Okay, looks like we're going to be starting Hi everybody, looks like we have some more participants coming in. We're excited tonight to be having a talk on medicine and social media by Dr. Park. Just a couple of reminders. This will last about 15 minutes we'll have q amp a at the very end so if you could just put your questions in the q amp a box and I'll be monitoring and I'll, we'll go through all your questions at the very end. So Dr. Park is a section head of female pelvic medicine and reconstructive surgery in obstetrics and gynecology and Women's Health Institute. She has dedicated her professional career to advancing the field of your gynecology through research and education. She specializes in minimally invasive treatment of urinary incontinence pelvic organ prolapse and pelvic floor disorders. Dr. Park obtained a bachelor of art degree in history at Brown University, she earned her medical degree at the University of Rochester School of Medicine and Dentistry, where she graduated at the top of her class and was a member of the Alpha Omega Alpha Honor Society. She then completed her residency training in obstetrics and gynecology at the University of Pittsburgh McGee Women's Hospital in Pittsburgh, PA, followed by her fellowship in female pelvic medicine and reconstructive surgery at the Cleveland Clinic. Dr. Park has extensively published in peer reviewed journals, review articles and book chapters. She has received several research grants and has been recognized for her research at national meetings. In addition to producing several award winning video presentations, Dr. Park serves as a reviewer for multiple gynecology and your gynecology journals. She has held several leadership roles at the national level in the field of gynecology, including the American College of Obstetrics and Gynecologists, American Urogynecology Society, the American Association of Gynecologic Laparoscopists and Society for Gynecologic Surgeons. So we're so excited to have you here. We all know you're an expert in the social media, and I know I'm a follower of yours. So looking forward to your talk. Thank you so much for being here. Thank you so much, Dr. Menahji. And I'm so pleased to be able to give this talk today. Like Dr. Menahji just alluded to, please feel free to drop the questions in the chat and she can interrupt me and I can address alongside if it's... And feel free to interrupt. Let's see, these are my disclosures. The objectives of my talk today are to review the public perception of physicians, as well as how the internet shapes the perception of medical knowledge, healthcare institutions, physicians and seeking care, and to review strategies that physicians can use to leverage their online presence and promote evidence-based science. So why social media? As of January of this year, over 4.7 billion people were using social media worldwide, and that's projected to increase to 6 billion in 2027. Average daily time spent using social media was two and a half hours a day. And actually it's projected to increase by 2% each year, which is about three minutes. So I just want to go over, like take a pan view back and see what people are talking about in terms of public opinion of physicians. This is a poll from 2019, the American Association of Medical Colleges polled the public. And the good news is there's a favorable overall impression of medical schools and teaching hospitals, two thirds and about 70% found favorable opinions of medical schools and teaching hospitals respectively. However, there's been an increase in trouble finding physician, about a quarter of the population had an issue with finding a physician in October, 2015. And then as of September, 2019, it went up to a third of the population. And then just in terms of how people feel about physicians worldwide, the US actually ranks 24th in terms of satisfaction, in terms of satisfaction with treatment received as well as, oh, I'm sorry, 24th in terms of the trust in physicians. But luckily we still enjoy a high satisfaction rate with the care that patients received. But it's sad that it's only like about 56% of this actual poll. And there's a growing distrust of the medical profession. And in 1966, it was much higher, over three quarters of Americans had great confidence in medical leaders. And today only about a third do. So just to summarize, people still trust their doctors, but I'm just going to quote Reagan in the, this is when he was talking about the Russians, trust, but verify. And at the same time, we've been undergoing societal shifts. There's a dissemination of information, which is fragmented. I'm dating myself, but in the old days, there were only three legacy networks, NBC, ABC, CBS, and PBS. And then now there's just so many different venues where you can find information and there's cord cutting, there's no more centralized TV networks, and there's a decline of newspapers and print media. So people are getting their information from the internet, from a program on Hulu, Netflix, what have you. And during the techno-social revolution, like I alluded to, there's just a plethora of information online. People are going to these information-based websites like WebMD, Mayo Clinic, Cleveland Clinic, these patient support groups. And I'll go into a little bit of detail of the Hester Sisters and obviously social media, Facebook, Twitter, Instagram. I did not put here TikTok, that's another example, but lots of different places online. And actually, as many of you know, many companies are exclusively marketing online via Google ads and on social media, especially on Facebook and Instagram. I have to say those Instagram ads are very much tailored towards me and they got my number. In 2019, it's so quaint, this is a headline from a JAMA viewpoint on counteracting health misinformation, and is there a role for medical journals? And the headline was, or I put this as a headline here, and it's lifted from the article, crowdsourced lies, fake experts, and misleading leaders. And essentially, there's just no editorial oversight or curation. Fake news spreads faster than the truth on social media. Negative attitudes about science have risen in lockstep with ultra-nationalist sentiments. You see that in Europe, and all over the world, really, and emergence of populist leaders and movements. And for those disadvantaged, despairing, and understandably distrustful government, alternative truths align with shared skepticism about scientific medicine and belief in traditional remedies. So this is just a table from that article, and in the role that we can play as physicians, how can we combat the misinformation? And we can contain the