#004 - Dr. Michael Narvey - Social media and neonatology

Dr. Michael Narvey is a Canadian neonatal intensive care physician. He is the section head of neonatology at the University of Manitoba. He maintains a popular and active twitter account (@nicu_musings) with thousands of followers. He is also the founder and main contributor of the blog www.allthingsneonatal.com

As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd.

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As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.

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Transcript

Ben: 0:44

Good morning, everybody. How Daphna, how are you today?

Daphna: 0:48

I'm doing great. We are. We're optimizing our sound for our listeners. So hopefully, you guys feel like we're seeing some improvements there. So I'm feeling excited.

Ben: 1:00

Yeah. We're trying to you know, trying to get 1% better every day. All right. Today we have the honor the privilege to have Dr. Michael narvi. With us. He is a neonatal intensive care physician from Winnipeg, Canada. He has a long list of title. He's the section head of the neonatology department and at the University of Manitoba. He is the medical director of the Child Health transport team. He's an associate professor of pediatrics. He also holds the chair of the Kenya Canadian Pediatric Society for the fetus and newborn Committee. He is the founder and main contributor of the blog, all things neonatal that calm and holds what I would say is one of the most followed and active Twitter accounts in the realm of neonatology and his Twitter handle is at NICU underscore musings. Michael, thank you for being with us.

Michael Narvey: 1:55

It is a real pleasure to be part of this. And thank you for being pioneers, and putting together a podcast like this. It's great.

Ben: 2:05

Thank you. Well, for the for the listeners and for us as well who may not know a little bit about yourself, tell us what your background is and sort of how did you end up in the field of neonatology?

Michael Narvey: 2:18

That's a great opening question. I've told the story many times, but I guess to your listeners, they wouldn't they wouldn't know this. But so I'm Canadian, as I think you mentioned so I grew up in Winnipeg, Manitoba in Canada, which for those of you who don't know, is right in the center of Canada. In fact, there's a sign just a few miles outside of my home to the east that says center of Canada. So we literally are in the center of Canada. But my background is I went through med school here in University of Manitoba, then did Pediatrics at the University of Manitoba, but the story of how I got to pediatrics and then eventually neonatology is something that I think your listeners might find interesting. So my background was during medical school from the time I entered medical school, right up until my fourth year, all I wanted to do as obstetrics and gynecology. And I mean, all I wanted to do, all my electives. Were in that I did. Gynecology, oncology, I did high risk obstetrics in Toronto, at Mount Sinai. And it was when I went to Mount Sinai in 1997, that I had an epiphany. And the epiphany was, as I was, I remember, I remember very specifically what happened. I was fascinated by the care of the fetus. And, you know, back then, of course, we had to go to the library, because we didn't have online resources. So after each day, I would go to the library, and I found myself reading more and more about the fetus, and less and less about the maternal care. And then one day there was a baby. And I'll never forget this, there was a baby born to a mum who came in off the street, no prenatal care, baby had multiple anomalies. And I was able by piecing it all together and going to the library to diagnose the baby with suspected charge Association, which is what, which is what ultimately they had. And so I had, I had that, that moment that some of you some of your listeners may have where suddenly your world is turned upside down and what you thought you wanted to do. You're no longer clear about so what happened was I went we have a match system here, just like you have in the US and I had already missed the deadline to apply to pediatrics, which presented me with an issue. And long story short, I was able to work out one interview here at the University of Manitoba for pediatrics and otherwise I traveled the country for 10 interviews for obstetrics and gynecology. And then I often joke that I got my last pick but no, I actually got my first pick. So I was able to, to get into pediatrics and then you know, right from there, I put much knew my interest was with obviously tied to obstetrics. And so on my second rotation in was neonatology and I just never looked back.

Daphna: 5:08

It's awesome. It's a it's a good reminder for people that it's right. It's never too late to pursue, you know, what you're really passionate about. It's a it's a good lesson, it shows that you're, you're brave, lots of people would have just gone through and, you know, Jenna Jenna life of obstetrics.

Michael Narvey: 5:26

Yeah, absolutely. And in fairness, I probably would have been happy. Of course, you know, I mean, I don't I don't want any of your listeners to say, Oh, my God. obstetrics is terrible. No, I think I probably would have been happy there too. But you know, what, I've never looked back. I've my passion is that newborn intensive care, education? You know, and throwing a little bit of humor and melanin, to try to lighten the mood. But that's those are my interests? Well, it

Daphna: 5:55

certainly comes through on your, your posts and your dedication. That's something that that Ben has spoken to a few times. You know, we were so excited for you to join us today that, how do you find the time given all of your, you know, clinical duties administrative to keep up with this? Which I don't think we can call a side project. I mean, you have a really well respected blog, and, you know, the Twitter handle is reaching a lot of people. Yeah.

Ben: 6:28

I mean, I want to I want to jump in on what definite is just saying, because I think it's not I had I have the same question. And the reason this question is important for you, is because the content of your tweets is is dense. You're not like you're not tweeting, hey, just got up this morning. Right? You're, you're tweeting stuff where you're, you're sort of really boiling down like an article, a paper, you're sharing insights. And I think, beyond the frequency at which you're posting, it's the quality of the content that is very impressive, and makes us wonder how do you manage to come up at such a true click of tweets? Considering how busy you are?

