Should More Doctors Participate in Social Media?

Should More Doctors Participate in Social Media?I’ve heard this sentiment more than once… “Doctors should participate more in social media. They should be Facebooking and Twittering and Tumblr-ing far more often than they do!”

Houston Neal makes the case again over at The Medical Blog, suggesting that because doctors aren’t engaging in social media as much as the ordinary person, they’re actually holding back the improvement of healthcare.

That’s quite a statement (and of course, one not backed up by any data, but it sure sounds good!).

So let’s look at his argument…

“Social media is about more than the relationships between individuals. It’s about the dissemination of information. Information that can improve health care and save lives.”

Yes and no. Social media is primarily about enabling relationships between people to allow for greater sharing of information. However, it is not primarily about the sharing of information itself (which the old web has been doing just fine for the past 16 years).

Sure, it might be nice to “follow” your doctor’s link-sharing on one of these services. But it’s a false dilemma argument to suggest that because your doctor isn’t doing this, it is somehow preventing empowered patients to go online and find the information themselves (which is what most of us do anyways). After all, doctors and psychologists don’t go to medical or graduate school to become glorified link curators, do they?

Neal suggests doctors would be a more reliable source of health information than the web as a whole. They could act as a “quality filter” by sharing more links that they find valuable through social media. But who’s vetting the doctors’ choices? Aren’t they also a part of that group of people — most of us — who don’t verify the reliability of the source of health information online? I couldn’t find a study that has actually looked at this question, so the answer for now is, “We don’t know.”

Neal goes on to make the argument that not only is it potentially beneficial (I use the word “potentially,” because, again, we have no actual data to demonstrate it is or isn’t), but it is an actual obligation of a doctor to do so. Obligation.

“To reduce the amount of flawed information online, doctors need to share reliable resources, address misleading claims, and most of all, help patients understand the issues accurately. Twitter, Tumblr, blogs and the like are perfect channels for this. In the case of the vaccine-autism link, we could mitigate the false information in search results if more doctors used social media to engage with their patients on the issues that concern them.”

I can see it now… “Sorry Ms. Harris, I’m going to have to make you wait in the exam room another 5 minutes while I Tweet about this link.” Because social media isn’t about a one-way information stream — it’s about engaging in an authentic, two-way dialogue with others. If doctors are to start engaging in social media en masse, they must do so in an authentic and very real way. Not just by sharing links, but by engaging in the discussion back and forth with others.

And here’s where the major problems come in. Because social media is so often linked to people’s real-world identity nowadays, it’s virtually impossible to protect a person’s identity if they are going to engage with you. Because patients don’t know what the rules, regulations and laws are about patient safety, confidentiality and privacy, guess who’s ultimately responsible — the doctor.

Neal addresses this primary issue in a paragraph right at the end of the article, suggesting the concerns are “overstated” (again, without evidence) and that they are readily addressed through even more regulations, guidelines and rules by the government or healthcare organizations (like hospitals… but would a hospital defend you in a lawsuit involving something violating patient confidentiality that you tweeted?).

Furthermore, how does that solve the problem of a patient over-sharing with their doctor through social media? Because once a tweet or comment is out there, you can’t really take it back. (Sure, you can delete it, but it’s already been cached and saved in one of the dozens of databases that save every Tweet made, as it’s made.)

So not only would he encourage doctors to engage more in social media, but to do so while trying to follow yet even more rules and guidelines, and be the one responsible even if it’s the patient who breaks confidentiality and privacy rules?

That and the fact that most doctors I know already feel over-worked most days. It’s not so much a payment issue as it is a time issue — doctors just don’t feel like they have a lot of free time. (Neal addresses the payment issue only in regards to individual patient encounters; he doesn’t address the whole “information sharing” aspect Neal was talking about earlier in the article, specifically mentioning the autism-vaccine example.) It’s about finding a balance between a work life, a home life, and a social life. Adding more things into the “work” category can’t be done easily without taking something else out of one of those categories — it’s that simple.

While many people can get away tweeting all day from their workplace, it’s not exactly conducive for a surgeon to do so from the operating room, or for a doctor to do so while working on notes. Social media encourages inattention — something you really don’t want to reinforce or reward a doctor to do. I want my doctor solidly focused on his work, my chart and my data — not my tweets.

Don’t get me wrong – I’m all for doctors tweeting and engaging more in social media. But I think it’s a weak argument to argue it is some sort of “obligation” of doctors to do so, or that it’s going to result in a massive public health difference in America. Social media brings a lot of potential benefits as well as pitfalls to the individual doctor-patient relationship, and these can’t be glossed over with the addition of some more rules or guidelines for doctors to follow.

A doctor’s involvement in social media must be a cautious and considered decision, weighing one’s own personal comfort level with different amounts of risk. Because for doctors and therapists, social media does bring more risk that it does for the average individual.

Read the full blog entry: Social Media Can Improve Healthcare, But Are Doctors Holding Us Back?

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Posted in: ethics | general | policy issues | pt/doc co-care | trends & principles

 

 

 

Comments

11 Responses to “Should More Doctors Participate in Social Media?”

  1. John, great post as usual – thoughtful, well reasoned.

    I read Neal’s post in the context of @SeattleMamaDoc’s great speech last December at Swedish Medical Center’s 100th birthday. (Video here.) She makes a pretty compelling case for her use of socmed:

    “My job, as a pediatrician, is about using my expertise, both as a pediatrician and as a mom, to help families make good decisions. And my venture, my journey, in social media, is just about extending the walls of what I do.

    I feel very obligated to improve the way that families understand and listen to health information, and this is one of the ways that I do it.”

    Having said that, I wouldn’t extend that (as I think Neal did) to assert that her feeling of obligation should accrue as a mandate for all other physicians.