dissemination, the containment of dissemination of misinformation through medical journals, and identify purveyors of clear-cut misinformation. You know, we have a duty to promote general understanding of medical science, and communicate about common misperceptions using websites, digital media, town halls, as well as conventional prints and broadcast media. And then prepare the next generation of health professionals to navigate a world of truthiness and pseudoscience, and then debunk myths and discredit purveyors of this misinformation. And that's where we leverage our contacts in the media, using journalists and journals, health professionals like we are, and researchers, and then directly rebut the medical misinformation using a variety of media platforms, and critically review the provenance of the misinformation, and expose the purveyors' credentials and conflicts of interest. And like I said, I think everybody is aware of this, but in 2019, it was still a thing where people were, or it had emerged already that there were vaccine hesitancy was a top 10 threat to global health. And this is just at the start of the COVID pandemic. People were just peddling a lot of medical misinformation about the vaccine. There were anti-vax, the anti-vax sentiment reached an all-time high. This Washington Post perspective piece, I just pulled this sentence out because I thought it was a really nice way of trying to combat the rhetoric, but to describe vaccine as a technology that allows the body's natural immune response to create protections and to stimulate a natural reaction, just to get people to trust it, not like you're introducing something foreign into the body. So I'd like to quote Willie Sutton's law, go where the money is, Willie Sutton was a bank robber, but the medical corollary is go where the patients are. It doesn't actually matter what you, I, we think, it matters what they think, and we need to go where the patients are. So where are they? They're searching online. 80% of internet users have performed an online search for a health condition up from two thirds in 2001, and about two thirds are looking into a specific disease or medical condition or a medical treatment and procedure. And then the health related searches are surpassed only by email or researching a product and service. And I will admit that I am not immune to Dr. Google myself. I diagnosed my tennis elbow by Googling forearm pain, and it just was exactly what I needed to, to, to diagnose what was going on with me. But in any case I alluded to Hyster Sisters previously, and that's a woman to woman hysterectomy support. And this is a website that's geared towards patients. You can see here, I just re took a screenshot of this for this talk, but you know, half a million members here, uh, over 5 million posts and, um, you know, 640,000 threads. Um, you actually have this hysterectomy date to customize your browsing and there's lots of, uh, features stories here. Um, where else do patients go for health information? Dr. Google, like I alluded to earlier, um, I Googled these common conditions in our space, urinary incontinence, pelvic organ prolapse, fibroids, endometrial cancer, and the top websites that came up were Mayo Clinic, WebMD, MedlinePus, womenshealth.gov, and health.harvard.edu. Um, so I just want to take a moment and, uh, discuss the Mayo Clinic social media strategy. This was actually an article from 2014, um, and they talked about how Mayo Clinic founded the Center for Social Media in 2010. And, um, I'm going to just read this quote from the article. Mayo Clinic believes individuals have the right and responsibility to advocate for their own health and that it is our responsibility to help them use social media tools to get the best health information, connect with providers and each other and inspire healthy choices. And they have this, um, patient facing website, Mayo Clinic Connect that connects, uh, patients, uh, and support groups online. Um, and, um, it really leverages and enhances their reputation as a source of trusted information through their online presence and social media. Um, and it's so clever because quite frankly, it is very hard to get to Mayo Clinic, Rochester. You have to fly into Minneapolis, St. Paul, you have to drive an hour or two. And, um, and really this is a, uh, a great hook to try and get patients to, to come to this, this world renowned center. Um, and in this survey, 40% of people said that social media would affect their choice of healthcare provider. And it's probably even increased since then. Um, and they really understand the power of patient engagement on social media. Uh, they understand that interaction is important, but patients also desire in-depth great content. And, um, Mayo Clinic has really, uh, had a lot of support from leadership, uh, and they've embraced the innovation and they actually use a social media presence for academic promotions and tenure process. And there's an article, um, by Dr. Cabrera et al in journal of graduate medical education that lays out their criteria, um, on their, for the CV. Uh, and how does this play into best gynecology hospitals in the U S news and world rankings? Well, part of it is reputation. See, um, Mayo Clinic's up here every year, the, um, criteria to make this list actually changes. Um, you can see here where the clinic clicks number four, um, but expert opinion actually accounts for, uh, 25 to 27 and a half percent of the score, depending on the specialty. And I just want to take this moment to emphasize that no one knows what you were doing unless you tell them about it. And, um, so what I will say, and I'm going to reiterate this throughout the talk is you need to create your own narrative and you have control over this and you can write your own story online. So what social media platforms are worthwhile, uh, whichever you feel most comfortable on, um, discursive medium is, is Twitter. Um, if you want to do video long form, you can do YouTube short form is Tik TOK and Instagram. Ideally, um, both, um, imagery, the photos, um, Instagram is best. Uh, the best way is probably all of them, although that takes so much work. Um, I personally am a Twitter person, and then I use Instagram and Facebook from my personal, um, uh, expression, but, um, you can, you can upload to all, uh, Instagram and Facebook automatically. And then Tik TOK takes a little bit of editing, um, and YouTube, I think you can also edit, but it's more of a long form. Um, and you can see here, Facebook is still the highest used platform with almost 3 billion users here. Um, and, uh, you can see that Twitter has about 350 million. Um, Instagram also huge one and a half