Michael Narvey: 7:10

You're asking me to lift the curtain, so to speak, tell you my secrets. You know, I think I mean, first of all, I'm not saying this because my wife is likely to listen to this. But having a supportive spouse or partner, I think is very important. And she has always supported and been enthusiastic about it, which, which really helps. She herself is on Twitter, but is an observer only. But no. So that helps. The other thing that the other thing that really helps, I mean, first of all, you have to go back to where does this come from? You know, I've sort of I've written about it before, actually, I think I had a blog post at one point about why am I doing all of this. And what it boils down to is one of my past roles, I wasn't always a section head, I wasn't always a director, and, and so forth. I used to be a program director. My passion was education. At one point, I was a fellowship program director in Edmonton, Alberta for neonatology for four years. Excuse me, and I, you know, obviously, you don't take that on unless you have a passion for education. Now, the story of where this all came from, I think is I love telling, in fact, I presented on this at conferences, on social media, but the story actually begins with Minecraft and a dog, which is an interesting, interesting part of the story. Because if you go back to February of 2015, which is really when this all started, I joined Twitter in February 2015. I started the blog then. And so what happened? So it has to do with a child named dog. So my son, my son at the time was really into a game called Minecraft, which I'm sure you've heard of. And then one day he said to me, he was five years old, and he said, Dad, I want to write a blog about Minecraft. What did I know about blogging? Nothing. And so you know what I thought like an educator, I thought, You know what, let's learn it together. Let's find a platform. Let's find, you know, content, let's, you know, explore it. So it became like a father son project. Now, the Minecraft blog you've never heard of, because it really didn't go anywhere we, but I discovered some important lessons. And the lessons were that places like WordPress are interesting, but you need something for distribution of content. And that's where Twitter, Facebook, LinkedIn, and other platforms come in. But where the dog comes in, is we got a puppy, and this puppy, I don't care what people tell you about training your dog to sleep, this puppy would not sleep. And so this puppy every morning was up progressively from four to 430 in the morning. And so after I'd created learned how to create the blog, And then started to explore the concept of distribution of content through Facebook and Twitter and whatnot. At that point, it was I'll never forget, it was one morning. And, and this will tell you a lot about where I find the time, but it was it was one morning, it was about 415 or so I sat down on my computer, and I thought I can't do it. I can't sit here and answer emails at 415, in part because I thought it's disrespectful to my colleagues, like no, you know, if I'm sending you an email at 415 in the morning, then the subconscious message I may be delivering, or you think I'm delivering to is, hey, I'm up, you should be too. And so I thought, What am I going to do? So I read an article. And it was from the Canadian neonatal network. And it was about rates of bronchopulmonary dysplasia in different units across the country. And, and although I love the Canadian neonatal network, there was something about the article that just didn't sit right with me. And so in that very moment, and an early morning of February, sitting with the dog sitting beside me, I wrote my first blog post for all things neonatal. And it was a critique of that article, and I publish it, and it went nowhere. But what I learned from that, of course, was using the social media channels. So then I started broadcasting on my own personal account. And then I started getting feedback from friends of mine saying, you know, love you, Michael. But like, why are you posting this medical stuff? Like it's some of it's disturbing, right, you know, to a layperson. So then I found the Facebook page now. That's the background. So how do I maintain it? How do I do it? So one thing I'm very grateful for, is as a fellow, and I would encourage everyone to set this up, if you're not, if you have any, I'm assuming you'll have residents and fellows listening to this. You can set up Don't ask me how I set it up years ago, but you can set up through PubMed, you can set up an automated search and mine emails me. Basically, my key words of neonatal NICU and so forth, every Sunday, I get a blast of across about five or six journals, I don't search for everything, because of course, you'd wind up with 1000s. But you know, I get I get probably about 5060 articles sent to me every Sunday. And, you know, I saw on Sunday, I go through the abstracts, and I see what ones I might think are good enough to really digest in terms of writing a blog post on, and which ones are really just short snappers that, you know, just would be of interest to people. And so, I plan out my week at that point, as to which ones I'm gonna post and when rough idea, I don't write it down or anything, but I have a general idea. And then, from there, I am an early riser. You know, I typically am up between about five to 515 each day, or 530, on a good day. And I sit down with my cup of coffee, and I now have two dogs sit down with a cup of coffee and the two dogs and, you know, see what's out there in the Twitter world see what's you know, see what I was planning on posting. And, and of course, you know, that's and then you know, some things are some things take more times than others. And one thing that I do want to point out now, if you've never noticed at all, I will point it out to you and any readers of the blog, I often stopped short of you no emphatically recommending something. I usually my style is to throw out the data, throw out the information, put my own spin on it, and then finish off with is this right for you? Does this make sense? Do we need more research? Because I'm very well aware that, you know, depending on where you are in the country, depending on your healthcare system, depending on the genetic background of the population you serve. As we know many you know, there are now predispositions to BPD based on your genetic makeup. So, you know, one strategy may not fit all right. So I like to put it out there, if there's something that I feel is an absolute must, you know, like everyone should be doing? Sure, I'll put my weight behind it. But that's sort of my general philosophy on it. And one question, I'll finish off with this. I mean, I could talk forever about a vote and

Ben: 14:32

we could we could listen just as well, social media. But

Michael Narvey: 14:36

you know, one, one thing that people commonly ask is how long does it take me, you know, to do a blog post. It usually takes me about two hours start to finish because one of the things that I learned a long time ago and it's great, great advice for any up and comers or people who like to read evidence based medicine. I am not by any stretch have imagination, you know, an expert in critical appraisal in terms of heavy statistics. But one of the things that I was taught a long time ago is if you know, because there's so much literature to digest, if you were to read the introduction, the discussion of every single paper, it would take you forever. So where I started, I started the methods, I always started the methods. Take a look, you know, based on the title, does the methods make sense? If I can see the methods are extremely flawed. I move on.

Ben: 15:30

Yeah. So I think it seemed to leave in one of his books talks about the volume of research that's being published on a daily basis, and came up with a calculation that said that if we wanted to be able to truly keep up with the evidence, we would have to read about 50 papers a day now. And that will just allow us to keep up to keep up with what's coming out. And obviously, we're all we are all starting at a deficit, because there's all this literature that came before us. But that just gives you the monumental task that it would be that you're describing, obviously. And I've done the same thing, as you're saying, I usually start off with the last line of the introduction, which is like, what are you trying to prove, and let's get into the methods and see if, if you're, if your structure holds. Now, I'm disappointed Michael, because I always thought that you were sort of like the cardiothoracic team of Twitter. And you were walking with like, 12 assistants pointing out to you, on tablets be like Dr. Harvey, this is this thing just came out hot off the press.

Michael Narvey: 16:23

So funny, you say that periodically, you know, periodically, I do get solicited, I get emails actually not not infrequently emails from companies who who write to me and they say, Hey, you know, we're very big fans of your blog, you know, in your your social media content. We'd like to talk to your, you know, team about, you know, ways in which we can either monetize or we can optimize your site. And I always write back and say, I am the team. Yeah. Now, one thing that you said, though, that I would like to touch upon, because I think that it's something that I think is under recognized, which is, I do have a team of people following me around. And it's the team on Twitter. So the number of people that, you know, tag or post, you know, so something comes to my awareness. It's incredible. You know, I mean, there are articles from journals. I mean, some of them are obscure, but, you know, articles that I never would have found, you know, if it wasn't for somebody saying, hey, and I see musings, what do you think of this? You know? So I think, you know, one of the things that I think is so wonderful about social media is you get back a lot, you know, you put out a lot, you get back a lot.

