Ep26: Dr. Austin Lee Chiang on Becoming a Physician Influencer on Social Media

Hills and Valleys is a podcast that uncovers stories from leaders in healthcare, tech, and everything in between. Straight from the heart of Silicon Valley, we give you a look at the good, the bad, and the future, one episode at a time. Brought to you by Potrero Medical.

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About Dr. Austin Lee Chiang

Dr. Chiang is currently an Assistant Professor of Medicine at Jefferson Health (Thomas Jefferson University Hospitals) in Philadelphia, PA, and serves as the Director of the Endoscopic Weight Loss Program and Chief Medical Social Media Officer for the health system.

He completed his undergraduate studies at Duke University before earning his MD at Columbia University. He stayed for Internal Medicine residency at New York Presbyterian Hospital and completed his GI and bariatric endoscopy fellowships at Brigham and Women’s Hospital. He obtained his MPH from the Harvard TH Chan School of Public Health before completing an advanced endoscopy fellowship at Jefferson.

Passionate about empowering patients with accurate medical information online, he is one of the most influential voices in the field of gastroenterology across multiple social media platforms including Instagram, Twitter, TikTok, and YouTube, Dr. Chiang has conducted extensive research in social media and is champion of physician presence on social media and is the Chief Medical Social Media Officer of Jefferson Health and Founding President of the Association for Healthcare Social Media (AHSM), the first 501(c)(3) professional society for health professional social media use. 

He has worked closely with all major national GI societies on social media efforts and was 2018’s Healio Gastroenterology Disruptive Innovator of the Year, The Philadelphia Inquirer’s 2019 Influencers of Healthcare Rookie of the Year, and 2019 Medscape Top 20 Social Media Physicians. His role in social media has been featured by The New York Times, CNBC, and BBC News .

        Interviewer: Omar M. Khateeb, Director of Growth at Potrero Medical

      Interviewee: Dr. Austin Lee Chiang 

Khateeb: Hey everyone! It’s Omar M. Khateen, the Director of Growth at Potrero Medical, with another great episode of Hills and Valleys. I finally got one of my favorite content creators online, the infamous, well-known and respected Dr. Austin Lee Chang. Dr. Chang, thanks so much for coming on. It’s great to finally have you.

We see you quite often on Instagram, Tik Tok, and other social media platforms, so we’re happy to be able to have you on considering your busy schedule.

Dr. Chiang: Thank you so much for having me. I really appreciate it.

Khateeb: Absolutely. You wear a lot of hats in your current role, but for the audience that’s watching, can you tell them your full role? I think a lot of people know you as this great content creator, as a physician, and a great teacher online. But outside of that, what’s the day job?

Dr. Chiang: Well, I have a full-time day job. Despite all that content creation, clinical work is still the main stay for me. I’m an Assistant Professor of Medicine at Jefferson health here in Philadelphia. I’m also the Director of the Endoscopic Bariatric Program and the Chief Medical Social Media Officer for the entire Jefferson health enterprise. I’m also the Founding President of the Association for Healthcare Social Media, which is a 501 C3 non-profit professional society to help health professionals get on social media and use it responsibly and effectively.

Khateeb: That’s fantastic. That’s definitely something I want to come back to in a moment, but the thing that we often don’t see from leaders like you is the backstory.

So, tell us about that. Where are you from? Where did you grow up and how did you get into medicine?

Dr. Chiang: I am originally from Southern California and I moved abroad to Taiwan when I was 10. I came back for college, and went to Duke for college. I did medical school at Columbia in New York, and stayed there for internal medicine residency for another three years.

Then I moved to Boston for my gastroenterology fellowship for another three years at Brigham and Women’s Hospital. During those three years, I actually completed a second fellowship in Bariatric endoscopy and also obtained my master’s in public health in the Chan Harvard school of public health. Then I came here to Philadelphia to do my final year of training in advanced endoscopy, which was my third and final shift. Then that really completed my entire medical training experience.

This may sound pretty cliche, but I got into medicine because of a combination of my interest in science and health and the human body and just wanting to help people. Fortunately, I had a couple of examples in my family to set the example for me, including my cousins who were physicians, and my grandfather, who was a surgeon.

Khateeb: That’s fantastic. I’m sure it probably felt so good after completing those fellowships. What people don’t understand is how much blood, sweat, and tears it takes to go through that because essentially, you’re being worked like a dog and you’re getting paid very little. It’s really hard. I commend you for going through it, but it must feel so good to get out and get to a place like Jefferson health.

