On Location ASH Annual Meeting
Dr . Schattner said she believes patients understand and respect these issues , and doctors should in turn respect patients ’ inquiries . “ Most educated patients are not looking for specific answers to their medical problems online ,” she said . “ That said , I admire doctors who treat patients with respect . Some doctors only follow doctors – not patients or people who identify as patients . Whether or not you choose to follow people who are not physicians , I think if you acknowledge the legitimacy of their questions , that can go a long way .”
Social media platforms also invite informality , but Dr . Schattner advised the audience to keep it professional . “ If doctors use words or phrases like ‘ LOL ’ or ‘ garbage ’ when referring to clinical trial results , for example , that can be hurtful to patients who are on those trials .” Patients are savvy enough to find and follow conversations about topics of interest to them , she said , adding “[ physicians ] should be careful , because patients may be paying closer attention than [ doctors ] realize .”
Maintaining privacy and safety online should also be of paramount concern , because some unwanted followers might be too close for comfort , Dr . Schattner noted . “ There are creeps on the internet ,” she said bluntly , “ and because I have a significant following , at this point I have learned that directly .” Blocking and reporting spammers or users who employ hateful language or share violent images is a must for any doctor who wants to seriously use social media .
Dr . Schattner advised audience members to be careful about divulging details about their personal lives ( such as their location or family , events they attend , etc .). “ When I ’ m here , it ’ s useful for me professionally to reveal that I am in Atlanta for the ASH annual meeting ,” she said , “ but I ’ m not going to publish my family vacation plans on the internet .”
Tips and Tricks According to Dr . Leonard , Richard T . Silver Distinguished Professor of Medicine and associate dean for clinical research at Weill Cornell Medicine and New York Presbyterian Hospital in New York , deciding what to put on the internet is half the battle . He discussed best practices for taking full advantage of the connectivity and exposure inherent to social media .
Twitter can be helpful for shining a light on your institution , programs , work , and the work of colleagues , he said . Retweeting colleagues ’ presentations or achievements to your followers – and providing your opinions – can be a great engagement tool .
For better engagement , Dr . Leonard noted , try to keep your posts interactive and , when possible , entertaining . Some doctors will use a lot of jargon , or will only post links to articles , and “ that ’ s fine if you just want to talk to your colleagues on the internet ,” Dr . Schattner agreed . “ To make your Twitter feed or any social media feed interesting , though , it ’ s helpful to have a hobby . For me , it makes Twitter more fun .”
The back-and-forth comments and camaraderie that builds between users and followers is an essential aspect of social media . But Dr . Leonard warned , “ Comment , don ’ t vent . It ’ s okay to comment and be excited about something you are posting , but be mindful of your language and reactions .”
And , of course , realize that not everyone online is following these same rules of engagement . In response to an audience member ’ s question about frustrating interactions on social media , Dr . Schattner advised that sometimes it ’ s best to just walk away from the situation . When conversations become argumentative , ignore them . “[ These interactions ] can be hurtful to both sides – they are not helpful to patients , and they are not helpful to the people who tweet ,” Dr . Schattner said .
The most important thing to remember is that social media is supposed to be informative and fun – not a burden professionally or personally . “ Do it as much as you like ,” Dr . Mohty said , “ but it is not an obligation .”
An audience member noted that in the era of “ alternative facts ,” constantly correcting misinformation on the internet can be a burden . While the internet is rife with misinformation , “ we are not in a position to police … Facebook or … what is said on Twitter , or in The New York Times for that matter ,” Dr . Schattner said . “ Conventional and new media all have some truths and some fallacies . My attitude is you can ’ t correct it all . I think patients , through better education , will gradually gravitate to people who prove to be reliable .”
A Preview of ASH ’ s Venous Thromboembolism Clinical Practice Guidelines
In November 2015 , the American Society of Hematology ( ASH ) and the McMaster University GRADE Center announced a collaboration to develop clinical practice guidelines on the diagnosis and treatment of venous thromboembolism ( VTE ). ASH is the sponsoring organization providing all funding for the work , while the GRADE Center has offered expertise in systematic evidence review and guideline development methods . This project represents the first large-scale guideline development effort by ASH , undertaken as part of a larger Quality Initiative approved by the Society in 2014 .
VTE was selected as the first condition for which ASH would develop guidelines because it is a commonly encountered clinical concern for hematologists and for other medical specialties and disciplines , including emergency medicine , internal medicine , surgery , oncology , and pharmacology . To ensure that the guidelinedevelopment team adequately met the needs of all these interests , ASH assembled a coordination panel and 10 expert panels . The panels comprised more than 100 U . S . -based and international hematologists , clinicians from other specialties , and scientists with expertise in evidence synthesis and appraisal and guideline development methodology .
Together , the panels are discussing a total of 237 relevant clinical questions in their respective areas , explained Adam Cuker , MD , MS , chair of the ASH VTE Guideline Coordination Panel .
“ This is a truly comprehensive effort ,” Dr . Cuker , who also is director of the Penn Comprehensive and Hemophilia Thrombosis Program at the University of Pennsylvania , said . “ After several years of hard work , I am very pleased to announce that we expect recommendations from at least four of these panels to be published in 2018 .”
According to Holger Schünemann , MD , PhD , MSc , chair of the Department of Health Research Methods , Evidence , and Impact at McMaster University in Ontario , the “ goal was certainly to provide comprehensive guidelines on VTE , but we also wanted to gain knowledge on guideline development for future guideline projects on other topics . Another goal was to research new methods to make guidelines more transparent and efficient , both in the process and for the users .”
The finish line for releasing the complete guidelines is in sight , and at a Special Education session at the 2017 ASH Annual Meeting , the chairs of each of the 10 VTE guideline panels presented key recommendations from the upcoming chapters , providing an inside look at the guideline-development process .
In each presentation , representatives described the process for reaching a “ strong ” or “ conditional ” recommendation . Steps included :
• prioritizing and specifying clinical questions
• conducting a systematic review of available evidence for each question
• weighing the benefits and risks of intervention options
• considering the certainty of evidence
• accounting for resource use , acceptability , feasibility , and impact on health equity of each recommendation
Below are a few of the recommendations previewed at the meeting .
Diagnosis of VTE : Start With D-Dimer Mark Crowther , MD , chair of the ASH Committee on Quality , which oversees the Society ’ s guideline development efforts , stepped in for panel chair Wendy Lim , MD , MSc , to discuss updates to the diagnosis of VTE . First , he recognized that VTE diagnosis is a problematic area : “ We have a vast number of tests available to us , but they are expensive in some cases , difficult to administer , and have toxicity ,” he said , adding that diagnostic strategies vary between hospitals .
“ No diagnostic test is perfectly accurate ,” he noted . “ They all have true positives , true negatives , false positives , and false negatives , irrespective of the technique .”
Dr . Crowther focused his presentation on answering the following question : “ In a patient population with a low clinical probability of pulmonary embolism ( PE ), what is the optimal diagnostic strategy to diagnose a first episode of PE ?”
After omitting a diagnostic strategy that resulted in a large number of false positives , the remaining two choices ( an initial D-dimer and a computed tomography pulmonary angiogram [ CTPA ]) produced similar rates of true positives . “ Based on a comparison of these two strategies , the panel chose the strategy of an initial D- dimer , followed by a CTPA in patients with positive D-dimer results ,” he reported .
However , because VTE diagnosis is based on pre-test probability ( i . e ., the clinical probability of VTE in the general population of interest prior to diagnostic
42 ASH Clinical News February 2018