Ben: 17:44

That's something that I wanted to ask you actually, I'm sorry that I'm hogging the interview. But that's, I have to get some of these things out the I've written papers before I have gone through the peer review process. And if the peer review process when you're publishing an article is very in depth, it's it's few, usually one or two reviewers, but it's in depth. When you compare that to the peer review that you're facing on Twitter and social media, where people may not go as much in depth as a reviewer for a peer reviewed journal. Or maybe they would but the volume of people reviewing it how do you what is your your What are your feelings when you're comparing here review on social media compared to peer review in in classic sort of publishing outlets?

Michael Narvey: 18:29

Well, the first thing I'll say about being out on social media is you need to have some thick skin because once you put your thoughts out there, you do run the risk of somebody will slam you, you know, for completely missing the point and that's happened to me. Not that long ago, actually. Something I've wondered about for years, which was why does the administration have Tylenol in pregnancy you know, not close the ductus like everybody. Yeah, if everybody you know, cuz our own cardiologist here when we started to promote the use of Tylenol or paracetamol acetaminophen, when we started to do that, a very respected cardiologist said to me, if it works, so Well, shouldn't all these duct I'd be closing. And so you know, I posted and then very quickly a colleague of mine in Nova Scotia Shubik Mitra, I remember it. Yeah. Yeah, he put the reason down, it had to do with the transferability across the placenta. And, you know, I took it in the best way possible, it would have been very easy for me to go to a place of, oh my god, I'm humiliated. Right. How did I not know this? Right? But I took it as, Hey, I've just learned something. Right. So this is a this is a positive thing. Now with respect to the peer review, so that's first of all, that's one point is you need to have thick skin. Secondly, You know, the the peer review is incredible, you know, because I'm not going to name names because I'm worried about leaving somebody out. But there are people who I think are world class researchers that I engage with on Twitter. And when they send me a comment or a question about the methodology, again, learning, you know, that it's, it's so powerful, but something that people don't realize. And again, you know, I've shared this with audiences who care to hear about this stuff. There is some interesting, interesting research that could be done then. And on the amplification of research, with Twitter as a as a tool, I actually have data on this. I was very, I won't name the paper because the person might be embarrassed. But in the three month period, there was a paper that was released by someone I know. And I will acknowledge it was Canadian, because I am being Canadian, I do try to boost a lot of the Canadian fields whenever it whenever I see it. But there was a very, I thought it was a very interesting paper. So I decided to write a blog post on it. In one day, that blog post, on my site, Wordpress, tracked 15 187 views of that blog post. That was one day, okay. And I am bragging, but it's, it's to make a point. So in one day, 15 187 views in a three month period, the publisher was able to send the author who forwarded to me over three months, how many times that paper up till that blog post was downloaded. That paper was downloaded 57 times from the publisher site, in a three month period. It was it was seen 15 187 times the commentary on it on my site. Not surprisingly, that individual knowing that data, he's slowed down now, but he used to send me every time he published a paper he said, because that's the reality is social media has a power to amplify. And so, you know, one piece of research that, again, I'm not a strong researcher, but one thing that I would love to look at is to take a handful of such papers, you know, and get the publishers data, and then compare it when there's a tweet or a blog post on the day of release, and look at and look, because the piece that we're missing now is, you know, what happens after the blog post? You know, does that article actually get a bump? In terms of the downloads? Yeah. You know, I do practice? Yeah, yeah, I do know, you know, there isn't like another impact of, I won't name the company here. But there was a company in Europe, that I tweeted about a product that they did, and of course, I mentioned this point, I'm not a paid spokesperson of this company, nor have I received any benefits and so forth. But what was interesting was the CEO of the company contacted me via email, the day after I tweeted and said, our site just exploded. We'd like to, you know, do some work with you. You know, because of your, your Facebook posts or tweets. So, you know, I welcome going back to your original question. I welcome the peer review. I think, the more peer review we have, the more that research has been talked about, and the more that research has been talked about, the more people that hear about it, and the better is that research able to potentially change practice for the better. That's right, I

Daphna: 23:54

hope so many industries. Were already doing that right. Folk, the focus on social media and medicine is really just, I think, catching up to so many other kinds of industries and I you know, I I was resistant to get on Twitter. But I've learned so much really, I've just been you know, I think your everyday you're learning even just by you know, being on social media and I love the question, Ben actually about the peer review. I particularly like your poll questions. When you talk about that, you know, you do have a whole team and we can see you know, what is practice without needing to put out a whole you know, survey or you know, to in the wait for the data to come out you get immediate feedback data on what are the practices? When did you start doing the poll questions, because those again, I think, open you up to critique.

Michael Narvey: 24:54

Ya know, the poll questions I started. I mean, embarrassingly, I'll say when I discovered there was a polling feature on Twitter. But you know, it's it's become, it's become a little bit of a joke in my center that people like people know, I'm very active on social media. And so they will say, when we have a question that we can't seem to resolve, they'll say, hey, why don't you? Why don't you use your they call it my celebrity status? Why don't you use your celebrity status? And you can figure out an answer. So, you know, looking at the latest poll, you know, I think it's a it's a wonderful lesson in house, Twitter can be very useful. So I'm in the midst of revising our hyperglycemia guideline for our center, or assisting with revising it. And I wanted to bring it in line with our Canadian Pediatric Society guidelines of which I wrote as well. So I'm chair of the committee. So it stands to reason that we should have something similar. But when I was looking at revising our guidelines from 2018, which predates the CPS statement, one of the things that I noted was that, of course, in the CPS statement, we have indicated asphyxia is a risk factor friable glycemia. So then, as I'm looking at it with a critical eye, I say to myself, what does that mean? Where does that come from? Like, it's on our list. It's always been on the list, but why? So I did what any good researcher does or any good clinician does, I went to the literature and I came up with bubkis. I couldn't figure out I mean, I understood physiologically burning through glycogen and stress, like I got that. Right. But I thought, how do we define as fixya? Is it based on pH? Is it based on based access? Is it based on clinical appearance? Is it based on a checklist for HIV? Like, what is it based on? So as I'm looking through the literature, I find nothing. That is really helpful. Although I keep finding asphyxia listed, but when you look at it, what you discover is, it's all in reviews, it's all reviews that mentioned as fixya, that's what you get a hit hit on on PubMed. So I thought, you know, what, if if people are doing this, let's at least get some sort of consensus. So that's why I posted the poll. Right. And in talking about utility of these things, one of I'm trying to remember the name Naveed might be a threat to Randy, I think, anyway, I apologize if he's listening. I just, I remember you, and I hope anyone with that, and we hope. Yeah. Anyone, anyone who wonders you can look at the poll from from yesterday, on May 25. And you can get the answer. But what I was looking at was, he sent me a paper he wrote while he was in Hamilton, you know, it's a short comment. But in there, I think was that was the answer. So, you know, I think that that's where, you know, academia, social media come together, to give you very fast answers. You know, very, very fast when you've got 1000s and 1000s of people pulling their experience from all over the world, I think it's a wonderful thing.