It was very liberating. It was 11 years after college, and a total of 15 years after high school. It was a long time coming, and I think I’m very fortunate to be at a place that’s very supportive of some of these more out of the box ideas. Part of the reason why I have this whole social media role is because of the fact that the leadership at this institution is very forward-thinking. I know that it’s not common to have a role like this. Hopefully, I believe that there needs to be more social media leadership across all academic institutions.

Khateeb: Absolutely. I a hundred percent agree. When I first found you on Instagram a year or so ago, it really resonated for me. I’m trying to do the same thing in my industry. I feel like in medical devices, our ‘customers’ or the people we want to do business with including physicians, hospital, administrators, and nurses, are on social media. So, I think it’s important to create content, engage, and build that trust on social media versus the old model of showing up to your workplace out of the blue and saying, Hey, can I talk to you about this random product? It’s old and outdated. I hope that a lot of my peers are starting to think about this new way, especially considering that COVID is here.

I shared something from PubMed that shows that if you look at the last 20 years, there’s just been this hockey stick curve on the number of publications on social media by physicians. That doesn’t happen by accident.

When did you start this journey in content creation on social media? Did you do that during fellowship or when you graduated?

Dr. Chiang: I’ve always been a fan of social media growing up. I went through the MySpace age and Friendster.

Khateeb: We’re part of that same generation?

[Khateeb laughs]

Dr. Chiang: When Facebook first came along, I really enjoyed it. I’ve just always been a fan and I always bought into the idea. Earlier about halfway through med school, I realized that there was that disconnection that you were describing. Patients are getting information online and they’re exposed to all sorts of information, yet there aren’t very many professionals on social media or at least back then there were much fewer.

I felt the need to be someone out there who had the training to talk about certain things and put that factual information out there. I spent some time at ABC news. Actually, I wanted to learn the whole process of how medical journal publications found its way onto the evening news. In that process, I saw how the network was using social media as a way to facilitate conversations online. So, that’s really how I got into it.

I started out on Twitter and then over the years, went onto Instagram and Tik Tok, as you mentioned. Along the way, I ran into a lot of different hurdles being a trainee at an academic institution. Then I started doing research to justify my use of social media in some way. I definitely was contributing to that rise in publications that you were describing earlier. I think that that’s really how I got into it and here we are now.

Khateeb: I’ve got to ask this question because I know plenty of my friends from medical school are getting into residency. Considering how hierarchical medicine, I’m going to guess you got a lot of flack when you were training, and being on social media. What was that like? It must have been so difficult to get that kind of resistance. I’m sure people tried to make you feel bad about it and stop. How did you push through and not listen? Especially being a fellow in training, people can sort of decide your future.

So, how did you stand up and find the courage to keep going?

Dr. Chiang: Yeah, that’s a great point. And you just reminded me of some moments.

Khateeb: Am I bringing a little PTSD back?

[Khateeb laughs]

Dr. Chiang: It’s actually the good moments. When I got some positive feedback from patients who would come across my content online and give me encouragement. That really showed me that I was doing something helpful. Another point that I want to make is that there was definitely a lot of hesitation, even from my end, going into it feeling like I wasn’t quite an authority yet at the time. So, I really stayed within certain boundaries about what I would be talking about. Over time I’ve expanded that based on what I understand and what I know, but I did get some flack in the beginning.

It was really interesting because as social media grew and I saw that other people were catching on, part of it was the research that I was doing really helped legitimize what I was doing. The other thing was, because of that research, I was also getting involved with our professional societies. So, I had the societies buying into what I was doing as well, at least in my field in gastroenterology.

Soon enough, I was helping the GI societies with their messaging and their social media efforts. From there, one thing led to another, and suddenly you have formalized curricula at certain programs, dedicating a noon conference to social media to educate their trainees about how to use it. By the time I left the Brigham, more than half of the faculty was on social media alongside me. We were actively a social media machine at that point.

Khateeb: That’s amazing. One thing that was amazing to see was that I remember a few years ago, as I was going through social media both for my personal brand and also for the companies I worked for, I saw the rise in users on LinkedIn. I remember looking more deeper into Twitter and seeing how many physicians are there. Not only were they having open discussions during conferences, but also having a journal club. The nephrologists are wild on Twitter. They have their own social media internship.

They have a journal club twice a month. It’s amazing to see that because, for both of us, back when we were in medical school, these things didn’t really exist to that extent. I learned more about nephrology just following the threads on Neff Twitter than I did in my own nephrology unit-no offense to my professor back then. It’s real-time and live where you’re seeing debates, and you’re seeing people update information. I think on the HCP side for physicians, this is great. But the other side where I’m trying to encourage more physicians to embrace is that there have to be more of you. There’s only one of you, right? Again, patients-whether it’s people who are young like us or people who are older-are getting their information from the internet.

