Social media part 1: Bye bye birdie

I joined X/Twitter almost 16 years ago in February 2009 and this week I finally took the decision to stop posting to the site. I always said I hoped the platform would last until I retired, and, in many ways, the timing of the slow deterioration and rot of X has mirrored my slow and intermittent progress toward retirement.In my initial foray onto Twitter, my account also served as the account of the Canadian Medical Association who I worked for at time. It represented a bold step for the national medical association and took the blessing of the board of directors and the CMA’s legal department before it could occur. (Interestingly, my original Twitter handle when acting on behalf of the CMA was @cmaer but after I left the organization I agreed to create the new handle of @pat_health and transferred my followers to this.) Those were the heady days when social media were a largely new and unproven communications and networking media for medical organizations.Read: Doctors engage the public by bringing a human side to social mediaFor more than a decade after that initial move, Twitter proved its potential as an instant communications platform and valuable networking tools where healthcare professionals, patients and their advocates could come together to share information and advice.Personally, Twitter gave me an unprecedented opportunity to make connections with thought-leading physicians around the globe—the pioneering physicians in the Philippines who started #healthxph and invited me to speak at their inaugural conference in Cebu, the always eloquent Dr. Liam Farrell in Ireland, Dr. Bryan Vartabedian in Texas, Dr. Jennifer Gunter as she developed her social media persona—all immediately come to mind. It also allowed me to become part of strong intradisciplinary Tweet chat groups such as #hcsmca (and its pillar of strength Colleen Young).Through Twitter I was able to develop expertise in a new form of journalism—the live reporting (Tweeting) of medical and healthcare conferences and the need to rethink and refine this when Twitter moved its character count from a maximum of 120 to 240 characters.Then things changed and darkness fell upon the land.The COVID-19 pandemic resulted in a flood of mis- and dis-information related posts occurring on Twitter and often swamping evidence-based posts from credible thought leaders. Then Elon Musk purchased Twitter. In addition to decimating the staff and changing the platform name to X, Musk trashed the strong moderation framework that existed on the site and allowed the racists, misogynists and haters to return.For the past two or more years, the situation has become worse. Many Canadian healthcare thought-leaders and organizations have abandoned X completely or gone silent and viewing of my live tweeting posts at medical conferences has often dropped by 90% or more.X post by former CHEO head and new CMA CEO Alex MunterSince U.S. election matters seen to have deteriorated further. The X algorithm is choking my feed preferentially with right-wing posts and the For You feed seems to believe I want to watch someone throwing someone else onto a trampoline made of barbed wire. In addition, X seems to be burying posts that have links to news stories and articles.I now find I get more engagement on LinkedIn and—like many others—my Bluesky following increased exponentially from fewer than 200 to more than 2200 followers as a result of the latest exodus from X. Bluesky is now the place to be to post and engage on topics of health policy and medicine.I realize that given what appears to be the inherently toxic nature of social media today this will not last and even now a colleague in Europe notes that they are getting lots of spam from strange people on Bluesky. However, it’s hard not to be enamored with a platform where an AI-assisted tool (Blueskyroast.com) describe my posts as: A blend of earnest insight and sly humour—think of him as a health policy superhero with a latte in hand.I recently abandoned Threads (and, with it, Instagram because that’s what you have to do) because of the stream of inane posts I was receiving. I still use Facebook with a personal network but now my stream is being clogged with AI-generated fake images.Unfortunately, what Bluesky or Mastodon or any other current social media platforms fail to offer is the ability to report on a conference in real time and engage globally with others who are viewing those posts which Twitter/X did so effectively. With the parallel loss of many print outlets for credible medical and healthcare news in Canada this is a serious deficiency.I have seen many grow and evolve on Twitter as the platform morphed into a way showing a personality that had both personal and professional aspects. And I have seen others post until the day they died and those last posts are unimaginably poignant.I’m not abandoning X totally as it still serves a source of information, and many brave Canadian physicians and others persevere there. But I will not be posting there anymore. In my last blog on Oct. 8, I noted that “posts about health and healthcare on X/Twitter still have the to power to engage or even move.” Unfortunately I now feel that those posts—if seen at all – are lost on a platform that no longer cares.(Part 1 of 2. Part 2 will deal with my thoughts on how physicians should deal with social media now.)Image: Photo of the remains of the statue that prompted English writer Percy Bysshe Shelley to write: Ozymandias:Look on my Works, ye Mighty, and despair!Nothing beside remains. Round the decayOf that colossal Wreck, boundless and bareThe lone and level sands stretch far away.”Pat Rich is a Canadian health journalist and former editor of the Medical Post. This item originally appeared on his website.

Social media part 1: Bye bye birdie

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