billion monthly active users. Um, Tik TOK is the most used social media platform among users 10 to 30 and has 1 billion active users. So these are the, the biggest, um, social media platforms, although, uh, LinkedIn and Pinterest also still have a lot of, of, um, users as well. Um, so what do you do in terms of social media strategy? You have to think about these larger questions, like who, what differentiates you? What's your pitch? Um, what makes you unique, craft a compelling story, how you execute, um, who's your customer, um, who, where is your audience? I cultivate more of a physician facing audience, but, um, lots of other people with very large followings have a patient facing audience. What are your goals? And I'm going to go into this a little bit further, uh, in detail later. And then when will you communicate? How often are you going to do it? Um, and these are just some nice little, um, um, columns on, on do's and don'ts, um, do use compelling imagery, mix up your caption length, keep the social and social media. So interact with people, jump in relevant conversations, post regularly, but don't over post social media as a marathon, not a sprint set realistic expectations. Don't let it consume your lives. Um, write for your readers and audience. Know your audience. This is when you're speaking. It's just like a form of public speaking. Think before you post, do not drink and post, um, and share stories on your business, uh, social channels and don't go hashtag crazy or doing all the talking copy, uh, post copy with grammar or spelling mistakes. Don't drink and post like I alluded to earlier. Um, don't replace human interaction with marketing automation. Don't veer off brand. Don't try and be everywhere and do everything. Don't need, don't have to jump into every conversation or ask too much of your followers and don't ignore questions, comments, and messages from followers. Although I will say you need to block the trolls. Um, so this is, was an interesting article about, um, in people's interaction on social media, um, and patients finding community on social media, looking into stress, urinary incontinence. And, um, this group, uh, I believe this is Jen anger's group analyzed, um, emerging themes. And, um, overarching themes were unsatisfying patient physician interactions. How can, uh, patients prevent SUI and what are the risk factors, the burden on quality of life, non-surgical versus surgical interventions. Interestingly, they, um, mentioned kegels, Yoni eggs, uh, vaginal eggs and Mona Lisa laser. Um, not really incontinence pastries, um, lots of stuff on pre and post-op logistics and post-op complications advice to seek multiple opinions prior to nine, uh, uh, mesh. Um, and people did not really use highly rated websites. Um, so I'm just going to go to the different platforms here. Um, so how do patients use Facebook? Um, it's, I think Facebook has really emerged as the medium for groups. Like I'm part of all these groups on Facebook and it takes up a lot of my feed. Um, it's a source of support and information for health conditions. For example, um, Nancy's nook for endometriosis association of pelvic organ prolapse or APOPS. It's also a mobilization tool, um, for anti-usher and anti-mesh groups in the gynecology space. Um, so in DC, it, that Nancy's nook endo group was a significant source of MIGS referrals, about a third of patients for Jim Robinson's practice. My partner here, Clara King gets a lot of referrals from this group as well. Um, they actually have a preferred provider list and they, um, they have a strong bent towards excision of endo, um, and do not favor medical management. Um, I'm going to be honest. I am a mole on this group, the association for pelvic organ prolapse support. So it was my partner in DC. Um, it's actually, he told me that there's three questions that you have to answer, but there's a lot of perioperative questions on this group. Um, but I also have gotten referrals from this group as a provide, uh, preferred provider in DC. Um, now I'm in Cleveland, but, um, they also, uh, would ask me things that the patients would ask me about things like PRP injections in the vagina that they gleaned from this group. And I just had a patient this week who, um, I was counseling her on the options and she was like, well, I need to do research. I need to talk to the pop people. And I was like, you mean online? And she said, yes. And so I think it might be one of these groups. Um, and I'm going to bring up this documentary called the bleeding edge on Netflix. Um, it's from 2018. Um, it was, uh, a very strong narrative of, of patients over profits of our patients. Uh, gynecologic devices were prominently featured, particularly the Asher, um, vaginal cuff to his instances associated with robotic hysterectomy and transvaginal mesh kits for prolapse. Um, the most interesting part to me, however, was that the anti Asher activists mobilized via Facebook groups to lobby their us representatives and the FDA to take action against bear. And as you know, Asher is now off the market, but, um, I just Googled Asher problem support group, and there's thousands of members in here. And the documentary actually, um, lays all of it out there of how they, uh, lobby their representatives and the FDA. So I thought it was fascinating. Um, in August, a couple of years ago, the Australian New Zealand, uh, urogynecologist also talked about how these Facebook groups in their countries, um, helped mobilize the patients, um, against the mesh. Uh, and as we all know, transvaginal mesh for SUI and prolapse are now bound in the UK, Australia, New Zealand, and Dubai. How about physicians? Um, well, it can be practice building. It can also build the personal brand. It can create support. And then activism, like for a political cause or a certain, you know, different causes. I'm part of a PMG, I think it's probably closer to 80,000 women now. And there's many subgroups, Disney, PMG, I'm part of this PM positions, moms group in Cleveland. There's a style MD group, there's this weight loss for positions group, and this FRS graduates group. But I just wanted to give this this example. My friend Linda Yang, who's a mig surgeon at Northwestern, has a classmate, and she quit her job as a pediatrician to do this weight loss for physicians full time. And she does it like marketing on Facebook, and she has a website. She has podcasts and does personal and group coaching. This is another example. I don't think she, this is a cardiac anesthesiologist, Sasha Shilcut, but she started this group style MD. I think it's defunct now. And now she has a website, she has a book called Between Grit and Grace, and