Daphna: 28:10

Well, and I can tell through the dialogue that and sometimes you have posed a question that maybe people have or have not thought about, and then they go to Searching the Literature also. So you're right. It's just a way to close the loop faster. It's amazing.

Ben: 28:26

Let me ask you a follow up regarding the surveys, because I've been I've been trying to use the surveys more and more. But I find myself a little bit hindered by by what we have called in the US HIPAA, I'm not sure if it has the same name. In Canada, where, where the, where there's always this. I mean, I could ask theoretical questions. There's many times where I would like to show an x ray, I would like to show, you know, an MRI and ask people, hey, what would you do about this, but I'm worried about PHSI and Twitter and all these things. So I just I just stay away. Have you found tricks and tools that you can use to divulge a bit more clinical data to the to the cohort of Twitter followers to get their input on actual patient cases?

Michael Narvey: 29:14

So the short answer is no. The longer answer is I know how I would do it. I think that so we have the same regulations up here. We call it FIA. Now the Personal Health Information Act which protects all information. We have, you know, consent forms in our hospital, for sex, for media, for photos for videos, and I think that could be easily modifiable. You know, for example, I had a personal medical consideration that had to be given and they weren't really sure exactly here, what the right answer was. And so with my permission, it was shared all over North America to a bunch of consultants. Yeah, and I think that that's, that's the way I would do it as I, if you've got a patient and you they've got a very interesting condition. You can ask, just go and ask the family, you know, and then in the tweet, I would put with parental permission, you know, shared with parental permission. And we might even, you know, because, of course, I realized that we're desperate for characters, you might actually just create, you know, S W, PP, you know, as a hashtag, which would be shared with permanent parental permission, you know, and so people would understand that you've been given permission. I think that that's, that's the strategy. And it's interesting, you raised that, because I do follow some other Facebook communities that are neonatal that come out of the Gulf area, Middle East. And what's fascinating to me, is, it's pretty clear that the same regulations don't really apply, because there's, there's photos of like, exposed abdomens and, you know, surgical findings, you know, and pitfall face has been shown all the time. And, you know, what's, what's unfortunate, is that there's always this competition between HIPAA FIA and the potential for improving patient care, right. So what we're talking about is doing it only official way. But I look at some of these posts, and I'm not criticizing them. But I look at some of these posts. And I think, wow, you know, I've never seen that. Right. I'm so grateful that I've seen that. But at the same time, I think I could lose my job if I did.

Ben: 31:51

Yeah, absolutely. Absolutely. And this is where, yeah, is it? Is it? Is it worth it? Before I give back the mic, to Daphna the person I was looking at your Twitter thread, and the person we were referring to was Naveen to do Ronnie? So you were very close. And his handle is at remain on discord in the view. So that's that's it this way we've done him just I appreciate

Michael Narvey: 32:15

that. I appreciate that.

Ben: 32:22

Definitely, you're, you're muted. I'm not sure. So while while Daphna gets back on, I wanted to ask you something about your, about your sort of the way you operate on Twitter. I feel like in the recent few months, there's been a switch where you increased significantly the frequency at which you post and I am not sure if that was a conscious decision. And if that was what motivated it.