The biggest thing is that we make jokes about memes and everything, but memetics has been around for a while and it’s a very powerful thing. Your short videos on certain physiological processes probably have more influence on people understanding certain diseases or procedures than if they go and search things on Google. That’s just the fact because it’s short and memorable.

If you were to look at 20 years from now, what would have to happen for you to be like, wow, I’m really proud that I was part of that movement and here we are now? What does that look like?

20 years from now, if you can say I hope for something to happen in the medical community, what would that be?

Dr. Chiang: I hope that there would be a general understanding from the public that there are experts online that they can access. I’m hoping that the novelty of us being on there now rubs off in the future. With every passing generation, I think there’s greater adoption of social media. I think that at a certain point, they’ll recognize that we can’t only go to social media to get cooking demos and fashion advice, or whatever it might be, but also that there’s plenty of health information out there.

I think we’re seeing it already. When I think about how my experience was while going through medical school and hearing about what sort of tools medical students have nowadays. They have all sorts of apps and visual graphic teaching materials than I ever had. And you’re absolutely right that some of the things that you are able to learn on Twitter, it doesn’t show up in textbooks. There’s always going to be gray areas that even people within the field will disagree on or there’s not enough evidence for. We rely on expert opinion and that’s really where we can get it.

Actually, in nephrology, they were far way ahead of the game compared to gastroenterology. I know some of the earlier nephrologists who are still very active now, and it’s incredible to see what they’ve done. Hopefully, not only does it engage professionals, but like I was alluding to earlier, also the general public can also participate and get something out of it too.

Khateeb: Absolutely. I think the biggest benefit is that on one side you are educating the public. On the other hand, you’ll never know how many MS1 or MS2 medical students watch some of your content and get influenced to pick a career in gastroenterology, for example. When you and I were in medical school, it was either we had to do time over the summer and shadow somebody or we had to wait for rotations in third and fourth year. However, I think with social media, especially with YouTube, Instagram and Tik Tok videos and discussions on Twitter, you can really get a good sense of what it’s like to be a nephrologist or gastroenterologist, for instance. You get to know what the community is like.

I remember reading this book on medicine about picking residencies, and one of the things it said that never made sense to me until I got into medical school was that a lot of the times when you pick a specialty to go into, a good part of that is based on where your personality fits. I never understood that until I got in. But now, you can really get a good feel for that environment through social media.

For some of the physicians who are listening now, whether new residents that just graduated or those that have been in practice for 10-15 years, if they wanted to get started, what would you recommend? I think they see someone like you and all your content and it seems like it’s so much to do. I don’t think that’s the case. I think it starts from a small step. What’s that small step?

Dr. Chiang: First of all, it’s getting over that mental hurdle of being self-conscious and putting yourself out there. I struggle with this with every single new app that I’ve adopted.

It’s always been a struggle and I still face that.

Khateeb: When you say self-conscious, what do you mean specifically?

Dr. Chiang: Well, I think that for me, with whatever content I put out there, in the back of my mind I’m always wondering what people are going to think about it. To a certain extent, that’s a healthy check. There should be healthy checks and balances. We want to make sure that what we’re putting out there isn’t going to be offensive and get us into trouble. Part of my work in trying to help other people is helping them understand that, and sometimes we’ve had to learn that the hard way.

Getting over that mental hurdle on certain platforms is not as apparent as others. On Twitter, for example, it’s all text-based. You just put it out there and it almost feels anonymous, which is what makes it sometimes dangerous. On other platforms like Instagram, YouTube, and Tik Tok, it’s much more image-based and you’re putting your own likeness out there. On a superficial level, you feel self-conscious about how you look, but you’re also putting your likeness paired with a message.  I can see how there’s a lot of trepidation going into this. So, the first step is somehow overcoming that. It might just take practice and it definitely gets better over time. Just stick to it, and then with time you’ll get over it.

The other thing is just not spreading yourself too thin to begin with. I think focusing on one platform is often helpful. We see that there are so many different platforms out there, and everyone wants to do everything all at once and it’s simply not feasible. Once you get acquainted with one platform, you’ll be able to be more efficient and crank out content much more quickly. That certainly has been the case for me. The biggest bang for your buck at this point in time, which will likely change, is probably Twitter for any physician out there. This is because there are a lot of other professionals and in terms of what you gain out of being involved on Twitter, you’re not only networking, but you’re also staying up to date with any academic discussion or what’s new being put out there by journals and societies. A lot of journals and societies are not yet on other platforms, and so you’re not going to get those real-time updates. That’s one less thing that you get out of being on Tik Tok, for instance, where there’s virtually no medical journal on there. They may never want to be on those platforms because it just might not fit the model of what the journal is trying to do. Certain platforms just make more sense depending on what you want to do.