this New England Journal of Medicine article, social media on an advancement of women physicians. But you can really leverage this platform in many ways. And now I just want to talk about Instagram. As many of you know, it's photo based with captions, the hashtag used mirrors Twitter. It's owned by Facebook. It's beloved by millennials, influencers, and shoppers. They have very robust data collection by Facebook and Instagram. I like to say, how dare they know me so well, because it results in these targeted ads. I never knew I needed a Casper mattress and a quip toothbrush and M&L for clothes, but it definitely makes me think I need them. And it's a mechanism for something called social patient acquisition. And that's something that we have done at the clinic, but through LinkedIn is, and we have a click through rate, and they actually perform very well. They have analytics on all the things that work very well here. This is just an article, an FRS journal, now you're a gynecology journal by Chin et al. It's called hashtag Uruguay and what's trending on Instagram. And they analyze over half a million posts. The most common hashtags were regarding the pelvic floor, IC, pelvic pain, incontinence and prolapse. The most common authors were from patients followed by APPs and physicians. And actually APPs author the most informational posts. The accompanying editorial was a call to action. They, Carl Jalad and Sherelle Iglesias talked about how urologists, oncologists and radiologists were early adopters. And actually urologists use a simpler portal to compile hashtags and ontologies based on disease process. And just a plug, Jocelyn Fitzgerald, Sherelle Iglesias and I actually published something on hashtags and gynecology just to try and organize us as a specialty because it's, as you know, hashtags kind of are like organizers or a Dewey decimal system. It helps you find other posts in the social media atmosphere. So it's very helpful to have a common hashtags. And it facilitates the online search for specific topics as well as development of more research collaborations and allows the patients and healthcare professionals to discover relevant content more easily. Other examples, you can advertise and promote your residency program. This is the Instagram page from OBGYN Tracks. This is our CCF OBGYN residency. It's a tracking program. You can see here, we have all these reels and stories. And then we have other examples, mom and Dr. Jones, I love her. She is a physician. I think now she lives in New Zealand because she's talking about being here in New Zealand, but she uses her voice on social media to challenge misinformation and to educate the public on all these issues in women's health. I also love Dr. CCT. You can see she has a hundred thousand followers. She is somebody who trained at Mayo Clinic. She's a boy mom. And she also has a patient-facing website that is educational about different issues that are of interest to the public in terms of GYN topics, COVID vaccine information, et cetera, et cetera. So onto Twitter, I always mention this, which is if you think it's superficial and unimportant, just remember that President Trump leveraged Twitter and Facebook through Cambridge Analytica to the US presidency. It's very short. It's 280 character limit. And I call it my productive time-wasting habit because this is sort of my main public-facing platform. The most famous gynecologist in this space is probably Jen Gunter. She has almost 400,000 followers. She has leveraged her platform into several books. You can see that she's written the Menopause Manifesto, the Vagina Bible. She has the Vagenda.com. She also had a New York Times website, or sorry, advice column. And then my former fellow, Jocelyn Fitzgerald is actually also a huge, we call it a GYN influencer. It's just funny because I remember she and I were at SJS one year and both of us were trying to get on the top 10 influencer site, like on Simpler. And we were, our fingers hurt because we were working so hard to try and get on this influencing list. And now she is kicking butt with tons of followers. She has 33,000 followers. She put together these GYN influencer lists and she actually got a ton of followers through a viral tweet talking about the influence of stress on health outcomes. This professor of hers in medical school talked about it and she brought that up and then it went viral. So when we look at physicians, about 90% of US physicians engage in social media, but why? The most common causes are, or reasons are for educational purposes, research, looking for news, networking, and advocacy. And probably in the more businessy realm, it's Doximity and LinkedIn. The other ways that people use it, like I mentioned earlier, is like the CCF OB-GYN residency website is trying to find other applicants online. So this urology applicant website is actually quite helpful, posting things that are relevant to the urology applicants. And then OB-GYN virtual match actually also is a similar sort of forum. And Dr. Southworth is actually going into urogyne, but she created this OB-GYN residency program accounts list. So it's an aggregator of all the residency program accounts. This virtual OB-GYN match I showed you, the Twitter account, they also have a Instagram, which I think is also very helpful because they have these programs that take over for the incident story, take over for a day. And then you get to see a day in the life, especially in the era of COVID where we pivoted to virtual. I think this is crucial. And I was just talking to somebody who is a fellow right now, and we were just talking about when I gave this talk in 2019 and 2020, not many programs had Instagram accounts, like some did, but now it is absolutely almost like a red flag if you don't have this for your residency program, because how are you going to differentiate yourself virtually from all the other programs? So I think it really is an opportunity to create your own story and showcase your best stuff. I also think social media is a great way to talk about your residence and just bring attention to the cool research or whatever accomplishments that they're doing. Carrie Bennett was a resident here who matched in MFM, but she wrote this great article that was published in A-Jog MFM, and it's a good way of just letting people know of the great things that people are doing in your program. The other way that people leverage social media is these tweet-torials. Emily Barnard is a REI who is now at Shady Grove in DC, and she is a member of the Fertility and Sterility Social Media Board, and they do these awesome tweet-torials with memes, and it's got like 10 or 12 