7 Questions: Bernadette Keefe on healthcare media

pharmaphorum spoke to Bernadette Keefe about why she moved into the world of healthcare media and became such an advocate for social media in this sector.

You come from a background in academic radiology. What prompted you to move into the world of healthcare media?

I practised medicine until a diﬃcult back issue and subsequent surgery intervened. I had joined Twitter in late 2010 but became interested in healthcare social media (healthcare Twitter) specifically because of my interest in developing a 'smart walker'; a technologically-enhanced walker to address/improve mobility issues in ageing and after injury. In July 2013 I launched the handle @walkeredu to represent 'The Walker Education Project': my endeavour to both educate people about walkers and to explore safe and improved walker designs.

Realising quickly that this endeavour addressed larger healthcare issues, I launched @nxtstop1 in August 2013 as my Dr Bernadette Keefe professional (and personal) handle.

Since that time my involvement in healthcare social media has escalated. Countless tweet chats, medical conference curations and illuminating, fascinating conversations later, the scope of my interest and participation in healthcare twitter seems unlimited.

What are your goals in this field?

I consider myself both a student of healthcare social media and a participant with three main interests:

1) to bridge/connect siloed stakeholders in the healthcare space

2) to provide information and guidance to MDs as to the most eﬃcacious use of Twitter for professional purposes.

3) to further learn and educate about the mobility issues and frailty that occur commonly with age, to foster fall prevention strategies, and work to improve the lives of those who use a walker mobility aid.

Additionally, I'm fascinated by how people communicate with each other (both the good and bad ways) and how those in science and healthcare can better speak with each other and the lay community. I believe that ineﬀective communication is at the heart of many issues today, including some of healthcare's major pain points, such as patient engagement, health literacy and physician eﬀectiveness. Underlying all my interests is a lifelong passion for public health and public health policy.

What role does social media have in healthcare delivery?

Social media has a huge potential role in healthcare through dissemination of quality information, providing connectivity between diﬀerent stakeholders, correcting rumour, hype and false health information, and providing general health and wellness support. Everyone can benefit from all healthcare stakeholders being active on social media; we already see some of that now.

Social media can be utilised to address the steep rise in chronic lifestyle-related diseases, through aﬀecting behavioural change via just-in-time messaging, peer-to-peer support and education. I believe that all successful healthcare apps will employ social connections as a way to motivate and support behavioural change. Healthcare providers are hoping that social data from social communication, along with other data, will prove useful in predicting disease, thus facilitating earlier intervention.

"Physicians not on social media miss a golden opportunity to observe the lay world"

For physicians, engaging actively on social media is invaluable to personal and professional development and for sharing information with the lay community. Physicians who are not on social media miss a golden opportunity to observe the lay world, on a scale much larger than their particular patient population. Observable on social media is people's context and perspective, their priorities, interests and reasons for engaging in their health (or not). Likewise patients' unmet needs, tips about better ways to communicate with them, and insight into how great the burden of chronic lifelong disease is on patients and their families are all laid out vividly on social media, especially in the healthcare Twitterverse.

The value of social media to physicians' professional careers includes unlimited information in every field, opportunity to connect with colleagues, to be informed of, and collaborate on, research, and to exchange ideas and experiences with clinicians around the world. Events for physicians on Twitter include conferences, journal clubs, grand rounds, tweet chats, and other special forums.

What do you think healthcare will look like in 2035?

For healthcare, the slow-moving giant, 20 years is not that long. The changes might be less dramatic than people are predicting. Technology will play more of a role than it does today with increased use of telemedicine (telehealth), healthcare apps, sensors/wearables etc. Healthcare professionals will work much more as a team, with skills of each applied more strategically. People (patients) will still see physicians (or the correlative) but the time between visits will be longer and much of the contact will be via telemedicine, online communication channels and messaging apps.

Hopefully there will be ongoing, seamless communication for patients with a personal and professional electronic medical record (likely to be cloud-based with limited, patient-controlled access). Anyone who is generally healthy will self-care with the assistance of apps. Those who have chronic disease will partner with a team of professionals in a self-care plus supportive-care role. There will be more personal responsibility. Given the significant lifestyle disease burden and ageing demographic changes, the majority of our population will have multiple chronic diseases, requiring significant interaction with healthcare professionals and hospitals.

