Twitter is a communication platform, and therefore, it is a neutral medium. It’s not the medium itself, but how you use the medium that makes Twitter ‘good’ or ‘bad’. In my 5 years of being an anonymous and 5 months of being a named individual on Twitter, I have come to realise that different people use Twitter for different purposes. In general, these are the 5 people (or doctors) I have met on Twitter. They have enriched my experience on Social Media and taught me much about life and doctoring.

1. The Knowledge Distributor

These are the ones who frequently tweet and retweet various information, news, latest studies, guidelines and opinions. Following a few of these people will add to your knowledge base. They often have tens of thousands of followers and they usually have tens of thousands of tweets. They are good at disseminating information. Their timeline is full of information. The downside? They read like a newsfeed and therefore often lack the personal and social engagement that is an enjoyable part of Twitter. But they serve their purpose well. I learn lots of new things from them.

2. The Court Jester

The Court Jester is the one who entertains, enlightens and yet educates at the same time. They’re the ones who put up a mirror to our faces. They poke fun at important issues, sometimes even taboos, and bring up a very important message. They are often the ones behind the mask who would tell the truth when no one else would. They provide the behind-the-scenes look at the medical industry (or any industry) and challenge the status quo. As you can guess, they’re often anonymous. They’re the ones the lawyers and administrators warn you about. But I see great value in following them. Because they tell the truth behind their masks, I reckon every industry needs some of these, with respect of course. I can think of a few doctors who are anonymous who make a massive impact through their Tweets and blogs.

3. The Social Collaborator

They are fun to hang out with. They are one of the main reasons for joining social media. It is social after all. There are lots of conversations about life. Lots of food photos and baby photos. And cat photos, of course. One must never forget the abundance of cat photos on Twitter. Sometimes, in their eminently sociable space, the line between public and personal lives get crisscrossed. Raw emotions, anger, bitterness and hurts make their way into their tweets. It can be painful to watch. Sometimes downright unprofessional. But I love following them, because at the end of the day, we’re human. I need to always be in touch with the raw and unpredictable nature of human emotions and relationships.

4. The Relentless Commentator

The devil’s advocate. They seem to have an opinion on and a comment for anything and everything. Some of them good, some of them very critical and negative. They always provide a contrasting view and they’re happy to let loose with their opinions. You’ll find them debating certain issues with passion and their timeline reads like an angry verbal joust. It’s good to follow them because there are always many sides to any story and you get to learn from them. However the line between respectful difference versus discourteous disagreement can be very thin at times. First rule of Twitter: be respectful of others.

5. The Thought Leader

Here’s the one everyone wants to be. The person who leads the world with contemporary ideas and tweets their sophisticated perspective to everyone. Twitter truly adds to their impact and in some immeasurable ways, they are truly changing the world. They are examples of what’s good on Twitter. The synthesis and harnessing of people and expertise. There are not too many of them around, true thought leaders. When you’ve found them, they’re a treasure to follow as they enrich your days with colourful thoughts and perspectives. I’m certain that they would be as amazing in real life as they are on Twitter.

It would be great to follow a few of these different kinds of tweeps to challenge your thinking and enhance your perspective. What about yourself? What kind of a twitter person are you? My guess is that most of us would be a bit of all of them. Who we are on Twitter is probably defined by who we are in real life and what our purposes are in joining social media.

I was once Australia’s most followed surgeon on Twitter, according to dear wife. She was probably right, as always. I had more than 3700 followers on my account, but very few people knew who I was behind that necktie avi. You see, I was an anonymous, or more correctly, a pseudonymous. There were 3 reasons why I chose to start off life on Twitter as an anonymous surgeon:

1. Who wanted to hear my voice anyway? I was a young trainee surgeon at the time. There were more important people and celebrities to follow. Who wants to follow me? Well apparently, as this twitter experiment rolled out, quite a few.

2. Is it really safe to be a doctor on Twitter? Australia was grappling with the legalities of doctoring and tweeting. No one was sure if it was safe to be a doctor on social media. I think we’re a little wiser now.

3. How do you use this Twitter thing? Twitter was new. It didn’t come with a manual. I haven’t found my voice. I didn’t know what works and what doesn’t.

So, over 5 years and more than 22000 tweets, I learned a few things from Twitter:

1. People are inherently interested in other people’s lives. So somehow, as I shared my victories and struggles through my surgical training, people listened and friendships were built.
2. Twitter is the great equalizer and collaborator. On twitter I can speak to a Professor, Astronaut and Miss Universe at the same time. We’re each individuals with a voice and the chance to collaborate on multiple issues affecting individuals and the great public.
3. The rules of real life applied to Twitter. Respect, kindness and authenticity are valued as much on Twitter as in real life. If you’re not a likeable person in real life, chances are, you won’t be likeable on Twitter.

