I do have a couple of questions, which is, I was intrigued to see in the charts that you provided comparative to 2005 to now, that there was actually increase in the percentage of personal time, which I'm finding a little hard to believe, which seems to, but perhaps that was the study's finding. A corollary to that, in terms of the face-to-face decrease noted on those charts, how is the interaction with patients, non-office hours spent replying to patient messages viewed by patients, is that felt to be as personal as being in the office, do you know, or are there any studies that have looked at this or surveys that have looked at this? There's more data coming on this, there's some things which are using, even though we're talking about humanizing the patient interaction in the era of technology, using technology to humanize patient interactions. So that's basically AI, like Dr. Asad gave a great talk this morning, so that's coming, that's a lot of studies coming down the pike on that, because patient's answer can be really done if it's a simple, straightforward, AI-based communications. There's some companies coming out, there's something, some company called, which is a, they call themselves a integrated, vertically integrated solution, it's well-held, where you start at the bottom, they will take care of after-hour works and all that, so it's coming, it's coming. Good to know. In terms of the team building and creating a team which sort of conveys the consistency and trust that you are trying to sort of convey to your patients, do you do any education, team building efforts, what is the approach you take? Yeah. So a few things we do, one is before the start of the clinic, we do what we call a huddle for five minutes, we look at all, five, seven, eight minutes, we look at all the patients that day, we, all of us in the office know that this patient is going to take five minutes, this patient is going to take 15 minutes, we have two of the needy patients today, so we all know all that, so that's how we, so nobody gets stressed, we know if I'm running behind in one room, why we're running behind because of that, so that's one thing is very, very important. So that's during the office part, but you also have to have a camaraderie with your, with your colleagues, usually with your office staff, we do very frequent after-hour happy hours, sometimes dinners, sometimes going out for a laser tag game or something like that, that really meeting your office staff after hour really helps to keep them engaged. Thank you. I think making them feel, making them feel like a part of the treatment process really validates what they do as our extensions in the office. We in our office also actually have educational series, which we found over the past 10 plus years to be very useful, which maybe helps the audience as well, in that we have sessions that where we give talks during lunch hour, even though last one year it didn't really happen, about the topics where they call our patients on, for example, what do polyps mean, what does H. pylori gastritis mean, for which you're asking them to treat, what does Barrett's mean, what are these procedures that you're booking our patients for, and we found it to be very, very useful. Education and information, as you know, is empowering to staff, and they feel when they talk to the patients about these procedures and calling them about results, much more comfortable in sharing that information. I have one other question, and then the rest we can definitely send to you via email, and thanks for being open for that, is with the touch part of it. I mean, I agree completely about the examination aspect, but in terms of putting your hands on a patient's shoulder, or shaking hands, or prior, I would say, quote unquote, older expressions of affection have really gone out the window, and at times can be perceived in a threatful way or a pervasive way. So how do you find the balance? When I talk about touch, most of the test touch part was patient examination, and during that examination, touch, not the touch you're talking about. Making sure. But what we're doing is multiple, multiple offices. I see when people in the hospital, they talk to the patient, never touch the patient. And when I say touch, touch is the physical examination of the patient. Thank you. Thanks for clarifying that. And I agree with you about the music. And actually, I have a colleague in the state who, before he starts a colonoscopy, asks the patient, OK, what do you want to listen to before you go off to sleep, and puts on the song that the patient chooses. And I actually had a specific patient coming in and say, I don't like that music, and we had to shut it off. So each one is so different, and I think it's important to ask for the preferences, which puts them at ease, and I completely agree with you on that. And I play some Bollywood music. They love it. I'll think about that. Thank you so much for the talk. And again, reminders. And we would be really grateful if you can take some questions after, if they come through, and I will send them on to you. Thank you so much. Thank you. Thank you so much for everyone. Thanks for having me. Yeah. This brings us to the end of our miniseries, and to the question and answer session with the panelists. And I'm pleased to say that Bruce Hennessey will be able to join us, who is our co-director, and so will Colleen Schmidt. And the only panelist who is available for Q&A, which I'm so happy about, because we get to monopolize him, is Austin Chang. And I didn't do the introductions, because I knew he would be here live for this, is, I mean, it almost seems like it's five different people when I read out all the things he talks It's five different people when I read out all the things he does, but it is the same person. And he is the Assistant Professor of Medicine at Jefferson Health, or Thomas Jefferson University in Philadelphia, Director of the Endoscopic Weight Loss Program, Chief Medical Social Media Officer, as he shared with us in his slides, currently also CMO of