    @SeattleMamaDoc says yeah, there’s crap on the internet, and patients read it – so it’s our job to get out there and counteract it by posting better information. On the other hand, I love your points about “Who says THEIR information is reliable??”

    Personally, I wouldn’t blame anyone who doesn’t post. But I like the idea of calling to docs who are inclined, and who see things Wendy Sue’s way (that’s @Seattle’s human name), and saying “C’mon, let’s do something about this!”

    • As I said in the post, I’m all for encouraging doctors to consider doing so. But not without first understanding the very real issues of confidentiality and privacy that will come up with your patients (even if you never tweet a thing about a patient encounter). It seems harmless at first — until that first patient sends you an @tweet (because not everyone is familiar with the technology) asking about a lab result for their disease.

      • It’s probably worth repeating here something that’s been said many times in discussions of this (on Twitter!): use social media to talk about medicine, not to do medicine.

  2. Is it a right, privilege, or a necessity to communicate via social networking with my doctor?

    The question I (http://twitter.com/glicklab (@glicklab)) recently posed to a 3rd year medical student was,: “Is it a right, privilege, or a necessity to communicate via social networking with my doctor?”

    I’d love to hear what you (@Susannahfox) and your followers at e-Patients.net have to say about this. any primary sources you could recommend to us would be greatly appreciated.

    As some back ground information:

    – By social networking I’m not referring to emailing with your doctor. Which, BTW, email is an avenue of communication underutilized by physicians. But in some highly integrated environments, i.e., Kaiser Permanente, has been shown to be efficient, effective at disease management, and accepted by both the patients and the medical staff.

    – By “a right” I’m referring to the Consumer Bill of Rights and Responsibilities that was adopted by the US Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. In it, patients have the right to accurate and easily-understood information about their health plan, health care professionals, and health care facilities. Also, patients have the right to know their treatment options and take part in decisions about your care. Parents, guardians, family members, or others that they choose can speak for them if they cannot make your own decisions. But currently no where does it state how this information is communicated. Traditionally, >99% of this is done face to face, physician to patient or to their health care proxy. But does, the option of communication via social networking need to be added to future versions of the Consumer Bill of Rights and Responsibilities in the future?

    – By “a privilege” I’m suggesting that at this moment, 2011, physicians are in a voluntary “op-in” mode to participate in social networking. In a recent American College of Surgeons Survey as high as 80% of surgeons have visited a social networking site, but most use if for personal reasons only. Only a small percentage of us, early adaptors, have recognized the power of social networking for patient related matters and we need to help move our colleagues from awareness and understanding to adoption and institutionalization.

    -By “necessity” I’m asking, can we afford to miss this opportunity? Our health care system is severely broken. We need to get in on the proper trajectory or system will collapse because of excessive cost and less than satisfactory results. Many solutions have been suggested and recently legislated; time will tell if these “fixes” will work. However, social networking may be another tool to help us control costs, improve disease management (especially chronic diseases), improve patient satisfaction, improve physician satisfaction, decrease excess utilization of services, empower patients with shared decision making, improve health literacy, and/or to help to level the playing field with information transparency to shift us from a fee for service health care market to a pay for performance health care market at both the physician and hospital levels.

    Again, I’d love to hear what doctors, patients, and the e-pt community have to say about this. any primary sources you could recommend to us would be greatly appreciated.

    • Susannah Fox says:

      Quick note to all: this was originally slated to be a separate post but since John’s essay is a perfect set up for these questions, I asked Phil to post a comment instead.

  3. Doctors should absolutely participate in social media. This will help them serve their patients better which will bring back the doctor experience of old.

  4. GailE says:

    Social media is a tool, like a scalpel is a tool, to serve a need or objective. Doctors should figure out why they are engaging with social media, only then can they use it effectively to support and extend their practice. The doctor who wants to use social media to extend their influence beyond the walls of their office already understands some of the “rules” they should follow online.

    I would love to see doctors engaging online to educate patients about quality information resources, supporting good health care practices for patients, or teaching patients how to be effective advocates for their own care. Social media could be used effectively to support those kinds of objectives.

  5. The idea that there is some form of “imperative” for anyone to engage in the use of social media is, respectfully, a laughable concept.

    There are those who enjoy doing so, and do it well, and may even be able to benefit others by so doing. And then there are those who are severely challenged to be able to put two coherent sentences together.

    Some physicians will enjoy and be good at using social media. Dr. Neal appears to be a case in point, and the fact that she is a pediatrician may actually make social media a particularly valuable tool for her. However, I have no interest in communicating with my primary care doctor through the use of social media. He and I get along just fine with old-fashioned e-mail, thanks! And I hope he is able to spend his time caring for most of his patients as well as he does me.

    Let those who want to twitter, tweet away. I am personally still trying to work out what specific benefit I can get from technology like that. It’s broadband instant messaging, but most health care information transfer is and needs to be personal to the individual patient.

    With respect to the question about whether there is some form of obligation for social networking in relation to Consumer Bill of Rights and Responsibilities … please Lord I sincerely hope NOT. But I do sympathize with the idea that greater participation by some members of the medical community in the opportunities to better educate patients with certain types of disorder about their decisions and their care would be helpful.

  6. [...] I’ve heard this sentiment more than once… “Doctors should participate more in social media. They should be … Read More >> [...]

  7. [...] the preponderance of optimistic takes on physicians participating (some even suggesting we have an obligation to participate) in various forms of social media through blogging, Twitter-ing, and Facebook-ing, [...]

  8. [...] the preponderance of optimistic takes on physicians participating (some even suggesting we have an obligation to participate) in various forms of social media through blogging, Twitter-ing, and Facebook-ing, [...]

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