posts, and it's very educational. So I obviously am a urogynecologist, but I'm just always curious about all these things, and they did a really great job doing these tweet-torials on different topics. As I alluded to earlier, people also use social media for advocacy purposes. Dave Hackney is a MFM here at UH, he's a division director, and he brought attention to this Ohio State bill that was brought to the floor. Thankfully, it did not go through, but this was a bill brought forward where a physician must attempt to reimplant an ectopic pregnancy into this uterus, and it went viral a little bit, but basically he essentially did a public-facing education that this is not medically possible. Ian Fields, as you know, very famous urogyne influencer, he actually wrote this tweet about his mom dying of cervical cancer, and he became a HIV vaccination, well, just a vaccine educator, I think, and I think it really struck a chord and resonated with people, and then he leveraged it into this self-magazine piece, talking about how HPV and cervical, or cervical cancer is preventable now with the HPV vaccine, and I think it was quite powerful. I also wanted to bring up this example from one of my former fellows, Lisa Hickman, who's now at Ohio State. One of her passions is postpartum care clinic. She set the one up here with Katie Props, and she connected with this group online, this Mothers with Fourth Degree Tears, and they are moving forward and collaborating in research efforts together. I like to use my Twitter account to talk about pro-vaccine things, COVID vaccine and HPV vaccine in particular, but basically, we did, my family participated in the Pfizer COVID vaccine trial here, and we got some engagements on that, and we did not grow two heads, et cetera, but I think it's just really powerful to see people who are actually participating in these things, and just giving an example of it's okay to get a vaccine and nothing untoward is happening to us. Foley is a MIG surgeon at Brown. It was cool. I got to see her connect with the former editor at the Green Journal, Nancy Chesher, and it's a really great way to connect with these movers and shakers and thought leaders in OB-GYN because the hierarchy is quite flat, and you can just respond on your phone to the editor of the Green Journal. Helen King-Morgan is an OB-GYN at University of Michigan, very active in APCO CREAG, and it was actually cool because I connected them. I think Elena, who's the fellowship director at Hartford, and Chris, who knows Helen, saw some of the tweets, and they invited her over to Grand Rounds to talk about well-being and reducing burnout. Then I loved following Dr. Cabele. She's not as active on social media right now. I think she's just busy being chair, but she just brought home the fact that very few U.S. medical school chairs are Black women. This hashtag, Her Time Is Now, was very powerful. There was a whole movement from AMWA and a report that was released, and I highly encourage people to read it. I think just connecting with all these people and just knowing that our experience can be universal and we're not alone is very powerful part of social media. The other thing we use social media for is just to advertise that we have a new program, this Transgender Fellowship at the Cleveland Clinic. When we went up to number two, now we're number four, but in the U.S. News and World Report rankings, we just retweeted Dr. King's tweet here, but here I am with my fellows, Viviana Casas, Libby Chang, and James Ross. It was in the middle of COVID, and we just had an opportunity to humble brag here about the achievement. I just wanted to move on to TikTok. TikTok is an extremely powerful medium, and it's very popular among the teens and 20-somethings. I would say among the residents and at the gym with the trainer crowd, I just noticed that 20-somethings just love TikTok, and that's where they're getting all their information online and news. I will say TikTok is probably going to get banned in the U.S., at least it's getting banned on government devices and is probably a little bit like the Facebook app is, a little bit of spyware on your phone, just so you know. I love this guy, Dr. Glockenflecken. He's an ophthalmologist. He is fantastic, but he does all these edited TikTok videos, and he is huge. I think he's giving commencement speeches and speeches at major national meetings. He's so popular, but I just wanted to put this little screenshot of doing a fundus exam, the eyes and the fundus exam for the uterus. Actually, just going back to Glockenflecken, he does a lot of just insidery physician posts on insurance companies and physician specialty. He just nails it, and he does it in such a great respectful way, but that's quite sarcastic and funny. I think he strikes really a great balance in the tone. Nicole Baldwin is a pediatrician. I think she's here in Ohio, actually, but she created this TikTok on vaccines. She went viral, but then she got harassed and doxed, actually. It struck a nerve in terms of being very effective, but then lots of people flooded the online rating system for her pediatrics patches and gave her zero stars, and they were getting threats online and via the phone. It just shows the power of social media. I just wanted to talk about the survey. It was featured in this Fast Company piece on TikTok, but about two-thirds of users in this survey were seeking out Google health advice. One-third turned to YouTube and 20% turned to TikTok. Almost 40% turned to influencers because they are seen as more accessible than a health professional. Actually, relatability is important. Over half of Americans say they look for an influencer with medical certification, but a quarter say they look for relatability. However, about 90% believe influencers contribute to misinformation, and three-quarters fact-check what they have to say. Nevertheless, 17% of Americans do say they trust influencers more than doctors, and about half say a celebrity endorsement increases their desire to buy a medication and supplement. I will say that I notice this particularly when it comes to fitness, but I think health is obviously adjacent to that, and there's a lot of misinformation as well. Probably one of the more famous GYN TikTokers is Dr. Karen Tang, who's a meg surgeon in Maryland. Actually, I think my friend Lucy Chi is friends with her because she went to Beth Israel for residency. I think she has a book deal that's pending. Just another note on Mama Doctor Jones. She has this YouTube channel, but she also goes on TikTok and then she's just talking about how social media is a good source of bad medicine. Again, trying to address some