactions with particular references to fatalities from anaphylactic shock. Bull WHO 1968; 38:159.

Mortality during excretory urography: Mayo Clinic Experience. AJR 1982; 139:919-922.

Reactions to ionic and nonionic contrast media: A report from the Japanese Committee on the Safety of Contrast Media. Radiology 1990; 175:621-628.