Medtronix. I believe that's a new, unique approach for Medtronix. And founding president of Association for Healthcare Social Media. And that's just a few of the things that he does, and I'm really happy that he's able to join us for this session. Bruce and Colleen, are you both live? I am. Perfect. So I have a couple of questions. Thank you, first of all, Austin. That was an amazing talk, and I'm hoping that you will be able to sort of answer a couple of the questions from the other two talks, because there's some things that sort of piggyback on that. We did get one question from these speakers, which was, do you, I believe, let me go back to the question and answers. Well, I'll come back to that in a moment. In terms of the platforms, I'm on two of the five. I'm only active on the medical Twitter, as you can tell, and I find it to be extremely difficult to maintain all of these things. So if you were to, Eric, recommend one or two to us, which one will they be, especially being healthcare individuals that can reach out to our audiences, which are patients and population? Yeah, I mean, I think that if it was specifically reaching out to the general public, I would probably still say Twitter, and also maybe Instagram, just in terms of ease of use. I think for those who are comfortable being on camera and have sort of some skills associated with that, like video editing, I would say maybe you can try YouTube or TikTok. But just because I know that there are time constraints for everybody, and just given the sheer number of our colleagues on Twitter, I think that's a good place to start. I do always kind of warn against the fact that it can become an echo chamber, but if that's your goal, and because we all have different goals with social media, if your goal is to communicate solely with your colleagues and network, then Twitter is the ideal place. But if you're trying to reach the general public, you might not reach quite as many people. I think to keep in mind, Twitter and Instagram really are platforms that are mainly based off of people who follow you actively. So unless they're looking for you or happen to come across your profile and start following you actively, they may not see your content. Whereas other platforms like YouTube or TikTok, that sort of content can show up in front of people who may not be following you in the first place. Thanks for highlighting the differences between the two. And I think YouTube and TikTok are definitely very easy for people to search information on and just randomly watch videos. And so that makes sense. Yeah, well, I'll go back to, again, sort of a generational thing. We've evolved as providers. There used to be, at one point, there was a doctor for a town, and everyone in the town knew the doctor, and they attended all the social events. Everyone knew about the doctor, and no one knew. Everyone also knew where they lived and shared all these social events. Then we evolved into a more distanced approach. And here we are back into the socially connected in a different way. And I find it a little uncomfortable at times, where some of the points that you pointed out, which is knowing exactly where people live or along the lines, how do you help some of us navigate through that? Oh, that's a great question. I feel like even though we're moving back towards a more connected feeling, I think the world around us has changed. And so I can understand why that feels a lot more uncomfortable these days, given safety concerns and whatnot. I think it really just depends on everyone's individual comfort level. Because how I work, living in an urban environment is different than somebody, say, in a rural environment. But I think uniformly, we have to just keep in mind that any communication on the internet, really, we need to still protect ourselves. Because when taken out of context, and often things on the internet are taken out of context because we are communicating in such short messages, it can potentially cause problems. And so one of the key things is, especially if we're putting ourselves out there and opening ourselves to communicating with potential patients or other members of the general public, we need to be careful that any recommendations that we give, if it's taken seriously, doesn't result in any harm. And likewise, any sort of private communication that you have in direct messages are really not private. Anyone can screenshot any private conversation and then distribute that to others. I've certainly had that experience before. Fortunately, it wasn't anything too serious. The example that I'll give is that I had a conversation about vaccines with somebody. And that person was sort of, you know, the question seemed very valid. But ultimately, my responses were distributed to a very kind of vaccine-hesitant or anti-vaccine community. I'm not exactly sure which, but that could potentially be concerning if I didn't handle that interaction appropriately. So I think, yeah, we just need to be careful with any communication that we put forth on the internet and just assume that it's going to be public. Assume that it can, you know, assume the worst, basically. And then kind of how you approach that will just depend on your comfort level. Thank you. I mean, I think that's a harsh reality that we all have to live with. And the same is true, I think, we see for journalists and politicians. Everything can be taken out of context. And we've all seen that play out. I'll open up for Colleen and Bruce to ask questions, and then I'll follow back in a little bit. Austin, I have a follow-up. I'm in that spectrum of the generation that would prefer less social media exposure. And yet I do recognize the value that it can bring to the practice. So two questions for someone like me. Is it OK to outsource it or insource it if there's someone in the practice who might be young and gets it? And if we do that, do you recommend all that content be vetted through someone or do you give them free rein? So that's a great question. I think, first of all, no one should feel pressured