Michael Narvey: 32:54

Very funny question. And I'll tell you, the history there. Yeah, I was on Facebook and Facebook used to have a feature that allowed you to cross post to Twitter. At some point, that feature of cross posting was disabled. But I didn't know that. And so I typically wasn't very active on Twitter, other than just having it automatically post to Twitter when I would post on Facebook. So I discovered at some point last year that suddenly this was not happening. And I had been basically off Twitter for months. Right? And so once I realized that I thought, oh, I need to engage in Twitter. So I started posting separately. And what happened was, this, this is just the way social media goes, some things come in, some things go out. Once I started posting on Twitter, I thought, holy smokes, it's gotten really active. Right, you know, and then. So that's one thing that happened. The other thing that happened was, I've done a little bit of reading into this, Facebook changed its algorithms in some way. Don't ask me exactly how. But it used to be that when I would post on Facebook, I would get 1000s of views of my posts. And with that, the audience was ramping up very, very fast. Suddenly, Facebook in 2020 changed our algorithms. And I think I hate to say it, but you probably have noticed there's all these boosting features on Facebook. And I think basically, they said instead of it being organic, we're gonna put some curtailing on this and make you pay to distribute your content. So I started to find Facebook more sluggish. And I started to find Twitter more explosive, as far as activity, so that that was why and then. And I've talked to you probably are familiar with the name Sarah Bernstein. So I'll give a nod to Sarah Sarah, Sarah and I met through Twitter and have had some preliminary discussions about about neonatology on Twitter and pediatrics even about pediatrics is a little bit more developed. But one of the things that I sort of question and it's a challenge I would put out to, to your listeners is, if you look at, if you look at surgical fields, plastic surgery en t, if you look at psychiatry, emergency medicine, there are people on Twitter and even PICU. Think about the Omni Omni intensivist with 50,000 followers, right? There are people with 10s of 1000s of followers. And, you know, Sarah, I think has something like 31 or 32,000 followers. So, although I appreciate it, you're not about me being one of the most biggest feeds, she's by far is bigger than my 5600. But the question is, why is that? That's, that's something that Sarah and I have been talking about is what is different about neonatology? And, and I think one of the things you've touched on is one of the reasons why neonatology is as small as it is on Twitter, is because take a look at Ben or Daphna for that matter. I know you're relatively newer, that's why I spoke to Ben first, but how often are your tweets shared? Like retweeted? You know, not not a lot, you know, it takes a really solid tweet, to get traction, on on Twitter. In the neonatal circles, whereas I'm sure you've noticed, there are other people, they tweet as you say, I had eggs for breakfast, and suddenly it's tweeted, like, you know, there's 400 likes, and there's, you know, 150 retweets for I headaches for breakfast, yet you post something about a new use for nitric oxide. And, you know, there's 1000s and 1000s of people out there, right, that would be interested in that. And they don't retweet. So there's something about the neonatal community, and Sarah and I have had preliminary discussions about engaging people and finding, can we get boosting? Like, why wouldn't you retweet? I mean, unless you don't, I mean, if you don't agree with the message, you're not going to retweet it. But for the most part, if it's just education, why wouldn't you retweet that? Right? And so, my, my vision, you know, for for our neonatal community, and certainly, I'm no leader here, but I mean, my vision, if I could be the leader of it, would be to say, let's all get behind each other. Let's grow this community, because one of the reasons why you found that I've increased my tweeting, is because I learned a bit of a secret. And the secret I learned was, there is a finite audience for simply posting medical literature. Yeah, so I was hovering around 20 503,000 people, when I apptech, as you say, but if you look at the uptick, I typically post between one to two pieces of medical literature, like an abstract or a blog post a day. But the rest of it are little tidbits of information that I think would be useful to practitioners. Or it's some humor, right. And the reason I do it that way is because I've gone I basically doubled in the last year, I think the number of followers I have, and it's not because of the sensational pieces I'm posting on neck and, you know, nitric oxide and PDAs. It's because, excuse me of stuff that I'm posting on behavior, you know, things that we do, like yesterday's post, for example, it was a late afternoon post, which, you know, I thought was somewhat innocuous, but it was about normalizing respect for not disturbing babies when they're sleeping. But but the additional piece was, because you have to be careful about how that comes across. I don't want to villainize the nurses and saying they're, you know, blocking people, yeah. But to say, hey, there's a good reason for it. So let's educate the residents. And hey, let's not get upset, you know, over the fact that we can't examine this patient right now, if they're sleeping. And you know what the truth is? If the patient's feeding and they're sleeping, they're probably fine. And you're not gonna find anything anyway. Right? Yeah, so that's just an opinion. And that just took off. You know, so it's that kind of stuff that you try to, it's a balance of mixing it in.

Ben: 39:43

I've always wondered if, if so far the neonatology community on Twitter just was too limited to medical providers and we're not really reaching the nurses, the therapists, the speech, occupational physical therapists, the parents, the former preemies now I think it's this expansion that potentially might give momentum to the to the movement, I guess of neonatology on Twitter.

Michael Narvey: 40:07

Yeah, no, I think I think to a certain degree, you're right. I mean, I know on my own feed, I have a lot of I mean, all of the people you just mentioned are on my feed all those groups, because I do every and this is something people may not know about me. Well, actually, nobody knows anything about me up until now, on on this great podcast, but you know, every time, you know, every single time, I see that somebody has followed me, I look at them, you know, I look at their bio. And through the beauty of Twitter, you know, I've developed a very big Spanish following. You know, Mexico, it's not just Spain, but I mean, Spanish speaking countries, Colombia, and so forth. And every time I get a follower from one of these countries, I mean, I don't speak Spanish, but through the magic of translate function, on Twitter, I read their tweets, you know, I can read their tweets, I know, I realize what the translation is, does not always make a ton of sense. But I can at least get a glimpse into what it is so so when you follow me I do take an active interest in who you are, where you come from, what your background is. And, yeah, and to me, it's just it's a real, it's a real thrill. And as I say, to the people that, you know, asked me that question, why are you on Twitter? Why are you on Facebook? It's because of how much I learned, you know, and I will share with you a beautiful story. Because it's, it's a story I've presented before, and I don't think you I don't think you would have read about it before, but there was a period of time, probably around 2018 When I'd been at this for about three years. And to your point about you know, all these other activities I had. There was and I had some things going on personally, that, you know, were causing stress and, and I one day woke up and I just thought, oh my God, why am I doing this? You know, I've got enough on my plate. You know, like, this takes so much time, you know, and what do I need this for? And then that day, I got an email from Little Rock, Arkansas. And it was a it was a teacher from a grade seven class. And he wrote me and you talked about privacy and restrictions. He said, you know, due to legal issues, my students cannot communicate with you directly. But we're doing a project on careers. And he said, one of my students read your blog. 13 years old. Yeah, exactly. One of my students follows your blog. His brother was born prematurely. And he found he found you. And he reads every post. And we're doing career day. And he wanted to interview you for career day. Because he wants to become a neonatologist. And so he sent me so he said, what the teacher said, Would you be open to this? And so I said, Oh, absolutely. So the teacher, the teacher sent me the list of questions. I responded in depth, you know, to all of the questions. And so this 13 year old child, or adolescent, I should say, young adult, will he become a neonatologist? Who knows? Right? However, the fact that a child in Little Rock, Arkansas was touched by something I was doing, that lit a fire in me, you know, and I never looked back, because I thought you don't know who is out there.

Daphna: 44:01

Yeah, that's awesome. That's amazing. I think the way I think that is an important part of what makes your platform so special, is that you're really you're not just putting stuff out there. You're really engaging with kind of your community. And I mean, I think that story, it tells the the present perfect example. I wonder, though, I think that says a lot about who you are. And so maybe you can tell us a little bit about, you know, how, how that presents itself, you know, in your clinical work and your work with trainees, you know, what would they say about you other than your celebrity status?

