Buzz e-sante

Watson has analyzed 605,000 pieces of medical evidence, 2 million pages of text, and 25,000 training cases — far more than any med student could remember.

The Internet has not only changed the way people communicate, it has become a powerful and important resource for health information. Today, 82 per cent of U.S. adults use the Internet, and among those 80 per cent have looked online for health related information. Indeed, social media (including online communities, blogs, and social networking websites such as Facebook and Twitter) is rapidly becoming an increasingly popular source of health information, helping to decrease health-related communication gaps and inequalities - Facebook is reported to be the 4th most popular source of health information in the UK.

In part this trend seems to be driven by consumer facing industries pioneering the use of digital channels to engage, educate, and build relationships with customers and in doing so, changing the public’s preference for information, creating an expectation that information should be easily accessible. There is also a genuine unmet need for information and support for patients and their carers/ family members who desire to feel empowered and take control of their own and their loved-ones’ health.

The pharmaceutical industry is well placed to deliver on this unmet need and, if they are successful, reap the rewards for their effort. A recent survey found that “mastering multichannel marketing and improving digital effectiveness” was a top strategic priority for pharmaceutical marketing executives. Digital communication channels can be used by pharma to:

While investment in social media is increasing, the focus is on lower risk and less innovative avenues than those adopted by other industries and indeed, the pharmaceutical industry is often described as a laggard in terms of its speed in adoption of digital technologies. An IMS survey of 50 of the top pharmaceutical companies recorded that almost half did not use social media to engage with consumers or patients on healthcare-related topics. For those that did, Twitter was the most popular (22/50) – a low risk option when used to simply link or broadcast information already out there (on company websites). This reluctance or slowness to adopt channels used by other consumer industries is mainly due to fear of regulation and risk as well as lack of content control and privacy concerns. For example:

Social media’s ability to challenge geographical and linguistic boundaries, bring people closer together and share information across differently regulated regions is unique and patients will increasingly use these channels as a source of support and information related to their health. Without pharma’s engagement, or some form of regulation, there is an increased risk for rapid dissemination of non-credible and potentially erroneous health information which can lead to confusion and misdiagnosis. Therefore, the pharma industry have no option but to find a way to work more in this space to help patients exchange ideas, experiences and form opinions. If Facebook is the 4th most popular source of health information in the UK then pharma companies have little choice but to create their own Facebook profile.

As of the date of writing this piece a PubMed query of the phrase "social media" yields 8,747 unique peer-reviewed articles.  When the search is refined to "social media medical education" there are 578 articles; when “professionalism” is also added to the search string, there are only 31 article results.  This suggests that very few authors are writing about the topic; approximately 0.4% of the available peer-reviewed literature about social media pertains to how we doctors should use and consume social media in a responsible manner.

While there appears to be a dearth of peer-reviewed available literature, it is important to recognize that nearly every residency program in the United States has a compulsory educational didactic training module focused specifically on social media. At the 2013 Accreditation Council for Graduate Medical Education (ACGME) Annual Educational Conference, the second item after Budgeting Tips was The Use of Technology and Social Media.  So, if social media is a top priority, why is there so little written about it?

As someone who has been medically educated in concert with the expansion of social media (I started medical school in 2004, Facebook started in 2004; I started residency in 2008, Instagram launched in 2010), I have experienced the proverbial growing pains of a social media-focused generation.

During my education, I have witnessed both medical students and residents suffering the professional consequences of being active on social media networks.  Posts of phrases and/or pictures that were thought to be benign were, in fact, flagrant violations of patient privacy. Photos that were thought to be interesting by some were viewed as utterly disturbing by those not involved and sometimes the social media fallout of a simple post yielded negative mass media coverage.  I truly believe that the authors of such posts did not mean any harm, and instead were using social networks for what they were meant to be used for: connectivity among similar individuals.  

Professional school and postdoctoral training can be grueling, isolating and difficult.  Attempting to express oneself over a social platform may be a way of attempting to normalize a flood of new and challenging emotions.  However, great care must be taken for not only what one posts but also how it is interpreted, given that social networks allow for a myriad of connections.

One of the best pieces of advice that I can give is the “icky test.”  Try to imagine reading a post as the first thing you saw when you woke up and if you were not in the medical profession.  If it feels “icky,” or wrong, or just like it is going “too far,” it is more than likely not appropriate to post online.  Furthermore, imagine if you were your patient and you read the post before meeting you--would you want to be your own patient?

As social media’s presence in our lives continues to expand, it is also important to recognize that online behavior becomes part of a user’s permanent, vast Internet identity.  Unfortunately, your internet identity may not be congruent with your actual identity, but when people search for your name, this may be what is found.  This information is also easily accessible when people are doing research about you for residency, fellowship and future employment.  

Social media is undoubtedly a wonderful resource for connecting with friends and family.  However, there is a dearth of academic literature that guides online behavior and how to utilize social media for those in training, so we must rely on our gut feelings, as expressed by measures like the ick test.  And above all, we all must recognize that everything that we touch/read/post on the Internet leaves an indelible mark that may be found by others.