After having found my voice and learned the good and bad of Twitter, I decided to lock the account, come out and start afresh with a new personal account. I’ve learned now the difference between the effectiveness of an anonymous, and that of a named account. I learned that these are the strengths of an anonymous:

1. People were happy to treat the anonymous as a sounding board of their issues. I had lots of DMs and private conversations with people from around the world. I suppose, it’s like talking to a bartender or cab driver. People were happy to spill out their guts to someone they don’t really know by name.
2. As an anonymous, I was the court jester or stand-up comedian who could point out issues in real life and poke fun at it with the hope of bringing a serious message. There are many effective anonymous accounts that do this very well. As a named person, however, I tend to be a lot more careful with my words as it can now be contextualized and locked to a person, time and place. The generality of the issues discussed suddenly become specifics.
3. Being an anonymous was for me a safe way to learn, observe and discover what twitter was all about. I learned the strengths and limitations of twitter. I have regretted a handful of tweets. Who wouldn’t? I have learned some good lessons.

Twitter is a powerful medium of communication and collaboration. I would encourage all physicians and surgeons to consider being on Twitter to extend your reach and impact. If however, you are concerned and hesitant about it, I would suggest a gentle progression from Twitter anonymity to community.

I wrote this on 27th December 2013 on my ‘anonymous’ blog. Interesting reading one and a half years later.

I joined twitter 3 years and 4 months ago. I did it twice. The first time as an observer-explorer, but gave up on it. The second time, with a friend’s encouragement I tried it again. Like any new technology, medium of expression, or tools, there were trials and errors. I didn’t know how to use twitter at first, but well, none of us did. People got into trouble for their tweets, and I did too. There have been doctors out there ready to crucify me and my tweets as it did not fit their brand of professionalism. The legal boundaries formed around tweeting doctors were blurred and there was a period when we doctors were forced to ‘come out’. All these anonymous witch-doctors were being pulled kicking and screaming out into the open.

Why did I join twitter?

1. Enjoyment (Social)

It’s social media after all. Twitter is mostly fun, encouraging and funny. There are a few out there for negative reasons, but it’s a mostly safe social arena. I have met many wonderful, interesting, fascinating people who are now dear friends to me. These are not friends I’d ever meet through ‘traditional’ social methods, frankly because I have no time to socialize in parties or pubs anymore. Remember that for every tweet, there are plenty of personal DMs not seen by the public. Some of those DMs from close twitter friends have pulled me together during difficult times. Hey, I even got Canadian socks from an awesome Twitter friend who I’ve never met before. It’s like pen pals in the past. The sharing of words and lives is an inherently human experience.

2. Education (Learning)

I’m on twitter to learn a bit of medicine, surgery and life skills in general. Some of the studies that have changed the way I practice surgery I first read on twitter. Some life wisdom that has encouraged me to live a better life I first read on twitter. Funny one liners, trivia, awesome pictures, random information, latest news and all sorts of beautiful things that colour my day all gets delivered through twitter. I have learned much through twitter. I’m usually the first on my unit to hear about a breaking news, new ideas, interesting studies, etc.  Twitter adds colour to my days.

3. Engagement (Teaching)

Yes, if you haven’t figured that out already, I’m an ENT surgeon in training. It means that one aspect of my calling as a doctor is to teach others how to live better lives and help them through their ENT problems. I also freely give out life advice that I’ve found helpful. Take it or leave it. More importantly, I want people to laugh or smile when they read my tweet. I want people to enjoy my tweet, not get a PhD in ENT.

What else have I learned through twitter?

1. Twitter is here to stay.

Just like moving from snail mail to e-mail, from phone landlines to mobile phones, from desktop computer to portable personal computing, Twitter is a new medium of communication that is here to stay. When I’m looking up another doctor, I not only look up their addresses, emails or phone numbers up, I also look up their twitter handle. Twitter is a new address, a new email, a new phone number, a new contact point in this increasingly interconnected society we live in. It almost does not matter if we live on different continents, as long as you’ve got twitter, you can contact/DM/interrupt my day any time, as if you’re a colleague working in the next operating theatre.

2. Twitter helps me express my thoughts.

I used to journal my thoughts. I still do. The word is my medium of self-expression. I find that I feel better if I can articulate my convoluted mind using a few well-chosen words. Not that I’m a poet or anything. Twitter is like a toothbrush. It keeps my brains clean and free from thought sediments. My wife knows this and although she hates me for spending too much time on twitter, she also knows that it is my medium of expression. It’s a way of me clearing up my thoughts as I go through my stressful surgical days. That’s why I hope to continue tweeting to keep my mind active.