Michael Narvey: 44:40

Yeah. I think they would say that I care. You know, I think they would say that you know, that I have an interest in furthering their education that I listen. You know, I'm not sure exactly how far along You guys are in your in your in your work. I mean, I started in 2004 as a neonatologist. So I will tell you and your listeners over time life changes, your priorities change. And you might be wondering, how does this relate at all to your question, but the reason it relates to your quiet the question is, at, at some point, I have to admit, as passionate as I was about education, you fatigue. And I, I became less interested, I would say, without even realizing it, we received some, we received a little bit of negative feedback about our education with with our trainees at some point. And that hit that hit hard, you know, and I, because I really was proud of, of everything we do. And so what actually happened was, I hadn't experienced that just it really changed me. It was just a few months ago, in fact, we were using trialing a video laryngoscope. And the there was a trainee who had never he was an r1 Never intubated anybody other than, you know, a pediatric cases and the or he used the video laryngoscope, I stood next to him. I walked him through everything, we talked about the anatomy, we talked about the approach, everything was very intimate. I would say in that way. He got it. He got he got that intubation on his first attempt. And he came up to me at the end. And he quietly said, that just made my rotation, anything. And he thanked me for standing next to him and supporting him. And that to me, again, it's these moments, right that like that ignited me. And I've gone from sometimes thinking, I've got to do this. Now I've got to, oh, I can't wait for the next opportunity. You know, to really see that light go off in somebody see that smile, that satisfaction knowing you in some way contributed to that? Right. Yeah. So I think that that's what they would say.

Ben: 47:26

I like it, because I always have questions about trainees and I know Daphna is going to preach the subject at some point. So I can just wait, sit down. But I have a question that has been on my mind for a while, which, which is that we see on Twitter, a lot of people showing up met students, college students, I am wondering if you spend any time doing this, and if and if you could share with us what your thoughts are, on what we should tell future medical professionals about the etiquette and the boundaries that we should set ourselves on Twitter. Because I, I personally feel that I started using the internet very early, my dad was one of the first people in our in our hometown to have like a computer and we had internet early on. And initially internet was just a sandbox, it was a playground, you went you you goofed around and, and it was just almost like a video game. But it has really become a professional sphere. And I think people get on it. And sometimes you see many, many individuals with their full names and titles in their bio engaging on very personal matters. And you wonder, Is that appropriate? Is that something we should educate people on? And so I'm curious to hear your thoughts?

Michael Narvey: 48:47

Well, that's something I'm always aware of. Having said that, I've been burned a couple of times. So my advice to people is, especially if you're affiliated with a university, you know, or if you're affiliated with a bigger organization or an employee, right? You really have to watch what you say, because once it's out there, even if you delete that tweet, somebody could have already screenshotted it, you know, and it's so once it's out there, it's out there. And you know, you gave the example of what asking about clinical care. There was I remember. So one time that I got burned, was I wrote a blog post after a very emotional night with a 23 weaker. And I began the story. And I began the blog post in such a way. I don't remember exactly what I said. But I received a lot of feedback from people who said, yeah, sorry, I knew it was a hard night last night. You know, so they knew The case, just just based on the timing of when I released the post, they could figure out which case it was. And then they shared that with friends in another hospital. And, and I modified it, because I realized, oh, you know, HIPAA, the, you know, they can identify. And the other thing is, you know, I had my department head, contact me twice, and asked me to take something down, you know, which is interesting. You know, because you talked about free speech, and he talked about, you know, our right to see what, you know, what we wish, but I posted something twice, and I meant to be, I was trying to be funny. But in being funny, I hadn't perceived that. If you looked at the joke, from a certain angle, some people could find it offensive. And I never meant it to be that way. Right? And because I, I am considerate of these things. You know, I was horrified, and I immediately took it down. So I think, when you're going to post you need to think about the optics, does this represent who you want to be? There is that there is that goal, of course, people want to grow their followers. And so the more controversial you are, the more crass you are. Like, it's like, you probably have noticed on Twitter, like there are, there are some posts, I mean, forget, you know, I had breakfast, there are some posts where when people are dropping F bombs, and they're swearing, it explodes. Right? Because they're, they're dramatic, right? And so you might be tempted to say, oh, maybe if I throw this little F bomb into this post, but then is that how you want to be seen? Is that how you want to be reflected? Is it worth it to you to get those extra 50 followers today? Right. You know, but have your reputation be tarnished? So? So I think that that's, that's something I think, number one is, be very careful about sharing. As you said, I think you said this to Ben, sharing personal experiences from your work. Because even if you change one or two details, the last thing you want is somebody texting you and saying, Hey, I know who that is. Right? You know?

Ben: 52:26

Yeah, I tend to think my moral compass has on Twitter so far has been would I walk into the NICU, gather everybody and say what I'm about to post? And so I'm thinking to myself, would I really feel comfortable bringing all the staff in the NICU and saying, Hey, hear what I have to say? Because if it is political, controversial, then the people in my se wouldn't want to hear about it. My people on my Twitter followers would shouldn't have to hear about that either. I want to follow up that question with during your Twitter career, you initially started off as all things neonatal and you then disclose your full name, and your bio. And I thought that was, first of all, let me tell you a story. I thought that was that was good, because it sort of put a name and a face to who was putting out these tweets. But I didn't know who you were until you put out your name out there. And I had this paper that you wrote on necrotizing fasciitis. Yes, I remember, I had a case and in, I had a case in fellowship about necrotizing fasciitis, and your case report was so good, because it matched exactly what I was facing. And the discussion taught me a lot about it. And then somehow, I remembered that it was from Canada, and I remember that you were the first author. So when your name came up, I was like, Oh, my God, that's the guy.

Michael Narvey: 53:47

That's the guy. Yeah. You know, I'll give credit to somebody for this. So, so strategically, I, I had it as all things neonatal and it the strategy was, I thought, I mean, I have no background in marketing. I'm a doctor. But my thought was, if I'm all things neonatal on Facebook, and I'm all things natal on, on Twitter, you know, and my website is all things neonatal. Like it's a brand, right? Yeah. And so I thought it makes sense to all be one. And then one day well, when you notice that I changed it one day, I got a private message from a follower on Twitter. And he said, and he said to me, he said, You know, I hope you don't mind me saying this. But he said, People deserve to know who you are. And he says, You shouldn't hide behind the brand, all things neonatal

Ben: 54:45

even though you're not you're not really hiding.

