Twurgery?

On the right side of my screen I’m watching a live Twitter feed from Swedish Hospital in Seattle.

Tweeting commenced soon after 8am this morning and was performed by 4 observers in an operating room in Seattle. Those 4 observers were in the presence of a surgical team who was performing a tumor resection on the kidney of a 69 year-old patient from California. The man had consented to the scenario, surgery, observers, twittering and all. While the surgeon did his job, his maneuvers, goals, and timed procedures were detailed on Twitter in a live feed.

It’s 10am on Wednesday as I write. I’m watching the twitter feed populate into my screen.

I must say it gives me an eerie feeling.

During medical school I assisted (translation: watched in awe and was likely told to be quiet) on a nephrectomy (removal of one entire kidney) for the same reason—a kidney mass. I remember well what the surgery looked like. This is the first time I know what it tweets like.

Tweeting from the OR is not entirely new in medicine. Take the example of a Wisconsin hospital that provided a live twitter feed last spring during a double knee replacement. Or an awake craniotomy anticipated today that one writer dubbed a “twurgery” where a patient remained awake while neurosurgeons prepare to operate on the brain while they map out and evaluate speech– in the presence of assistant tweeters. Around the country it seems more and more surgical teams are jumping on board to tweet from the OR.

Swedish Hospital tweeted their rationale for the twitter-surgical hybrid at 10:39am:

Why did surgeon allow Twitter coverage? To raise awareness that these new treatments are available for kidney cancer. #Swedish

I suspect to lead the charge at the interface of medicine and social media. And to increase awareness of their use of da Vinci robot for surgery, the surgeon’s specialty, thus increasing their name recognition, brand and ultimately, their business.

Something about the decision to allow the public into a wholly private place, the operating room, seems provocative. I have been chewing on this concept for months, and today I come up with the same conclusion: this feels like advertising, not medicine. A slogan more than a solution.

I can’t determine how this helps and benefits the patient on the table.

Why not go on TV after the surgery, blog about it, write an Op-Ed, or describe the case on radio? Why change the milieu of the OR, adding strangers and potential confusion, stress and non-routine for the sake of advertising. In the era of check-lists, tweeting seems checking off one box too many.

Does having an audience change how you would perform at your work? Does it change how a surgeon operates? Today’s tweets mention a hope for the actual tumor resection (requiring a clamp on the vessels that feed the kidney) in less than 30 minutes. There seemed to be elation when the tweeters announced clamping of the arteries, in “13 minutes 23 seconds.” Does the surgeon change what he does when he senses an audience?Is it more important to preform with a live twitter feed streaming? Is this in the best interest of the patient?

Social media is rapidly integrating into our lives and into our work. There are tens of millions of parents online daily, reading information about children and health. A traditionally cautious and careful institution, medicine must weigh the risks and the benefits of any modality, that being a type or ventilator, antiseptic, suture, or social media network.

I was no early adopter of Twitter, nothing like the fetus who started tweeting in-utero back in 2008. But compared to most pediatricians, I may be. I’m a huge proponent of social media in healthcare. Clearly. I blog, I tweet, I spend hours every day online surveying what people are saying about research findings and pediatric health care news. I really care about integrating pediatric health news and research findings where families already are. Social media is one of those places.

But I must say, there is something about witnessing Swedish tweet this AM from the operating room that leaves me squirming.
I tuned in around 9am.  By 10:06am this AM, they tweeted, “Patient stable as a rock. No bleeding.”

Fantastic!  But what if the opposite had happened? What if an unexpected complication presented? Would they sign off and leave we observers to fret and wonder? Would there be a sign-off like “We’re running into some complications, We’ll be back later,” or would the feed simply stop?  Would tweeting reveal partial truths? Would the essentially transparent surgery become opaque? In an era where there is a big push for more transparency in medicine, does Twitter provide or detract?

How nervous would that make you if you were witness to a live complication on Twitter? Would you present to your own scheduled surgery more terrified and distrustful of the system after peering in on another’s? I believe hospitals risk misinforming the public when allowing for live twitter feeds. In health care or surgery, as in life, nothing carries a100% guarantee for success. The unexpected and the unthinkable can happen. Just like miracles occur, bad outcomes do, too. Medical errors occur as do surprising side effects. Everywhere. All the time and without warning.

I trust there was a contingency plan for a complication during the surgery. And I’m ecstatic it didn’t have to be implemented.

I am left wondering if our quest for an on-time-immediate-instantaneous-message-understanding of the world provides an excuse to exploit and advertise patient care at the cost of prioritizing the patient? Does this quest for data distract?

We parents are data driven, no question about it. Wired magazine published an article discussing our increased dependence on technology to teach and track our children. Twitter may be an extension of this phenomenon.

Twitter seems a distraction more than a teacher in the operating room. I’ve never been there; I am merely speculating.

After the surgery there was a pause on the twitter feed.  Then a new tweet at 2:14pm:
For those wondering why @JamesPorterMD has not tweeted today, he is still in OR. He had a 2nd surgery following the earlier one. #Swedish.

Off taking care of another patient. Thank goodness.

I congratulate you, Swedish Hospital. I know we will all learn from you. But I worry about complexities of gaining true consent from patients for Twitter during their care. Does the allure of social media around their own care cloud patients judgment in consenting? In pediatrics we often rely on the best-interest standards when evaluating decisions for children. I don’t know when I’d ever feel it was in the best interest of a patient to have observers tweeting from OR #12.

Do you? Discuss…