How one NHS consultant is using Twitter to improve treatment

Twitter allows Dr Graham Mackenzie to tap into the latest thinking and research from around the world to help improve outcomes and treatment, he tells Kevan Christie in the latest of our series marking the NHS at 70

In the third part of our NHS at 70 anniversary series we shine the spotlight on the future of healthcare and look at ways in which social media is being used to source cutting-edge research and the latest developments with the aim of providing patients with the best possible treatment.

Dr Graham Mackenzie, an award-winning consultant in public health with NHS Lothian, is at the forefront of a concerted effort to pool data from around the world using a “spider’s web” style Twitter map for particular subjects.

The maps enable Dr Mackenzie to monitor popular tweets and retweets from health experts around the world that can then be used in a practical setting.

He compiles summaries of the most relevant information, on, for instance, bowel cancer, and then puts together a free and easy to use textbook that enables his colleagues to keep up with the latest developments in any given medical field.

Dr Mackenzie, who says this kind of mapping first started in the manufacturing industry, firmly believes that the work he has been doing in the last five years makes the best use of social media.

He now plans to return to a clinical setting to put everything he has learned into practice, having worked in the public health arena for the past 17 years addressing inequality.

He says: “If you’ve got thousands of clinicians sharing information about a particular topic it’s a shame for that to get lost.

“Stories on social media often only have a lifespan of a few minutes and if you’re lucky a few hours but if you can gather together information that’s come out around a particular awareness campaign, say bowel cancer, and collect it into a summary – then it’s like having a textbook that costs nothing.

“It’s completely free and it’s linking you in with the best science, the best communication aids to help patients and sometimes real advances are being made.

“You really learn something from a person in another part of the world that you can then apply to your next day of clinical practice.”

Dr Mackenzie has been carrying out work in this area for the last five years and says it’s important to “learn from mistakes” and improve practice.

He began his career in general medicine and cardiology, joining the Western General Hospital in Edinburgh in 1995.

The consultant was given the Cullen Prize Award by the Royal College of Physicians last month by way of acknowledging his excellence in teaching.

He said his work is not about cost saving but making the best out of the treatments and assessments available so patients receive better treatment.

He told The Scotsman how his blueprint works.

Dr Mackenzie says: “I saw that somebody had mapped tweets at an event I was at back in 2015 and they had tracked the tweets that had been posted and the different interactions between people.

“It’s like a spider’s web of connections. For example, if I post a tweet about a particular clinician who’s discovered something new and it’s based on local practice I would mention that person, the institution where they’re working and I’d mention a person in another part of the world who might be interested in it – if they were all on Twitter.

“I’d look to add to the research and all of these people would be connected on the map.

“I saw one of these maps and I thought that’s fascinating – it’s amazing that just out of a small event, you can see the huddles that generate and the connections between people.

“So, I started to think how can we apply that in our own development?

“Individual clinicians need to develop throughout their careers – it’s not just a case of doing well at school and passing your exams.

“It’s about continued development, all the way through to your retirement and often beyond.”

He adds: “With social media – even if people are sharing their mistakes or a new tool to communicate more effectively with patients or something, for instance, like a picture that shows how antibiotics work – that kind of information if it’s been developed in somewhere like New Zealand then we can apply it in Scotland and vice versa.

“We can suck out all the information from the internet, from these big complicated spider maps and then start to identify the best content to use.”

Dr Mackenzie says he keeps track of retweets and things around important health topics that appear to be trending on his network.

He says the trick is to have people share the information through social media.

He said: “If people like something on social media and share it with their friends and their colleagues, that is useful and other people start to retweet it then I can see that as a signal in one of these maps and I can pull out the relevant information to share with my colleagues.

“What I’ve done is pick big topics that have tens of thousands of people tweeting which is overwhelming.

“No individual can look at all these messages. Imagine what a sore thumb you’d have. For example there was a big drive on colon cancer screening a couple of months ago and there were tens of thousands of tweets on this subject and no individual can scroll through them.

“However, I was able to pull the popular messages from the thousands using the technique I’ve developed from these maps and was then able to share the top messages.”

Through his work Dr Mackenzie has developed an international profile in his use of social media analytics to demonstrate connections, support individual learning, and to present key messages from professional development events. He started a programme of online demonstrations to show how others can develop these skills.

Dr Mackenzie says: “I started in the wards as doctors do and I did six years in hospital.

“I decided that I wanted to look past the individual patients and look at the population – studying why is it some patients become ill at a younger age and what can we do to prevent that?

“That’s what I’ve been doing for the last 17 years, but over the years I’ve been doing much more of this quality improvement work. It’s not rocket science it’s actually very simple. Say I wanted to sort out diabetes care – I know that some of the information is way too big for even a team to get their heads round, so I look at how we can improve things one patient at a time. So, sorting out one little thing for the next patient through the door and then sharing that with your colleagues you can see why that links with social media. You discover that something that you thought as a clinician worked, actually when you talk to patient or relatives you discover it doesn’t work, that they haven’t understood it in the way that you’ve understood it.”

There is an emphasis on quality improvement in the NHS with lots of attention turning towards making the best use of social media.

Dr Mackenzie adds: “Often the focus is about sharing things with your own team but there’s an awful lot of learning you can have if you look further afield. If I looked at a particular topic, say antibiotic resistance on social media and search for the tweets that have been posted about these topics over the last 24 hours, there will be hundreds, sometimes thousands of people posting messages about any particular subject.”