Social Media: Disruptive Force in Medicine

Before the Obama administration set aside billions to accelerate the dissemination of EHRs, providers were slow to adopt them. As recently as 2 years ago for example, a study published in the NEJM revealed that only 4% of non-hospital based providers had fully implemented an EHR, and only 13% more had a partial installation.

By contrast, the growth of social media including Facebook, Twitter, YouTube, blogs and virtual communities like Sermo and Physician Connect, has been explosive.Enterprising providers have already deployed sophisticated social media strategies to extend their brand around the world. The Mayo Clinic for example, maintains several blogs, a Facebook fan page (which has 8,800 fans), a library of YouTube videos and a Twitter page (7,120 followers).

And within months after Alan Copperman, the vice chairman of obstetrics and reproductive science at Mount Sinai launched pair of YouTube videos on in vitro fertilization, 40,000 people had viewed them.

Many physicians also leverage social media to help their patients access illness support networks, a heretofore difficult undertaking for homebound or geographically isolated patients, or those with rare diseases. The result is that a short doctor visit can turn into an ongoing dialogue in which patients are empowered by a continuous flow of relevant information.

But social media also creates new and vexing challenges for providers and medical educators, and few if any claim to have figured out how to address them.

Consider questions like these, which physicians deal with thousands of times each day: Should I accept friend requests from patients on Facebook? Should I trust the input provided by unknown physicians on Sermo? Am I liable if I miss my patient’s tweet indicating his shortness of breath had worsened?

In some ways, the challenges are most acute for the youngest physicians, who grew up with Facebook. Unlike their older counterparts, they are intimately familiar with social media, but have in many cases become ensnared by it.

Thousands of newly minted physicians have long-since created detailed personal social histories and exposed them on Facebook to hundreds, perhaps thousands of people. Their challenge is to manage this archive while forging identities as professionals.

A study by Lindsay Thompson and colleagues the University of Florida has shed light on the challenge. They found that of the 44% of medical students at the UF Medical School who maintained Facebook profiles, only 37% made their entries private. More than half shared information regarding their sexual orientation with others, while 58% shared their relationship status and half shared political opinions.

A closer inspection of the profiles of 10 randomly-selected medical students revealed that 7 included photos showing them drinking alcohol, and 5 of these implied excessive drinking. Three students had joined groups that were either flagrantly sexist (“Physicians looking for trophy wives in training”) or racially charged (“I should have gone to a blacker college”).

The boundary-blurring effects of social media extend in every direction since nowadays medical students, nurses, housestaff, fellows and senior physicians are frequently linked together, and the chain is only as strong as its weakest link.

A nurse who blogs carelessly about a negative encounter with a patient might be linked through a physician to that patient or her family, for example…and although thoughtful deployment of privacy settings can prevent most of this, the fact is many health care professionals aren’t paying attention to the risk.

What has been done so far to mitigate the risks associated with social media?

Many have issued warnings. “Caution is recommended,” wrote Jules Dienstag in an email to Harvard medical students. The Dean for Medical Education explained in the communiqué that when “using social networking sites such as Facebook…items that represent unprofessional behavior that are posted by you on such sites reflect poorly on you and the medical profession. Such items may become public and could subject you to unintended exposure and consequences.”

Similarly, Drexel University College of Medicine recently warned students that information on social-networking sites can impact decision making regarding their applications to residency programs. Warnings like these will have a favorable but still largely inadequate impact, much like a “Dangerous Rip-Currents” sign posted at a beach. By the time people read the warning, they are at the beach, in wet suits, having driven an hour to get there.

Some believe the challenges posed by social media are large enough to warrant the promulgation of formal guidelines for using social media in health care, modeled after the American Medical Informatics Association’s “Guidelines for the Clinical Use of Electronic Mail with Patients” which were published just as providers began relying heavily on that medium.

Such an approach begs questions like who has the authority to issue such guidelines, or whether they could impact behavior without an associated means for enforcement. Of course no one seriously believes that the use of social media in healthcare should be regulated, so it would seem the most likely alternative is to modify medical school curricula and beef-up continuing medical education in a way that helps professionals leverage the benefits while mitigating the risks of social media.

Approaches like this are covered in the final post of this series, to be published soon. For now, we conclude that social media has indeed become a disruptive force in medicine because of its explosive growth, the unprecedented scale and scope of communication possibilities it enables, and the incessant challenges it poses to heretofore well-defined and easy-to-maintain personal and social boundaries.

With social media, the genie is out of the bottle.

Author’s Note:The purpose of this 5-part series is to make the case for implementing a widespread, systematic approach to HIT education in medical schools and continuing medical education programs for physicians. Previous posts reviewed challenges posed by the HIT Deluge, the Impact of EHRs on Medical Education, and Tweaking Medical Education to Leverage the Benefits of EHRs.

Glenn Laffel is a physician with a PhD in Health Policy from MIT and serves as Practice Fusion’s Senior VP, Clinical Affairs.  He is a frequent writer for EHR Bloggers, where this post first appeared.

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15 replies »

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  2. Unquestionably imagine that which you stated. Your favourite reason seemed to be on the internet the easiest thing to take into accout of. I say to you, I definitely get irked whilst folks think about issues that they plainly don’t recognize about. You managed to hit the nail upon the highest as well as outlined out the entire thing without having side-effects , other people could take a signal. Will probably be again to get more. Thanks

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  4. I certainly can see both sides of this complex challenge. On the one hand we all need to recognize how transparent this space is and take care with our posts.