of this misinformation on the COVID vaccine. I would be remiss if I did not mention the role of podcasts. I remember when this started, and now it's huge. The residents tell me that they listen to the Krogers over coffee all the time, but there's another one, Dr. Chapa's Clinical Pearls. Scott Steele is the colorectal chair here at the clinic, and he has a podcast called Beyond the Knife, and that is hugely popular in the general surgery space. This Cleveland Clinic Digestive Disease and Surgery channel is also very popular. I just have to shamelessly promote my own podcast called Backtable OBGYN. This is a podcast that I host with my co-host, Mark Hoffman, who's a MIG surgeon at University of Kentucky. We talk about a lot of different topics in OB as well as GYN. So what are some concrete tips on how to optimize your online presence? Use a professional headshot, use doctor or MD as part of your handle and with your name, put a short bio so people know who you are, and link to your website. Put a disclaimer that the postings or opinions and tweets are your own. Make sure you know your institution's social media policy. Actually, the Cleveland Clinics is quite strict. You cannot put anything about patients, and there's some verbiage about not political activity. And then keep your posts positive and professional. I'm just going to warn you, if you put yourself out there, be ready for some hate. I posted a link to an AP article that my friend Jeff Clements was quoted in, and the trolls came out. And essentially, they went personal. This is a little blurry, but they went after a couple of the members of the OGS boards. And essentially, I had to block and mute them. So what are my own thoughts about Twitter? Create your own brand, personal brand and narrative. You can elect to do a narrow versus a broad focus. One of my colleagues only posts on stimulation, surgical education, endometriosis surgery. My personal interests are to promote science and evidence-based medicine. Anything that kind of interests me, best practices in leadership, work-life balance, women in medicine. I like to stick to reputable sources. I would encourage people to build their reputations and embrace the humble brag. Use this platform as an opportunity to elevate interesting and innovative people, concepts, or work, and retweet others. This is your opportunity to show your thought leadership. Be aware of the echo chamber, and then, like I've been mentioning to you earlier, block the trolls. I just want to quote Sarah Mojarad, who has a very excellent guide to academic Twitter. These are her personal rules and focus. Follow high-value accounts. Retweet high-quality posts. Add value and create conversation. Congratulate others for achievements. Use Twitter to network. Reach out to more experienced Twitter users in real life. Share your ideas. Use hashtags. Avoid sarcasm, and don't plagiarize tweets. I'm going to be honest. Sometimes, I do engage in some sarcasm, but I can't help myself. It's just like email or any online forum. It can be misinterpreted very easily, so I'd be very careful. Social media is becoming more critical to academic success and information dissemination. This was an article showing that tweeting does improve citations. This is sort of mixed. Some specialties, it does, and sometimes, it doesn't. This was in urology. This one shows that it's positively associated with the number of... If it's tweeted about... The number of citations that urologic publication receives up to three years after release is positively associated with the number of mentions it has on Twitter, so it's sort of a harbinger. Then, you can see it at the thoracic surgery social media network. It did increase the citations. This is just a white paper about how social media impacts or supporting putting social media impact on the CVA. This is a Cabrera article that I mentioned earlier from Mayo Clinic talking about how they've structured that in a formal way for the Mayo Clinic Committee on Academic Promotions and Tenure. Then, I just want to mention altometrics. This is one of the criteria that goes into the impact factor of a journal by looking at the social media activity around it. They calculate each online mention of a piece of research. It's just another measure of the impact that the article has. Back to the altometrics score, when you publish a paper, you should absolutely tweet it out and just give a little blurb about it just to let people know that it was published. In terms of personal brand and narrative, I'm just going to say nature abhors a vacuum. If you don't write your own story, someone else will write it for you. My advice is to own the first page of your Google search content and to perform online hygiene checks every four to six weeks. Be your best self. My brother likes to say, if it's not online, it doesn't exist. He works at Google. Basically, you really don't have an excuse for not having an online presence. I used to argue with him and I'd say, well, how about that small hole in the wall ethnic food place? He's like, he doesn't even think that's an excuse anymore. One of the easiest places to create your own narrative is your website bio. The Cleveland Clinic, I just literally, they have your headshot and all you have to do is fill out all these criteria. I wrote a little bio about myself, professional highlights, honors and awards, all these little things that I don't even know what they mean, this Castle Connelly, exceptional women in medicine. You should put that in there. Patients love that stuff. LinkedIn is another way that you can put your credentials and your own narrative out there. It actually does make it because of the way they've configured the algorithm for LinkedIn. It does show up on page one of your Google search. Another website, another very important part of your online presence is the website for your practice. My friend, Matt Reeves, owns DuPont Clinic. They're actually in DC, but they're going to actually open a branch in Los Angeles, I think this summer, but you can see here it has a theme. You can tell his favorite color is purple. He has a little bio about himself. He has a professional headshot, all that good stuff. I love this little graphic. It's a play on Maslow's Hierarchy of Needs, Maslow's Hierarchy of Search Engine Optimization Needs. Essentially, the very minimum is that you need to have crawl accessibility, but you really need compelling content that answers the searcher's query and that is keyword optimized and has a great user experience. Even better is having shareworthy content and you want shareworthy content and you want to have a really good title and description and