What are the biggest hurdles in healthcare provision and how can they be addressed?

The biggest by far, in my opinion, is the fact that the social determinants of health account for most of the disease in every part of the globe, i.e. lack of clean water, poverty, poor nutrition, inadequate education, lack of health literacy, increasing stress levels, inadequate broadband access etc.

"Social care and health care must be intertwined in smart, eﬀective ways"

For this reason, social care and health care must be intertwined in smart, eﬀective ways. There must be the political will to provide adequate funding for social support, community health services and excellent public education. Mental health care is grossly underfunded and is not on a par with physical health in terms of research funding, yet it impacts all of us. Few families are untouched by the ravages of mental health issues and/or addiction and yet there is not timely or adequate care for these problems.

For the most part these are political/societal responsibilities – ones best addressed by good governance. After that, personal responsibility is the next important step. Obesity, type 2 diabetes, heart disease can be addressed by diet and exercise with supplemental medications as needed. Tobacco-free zones must be created and anti-smoking eﬀorts vigorous. The built environment must be conducive to walking and exercise. All aspects of society must work together to produce healthy (best personal health possible) citizens.

What person, thing or problem would you like to wish away?

I wish we wouldn't wait to talk about ageing and death, both of which are natural and inevitable. If conversations about the natural course of human life from birth to death took place around kitchen tables when children were young we might avoid the otherwise inevitable medicalisation of these processes. Replacing intimate communication and understanding about our bodies with only medicalisation, and addressing healthcare issues and decisions without forethought about our lives is a disastrous way to go about things. It is a backwards, ineﬀectual, chaotic, and extremely costly route, both financially and emotionally, and leads to massive pain for people and their families throughout their lives and especially at the end of life.

It is human nature to avoid diﬃcult topics, but we become fools if we do. Physicians are not to blame but they can certainly play a positive role by supporting palliative medicine initiatives and hospice care, as well as insisting on speaking about ageing, dementia and goals around the end of life. Families must do their part as it is often their decisions, taken on behalf of their dying relatives, that determine the quality of life and death. We talk about quality of life, but there is also a quality death which is in the home, surrounded by family and, if desired, supported by hospice professionals.

Conversely, what or who provides you with inspiration?

Given that our healthcare world is siloed and has a 'bandwagon' mentality, I admire those with knowledgeable voices who provide a mile high, moderating voice; a balanced perspective to the conversation. As a believer in the value of the physician (healthcare professional)/ patient therapeutic relationship, I admire those researchers, MDs, health IT persons and developers who appreciate and remain mindful of the importance of relationships and the human touch, amidst the advances in technology. I also respect those practicing physicians who take time out of their busy days to engage on social media. What they do is a service.

Data, technology, pharmaceuticals, research must be of service to the ultimate goal of peoples' sense of wellness, their best health. An individual's goals regarding their lives and health dictate the right therapy for them. In most cases, a trusted healthcare professional is invaluable to teasing out these goals, and their relation to health and healthcare, and then crafting with that person the best therapeutic course. I am inspired by my physician colleagues who love their work, their patients and cope with business forces that are foreign to them. I remain inspired by the grace and courage of people to deal with the diseases and illness that life brings. The indomitable spirit of humanity reigns in all corners of healthcare. That is inspiring!

About the interviewee:

Dr Bernadette Keefe practised Academic Radiology at UNC Hospitals-Chapel Hill, NC, US from 1987 until 2000. She received her medical school and residency training in New York City from 1977-1986 at Columbia's College of Physicians & Surgeons and NY Presbyterian & Weil Cornell Medical Centers, followed by a Fellowship in Ultrasonology at Thomas Jefferson Hospital in Philadelphia.

Dr Keefe has participated in numerous tweet chats, jointly moderating the #HCLDR tweet chat, other health chats, as well as online global medical conferences. She writes on healthcare technology, healthcare delivery, ageing issues and the role of social media in healthcare delivery.

She will be speaking at the Doctors 2.0 & You conference in Paris, taking place on 4-5 June.

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