into going on social media if you don't personally feel comfortable with putting your name or face out there. I mean, by nature of what we do, I think that that automatically opens ourselves up to kind of public scrutiny a little bit. Or people can look our names up on the internet. But if you don't feel comfortable having social media, I always feel like that I don't push anybody onto the internet. But I think that it is OK to outsource or insource. I have colleagues who do. But as I alluded to during my talk, I personally feel like I like control over the voice that I have out there because I do think there are a lot of nuances. So if you are going to outsource it, I would say that there should be a monitoring period, especially with, I would say, how to handle comments or responses to some of your posts. I mean, I think there's so there's challenges with kind of putting information out there and making sure that it's accurate and well presented. But there's also handling responses because sometimes if those responses are ignored or neglected, that could also cause problems. So just be aware that there needs to be sort of a training session that happens, especially if somebody's, even if it's someone in your office who is sort of involved in the medical practice but not really a clinician, it can be challenging to understand kind of the nuances of how to communicate something medical. So I would just say, in general, kind of monitor it for a while. Make sure that whoever is communicating for you can be trusted with how they interact with others online. But otherwise, I don't see any reason not to have someone else kind of help you out. I loved your timeline of your journey. I wish I'd had your crystal ball. It was over a decade of evolution. And you mentioned that you think social media will shape the future of our discipline. I'm wondering if you could talk more about your thoughts on that and use your crystal ball for me. Yeah. Well, I can't say that, you know, I think that social media will probably be more used to kind of, and we're already seeing it in some ways, kind of target certain groups in terms of like advertising and whatnot. I think that we'll see social media platforms use this sort of functionality to potentially influence health outcomes in the future. It's already happening. Facebook, a couple of years ago, rolled out a prevention tool, which I somewhat argue maybe is getting a little intrusive, but like many things, Facebook. But essentially, I think the tool was meant to basically alert you that it might be time to get screened for certain cancers or other health conditions. And I think we'll see more integration, you know, into digital health and whatnot. But, you know, I don't have a full, obviously, I don't, my crystal ball is not always accurate, but I think that, you know, I'm also excited to see, I think basically digital health in general, not just social media is going to play a much greater role in the practice of medicine in the future. So I would say kind of taking a little bit more of an active approach in adopting technology and trying things out is kind of the general approach I would suggest to many people on here. So, you know, I know that I feel like some of that is inherent to what we do as gastroenterologists. We work with, you know, tools and gadgets and devices and new technologies, but even being more open to that moving forward is probably the way to stay on top of it. Thank you for that. Welcome. Austin, I'd like to know if you sleep at all, because I mean, I'm kind of, I'm amazed at the amount of work, I think Austin gets more done by 9am than I get done all day. My question really is, along the lines of practices that are involved in social media, how do you, you're trying to maybe set yourself apart, or at least allow for some recognition of a practice. How do you avoid being too generic? I mean, we can, there's a desire on the internet through forms of social media to create sort of an openness and there's almost some of the viral videos and things like that, or things that go viral have to do with this amount of openness, which you have to be very, obviously very careful about. But as a practice, you know, we also want to be a little bit careful about being too generic so that it's just a, you know, another road sign. How do you kind of balance that? That's a wonderful question, because I think any organization or practice will face the challenge of feeling too impersonal, and I think that a practice should focus on identifying maybe, you know, if it's not all of the people in the practice, one or two representatives of the practice. We actually don't see this done particularly well in gastroenterology, you know, I'm part of a big academic center and practice so it's not, it's very different than I think, say somebody in a community practice trying to market the practice. So again, I think I would identify one or two representatives who may be more comfortable on camera and, you know, comfortable with social media to kind of be the faces of the practice. If you go on, I feel like, you know, this is commonly done in like the plastic surgery community and I know it's a very different field and, you know, gastroenterology is, you know, much less visual, but I would say if you take a look at on TikTok, for instance, there are certain accounts that have done this really successfully, like the braces guy, he's an orthodontist and I think that he markets his practice very well, it's still very informative and entertaining and, you know, he clearly is good on camera, and I don't know if there's other people in that practice, but there's a way to kind of, I think he serves as the face of that practice and there's so many other examples online but, yeah, I think picking one or two and highlighting the individuals and not just the group is what I think will stick, just because ultimately people identify with individuals and not necessarily, you know, with a group. Thank you. I have a question about how you maintain sanity with all the different platforms. Yeah, that's, it's