Vineet Arora, MD, met the co-authors of her latest book on Twitter. She has received speaking invitations from people who read her blog. When she applies for NIH grants, she explains how she will disseminate her research on social media.
But she isn't advocating that all doctors necessarily do the same -- at least not immediately.ADVERTISEMENT
"You don't have to dive into the pool if you're here and you're just learning," Arora, an internist and director of Graduate Medical Education Clinical Learning Environment Innovation at the University of Chicago, told attendees at the American College of Physicians (ACP) annual meeting.
Arora said it took over a year for her to become comfortable transitioning from someone who consumed information on social media to someone who created it.
"I Think the 'Why' Is Very Important"
It's important for doctors to understand why they want to engage in social media and what their goals are, Arora said.
The "why" may be a moral impulse, as articulated by popular blogger Bryan Vartabedian, MD, a pediatric gastroenterologist at Texas Children's Hospital in Houston.
Three out of five adults go online to research health information, and nearly half of those searches ultimately impacted patients' decisions about their care.
"There is a professionalism space here we can fill," Arora said. "One of the things we can do as a profession is counteract bad information," she added, referencing celebrity Jenny McCarthy's online anti-vaccine activism.
But one must pick and choose those battles, she added, noting that some audiences may be more receptive than others. Arora said she prefers to convey positive information, "because I don't know where they're getting their information from."
Echoing the sentiment was panelist Humayun Chaudhry, DO, an internist and president and CEO of the Federation of State Medical Boards (FSMB). "I think it's important to speak up, but do I have to respond every time a friend makes a medical comment?" he said.
When Chaudhry served as a health commissioner for Suffolk County in Long Island, N.Y., he was reluctant to establish a Twitter account. But "900 tweets later," he found that the medium was useful for pushing out accurate health information to the public.
The "why to engage on social media" can also have more of a personal focus, Arora added.
Informal relationships that grow out of social networking form "weak ties" that can provide fodder for new ideas or opportunities. "You're opening up your network to people who you may not have thought about before," Arora said.
"Pause Before You Send"
But with opportunity comes risk, cautioned panelist Janelle Rhyne, MD, an infectious disease specialist in Wilmington, N.C. and board chair of the FSMB.
"From a medical board perspective, we see the negatives," Rhyne said, citing examples of patient privacy violations, inappropriate contact with patients, misrepresentation of credentials, and inappropriate prescribing of medications.
Arora gave an example of an actual inappropriate tweet: "My DNR/DNI patient got intubated by pulmonary. Medical errors on multiple levels. This should not have happened."
Just like sending a handwritten letter, it is imperative for physicians to "pause before they send" information online, Chaudhry said. There can be difficulty in striking a balance between "harnessing the opportunities" of social media while "being aware of the challenges," he said.
Recognizing the need for guidance in this sphere, the ACP and FSMB put together best practice guidelines for online medical professionalism, published as a position paper in the Annals of Internal Medicine in 2013.
Key guidelines included:Consistent application of ethical principles to preserve the relationship, confidentiality, privacy, and respect for patientsKeeping professional and social spheres separate onlineThe use of email only in an established patient-physician relationship and with patient consentPeriodic "self-auditing" by physicians to assess how they are portrayed onlineAwareness that online postings are permanent and can have professional implications
Chaudhry noted pushback by some physicians on what they perceived as rigidity of keeping professional and social spheres entirely separate. The guidelines on this point use "should" rather than "must," he added, acknowledging that gray areas exist.
One audience member mentioned his success in using social media to keep up with the latest medical literature. Rather than simply following journals on Twitter, "I'm following people who read journals with a discerning mind," said Michael Wagner, MD, an internist and ultrasound fellow at the University of South Carolina School of Medicine in Columbia.
"With the proper setup and 'followers,' Twitter can serve as a constant journal club that helps you distill medical literature and stay current," he added in an email to MedPage Today.
Wagner, who will be ultrasound director for the university's internal medicine department starting in July, has been experimenting with new ways of teaching residents and medical students.
"Twitter can also be used to augment a flipped classroom curriculum by tweeting questions that reinforce online lectures," he said. "Tweets can be scheduled for the convenience of the teacher and can be completed when convenient for the learner in small aliquots."ADVERTISEMENT
Another audience member also wanted continuing medical education (CME), but for a somewhat different purpose.
He recalled that when he was a resident, he had a curriculum dedicated to answering the phone. "Is there CME online for how to do social media for old guys like me?" he asked.