  5. Glenn,
    I believe there is, and will continue to be, the peer to peer trend of patients sharing information with one another online. Furthermore there is growing desire from patients to learn real-time about the latest treatments and procedures from primary care givers in and around their respective locations. Like everything else-they will share this information with others via Facebook, Twitter, and YouTube on the social web.
    It’s great to see Mayo leading the charge (as always), but individuals want to know what their local physicians are doing in those same service areas. We don’t have to go to Paris or Milan to buy the latest fashion trends, we can learn what’s new online and where to find things locally. I believe health care is moving the same direction. There are world class physicians in Neuroscience and Electrophysiology in Austin, TX now, and it is incumbent upon hospitals and physicians to share how they can help provide amazing service locally. The social and viral aspect of the internet make social media a phenomenal vehicle for accomplishing that task!

  6. As a practicing physician, I can’t think of any goodreason supporting Facebook between physicians and patients, yet I know that others disagree with me. Is this an essential tool for improving patients’ health? Does it improve our medical skills? The effect that sharing our personal worlds with patients would have on the doctor-patient relationship is predictable and adverse. It’s called social media, not health care. See http://www.MDWhistleblower.blogspot.com

  7. This is a nice way to frame the debate. I certainly can see both sides of this complex challenge. On the one hand we all need to recognize how transparent this space is and take care with our posts.

  8. This is a nice way to frame the debate. I certainly can see both sides of this complex challenge. On the one hand we all need to recognize how transparent this space is and take care with our posts.
    And to that end there is no reason this concept should not be taught and talked about in high school, college, and beyond into the workplace. The importance should focus on both being authentic in this space and recognizing we have a personal and professional brand to think about when we are building our social networks.

  9. These are very good observations and a terrific series of posts. That physicians (particularly young ones) are facing the same blurring of personal vs. work lives that people working in the media, finance and other professions are also facing is testament to how quickly medicine has been moving toward “mainstream” use of popular technology.
    Another area in which physicians have been discovering the power of web-based media is the now ubiquitous “rate a doc” sites, which have proliferated in the past few years as part of the rise of the so-called “Web2.0” pioneered by bloggers in which ordinary users generate the content found on websites. While physicians rightly decry the partial loss of control over their reputations that these sites can represent, the phenomenon is no different than other service providers and retailers having to deal with the boom in user reviews.
    As your previous post on the HIT Deluge recognizes, physicians are also facing rising pressure (and it seems, will increasingly be required) to use new technologies as an integral part of the way they practice. As an executive of Lime Medical, a company that makes iPhone applications for physicians, I also see them grappling with a bewildering array of technology, trying to determine what is worthwhile and what could be an expensive waste of time. While the debate is sharper in medicine because of the stakes involved for patients and providers alike, it really is not much different than debates that have long raged in other professions.
    What makes this debate so interesting is that the march of technology truly has arrived in medicine like a tidal wave, after many years (too many?) in which tradition and the complexity of medicine itself kept it on the periphery.

  10. You make an excellent point. Social media are a very public forum. Professionals in public facing positions such as primary care and sales need to be aware of the very public image being projected in the social media.
    A poorly projected image can damage a career. There is a place for personal pursuits that may not be politically correct. Time shared with friends can be fun and rewarding. Even binge drinking has a place. Cultural pursuits that are rooted in ethnicity can appear to be racist from someone on the outside looking-in.
    We mature, grow and evolve over time. Our friends and interests evolve with these dynamics. I can see two good things coming out of this over time. Awareness will be raised about the “goodness” of certain behaviors and these behaviors will be adjusted to have more “goodness.”
    Our lives will become more open and transparent. The lines between professional and personal will blur. You won’t be dealing with a professional role player (e.g., primary care physician), instead you will have a whole person sitting in front of you at the doctor’s office. You’ll be dealing with Dr.Joe who has a wife and two kids. He is more than a great doctor. He goes dancing on the weekends with his wife, is actively involved in finding safe havens for the homeless, and went to Disneyworld on vacation last year. This is fertile ground for more relatedness and can greatly enhance the doctor/patient relationship.

  11. Glenn —
    Nice post; I’ll have to check out the rest of the series.
    An approach to the issue more effective than the equivalent of posting the riptide sign is engaging in dialogue with clinical and administrative stakeholders within an organization and jointly developing a social media policy that is based not only on common sense and generally applicable law (HIPAA, etc.), but also on local standards and concerns. Every institution has its own unique culture, and the social media policy needs to be tailored to that culture. That will make it more lasting, more likely to be adhered to, and therefore more likely to encourage the positive effects of engaging in social media.

  12. Social media is a growing force in modern society and an increasing amount of businesses and industries are turning their hand to the phenomena in an attempt to bolster their customer base or aid the running of their business.
    Social media and healthcare shouldn’t mix. An industry that is crucial for the well being of the public shouldnt mix with a phenomena that is that is based around socialising- its like trying to hold a healthcare conference in a pub! This does not mean to say however that physicians shouldn’t have facebook accounts or post videos on youtube, these websites were initially intended for peoples personal lives not their business life!

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