you want to have a good snippet and schema markup to stand out in the search engine stuff. That's essential to Rankin's and it just improves the competitiveness. This is just taken from my colleague here, Elliott Richards. He's an REI at Cleveland Clinic. He just has broken it down into real estate you don't control very much, which is web searches for your name, institution, topic area, but then the real estate you can control is your own website, a blog, Twitter, LinkedIn, Facebook, Doximity, Facebook, Instagram, and that's social media and that all feeds into the search engine optimization. SEO is worth over 80 billion dollars. The objective of SEO is to increase the likelihood that a site will be in the web user's top search results and the first page of Google captures the vast majority of search traffic clicks, up to 92 percent. So how can you own your first page of your Google search content? Well, be your own real estate developer. So this is a case study. Like I said, Elliott Richards is a CCF REI and he googled himself and you can see here there's the first one is this person on IMDB, but he's here, Beachwood, Health Grades, REI Fellowship, and then this Hollywood guy again. There's images, there's a kind of a not so good situation here with the Elliott Richards goods who marched Hitler's birthday with a swastika graffiti and he was jailed. And, you know, he talks about this is him, but not controlled by him. And then none of these other people are him and there's no additional information here. So he took 60 minutes and he spent about an hour uploading the same photo and blurb to seven social media sites, Twitter, Facebook, Instagram, LinkedIn, Doximity, Google Scholar, ResearchGate, and double-checked his authorship and citation and Orson and Scopus. And he created a Google business profile and he put a business profile manager here. And then he was able to look at the analytics and he could see over the quarter, he had like a hundred searches, but total actions was a hundred actions here, but this was 2,200 searches in a quarter. And, you know, you could see how they came to him. So Beachwood Fertility Clinic, Fertility Clinic near me, you know, all these different things. So it's actually like interesting and good to know how people are coming to you so that you can optimize your search so that the path is easier. It's like a well-worn path. And so you can see here, this is controlled by his institution, but then he, this is now all directly controlled by him. And then he created this Google business profile. And then this is something that he controls. So other content, patient-oriented videos, using the rating websites, the hospital system, WebMD, Google, and health grades. And I'm going to go into that in more detail here. I like to say we live in a Yelp world. It's a number of stars versus a times number of reviews. You could also plug in Amazon here too, because it's the same kind of thing. And I give this example, when I moved to Cleveland from the DC area, I needed to find a new hair salon to cut my hair on the east side of town. So east side of town over here, I live in Shaker Heights, and I wanted to hone in on this area. And then I cross-referenced to this east side salon called Sean Paul Salon, and I liked this one stylist. And then it turns out three other people in the Women's Health Institute at Cleveland Clinic used the same method and went to the same hairstylist. So this is a very common strategy. Well, it's no different than for doctors. Fascinatingly, I somehow got the most reviews out of everybody in my group when I was at MedStar in DC, and patients would tell me all the time, I researched you and I knew you were the best. And I think they were alluded to my online stars. And for some reason I had 830 patient ratings as opposed to all my other partners had about 70, and it was 4.7 stars. And it really drove a lot of traffic to my clinic. But I also wanted to go over what happened here as a cautionary tale. So you saw Elliot Richard's box over here. Well, I did not create this box. This box over here, you can see you Google my name. There's ZocDoc and health grades, healthyusnews.com, vitals.com. This was not created by me. This was created by someone here. And this is a review aggregator. Not only does it show you the name and the address, but it shows you reviews from the web. And then you can put in a and a narrative review. This person actually went to every website, vitals.com, WebMD, all the things. And she wrote essentially the same thing. I'm going to just read it here. I had a horrible experience with this doctor. She is condescending, rude, disrespectful, and pompous. Her bedside manner is horrendous. Moreover, I have more pain now than prior to being under Dr. Park's care. I wouldn't recommend Dr. Park to my worst enemy. I'm seeing another doctor to correct Dr. Park's mistake. She was way out of her league for my particular surgery and was arrogant to say so. And see, there's like three likes right here. So after I went through the Kubler-Ross's stages of grieving, I was like, you know what? I am going to fight back. So I looked up online how to engage in reputation management, and I decided to bury the review. So I solicited grateful patients to submit reviews for me on online patient reading sites, like WebMD, HealthGrade, ZocVitals.com, Yelp, my Google location, and my institution's patient review system. And I explained it to them. I'm like, Mrs. So-and-so, I just want to ask you a huge favor. Somebody wrote something about me that I can assure you is not true, and I'm just wondering if you would do me a favor and put a review online. I would be so appreciative of your time and energy on this. And a lot of my patients did it, and it worked. So just a couple of closing thoughts. Reputation management, internet is maybe useful for you, but it's not working for you. Prospective employers and patients will be doing searches on you, and significant online damage can be inflicted due to personal and professional grudges. The bad news is you can't erase it. It lives on the internet forever. But the good news is if it's off page one of Google, it basically doesn't exist. And create your own story and dominate your profile. Consider setting up a Google alert on yourself to monitor for negative reviews, hate sites, negative media. Maximize your Facebook privacy settings and don't post a lot of photos about your family on social media, although I do that, and try and keep the privacy settings pretty close on Facebook and Instagram. And I just want to just mention about this negative patient reviews and online defamation. This is a great review written by