Michael Narvey: 54:47

No, and I wasn't hiding, but very, very sad, you know, like people would actually want to know, you know who you are. And so for that reason, right there and then I thought, You know what, he's got a point, you know, Because Because when you're writing under all things neonatal you're kind of writing under. It's almost like a ghost writer. Right, you know, and so, yeah, so yeah, so I put my name out there. And I thought, you know, if I was writing different content, I mean, if I was writing extremely controversial right wing or extremely left wing, you know, content, I might stay under all things political, or, or something. But But I thought, you know, what? I'm sharing evidence. I'm sharing knowledge. So so that's why I switched.

Ben: 55:33

I think I think it makes you even more accountable as well. I think whenever you see your full name, when you're about to press send, you're like, is this something that my mother would be proud of me saying?

Michael Narvey: 55:43

Yeah, yeah. And, you know, I was just just thinking back, you know, to, there was one post recently, that was a real eye opener for me, and it talks about that, you know, it was what you said about if I, if I hit send, would I show the unit this? So there was one post I did. And I got a lot of flack for this post, and I eventually took it down. It was a post in which I talked about the experience of loss, and contrasting it in the NICU in the PICU. And people used to ask me, why didn't you do PICU? And for me, it came down to one thing. I remember 10 year old hangings, motor vehicle accidents, families coming into the PICU and just screaming when we were withdrawing support, and, you know, just the photo albums and the well, when we used to have photo albums, but I mean, the, you know, the pictures and the videos and birthday celebrations all these memories. Right? Yeah. And in the NICU? My the point of the tweet was, yes, loss is loss. But when you lose a baby, who you've never had at home, who 95 times out of 100, because of excellent antenatal care, you already knew this baby had a very high likelihood of, of death. And so you've had an opportunity to prepare in some ways. I personally, it was about my personal experience, I personally found it when I was grappling with how I deal with loss that it was easier for me in the NICU. But yet somehow that message was twisted, to suggest that I believe that the loss that a parent experiences in the NICU is not as difficult by a mile from the loss and in a PICU Ouch. And that there were there were dozens upon dozens of very angry people who were calling for me to take down the post. And what was and so you talk about, you talk about incentive. So that post, I think by the time I eventually took it down, it had hit something like 20,000 impressions like it, it would like it blew up. Right. Right. But ultimately, I thought, You know what? Going back to your question, I thought, if I leave this up here, and I know that there are that many people out there who are experiencing probably pain from thinking that I am minimizing their loss. Like who am I doing that for? Right, you know, I'm not doing it for them. You know, I'm doing it for my own, you know, self interest. So I took it down.

Daphna: 58:44

Glad that you have shared some of these kinds of difficult posts and situations and I think it helps us you know, moderate what, what what we're doing, but I was hopeful that maybe you'd share your your favorite tweet, your favorite post or the one that got the most buzz to give the other side of the coin?

Michael Narvey: 59:06

Oh, geez. Oh, what was Oh, actually, this was another one of these things that is informative. Also. There was a poll. So I was I can't remember where I was either on LinkedIn or I was on just scrolling through one afternoon and I came across a beautiful picture. A beautiful picture of three women feeding their babies. One was fed by breast one was fed by bottle and one was fed through a gastrostomy tube. It was a photograph. The the artist's name was actually in small letters, but was the signature was on the bottom. And I posted it to Twitter. It got picked up by Oh and it said something like fat is best or Something that something like that I just thought was a beautiful picture. So I posted it. And Jen Gunter picked it up. And she retweeted it. And I think I stopped counting, but it was like 200,000 impressions or something like that, like, it was like to like 1500 times it was retweeted like 400. At this point, it went viral. But at the same time, the trolls came up. So that was like, I thought it was a beautiful picture, I was very happy to have posted it. But I learned a good lesson. And that's another one of these lessons I teach, is, because I didn't specifically name the artist who had done this, the trolls came out, you know, saying that I was a horrible human being I was stealing property and, and blah, blah, blah, blah, blah. Long story short, I then put in the replies, I actually looked up who the artist was it, you know, and tagged him, he's on Twitter. And then he offered to sell prints to everybody if they want copies, and I was fine. You know, but, but that is a good lesson is that if you are going to use content, if you're going to use content that's not yours, they're there. You know, there's free content that you can get, there's content that people would want to charge you for. So be careful of what you post out there. But that to me, that was my biggest hit. As far as as opposed went. And I still I still love the message. I think that it was a beautiful picture.

Daphna: 1:01:36

Yeah. And it keeps posting and over and over again. And I wonder what you think is kind of the future for social media, the future for kind of the interface between technology and education?

Michael Narvey: 1:01:54

I think I mean, I think we've, we're already somewhat there. As you can tell, I've got I tell stories, and I've got lots of stories, but I was, you know, 2015 16, when I started this, I was stopped in the hallway by a senior member of my department, who said to me, the following said, I need to talk to you. I'm very concerned, what are you concerned about said, you have become a public embarrassment to our department. And I said, I said, Pardon? And they said, they said you are the section head or what you would call a division head. They said you were you were the section head of neonatology. And how can you be out there on Twitter and Facebook? It's an embarrassment. And you need to consider stopping this because it is not becoming of a academic position. Wow. So that, you know, that was an interesting experience. It was a person I respect, continue to respect and I understood where that person was coming from. But I did some research. And I actually have a, I'm not trying to advertise to give the presentation. But I have a presentation where I basically make a case based on that comment as to why academics belongs on Twitter. Why social media is the future, you know, and that the academic clinician, who is not on social media is actually missing out, you know, in if your goal. So this is the future if your goal. Is that mean, why do you do research? Let's start there. You do research because you have an inquisitive mind. You want to solve a problem, and you want to others to know about it, disseminate the information. There is no question. And then the journals get this. All the journals now have social media departments, and they're all posting articles that come out that are of interest, right? So if you're not on social media, as an academic clinician, you're missing a big piece of the dissemination piece. And so what I see is that there in the future, there's going to be a blurring of the lines. I think that you know, I won't name the journal but a very prestigious journal. And I'm not making this up. It was this morning, I wake up and in my inbox, a very prestigious journal in pediatrics. Sends, sends me a note and says, Dear Dr. nervy we have, we've taken the liberty of setting you up an account, to be a reviewer, please click on this link. You know, and we would love to be able to send you papers right. Now, why is that happening? Well, it's not happening but Because I have, you know, a huge, you know, research portfolio. It's happening because my name is out there. Right. So, to that end, that's where I think we're headed. I think that the big names in academia, and you can see that already, again, I don't want to name names for fear of leaving somebody out. But there are big, big names in academia that are on Twitter. And I think that they get it, where I'd really like to see us go. And I hope that somebody listening, you know, does this is I want to see our neonatal community get boosted. And I mentioned before, you know, there is no reason, when I see plastic surgeons that have 100,000 people following, you know, when I see e and t dogs with 50,000, intensivist, with 50,000. Why shouldn't we be at 50,000? You know, now you can say, if you make your interest to focus, that's one reason you're not going to be there. But don't forget, the same people are also posting about medical information, yet there's a greater uptake. So I think that's, that's where I'd like to see, I'd like to see there to be great discussions, I think there. There's already journal clubs that are on social media where we digest the information. But I think also the future is, imagine sharing that information. In sort of, like with a quality lens to say, like, Wouldn't it be great Daphna, if, if you are Ben took a paper that created a policy change. And then you were able to present some quality work on Twitter, and say, here's a here's a, here's a graph, a timeline graph, a run chart, showing what our incidence of nosocomial sepsis is, in our unit since we implemented this one change, which was sparked by this paper. Right. And you saw it went down. Well, wouldn't that be interesting? You know, for people? You know, I think that that's, that's sort of the direction that I think we should get to.

