Thank you. So I have the con side. It probably won't surprise you, anyone asked to speak about social media is probably pro-social media in some way, but it's important to share the potential downsides and challenges of the use of this tool for advocacy. I do not have any financial conflicts of interest, but in the spirit of full disclosure, I manage or co-manage several professional Twitter now X accounts, including the pediatric section of SCCM, the Polizzi, and also one called Nutrinet, which is a pediatric ICU nutrition site. And I am finishing up my term as chair of the social media committee for SCCM. So we're going to talk about the potential negative personal and professional consequences of using social media as a platform for clinicians and argue that we're actually not obligated to use our voices via social media to promote public health, but then also talk about it if you're out there or it got out there, which we'll talk about, sometimes it will, even if you didn't put it out there, how do you manage and mitigate that? So why would I want to use social media in the first place? Because many people have this approach to social media. It's scary. There's crazy people out there. And I'm not interested. And there's a number of different platforms on which you can be present. One of my favorite follows on X is Dr. Jack Maple, who's actually a primary care pediatrician who talks about how we can leverage doodles and graphics to engage patients and families. But he also talks about can we, in his case, primary care providers, leverage it, or are we going to be called out for trying too hard, trying too hard to be cool? If you are involved in social media, I use this courtesy of Dr. Chris Carroll, who's a PEDS intensivist, very actively involved in social media. And our presence out there can vary widely. You can start at level one, which is kind of being a lurker. You're just watching. You're not even liking anything. You're not reposting anything. But you're just watching to see what happens up there. And your level of engagement, if you so desire, can increase over time that you begin interacting because you like. You maybe repost something someone says, but you don't add to it. You don't put your own voice out there. And then you can move towards endorsing, supporting. And then level five is actively contributing your own unique content in addition to supporting that of others that are posting in your areas of interest. So we know social media is extremely effective for rapid dissemination of information and education. Probably the biggest home run on this was our early contributions to understanding what was happening early in the pandemic. And in this paper published in Critical Care Medicine by Sapna Kutagkar and Chris Carroll, two PEDS ICU intensivists, looked at the rapid fire dissemination of COVID-19 across the globe. And one of the things that happened for us was what we now know as MISC, and in adults, MISA, our previous ways of disseminating information, such as publication or waiting to the next conference, were insufficient. And we first learned about MISC via Twitter from the U.K. and said, hey, are you on the other side of the pond seeing what we're seeing in these kids, this Kawasaki-like syndrome? And we were. And so we were able to start coalescing around this new entity via the power of social media. And so we said, we need more of you. But there are downsides. Are we actually obligated to be advocates at all, social media or otherwise? Well, from an SCCM perspective, as the nonprofit organization that we are, we cannot be lobbyists or legislative advocates. But we are very much advocates for health care. The actual language out of our bylaws says that no substantial part of the activities of this corporation shall consist of carrying on a propaganda or otherwise attempting to influence legislation, and the corporation shall not participate or intervene in a campaign on behalf of any candidate of public office. So on behalf of SCCM, we can't legislate or advocate for legislation. But we can advocate for health care. But should we? Because Martin Luther King, and it's a great week to talk about that, one of his stances was of all of the forms of inequality, injustice, and is injustice in health care as the most shocking and the most inhumane? There are those that say political advocacy in areas of public health and advocating for health equity is in fact a form of implementation science. And this is a great article that talks about that. If we know there are things that need to be changed to improve health care, we have some obligation to do that. And that is implementing the best science. But it might take advocacy for that to happen. So what could happen? Why is this even a con in this debate? So one of the things that happens out there is misinformation. And the definition of misinformation is incorrect or misleading information, which you can see in the pyramid. We have the top of this pyramid are things we're very familiar with in terms of levels of evidence, right? Clinical practice guidelines, case control reports. Down near the bottom, animal and lab studies. But look at the bottom of this pyramid. Your high school acquaintances on Facebook. So if you're picking that up, or pick any social media platform, and using that as what you choose to share verbally on social media or elsewhere, you're picking it up on social media. And by sharing it and not validating it, you are spreading misinformation. Maybe not with malintent, but misinformation. Disinformation, on the other hand, is false information deliberately and often covertly spread, such as the planting of rumors, in order to influence public opinion or obscure the truth. So this is intent and with malintent. And one of the ways that we know both misinformation and disinformation have harmed our communities is the vaccine disinformation campaigns. And in some cases, they are very much campaigns. So disinformation. Most