This is an interview with Dr. Aditya Shah, the creator of an innovative way to share infectious diseases information called #stewardmeme. His experience using social media and professional interests are discussed.
Interviewee: Aditya Shah, M.D.
Interviewer: Timothy P. Gauthier, Pharm.D., BCPS-AQ ID
Last Updated: 11 November 2019
Social media is an amazing space for finding new information, connecting with people who have common interests, and joining the conversation on trending topics. Each social media platform is a little different secondary to format structure in how accounts interact. Twitter is a particularly interesting social media platform from a professional standpoint, because it enables concise open interactions with many people while allowing us to connect with opinion leaders from across the globe.
It is natural that on social media content that is innovative or engaging does better in terms of generating interest (e.g., comments, favorites, and retweets). This type of content is valuable, because it can help extend the reach of a basic concept or topic. For many years I have been interested in education on social media using entertaining content, which is demonstrated by the @IDstewardship Instagram profile. Not long ago I found out about a new phenomenon for sharing educational and entertaining content on social media: the #stewardmeme.
A #stewardmeme combines a gif (short video) with text in a way that the text describes items in the video. The topic of the #stewardmeme can be anything, but in essence the name indicates it will have something to do with antimicrobial stewardship or be for people interested in antimicrobial stewardship.
Recently I had the pleasure to meet the creator of #stewardmeme in person. We had a great discussion and later on I reached out to see if he was interested in doing an interview about his experience. He agreed and the following was created.
Here is an interview with the creator of #stewardmeme: Dr. Aditya Shah (@IDdocAdi)
Question 1: Who is Dr. Aditya Shah?
My name is Adi and I am originally from a small town (6 million people!!) in Surat, India. I went to medical school in Mumbai after which I moved to Chicago to complete medical residency training.
I went into residency knowing I wanted to do infectious diseases (ID); considering I like the “thinking” aspect of it. Also, I am not sure if aliens are going to invade and destroy the planet, but antimicrobial resistance is well on its way to doing so!
I like the idea of an ID doc being able to see the patient “as a whole” and thus needing to have good internal medicine skills. It is exciting that as an ID physician you can help a medical team make an alternative diagnosis which serves the dual purpose of helping the patient and also saving the patient from unneeded antibiotics.
I was toying with the idea of doing both critical care and ID training, but have had the good fortune to get a enough critical care ID research experience during residency to satisfy that interest.
Question 2: As an infectious diseases physician, what made you interested in using Twitter professionally?
I first got on Twitter in March of 2018, after an airplane incident where along with a team of health care providers I was able to help a passenger on an international flight. The story made news headlines and was published online. It was an experience I will surely never forget.
However, I remained largely inactive until May 2019, at which time I saw a post from ScratchpadMD of a wedding gif, where a man prevented the lady sitting next to him from catching a flower bouquet. That to me just seemed like when ID physicians tells consulting medical or surgical teams not to add metronidazole, when a patient is already on IV vancomycin and piperacillin-tazobactam. In turn I made this:
[View as a gif here]
People got a lot of laughs out of it along with knowing that barring rare caveats, one does not need metronidazole for anaerobic coverage when a patient is already on piperacillin-tazobactam. This made me curious about the value or impact of using humor to communicate a teaching point. It was not the first time I used the #stewardmeme hashtag, but it was in line with what would become the first official #stewardmeme.
Question 3: What inspired the first real #StewardMeme?
Analogies work for me. I use analogies to explain concepts to myself and my patients. For example, how I explain susceptibilities to patients is I tell them: “Right now we know the name of the bacteria. We know what team they are playing for. We know the team jersey they wear. Susceptibilities are like knowing what the ‘number’ of the jersey is to identify the exact name of the player.” This way of thinking helps me make memes.
June 4, 2019 was when the first #stewardmeme was made.
[View as gif here]
This was a meme about a very common ICU ID phenomenon, where the patient is admitted to the ICU for a “pneumonia” gets started on vancomycin + piperacillin-tazobactam, ID does various studies especially the MRSA nasal swab and manages to de-escalate and sign off, only to have an isolated low grade temp for teams to escalate back to vancomycin + piperacillin-tazobactam. This resonated very well with twitterati too and got a lot of laughs and shares. The goal was to spread awareness about the utility of the MRSA swab in stewardship and the utility of patience while treating patients. Also the utility of pharmacist colleagues in stewardship.
This was followed by many #stewardmeme posts about diagnostic stewardship, utility or not of procalcitonin, immense utility and importance of pharmacists, utility of MRSA swabs, mechanisms of action of various antibiotics, memes about different types of shock and non-utility of antibiotics in non infected patients, importance of infection control, mechanism of spread of C. difficile, importance of contact precautions in certain scenarios, importance of vaccination, mechanisms of action of vaccines, importance of barrier precautions and condoms in prevention, importance of PrEP, issues with burnout, issues with medical provider well being, systematic issues in institutional strategies to prevent burnout, and more.
There have been way too many topics I have made memes about to enumerate in detail!
Question 4: What has been your favorite #StewardMeme so far?