Ben: 1:07:05

I think there's, I think you're absolutely right, I have personally, I think I was recently watching a documentary about Napster, the downloading platform, you could and and it showed how it disrupted the music industry where we used to go to the record store and buy CDs, and then got home. And then Napster sort of changed the mentality as people consume that product, which was music, and now everybody uses streaming and downloads, and we Tower Records is out of business. Yeah. And I think I think something similar will happen to the journals. And I think it's up to them. That's what the documentary was sort of hinting at was that it's up to the established industry to adapt and foresee the change. I think when you look at publications, it's a mode of disseminating evidence that is archaic, which is you finish a study, and then three months later, it goes in on paper into a journal that will go to subscribers. And as people realizing that you could build an audience on Twitter, and you can have better reach. And we're not making any profit of these publications aside, maybe from a little bit of the prestige. But I'm wondering if the prestige of the publications is not going to be replaced by the prestige of the clicks, the likes, the retweets and the followers. And then if you're a journal, I think that should be extremely concerning. Because why shouldn't I put my PDF on Twitter and let everybody read it for free, get feedback, and then build myself some stature through followers and through social media, rather than through just the number of publications I've had? I think, I think that's something that people will have to look at very carefully.

Michael Narvey: 1:08:39

I think you're right.

Ben: 1:08:43

Definite, do you have any more questions? I mean, we're coming close to our a lot more. We could keep, we could keep going. So

Daphna: 1:08:50

maybe we'll continue some of our discussion on Twitter. Am I I'll leave you with one other question. I want to know when you started wearing the kangaroo suit on kangaroo.

Michael Narvey: 1:09:05

That started I think, I think it was four years ago. I think it was 2017. They were looking for someone who was willing to put one on I said, why not?

Ben: 1:09:17

And your your, your chair didn't say that it was unbecoming of a section.

Michael Narvey: 1:09:23

No, although I will tell you there's a few senior nurses that see me come in with this and just shake their head and say, Oh my God.

Daphna: 1:09:33

But just like your social media presence, I think that people know that it works. So

Michael Narvey: 1:09:38

it does, it does and you know what? I can say this without you. I was just thinking can I say this with fear, but I can. Probably the most special moment that I've had with the kangaroo suit was just this past week. Because I went around the unit several times and I As I went around the unit, I came up to one room. And I think I posted this on Twitter actually, I came up to one room. And the bedside nurse stopped me before I went in because I was going around to talk about kangaroo care with all the families. So I don't just walk down to kangaroo care. I promote kangaroo care.

Ben: 1:10:18

Do you hop from from

Michael Narvey: 1:10:20

first year? I did first year i? And then afterwards, people told me it looked ridiculous. But no, so I went up to this one room and and the bedside nurse came out of the room and said, You know what? Dr. nervy I think you might just want to move past. You know, she's, this family's having a really hard day. And I looked at her, I said, you know, maybe I should go in. Because I knew I looked ridiculous. So I thought, maybe I should go. I went in. And a mother's tears turned to laughter. She was crying. And then she looked up, she saw me and she just went, Oh my God. She started laughing. And I didn't spend a long time in there. But I just said, Hi. It's kangaroo care week, wanted to make sure you're aware of it. And she thanked me for coming. I finished my circuit. And then I went on a second circuit. But an hour later, when I went an hour later, her mother was in. And they she'd obviously been telling her about the kangaroo. And they found me in the hallway. And they asked if they could take my picture with them. And one was smiling. So, you know, to me, I'd wear that kangaroo care suit every day. You know, if I could get that kind of turnaround in emotion. I just do rounds in it every day. But no, I mean that. You know, I think sometimes if you're willing to look ridiculous, you know if we can bring a little bit of laughter to the NICU. It's a beautiful thing. Thank you.

Ben: 1:11:52

almost want to end on that. It's so good. Well, Michael, thank you so much. This was this was so much fun. We should definitely do that again in the future. For the people listening. You are on Twitter, obviously at NICU underscore musings, and you have the all things neonatal that comm blog. Thank you so much. And it was a pleasure. Definitely. Thank you again.

Michael Narvey: 1:12:20

Thank you both. Thank you both anytime.

Ben: 1:12:23

Thank you. Thank you for listening to this week's episode of the incubator. If you liked this episode, please leave us a review on Apple podcast or the Apple podcast website. You can find other episodes of the show on Apple podcasts, Spotify, Google podcasts, or the podcast app of your choice. We would love to hear from you. So feel free to send us questions, comments or suggestions to our email address NICU podcast@gmail.com. You can also message the show on Instagram or Twitter at NICU podcast. Personally, I am on Twitter at Dr. Nikhil spelled Dr. NICU. And Daphna is at Dr. Duffner MD. Thanks again for listening and see you next time. This podcast is intended to be purely for entertainment and informational purposes and should not be construed as medical advice. If you have any medical concerns, please see your primary care practitioner. Thank you