recently heralded by outbreaks of measles in places like Philadelphia, Atlanta, and the U.K. So, and Dr. Pai here calls out, it's 2024, and we are seeing outbreaks of measles in the U.S. and U.K., and he calls it out as disinformation. Intentional and not just misinformation. So is one of the ways that we can do this separating our personal and professional lives on social media? Our leaders should be helping us to be the best possible professional that we can. But maybe one of the ways to do that, one of the strategies some people use is they have a personal social media account or their personal on this platform and their professional on another platform. Some people will put in their bio a statement that say, my posts do not represent the positions of my employer or something along those lines. Is that enough? Does it even matter if you do that? So what I would say is you've really got to go back and look at what your institution or institutions, sometimes we have an academic appointment as well as a hospital appointment, what do they say about their employees and their use of social media, if anything? And questions that you want to try to find out the answers to include things like, is your stance on that particular topic different than your organization's? Well, then you're more likely to run into conflict. That's kind of obvious. Should you maybe disclose to them a priority? This is something that I advocate. You're going to see me post that. I'm not going to include you. I'm not saying I'm an employee of this organization. I'm doing this as my own personal professional advocacy. What are their funding streams? Are they private? What are the influences of those organizations? Are they public? Are they government funded? And what does that mean for that organization and their ability to support or even hold neutral to what you may be trying to do in your advocacy? And so how, if at all, should you be interacting with your organization's public relations and communications marketing teams? Because if you're tagging them in some way, then you might say you're not representing them, but you're linking yourself to them. So I'm sharing stories with permission or out in the public eye on when it can become difficult. A critical care provider and leader involved in a hospital system was very involved in legislative advocacy with a professional organization. They were there on their own time. They were not at all there as a representative of their employer. Made clear there was no affiliation. Their department and hospital leadership were aware she was doing this and were initially very supportive. In 2023, she was asked to testify as an expert witness, if you will, to the state legislature over three controversial healthcare-related bills that were coming to the state legislature. All of a sudden, she starts getting pushback from the board of her institution. You need to soften your stance just a little bit. And at one point, she was asked to write a letter to the board of directors explaining that her stances were actually supported by major medical organizations so that she could justify what she was saying. The background, which she knew, was that the hospital received significant funding from the state budget. It's a public hospital. At this point in time, a very conservative supermajority is in control of the legislature, and they did not like her stances towards public health advocacy that she was bringing forth. She was doing it completely unaffiliated with her employer. That wasn't good enough. Ultimately, the hospital board completely flipped their stance on their support of not only her activities, but some of their stances on some of the healthcare they were delivering in these controversial areas. Flipped and no longer supported the healthcare they were delivering, as well as her advocacy and said she needed to change or at least submit anything she was going to present for their review and censorship before she went to the state legislature. She declined to do that. She resigned from all of her leadership positions, still does some occasional part-time clinical work, and is primarily with an institution that is working in safety and quality and advocacy and finds herself happier, but it was a very difficult time, as you might imagine. Another important point on the con side is, in this day and age of social media, is even if you are not on social media, not one single platform, what we do, professionally or otherwise, is not necessarily private anymore, and it's certainly not considered sacred. And what you do can end up on social media, even if you're never out there yourself. In this next one that got a fair amount of press, an award-winning medical student research, it was like the top winner in a competition that was taken out of context. Conservative activists took one line from the study summary completely out of context, a parenthetical noting that the youngest transgender patient seen in this particular institution was four years old. Not that they were receiving therapy, simply that they were seen as part of the demographics of this report. They then turned around and inaccurately claimed that this four-year-old was being prescribed hormones and being physically transitioned as part of a gender transition, which was not true. And so it brought out social media at its worst. Elon Musk starts tweeting, X-ing. And Thomas Beach was a member of the state legislature at the time, and so it was very clear that this was not true. The state legislature, the state legislature, and a bunch of trolls and bots. Trolls are, if you're not familiar, real people, but who are out there really just to cause malicious harm and disruption on social media, and bots are literally, they're robots, automated accounts set to look for certain language or terms, and then post-controversial statements, and we got blasted because we weren't wearing masks, and we were going to take everything we