The Social Media Kardashian Index

With the exponential increase in knowledge within the field of cardiology, the dissemination of this knowledge in a relevant and timely manner becomes increasingly difficult. Never before in history has there been a more efficient method of information exchange than social media. The most frequently used platform in medicine is Twitter.

The beauty of Twitter is the representation of all voices. However, there is, of course, greater representation of those louder voices with more followers who spend significant time on the platforms tweeting, teaching, and commenting. A recent article by Khan et al. (1) evaluated a cohort of cardiologists chosen randomly by the those authors using the “K-index” (2), which incorporates number of followers and number of citations into a formula as a proposed metric of expertise versus celebrity, with lower numbers representing a greater ratio of research citations and to Twitter followers.

The problem with this sort of an index is that it is antithetical to the advantages of Twitter as an open platform for disseminating clinical insights, interesting cases, research, and commentary on all of the above. It implies that the most valuable members of the #cardiotwitter #medtwitter community are those with the highest number of research citations. An accompanying editorial (3) furthers the notion that those physicians with large follower counts and few publications may lack expertise, and that the ease of career progression via “tweetology” may dissuade true clinical investigation. A k-index, by definition, does not acknowledge the importance of clinical cardiologists and marginalizes the value of their experience and voice. Volume of publication does not necessarily equate to good clinical care.

The ideas presented and supported in the editorial undermine not only the value of the non-researcher in spreading medical knowledge, but also minimize the curiosity of young investigators to further their research careers via original investigation by implying that they will follow the path of least resistance.

This does not imply that all voices are or should be given equal importance. Wall Street personality, Ray Dalio, in his book Principles, writes of believability-weighted decision making (4). Dalio posits that the best decisions are made by an idea meritocracy with believability-weighted decision making, meaning that we should weigh the opinions of more capable decision makers more heavily than those of less capable decision makers. For example, a higher number of citations may suggest greater merit in research commentary; however, an experienced clinician may provide better insights into the feasibility of incorporating trial results into real-world practice.

Never has the importance of the frontline clinician been highlighted to a higher degree than during the #COVID19 era, during which many insights on personal protective equipment, social distancing and lockdown strategies, and clinical care strategies have been shared on Twitter by Asian and European clinicians. This has allowed much greater preparation for us in the United States who follow SoMe than would have been otherwise possible. One of the coauthors here initiated an extending tubing strategy in-hospital the day after seeing this on Twitter, allowing for medication administration outside a patient room and minimizing infectious exposure to staff. Another recent case presented on Twitter used a novel technique to curb a lethal procedural complication to save a patient’s life; this was subsequently seen and used by another cardiologist to save another patient’s life. These are powerful examples of the uses of Twitter IRL (in real life) which involve physicians across the k-index spectrum.

It behooves us to stave off myopia and keep in perspective the value of different aspects of social media in the world of medicine. The #COVID19 crisis further highlights this as we work to incorporate clinical experience, while ongoing research will solidify the scientific merit of treatment strategies. If we all keep this in mind, the mutually beneficial relationship between the researcher and clinician can continue to thrive and accelerate significantly via SoMe.