For Medical Toxicologists and Emergency Practitioners, Bluesky® is the New Twitter/X

Figure: Emergency Medicine News debuts on Bluesky® in February 2025.Ever since Twitter became X and turned into an online experience combining unwanted features of both ONLYFANS® and Ultimate Fighting Championship®, the tribe of medical toxicologists has been wandering the internet looking for an alternate microblogging platform on which to exchange ideas and share interesting findings. Unfortunately, none of the initial alternatives seemed to work out. Mastodon was too slow and confusing. Reddit was chaotic and overwhelming. Threads developed a strong following after it launched in 2023, but user engagement has steadily dropped since then, and many find it off-putting that signing up requires opening an Instagram account. But recently, there has been much excitement about the microblogging app Bluesky®. Growth has been explosive, with membership more than doubling since October 2024. And a real community of toxicologists, emergency and critical care practitioners, pharmacists, and other medical personnel has gathered on the site. I would highly recommend checking out Bluesky® if you at all enjoyed and participated in medical discussion on the old Twitter. The following are seven suggestions to help get you started. It's easy to open an account. Signing up takes just a few minutes and is completely free. Go to bsky.app, create a new account, and you'll be posting—here also called “skeeting”—in no time. While it's beyond the scope of this column to give step-by-step instructions on how to establish a presence on Bluesky®, there are many excellent introductory web tutorials on YouTube. I found the ones by Dr Josh Farkas and Matthew Rathbun1 to be especially helpful. Finding medical toxicologists to follow couldn't be simpler. A Bluesky® feature, called “Starter Packs,” offers curated lists of good accounts to follow in a specific field of interest. I created a Starter Pack of selected medical toxicology and emergency medicine accounts.3 Among the most active accounts are those belonging to: Dr Ryan Marino from Case Western Reserve University School of Medicine Dr David Juurlink from the University of Toronto Dr Jeremy Faust from Brigham and Women's Hospital in Boston Dr Andrew Lau, EM pharmacist Dr Lawrence Lynn, critical care pulmonologist and sleep specialist, fierce critic of Petty/Bone RCTs. Dr Seth Trueger, emergency physician at Northwestern Medical Center and digital media editor at JAMA Network Open Dr Graham Walker, emergency physician and creator of mdcalc.com The CC/EM PharmDs starter pack put together by Dr Austin Camp from the Union University College of Pharmacy is also very useful.4 In addition, Bluesky® has a searchable list of all starter packs on the site.5 Another good way to identify Bluesky® accounts to follow is to pick out someone active in your field—be it medical toxicology, emergency medicine, pharmacology, or another specialty—and see what accounts they follow. It is possible to transfer your followers on Twitter/X to Bluesky®. Sky Follower Bridge is a free extension for either Firefox or Chrome browsers that apparently makes it (sort of) easy to find Bluesky® accounts from individuals and institutions that were following you on X. I have not yet had the chance to try this out. Users report that SFB is a good way to start on Bluesky® with a substantial list of familiar followers, but that the process, which can be clunky, takes time and patience. It is easy to leave Bluesky® should you wish. Unlike Twitter/X, which deliberately makes it difficult to migrate your followers to another microblogging platform, Bluesky® is open source and makes it simple to pack your followers and go. To export followers, click on “Account” in “Settings” and look for the “Export my data” button. If scrolling through Bluesky® feeds and skeets seems fatiguing, change the appearance. When I started using Bluesky®, I found that interacting with the platform caused eyestrain and headache. That all vanished when I went into settings and changed the appearance to dark mode. That one simple tweak made scrolling through the site much easier and less stressful. Bluesky® allows for extensive control over what type of posts appear in your feed. In the “Moderation” section of “Settings,” you can mute specific words or tags, block discussion of certain topics, and specify who, if anyone, can reply to your posts. You can also block specific followers. You can group your followers into lists according to their interests and expertise. The ability to create such lists was one of the most useful features from the early days of Twitter, and it is just as useful here. If you're interested in catching up on what medical toxicologists are posting, you can see only content from your curated list. If, on the other hand, you just want to chill and watch cute videos of golden retrievers, go for it! There are a few other things to note. A Bluesky® post has a limit of 300 characters but—as with Twitter/X—it's easy to create a thread to post a longer discussion. You can also add a single video to each post with a maximum length of 60 seconds. Surely, Bluesky® will face many challenges in the future. As membership expands rapidly, the app may struggle to provide sufficient infrastructure to keep up with demand. Already, obvious bots and apparent refugees from OnlyFans® are showing up on the site. I find myself constantly culling my list of followers and blocking many. But I also find myself using Bluesky® more and more. Checking in on my toxicology list has become a routine part of my morning. I strongly suggest you give it a try. Editor's note: Emergency Medicine News is now on Bluesky®! Check out EMN updates @EmergencyMedNews.bsky.social and join in the conversation!DR GUSSOW is a voluntary attending physician at the John H. Stroger Hospital of Cook County in Chicago, an assistant professor of emergency medicine at Rush Medical College, a consultant to the Illinois Poison Center, and a lecturer in emergency medicine at the University of Illinois Medical Center in Chicago. Follow him on Bluesky at poisonreview.bsky.social, and read his past columns at http://tinyurl.com/EMN-Gussow.Share this article on X and Facebook. Access the links in EMN by reading this on our website: www.EM-News.com. Comments? Write to us at [email protected].

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