had here back home and kill kids. So what I did was relatively simple. I went down the accounts that were involved and just blocked all of those people, so there are tools that we can use, and so it's just a reminder that whatever we do, it can end up on the front page of media, or social media, or other kinds of media, so look at funding sources for organizations that you are involved in to know what potential pressures and backstories exist. Assume that anything you post can be posted out of context, and be prepared to fight back, and fighting back is with facts, with responding and not reacting, and know that a lot of good advocacy can still be done within academic medicine, within and outsides of our conventional institutions. When others are telling you to be careful or be cautious, something's coming, don't poo-poo it, stop and listen, consider all of the sources, and a couple of other examples that people who have had a difficult experience but turned it to good. This is our lane some of you may or may not be familiar with, and Dr. Behrens is going to talk further about that on the plus side, but in advocating for gun control, because gun violence is the number one killer of kids in this country, the NRA pushed back in a social media post some time ago, talked about stay in your own lane, this is not a health care lane, well we've promptly flipped that and said in fact this is our lane, and it became one of the most popular hashtags ever out there on social media, and she'll talk a little bit more about how that turned to a huge positive on the advocacy side, but just because somebody pushes back doesn't mean we can't take it and transform it. Some of you may or may not be familiar with the story of Dr. Annie Andrews, who was a pediatrician who practiced in South Carolina and ran for state legislator as a part of her advocacy plan. She ended up being in that effort, got tremendous negative pushback, blatant lies told about her, her practice, her institution, and I put the link to one of her Twitter ex-posts here and posted the excerpts, and she didn't win that political race, but she's since moved to another state and is again working in a place and a space where she can almost solely focus on health care advocacy for children, and it's never stopped her presence on social media, but you can see here I've posted her response that she put out there, which was eloquent and really talks about it is our job to advocate even in the face of that adversity, and the pushback wasn't going to stop her. So I've already alluded to having a plan for pushback is including having, if you're going to go out there for anything potentially that you think could be potentially controversial, have a plan to push back. What are your talking points? Make sure that you have resources and references and evidence to back it up. Respond rather than react, but that doesn't mean respond to trolls and bots. That's probably not worth your time. Just block them. You can also in almost all of the platforms that you're out there on, moderate your account meeting by the people that you follow, the posts that you like. Do you allow people to private message you? Do you hold that closed? Or only people whom you follow? There are ways that you can manage your account to help you keep at bay to some degree people who are going to potentially bring disinformation and adversity to the work you are doing in social media. Kindness in the face of that adversity and not engaging in an equally negative way is important, because that will never do anything but go downhill. Never. Some general rules, no matter how or what reasons you're out there posting. This is Twitter, but it really applies to any social media platform. Never post unpublished data. Never post patient or family pictures without explicit permission. HIPAA rules apply, and that means even if you don't list one of the, what is it, 17 identifiers, if you post enough of a story that someone can identify that person or that case, that is a violation of HIPAA. So you need to leave time, leave out enough details, change some of the details to make it not identifiable. Never give specific medical advice out there. In legitimate conversations with a disagreement, never sacrifice collegiality just to win out there. And don't forget to cite your sources. So you can help advocate for the patients and the families and the causes that are important to you inside your institutions or outside. It's hard to do both, especially if they have some potential conflicts. So you might have to choose your path. The good news is despite all the pushback and the disinformation out there, there are many people out there on various social media platforms still pushing for good health care, best practice based on best evidence, advocacy to change rules and laws that benefit our community's health, and it's never too late to start becoming part of that voice. It can be a quiet voice, it can be a loud voice, but you can be a part of the voices. The power in the social media community is not to be underestimated. There are people here at this meeting here today that I've met for the first time from other parts of the globe that I've literally known for years. I've done projects with, I've been in leadership positions with, we've published together. Those relationships can be real, warm, productive, and so it can be a great power for good. But you do have to be careful. Don't jump on a bandwagon without doing your homework. There are lots of folks here, how we use it and how the reach of SCCM and all of us has spread. There is a whole social media page for SCCM if you want to get involved as a social media ambassador, folks that are willing to talk to you about it, and I've shared a few references. And with that, I'm going to turn it over to, you're going to introduce Dr. Behrens.

social media advocacy

misinformation

professional conflicts

healthcare advocacy

institutional policies

public scrutiny