I guess the other thing is finding your purpose and figuring out what exactly you’re hoping to achieve.

Khateeb: Let’s talk about that. I think on one side, for professional engagement and learning, I totally agree with you. Twitter is high up there as number one, and LinkedIn maybe second. However, in terms of the public facing side, I think a lot of physicians struggle between picking Facebook and Instagram. I think Facebook is the equivalent of having a website back in the 90s or 2000s. I don’t even know if I’m following your Facebook page. I feel like the real game and attention for public awareness and patient awareness is on Instagram. Would you agree?

Dr. Chang: I will admittedly say that I don’t spend much time on Facebook anymore. I have the benefit of working at an academic center and for someone who’s in private practice, and for search engine optimization reasons, having a Facebook page might be a better option where you can promote your business a bit better on there. In terms of building a brand and a relationship with the general public, I think that there is additional value on Instagram.

Facebook still seems a little bit sterile like Twitter in some way, but Instagram is where you can really get a glimpse into the personality a bit more. That is becoming increasingly more important. In general, even outside of medicine, we’re appealing to feelings much more than facts, and achieving that balance is the challenging part.

Khateeb: I really mean it when I say that I love your content and the brand you have online because it’s unique to you. It’s not replicable by anybody. There’s only one Dr. Chang. In medical school we learned that certain communities want to be treated by doctors who represent that community, look like them and talk like them. Personality is a big part of that. We both had a doctor growing up. Our favorite doctors weren’t there just because they were great doctors, but it was also because of their personalities and how they made us feel when we went to go see them. I’m sure your patients all love to see you because they know your personality and they’ve built this trust by seeing you online.

So, when they go to see you, even if it’s for something very serious, there’s this trust already. You’re not some guy that they just see only when they go to the doctor’s office. They’re seeing you online and there’s this familiarity being built. Do you feel like that’s happened with you and your patients?

Dr. Chiang: Yeah, I’m seeing it more and more. As patients are savvier and are googling my name before coming to see me, they’ll inevitably come across my social media which is a good thing. A lot of the time I realize that they often won’t mention it, but some patients will. I think that they appreciate the fact that I’m there. It gives them a better sense that I’m a human being too and not a machine or a robot. I’m approachable, and those are all the things that I’m hoping to achieve on social media.

Khateeb: I know that in medical school, they always say that you need to empower the patients to make the best decision and give them the right information. I think a lot of times patients can be intimidated by a physician. From your content online, have you noticed that more patients seem to be a lot more comfortable and at ease talking to you? Do they ask you questions that you didn’t think they would normally ask you?

Dr. Chiang: Oh, totally. And the same thing goes for trainees and aspiring physicians. I remember when I was in college, I would never think to just DM a physician online and now people will reach out to me all the time. I feel like they’re so used to seeing me act a certain way online, that they feel that comfort level. In fact, actually yesterday I put a dance summarizing the news about the COVID vaccine on Instagram reels and also on Tik Tok.

Khateeb: I saw it, that was great. Again, I learned more from that 30 second video you made, than most of the articles I read.

[Dr. Chiang laughs]

Dr. Chiang: I mean, that’s the thing. I want to distill what’s out there because there’s a lot of great information coming up out of the media, but sometimes it just needs to be distilled into something that’s more easily consumed. It’s interesting the comments I had on there, because I think a lot of people know me for doing stuff like that, but for those who are new to it, they were like, Oh, I wish I always got information this way. I was really glad to see some of that feedback.

Khateeb: Totally! I think that you tapped into something and if I can encourage you, please make more content like that. Here’s the thing, we live in a very complicated world. That’s what a billion-dollar company like Google does. Essentially, they curate content and answer questions as quickly as possible.

What we were used to about a decade or two ago with things like medicine is to have an expert like yourself go on the news and talk about it from a very unbiased approach. And people have the information and they know what to do with it. But now, the media has gotten so much more biased to the point where they’ll bring on experts just to double down on whatever bias that they might have.

I think the important thing, not just in medicine but in other areas too, is to have experts like you distill this stuff down. That way, instead of me going and reading this information on CNN or Fox that’s under the guise of being unbiased-but in reality, is biased-you’ve taken and distilled it down, especially for something that’s as controversial as vaccine vaccinations. I’ve read quite a few articles since the Pfizer announcement happened a couple of days ago, and yours was by far the best one.