some physicians, OBGYNs and a lawyer physician in the Green Journal from 2020. And there's some pretty strict criteria about how, you know, if you can pursue a legal case against negative online patient review. And these are the criteria. Presence of a false or defamatory statement. False amounting to at a minimum negligence with the author knowingly or negligently making the claim which may or may not be true. Unprivileged communication to a third party. And in the case of online communication, this browsing online can be considered the third party. And then harm or damages suffered by the plaintiff directly attributable to the statement like a tarnished reputation. The problem is it's very challenging to prove defamation. You cannot sue the review website. They're indemnified just by the structure of things. It may be difficult to determine the author in anonymous postings. There are First Amendment considerations which includes the right to anonymous free speech. The statute of limitation is one to three years which depends on the jurisdiction. And it creates media attention and negative publicity. So I'm just going to summarize what the author said in so many words. Don't do it. So key takeaways. Flood the zones with evidence-based information. Create your own crafted personal narrative. Tout your accomplishments. Be positive. Elevate and do not denigrate. Do online hygiene checks and follow your Google page search. So I'm happy to take any questions. I think you're muted, Dr. Menagie. Oh, thank you. Sorry. I thought I unclicked it. Thank you, Dr. Park. That was a really great talk. Thank you so much for going over the Google business page. I feel like that's such an important thing that most physicians don't know about. And it's not even Twitter or any of the other social media, but just being basically on Google and putting yourself out there. That's so great that you were able to mention that for us. I will say one other story about that. One of the people that I know just from being a resident here, if you Google her name, her home address shows up. So you should control it because otherwise Google will populate something else in there and you really want it to be your own narrative. So you just assume that that wouldn't happen, but it can happen. So I really think it's important. And I learned the hard way. I think it's just generation dependent, but when I saw Elliot's slides, I was like, this is definitely an easy thing to do in an hour. You know, you use the same blurb, same headshot and just put it everywhere. And then the Google business thing, I think is really helpful. It definitely helps. I can say like one tip I learned was when I started my job, I created one because I was advised by great colleagues that they're like the first thing you should do, set that up. But my institution then created a business page on Google and that overwrote the one I had created. And that actually deleted like reviews and all the links and everything I had worked on. So I totally agree that people should be sequentially taken a look because that didn't happen until months later. And then we fixed the problem and then again, it happened. So it took many steps to actually be able to combine the two Google business accounts. So being in charge definitely matters. Yeah. Great advice. And the other thing I will say is my experience here at the clinic, it was kind of weird because the way that the patient reviews were, they were tethered to a particular site. Like all of us go to two hospitals. And so if you go to, for me, I go to Hillcrest and main campus. Well, for some reason you couldn't get the reviews, even though the same provider, you couldn't get the reviews to register. It would only be tethered to like Hillcrest or something. And then it was a big problem. I don't know why. And then they, our system does not publish the stars unless there's at least 30 reviews because of the sample error. And then a couple of my partners had no reviews and to patients having zero stars is like a red flag. This is, this is just like a marketing thing too. But we, I had my team, my, all my positions we had a team's meeting or zoom meeting with the call center. And so we introduced ourselves and we told them our niches and interests. And I just think that personal touch helps. Also, they told us that the stars in the website really drive a lot of their stuff. You know, it's, it's, it's a calculation. Cause like some patients will travel and some people will not travel. Like if you're on the East side of town, yes. People want to go to the East side, but they will travel across town. If you have enough stars, all of this stuff is in San Diego is a big place. Yes, it is. I have also noticed that a lot of patients will come in our institution. I'm at sharp here and they have videos. So the, after a month or two where when we've been here, the marketing team has you sit down and do a video and it's on YouTube and everywhere. And patients have come to me saying, they looked at my video and that's what made them want to come to me. They liked the energy or something. They liked something that clicked for them. So those videos are really helpful to beyond just the picture because they kind of get a better sense of your personality, I think. Yeah. Which I was hoping when I saw it for me, I was like, this is embarrassing. I don't want anyone to see. Yeah. Oh, I know. I love you. I'm like, great. I've had that same experience. People were like, I watched your video and that's why I chose you. And, and then I always say the same thing back, which is I have not watched my video at all. Cause it's, it's cringy to just even hear my own voice. But, but it does help in terms of, of just, you know, explaining your philosophy It doesn't even have to be that long, like two, three, five minutes and that's enough, but patients want to know something about you. So I think that's also very helpful. Yeah. Very true. Well, thank you so much. This was so great. And it was so nice how you broke down all the different social media platforms because there's a lot of options to choose from for sure. Yeah, absolutely. Well, thank you so much. And I forgot to say thank you to Weiyi and Augs for hosting. So thank you so much. Of course. And just as a reminder, we do have two upcoming webinars as well. Next week on the 24th, there is a webinar on complex cases. And on June 6th, we have Dr. Sarah Collins discussing minimally invasive repairs of gender urinary fistulas. So hopefully we'll see some people there. Thank you so much again, Dr. Parks. Thank you. Great. Have a good night. Thank you.

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