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Recently, we published a paper on the “K-index” of cardiologists, an index based on the number of followers a physician has on Twitter relative to their scientific impact based on citation counts, a traditional measure of academic output (1). Although our piece was meant to be satirical, and the “K index” not meant as a real academic index, we hoped to make the point that sometimes the loudest voices on social media were not the ones in the “arena” of generating new scientific content, a perspective that was further emphasized in a subsequent commentary (2).

However, for clinical care in medicine, the “arena” belongs to far more individuals than just those publishing the primary studies. The arena belongs to multiple stakeholders—including patients, practicing clinicians, industry, regulators, and other researchers. Their insights from their unique perspectives are valid and should be heard—the voice of the community cardiologist with 50,000 patient encounters in his/her career is an important one. Busy clinicians can and should comment on the results of a new clinical trial or set of guidelines, relevant to their clinical practice. One of the great advantages of social media is leveling the playing field of voices to both disseminate and critique new research. Therefore, we read with interest the letter by Dr. Daly and colleagues in response to our paper (1), and we agree with their valid points. Cardiovascular clinicians can and should contribute to social media to stay current with new research and incorporate new information and techniques into clinical practice.

However, with the great potential and power of social media to democratize voices, also comes the responsibility that scientific information is being disseminated accurately and rigorously. It is important to be able to discern these wise clinical voices from otherwise loud voices that do not provide meaningful contributions, or at worst, spread misinformation. Sometimes it can be challenging for an audience less familiar with a topic to discern the valuable “wheat” among the “weeds.”

Despite these challenges, social media is now a key learning model to advance medical education with educational nuggets marked by hashtags such as #Cardiotwitter, #CardioEd, #MedEd, and #FOAMed (free open access medical medication). There is tremendous value in putting forth important clinical content for education that can benefit hundreds or more students and clinicians who see these tweets. There are many different formats to share medical education online such as the use of open-chat forums such as Twitter Journal Club or by creating “Tweetorials” by which one can present important topics in cardiovascular medicine through a thread of multimedia tweets that are linked and posted all at once, often containing references back to the original sources. Additionally, those attending scientific conferences can use conference meeting hashtags to enable rapid dissemination of key meeting takeaways to clinicians, researchers, and even patients who are following online (3).

It is unfortunate that sometimes academic elitism does not put sufficient value on the “clinician educator” with a strong teaching portfolio, who often faces a much tougher path to academic promotion compared with the traditional model of the well-published, grant-holding “clinician researcher.” This real-life scenario is mirrored in social media, too. However, this doesn’t mean that these educators hold any less value for an academic institution. Rather, the next generation of clinicians depend on their wise teachings.

Some of the more progressive academic medical centers are now starting to consider a “social media portfolio” as part of the promotion package for academic advancement, if faculty can demonstrate that they have generated meaningful social media content that aligns with the institutional values and priorities. For example, the Mayo Clinic Academic Appointments and Promotions Committee started considering a social media portfolio in the promotion package in addition to other typically recognized achievements (4).

Clinicians who are active on social media must continue to take care to not make any medical treatment advice for a given individual, as these should be left to a person’s own medical provider, or post any information that violates Health Insurance Portability and Accountability Act (HIPAA). Clinicians should be reminded that their online activity may be construed as representative of the institutions that they work at, and respect and professionalism should always be prioritized.

In sum, Twitter and other forms of social media can strengthen the impact of new research by offering rapid dissemination of clinical trials and guidelines, and generate new educational content that directly impact patient care. The use of social media in clinical and academic medicine is here to stay. K-index aside, it’s time to recognize all of those who are doing progressive work in this space.