Dr. Chiang: Oh, thanks.

Khateeb: You mentioned something earlier which I wanted to ask you about. You said getting on social and then finding your purpose. What do you mean by that? What’s your purpose? How did you come about finding it?

Dr. Chiang: I think this goes back to that whole idea that there’s a disconnect with how patients are getting their information and where they’re getting it from or who they’re getting it from. Ultimately that translates to wanting to put out accurate information and share my expertise. I think beyond that there are other things that I try to do, like dispel misconceptions about what I do. A lot of people have ideas of what a gastroenterologist does and I’m in a very specific subspecialty within that which most people don’t know about. So, I’m talking about these areas that don’t receive as much attention.

Then also, humanizing the profession as we’ve just been talking about. Not everybody has that goal. Some people want to purely only educate their peers, others are in the medical profession, others just want to build their practice and promote what they’re doing from a business perspective. I certainly had an academic center but don’t have as much of that interest like somebody in private practice, for instance. It doesn’t have to necessarily be one singular purpose, but having a main focus is key. For me, it’s facing the general public.

Khateeb: In line with that I want to ask a question, and I think this is where you’re doing a great service for the medical community and your peers. Tell me a little bit about the non-profit that you started, because from my understanding, you’re helping physicians get online. And again, for everybody who’s listening or watching, I’m leaving a link to the non-profit in the show notes so you can check it out. Tell us a little bit about that, and how people can find you, and what it is about.

Dr. Chiang: Yeah, for sure. This actually all came about because several of us who are active on Instagram started noticing concerning trends about people misrepresenting themselves. This was about two years ago. They were speaking about medical or health issues without having the appropriate credentials. So, we had a hashtag campaign called #VerifyHealthcare, where we encouraged professionals to share their credentials with everyone and why they were qualified to speak about whatever topics they speak about. We also encouraged their followers to really double check who they were trusting online.

From there we started brainstorming about all the different issues and concerns that we were facing with social media, a lot of which never existed before on other platforms. There was this rise in the influencer movement. Then we started noticing that with larger followings, as health professionals we were running into issues like imposter accounts.

Khateeb: Things like healing with crystals and oils?

Dr. Chiang: Yeah. Or even people just taking our likeness and using it to promote other products without our permission.

Khateeb: Oh really?

Dr. Chiang: Yeah. All sorts of things that we would never have expected. Of course, like we were just talking about controversial topics like vaccines, we can be targeted from some of these groups that are very anti-science. In some instances, we had to learn the hard way about how to navigate that.

In essence, we wanted to, um, have an entity that could really treat what we’re doing here on social media as something just like any other medical subspecialty.

Khateeb: Can you tell us the name of the entity?

Dr. Chiang: It’s called the Association for Healthcare Social Media. We have accounts on most of the major social media platforms. Our website is ahsm.org.

Basically, we felt that those of us who are active and doing similar things as I’m doing could come together and share our expertise with other health professionals so that we could really build the number of health professionals who are online to put up more accurate information and be the spokespeople for each of our areas of expertise.

We learned how to do this not only responsibly to avoid all these different pitfalls, but also effectively, because you could put out the best content out there with the most beautifully curated grid and it might not reach anyone.

Khateeb: I know the feeling, man.

[Khateeb laughs]

Dr. Chiang: A lot of us have spent years working on this, trying to cultivate a community, and engaging with one another. One key thing, if there’s anything to take away, is that social media has to be social. You can’t really just put information out there and expect it to take off. There’s got to be a social element where you’re engaging with your followers, and other people who are doing similar things.

Khateeb: For the newbies who are trying to do this, what do you mean by engaging with your followers?

Dr. Chiang: For me, it’s often responding to comments.

Khateeb: You get a lot and you respond to every single one. I’ve tested it.

Dr. Chiang: I try to do as much as I can. When I first entered this space and I would see some of the big YouTubers or Instagrammers, I’d be like, Oh, they never respond to anything so I’m not going to respond to anything either. However, that’s because at a certain point they can only do so much and that’s why it appears that way. But to get started, it involves responding to comments, and now all the platforms make it relatively easy to engage. Take Instagram stories, for instance, there are different functions like Q and A’s and live streaming. There are different ways to maintain people’s attention, and maximizing all those functionalities is important too.

Khateeb: It’s A-H-S-M, right?

Dr. Chiang: Yeah. ‘Ah-sum’ for short.