3. Get a shorter twitter handle next time.
4. 3,700 followers mean nothing if you’ve added nothing into their lives.

There are celebrities with millions of followers. I don’t want to be that. But I do want to be an inspiration to a few. I want to help if I can. Twitter is a unique method of getting into people’s lives. When I’m followed, it means that I’ve been invited to enter into the lives and thoughts of someone, and I need to respect that. I cannot be putting up garbage on their timeline. I want people to laugh, or be inspired, or learn something from my tweets because they have allowed me the privilege of allowing my words to enter into their conscious minds.

5. The timeline is the appetizer.  The DMs is where the public becomes personal.

I’ve seen your hurts on your DMs (Direct Messages). I want to reach out and help. Words, even mere words, can be an incredible powerful agent of change. Tell me your pain, and I will do what I can to share in your struggles. It’s like being in a busy train, sometimes you strike up a good conversation and tell your story to a total stranger who can share your pain even if only briefly.

6. People are inherently interested in other people’s lives.

The common bond amongst us all: life. We have lives to live, stories to tell. I’m interested in your life and thoughts. And I know that many people are interested in what it’s like to be training as a surgeon. I tell you my story. I allow you to see the raw emotions I feel when I’ve been on call non-stop for 10days. I tell you my struggles with family, work, dying patients, etc. And I’m interested in your stories too. It’s like sitting around a campfire, trading stories, enriching lives.

7. Don’t judge a tweep by a single tweet. See the whole timeline.

Lots of bad twitter fights happen because of this error in misinterpreting a single tweet. In life as in twitter, there is no point winning an argument but losing the friendship.

8. Everyone is equal and accessible on Twitter.

I can speak to a professor, an astronaut and a Miss Universe contestant on Twitter. And I get to discover that they are all down to earth people, happy to live out their ordinary lives. It’s inspiring like that. Similarly, I hope people can just tweet me up and I can help them in whatever way I can.

9. There are different uses for twitter.

Some are on twitter for commercial reasons. Some for clinical reasons. Some for political reasons. Others like me, are here for fun. Just like in any social gathering, don’t assume that everyone is here for serious purposes. For example, my lighthearted comments about medicine and surgery have been mistaken for serious criticisms. The funny thing is I never meant for any of my tweets to be a serious opinion. I liken myself some times to the court jester who performs and cracks jokes to provide a lighthearted alternative at looking at this serous business of life and surgery. The Surgical News, which is the monthly magazine of The Royal Australasian College of Surgeons, read by thousands of Aussie and New Zealand surgeons routinely include several articles written by anonymous Prof R U Kidding, Dr BB Gloved and Dr IMA Trainee. They are anonymous articles meant to poke fun at the serious business of surgery. Sometimes being told directly about an issue has a negative effect compared to being told a funny story by an anonymous. The effect is the same though: laughter, enlightenment and behavior change. I hope my tweets do that. If you’re looking for medical information, there are plenty of doctors on twitter who do that better than me.

10. It’s ok to be an anonymous doctor.

I know some would not agree with that. This is how I see it: being a doctor is who I am. I cannot separate who I am in real life and who I am on twitter. But I’m not here on twitter as your doctor, so I’m not going to offer you personal medical advice. Also, I’m not here as a professional entity, although I will remain professional and courteous. I’m not here marketing my surgical practice. I’m here as me, myself and I, who happened to be a doctor and tweet doctorish thoughts. If I can help you in any way, does it matter if you don’t know my full name? I’m not endorsing any special treatment, surgery or thoughts. You don’t really need my name.

Sometimes I share the raw emotions, the confusions,  the frustrations, the anger, the uncertainties, the inexactness of the science and practice of surgery. All those things are real. Real patients and real doctors know that. Medicine is not a sterile, perfect, exacting practice. I don’t think I’m painting a bad picture of medicine and surgery when I share some of those raw experiences. I don’t think I’m being unprofessional when I’m questioning my own and my hospital practice. I don’t think I’m being unprofessional when I’m sharing the human side of medicine and surgery – the blame game, the politics, the money, the administration, the ego clashes. And I don’t think that I’m hiding behind my anonymity when I do that. I’m sharing the real story behind doctoring that does not need to be hidden. One day I will come out. But at the moment I still feel that I am effective being an anonymous. And yes, I am accountable for every tweet I have tweeted. I’m fine with that.

Twitter has become a routine part of my daily life. I’ve had so much fun with it. I’ve learned much, and I love it. It has given me so much needed support during odd hours of my nights. It has been a real enjoyment, education and engagement tool. I hope to have inspired some lives out there during the process.

But I need to let it go.

Why? Because it has taken up so much of my thoughts and my time. I need to focus on something else of immense importance in the next 3 months, and I need to be single-mindedly preparing for this and this alone: FRACS Fellowship Exam. It’s like taking a sabbatical. I need to focus on studying and training myself up to be the best I can be, so that hopefully I can return as a fully trained surgeon and be even more helpful for the people around me and my friends on twitter.

So farewell, my friends. While I fall in love with ENT, will you keep a space for me when I return.