My favorite #stewardmeme has been:
[View as gif here]
This is the times we live in, in medicine. We seem to have a plethora of resources, facilities, tests, imaging studies etc. I feel that at times, we might be overdoing the testing, with so many “panels” “order sets” etc. This very often leads to ordering of tests, without knowing what to do with the results.
The take away point of this meme is “If you don’t order the wrong test, you don’t get the wrong result, which then prevents the wrong treatment, and harm to the patient” This is the principal of diagnostic stewardship, which again, is a strong career interest of mine.
Question 5: Why have you chosen to be an active user of social media (rather than a passive one) and how do you feel this impacts your experience using Twitter?
There are a few parts to this answer.
Firstly, I have chosen to be an active user as it is a media through which I can learn, see what others in medicine are doing, ask questions, interact with experts and in general be a better physician.
Secondly, for my particular interest, I believe that using social media is a quick and easy way to reach the general population. We in medicine and indeed ID know the issues with antimicrobial resistance, we know the importance of vaccination and public health topics; however, it is key that we use this media to reach the non medical population and educate them on the importance of these issues.
Thirdly, this is a good medium to counter pseudo-science and negative publicity with issues like vaccination.
With my particular content, there are downsides though. You have to be really careful what you put out. One cannot take a chance and offend anyone, as that is not the purpose of what I do. Trying to make content which is a good mix of humor, awareness, education, without offending anyone is at times challenging.
Question 6: Has creating #StewardMeme tweets taught you any important lessons about using social media as a doctor?
#stewardmeme has frankly been a revelation. So many other providers now make similar memes and share this widely. People regularly make similar memes with their own ideas, but using the same hashtag and tag my handle. People also tag me in interesting and funny videos requesting me to use those to make medical memes. The main goal of these memes was to spread awareness of correct antimicrobial practices, educate about mechanism of action of medications and indeed educate about antimicrobial resistance. This medium has let me do all that.
As time has passed, I have also started expanding into the space of burnout in medicine, the problem of student debt in medicine, the problem of mental health of medical providers, issues with medical providers not taking care of themselves. Making memes using humor for these important issues has led them to be widely shared, distributed, liked on, commented on. This has led to awareness about these issues.
A nice side benefit has been new friends (like @IDstewardship, @AlastairMcA30), new collaborators, and new opportunities.
My rules for social media are simple:
1. Be yourself.
2. Respect every opinion, even if it is totally opposite to yours. I am not asking you to agree with it, but you HAVE to respect it.
3. Don’t pick a fight.
Question 7: Has the #StewardMeme phenomenon changed your perspective on the world?
This phenomenon has mostly surprised me. I do not intend to go out looking for videos with ideas for those videos. My process is simple. I see a video/gif, an idea strikes me, I put it out if I find it funny. I have always thought I have a weird sense of humor and I was surprised with how people identified with it. I had in general ignored Twitter before this, but now I see it as a media to spread education, awareness and talk about very important topics.
Medicine is a stressful field to work in. Using humor in it makes it a little easier; if the said humor can be used to educate people, improve awareness and talk about important issues, then what can be better than that?
Question 8: What’s next for the creator of #StewardMeme?
I am currently on ID consult service at work so that is awesome. I love seeing patients and learning everyday in fellowship and honing my skills. I am also doing a 2-day intensive certificate course in the fundamentals of critical care medicine where you learn the basics of shock, pressors, ventilators, trauma, burns, intubations etc. This is offered by the Society of Critical Care Medicine and is being offered by as a part of my training in ICU ID medicine. That’s the most immediate goal.
I am now also focusing on working on manuscripts of projects we started with my mentor in fellowship. We plan to publish our study on antimicrobial stewardship and its challenges in India. We recently managed to publish our study of overuse of bronchoscopy studies in the ICU. My main interest in ID is critical care ID and specifically ECMO. We are in the process of working on our manuscript; of a part retrospective and part prospective study to propose some standard guidelines in antimicrobial prophylaxis in the ECMO patient population.
Eventually I hope to start a faculty position in July of 2020 after graduating from my training.
My 5-year goal is that whatever center that I work at, if there is a patient in any ICU and on antibiotics, that patient must have a stewardship expert review the appropriateness of this or have a formal ID consult.
I have also over the years worked on and made sketches, poems, short stories and eventually want to publish a book called “Brown man in the city”; cheesy yes, but hey, that’s what I want to do.
Disclosure: The opinions, views, and content presented in this interview represent that of the interviewer and interviewee and do not necessarily reflect the policy or position of any previous, current, or potential future employer.
ABOUT THE INTERVIEWEE
Dr. Aditya Shah attended medical school in Mumbai, India. He is currently an Assistant Professor in Medicine and a Chief Infectious Disease fellow at the Mayo Clinic. His research and career interests include antimicrobial stewardship and diagnostic stewardship, particularly in critically ill populations.
In his free time Dr. Shah enjoys baseball, soccer and cricket. He believes in fitness and making healthy life choices. He confesses he will travel for food and experiences. He strongly believes that humor is the best way to make an important point! You can find him on Twitter @IDdocAdi.
I would like to express my utmost gratitude to Dr. Shah for taking the time to do this interview and share his experiences. I would also like to thank him for finding a new creative way for making ID fun!
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