[Khateeb laughs]

Khateeb: Awesome! You are from my generation. I’ll put Ahsm.org in the show notes. Are there resources there? Do you have an email signup? What should they do when they go to the website?

Dr. Chiang: We’re shifting gears with the organization a bit. We started out wanting to be more of a guidelines-forming organization, but we’ve realized that social media is just one of those spaces that it’s really hard to put up _____.

Khateeb: Super hard because it just changes all the time.

Dr. Chiang: Exactly. This whole past year, we’ve seen so much evolution with all these platforms and all of the things that they themselves are putting up with. So, we’re trying to be more resource-based moving forward. We’re going to have a resource library trying to curate all of the most helpful resources out there. This past August we had our first annual meeting where we had a whole series of lectures. We had a whole patient-advocate fireside chat and also had an abstract submission. It was treated like an academic conference, and we’re hoping to do that again next fall.

The resource page is great and we’ve already developed some collaborations. We collaborated with YouTube to have a series of YouTube training sessions coming straight from the YouTube headquarters. We also have collaborations with other platforms coming very soon as well. Especially with the pandemic, there’s been a lot more interest from the platforms themselves to get more health content onto their platforms. It’s been a really opportune time to get into this space.

Khateeb: That’s fantastic. I remember reading an article a while back on either CNN or HuffPost about how many thousands of hours are spent by physicians looking up procedures on YouTube. They made it sound like it was a bad thing, but I’m like, no, that’s how medicine is done. What you read in those textbooks, only 40% of the time do patients actually present like that. I think it’s great that you guys are creating that kind of content in real-time. The old way was that you come out with, let’s say robotic prostatectomy two decades ago. By the time those guidelines are published, the procedure might’ve changed. And then even if it hasn’t changed, once it’s been published and you have more people doing the procedures, they discover better ways to approach it such as troubleshooting, approaches, and all those different things. I know you see the same thing in gastroenterology.

So, it’s not a good thing to wait, even if it’s a year, for the annual conference to talk about it at a session. It’s so much better when physicians can see this in real-time, not only in procedure. I’m sure that physicians are starting to use social media to get an idea of topics that are starting to trend in the public domain. With that, they should be expect expecting more patients to come in and ask about such topics. As a hospital or health system, they need to know the procedures and guidelines to put in place right away so that they know how to talk about that. In the past, you don’t know about those kinds of things. People come in and it’s based on the doctor to decide on what conflicting information they should give patients. You’ll have two great doctors giving different opinions about some public domain topic. Does that sound about right?

Dr. Chiang: Yeah, absolutely. When you mentioned textbooks, for anyone who’s had to contribute to a book chapter or help out with a book, we know how long that process is. It’s often a year and by the time the book is actually published, a lot of that information may not be up to date. I think what the pandemic has really illustrated is that there is this virus that’s completely unknown and we have no experience about it. Some of this information getting thrown out is peer reviewed and some of it is not. We’re trying to communicate with one another to figure out what the best solutions are. Waiting for that to show up in the next issue of a mailed journal is just not going to cut it when people are actively suffering from the pandemic. Early on, I think that there was this whole panic because of how little we knew. Imagine a world where we didn’t have social media. I can only think of what would happen. As we all know, there’s pros and cons of having social media now, because there’s plenty of misinformation that’s being put out there too. For scientists, public health experts, physicians, and other health professionals, I think it’s been a lifesaver in a lot of ways, too.

Khateeb: I don’t know if this has been thought about, but I hope that this is the first time someone’s thinking about this idea. Something that I think I would really love to see is that, for example, on Twitter you get verified if you’re a physician or a scientist. I think it would be great is if social platforms like Twitter, Facebook, Instagram, or YouTube reach out to physicians and ask for your NPI number and they verify you. Let’s say that you’re a physician who’s in infectious diseases, then if there’s a certain post that falls into that category, you can get paid to review a post related to your specialty. Maybe there’s a group of 50 infectious disease physicians that will check a post in real-time to verify it. If it’s not, they can get flagged right away.

What I don’t like is social media companies trying to decide on these topics as to what’s real and what’s not. I think they need to put it back in the hands of the people who actually know what they’re doing.

Dr. Chiang: It’s really tough. Some platforms like Twitter really pushed verifying a lot of physicians earlier on in the pandemic, but it’s a bit of a challenge. I’ve definitely floated this idea with the social platforms and I’m sure other people have as well, but it’s just difficult because where do you draw the line?

It’s not just physicians; there are plenty of other types of health professionals online. There are some professionals out there where it’s a little gray area, and it’s hard to decide what do you verify and what do you not? There are verified physicians out there who are saying really awful things as well.