a constant struggle. I have to disconnect sometimes and please, you know, keep this in mind because social media can be very much a, you know, a rabbit hole and can be very mentally taxing, so there have been many moments where I've had to completely disconnect off all the platforms, and I think it's good to do so from time to time, and I certainly have scaled back. You know, I really try to go with the flow. I don't want to push it too hard. There are moments where I feel like, oh, there are certain topics out there that people are talking about that I try to capitalize on, but there are other moments where I think it's good to take a step back and slow down, and so, you know, over time with using all the platforms regularly, I've been able to become more efficient at it and been able to kind of even kind of not be so immersed in it too much because it can be a little bit hard to, you know, keep up with, but yeah, I would say, you know, disconnecting from time to time is okay, and I would say also that, you know, if you do have positive experiences through social media, it's good to hold on to those because there can be great friendships and connections that you build through that, and then taking that offline is also, you know, helpful and not necessarily doing everything on social media. Thanks for those tips. Those are very useful. I just have two very quick questions, and then we'll wrap up because otherwise I could go on all day asking you questions about this topic. In terms of the patient preference or having used so many different platforms, do you see any specific preference in terms of where people are going for information, whether it's good information or bad information? I would say YouTube is probably the place where patients will go, whether or not that's not necessarily where I think that they will want to go to develop a relationship with you and kind of see you as the physician they want to go to. It may be a start, but it also depends on what the YouTube presence is because I'm sure those of you who are on YouTube all the time may notice that different channels have different approaches. Some are more humor-based. Some are more, you know, educational and kind of lecturing, so it really depends, but I think the place to really develop relationships is Instagram, and I've noticed that, you know, patients will often, you know, follow on Instagram, and many of my patients actually follow me on Instagram, whereas, like, Twitter, for instance, is far less personal, and so, you know, I would say Instagram is probably the most personal, at least in my experience, but yeah, sorry, I forgot. I think you answered the question. I think YouTube for information is reasonable, and I don't know if, again, as Colleen said, you have a crystal ball on what the, you know, folks' behavior will be, population behavior will be in terms of what they will be looking for in terms of a platform, and I don't even know if the platforms we have not right now are ideal. There may be a new platform in future. Yeah, this is a great point because there are healthcare kind of oriented social media platforms that have, many of them actually over the years that have been developed, and I feel like none of them have truly taken off the way I would think, especially patient-facing ones. They, I think that, you know, we'll see more clarity in the future because I think patients are finding their way around these social media platforms, and the platforms themselves were previously not invested in healthcare, but because of the pandemic, I think have really, that's really catalyzed their interest in healthcare. So, for instance, kind of in my disclosures where I mentioned that I'm part of the YouTube Health Advisory Board, first of all, they only hired a head of YouTube Health last year, and then this year, we just had our first meeting this month, so, you know, and they're really trying to think about, okay, how do we make sure that we're getting good information out there and minimizing the misinformation, and how do we help, you know, health professionals engage better on social media platforms, and now all the platforms are really trying to take a more, you know, methodical approach with how they convey health information online. So, it's, I think it's just the beginning. I know that social media platforms have been around for a long, long time, and many of us have been active on social media, but where this space is going, I think we're just seeing the beginning of it. Thank you so much, and I have one last quick question. Any tips on how we educate our students, fellows on user platforms? Oh, you know, I would say that I would say what is most high yield is really just connecting them with those of us who are active on social media. You know, I think that our experiences, you know, I think are probably best conveyed in that way. I think many of us are on social media because we are opening ourselves up to be approached. So, I'm always happy to, you know, speak to fellows and trainees who are interested in kind of growing in this space, but, and you know, as I mentioned, you know, ASGE has many more offerings coming out, and we have a social media task force that hopefully will be able to kind of be a good place to start in the future as well. Thank you so much for your work on this, and really bringing this to the forefront of gastroenterology and educating all of us on a topic that just makes us really sort of feel uncomfortable in our own chairs. I get it. Thank you so much for having me. Oh, thank you. And fun fact, my daughter is a resident at TJ Jefferson, and she just started there. Before she started there, she used to let me watch your TikTok videos through her TikTok app, because I don't have one. I'll have to say hi to her. Yeah, thank you so much again, and this was a great talk, and as I said, I will definitely have follow-up questions, and thank you for allowing us to follow up with those questions.

social media

healthcare

challenges

benefits

artificial intelligence

patient communication