Khateeb: I know which ones you’re talking about.

[Khateeb laughs]

Dr. Chiang: Just because they have an MD or a DO doesn’t necessarily guarantee that they’re putting out great information either.

Khateeb: Absolutely. It’s funny that you mentioned that because, for the general public who’s listening, in my eyes having an MD is not enough to be a doctor. You actually have to go through training and residency. I know some of my friends who have an MD and did not go to training. They’re not a doctor in my eyes. They don’t know what they’re talking about. I think it’s okay to have MD at the end of your last name, because you paid the money and you went to med school. That’s fine. But to have the MD and then come out with a really strong opinion about a clinical topic? I disagree.

Dr. Chiang: Yeah. Especially for a clinical topic, I think that there is a certain amount of training and exposure that you need to have for that. I understand that with broader public health topics and things like that, it’s maybe not as necessary, but for clinical topics, it is for sure.

Khateeb: Totally. I’m saying this kind of tongue-in-cheek, but I think at the beginning of the pandemic, someone sends me something and they’re like, did you read this like comment from this doctor, who’s talking about how the virus works? I looked at it and asked why they trust it. They said it’s because this guy’s a physician at a well-known institution. And I’m like, yeah, this guy’s a surgeon though. What does a surgeon know about virology? I’m sorry surgeons, but it’s true. It’s, it’s the same thing if you saw somebody from internal medicine commenting about surgery, they would say the exact same thing.

I think these are the little nuances of social media. The only way that this is going to be improved is if more physicians in those specialties come online because then, you can overwhelm the misinformation with the correct information from the people that you should actually trust for that domain.

Dr. Chiang: It’s hard to get more health professionals because there need to be incentives, proper guidance, and a culture that is more accepting of people screwing up and making some mistakes from time to time.

Khateeb: When you say incentives, what do you mean by that? How would you incentivize it for the United States if it was you?

Dr. Chiang: Something that I’ve been actively working on is that at an academic institution, we’re not incentivized to contribute to social media or really any media really outside of publications and medical journals. Yet that’s where our patients are getting their information from. So, we’re trying to figure out how we can go about trying to build on that social media participation. Certainly, institutions like Mayo Clinic have attempted to create a rubric. I don’t know exactly how often that’s adopted into real practice, but that’s the sort of thing that we need to reorient how we think about social media and the time we spend on it.

Khateeb: At the end of the day, for anything, when it comes to human behavior if the incentives aren’t there, you’re just not going to get the behavior change. The social proof of seeing physicians like you online is a big help, but at the end of the day, unfortunately the institutions are going to be the ones that are going to drive this if its incentives are right. At least with some physicians I talked to, it’s a light incentive where the hospitals are saying we prefer to see you there, but I don’t think that’s enough. I think there needs to be more of an incentive to reward physicians who are creating content and are active online.

People don’t follow companies or brands, people follow people. And so, there’s a benefit to that. Let’s say a hospital had four or five Dr. Austin Changs in different departments. that will boost their health system brand and trust quite a lot with the community. So, I think there are several ways to do that.

Dr. Chiang: Yeah, totally. It’s a work in progress and I don’t expect it to happen overnight. It’s something that we’re working on.

Khateeb: Totally. I want to be respectful of your time because we’re getting close to the top of the hour. We usually wrap up our show with rapid fire questions.

Now, here’s the rule. You can answer this as quickly as you want, which means I’ll move to the next question right away, or you can take as long as you’d like.

Dr. Chiang: Okay.

[Dr. Chiang laughs]

Khateeb: Question number one is, what’s the most memorable thing a mentor has ever told you?

Dr. Chang: Oh, gosh. The most memorable thing? I would just say, stick to your gut and don’t give into the noise on social media. There was a lot of noise and I stuck to it and I was thankful for one or two mentors who saw the value in it and just stuck to it.

Khateeb: Great. On to the next question. There’s a whole culture behind continuing education well after you graduate, right? These days, what’s a book that you most often gift or recommend to people? It doesn’t have to be a medical book; it could be anything.

Dr. Chiang: Oh, that’s a tough one.

[Both laugh]

Dr. Chiang: I want to say Checklist manifesto or one of his other books.

Khateeb: Got it. And why Checklist manifesto? What did you like about the book?

Dr. Chiang: Although I may not follow it to a T, I think that it gave me some perspective about how to approach things, organize myself, and how to make sure that things get done. Just to see someone else’s perspective on that was part of it.

Khateeb: All right. A couple more questions. I want you to imagine that for a whole year, here in the United States, there’s going to be a billboard outside of every hospital. All the physicians, nurses, clinicians, and patients, are going to see it. Since we focused a lot on physicians, let’s just say this is a billboard that only the physicians are going to see for one whole year in front of every single major hospital. What message would you put on that billboard for your peers to see and why?

Dr. Chiang: I would probably want to say something very contrary to what we’re used to saying. I’m thinking through the lens of this social media conversation. Seeing how much misinformation there is, and how many people are buying into that misinformation. I want to say something to stir up things. Not really a positive message, but something to get people agitated about what’s actually happening out there.

I think that a lot of the conversations that we have in medicine are so siloed and we’re stuck in our bubble. That’s going to spell the downfall of it all. We need to really see what people are actually saying out there and respond to that.

Khateeb: So, what message would you put on there?

Dr. Chiang: Honestly, it would probably be a screenshot of some really popular health influencer spewing all sorts of misinformation.

Khateeb: Oh, that’s a good idea.

Dr. Chiang: Yeah. I think that a billboard that’s positive and reinforcing isn’t going to do us any good, but something that’s going to provoke us, and get people angry about something is what’s going to spark change.

Khateeb: You’re totally right about that. Well said! If I didn’t know who I was talking to, the first thing I would say to that is, does that person even know social media works or are they an influencer? You’re totally right about that.

[Dr. Chiang laughs]

Dr. Chiang: In some ways, every poster that I put out there is a little mini billboard. What’s going to get someone’s attention to keep on reading or watching? A lot of the ways that these platforms work is based on how long people stay on your content. YouTube is based on watch time and whether or not people actually sit through your entire video. It just goes to show that there’s a little bit of an art to all of this.

Khateeb: Absolutely. The biggest thing is that in order to persuade and influence people, you first have to get attention.

Dr. Chiang: In medicine, we don’t have this marketing PR mindset. Going back to your question about what book to read, I almost want to say that spend some time looking at what the influencers are doing. The people that you probably hate because they’re famous for no reason, think about how they became famous for no reason. Behind the scenes, they’re putting a lot of effort into maintaining that fame. If you talk about the Kardashians, it’s not an accident that they were able to maintain this for 20 years. There were so many other people who could have done the same thing, but they came out and there’s a certain formula that they have followed to get there.

I wish that we had an insider’s look into how that machinery works in healthcare. Imagine if people subscribed to our way of thought and the information that we’re putting out there as much as they did to other topics, that would really change how people perceive the healthcare system and how they’re able to trust health professionals more and execute their treatment plans.

Khateeb: What you just said is a big pearl of wisdom. Again, I hate to pick on the medical community, but I come from it. There’s this ego where if it’s not a physician or it sounds hokey, it’s rejected. I really admire the fact that you said that. People can hate on the Kardashians, but to your point, for two decades this family built a multi-billion dollar empire. It did not happen by accident.

We do this in medicine all the time. Atul Gawande wrote Checklist manifesto. He didn’t come up with checklists. He took it from something else and said, how do we take this and apply it to medicine? I think your point is so spot on. Thinking about it from a healthcare system standpoint, how do health systems utilize influencers to get a message out there for the good of the public? How do physicians understand how social media works and figure out how to get attention and influence it?

I think what you said right there is so deep and valuable. I really encourage a lot of physicians listening to this to rewind and replay that again and think about it.

Dr. Chiang: Partly why I say that is because I’ve faced so many situations in the past where people just didn’t believe in this. Years later they’ll come around, probably not even remembering that they said certain things to me in the past, and they’ll have totally changed their outlook on social media and health. It’s undeniable now, especially after 2020, that it’s an integral part of health these days.

Khateeb: Absolutely. 2020 didn’t create any new trends. It just hyper accelerated the inevitable.

Dr. Chiang: Yeah.

Khateeb: Dr. Chiang, this has been so fantastic. We’re definitely going to have you back in the future. Good on you, because I thought for the billboard, you would say AHSM.org.

[Both laugh]

Dr. Chiang: That’s the thing. It’s not necessarily about promoting the direct idea, but something that gets people thinking and then leading them elsewhere.

Khateeb: Totally. I’ll leave the link to AHSM.org in the show notes. And then, of course, how can people find you online? What’s your handle?

Dr. Chiang: Austin Chiang MD. Basically, it’s the same handle everywhere. Twitter, Instagram, Tik Tok, YouTube, Facebook, LinkedIn, you name it.

[Both laugh]

Khateeb: Fantastic! Dr. Chiang, thank you so much for joining us. Thank you all for listening. This has been another episode of Hills and Valleys, and we will see you next time.

Dr. Chiang: Thank you.