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what do you think about social media in medicine?

In a recent post I discussed some of the reasons why physicians like myself might choose to blog, tweet and communicate via Facebook, LinkedIn and Google Plus. As I mentioned then, there is a bunch of controversy over the use of social media communication in the field of medicine. Those who don’t use it don’t see why anyone should use it. Some use it inappropriately. Some break ethical standards, or laws such as HIPAA by divulging protected private information about patients.

As I have spent more and more time on Twitter, I have participated in conversations concerning the use of social media in medical education, and have witnessed other health care providers interact with lay people about tons of topics, ranging from end of life issues to discussions about non-communicable diseases, rare diseases, rheumatoid arthritis, diabetes, and lots more. I “follow” about 700 people on Twitter; I suspect about half are medical providers of some sort. Never have I read anything aimed AT a particular patient or ABOUT a particular patient. Most tweets are general “I had a busy day in clinic today” or topical “wow, seeing a lot of influenza in the office, how about everyone else?” or personal. Sometimes a provider asks for help from the Twitter community of providers—and usually gets it quickly. The help might be patient-related, research related, public health-related. It is all good. It might save someone’s life some day.

Imagine this…

A physician in his office in Omaha, Nebraska sees several patients with an odd constellation of symptoms. He tweets about it, because it is interesting to him, and seems unusual. Another physician in Washington, DC has had a similar experience, but didn’t think anything of it. The two start to “chat” about this phenomenon and shortly others join in. Very rapidly, someone realizes that this could be an outbreak of an unusual illness. Most likely, someone at the CDC or the NIH is involved in or sees part of these comments in their stream. Within minutes to hours, the public health impact of a new disease, unusual presentation of a typical disease, or whatever, can be identified and the investigation can begin.

No, the investigation can’t all be done on Twitter.

But Twitter is an excellent way for information to spread through specific networks. Twitter helps predict results of contests and elections. It can spread news quite rapidly. Of course it can also spread rumors and untruths quite rapidly. So caution is always prudent. But when real people can communicate in real time with other real people, things happen. Twitter has been likened to an old fashioned word-of-mouth mechanism for spreading news and information. Networks are interconnected. You believe those you know. You pay attention. You do something. That is partially why Twitter has become such a powerful channel for brand advertising—ah, but I am digressing. Back to medicine…

Hospitals and medical schools are worried about the implications of social media on medicine and in medicine. They worry that doctors, and especially doctors in training, are likely to violate patients’ rights to privacy when they engage in social media.

Do you think that is true?

For years, physicians and other health care providers have violated patient privacy rights by talking about their admissions on the elevators, by dropping their patient lists in the cafeteria, and other similar indiscretions. So, what’s the difference? Why is social media so much worse? Because it is so open, so public. Whereas a comment made on an elevator might have been heard by several people, the risks are relatively small that the patient himself would ever hear the comment that was made. However, the power of social media is also its danger—information can spread rapidly, the patient might actually be able to identify herself, and aside from the ethical and humanistic issues, the HOSPITAL OR MEDICAL SCHOOL COULD BE SUED.

I would like to hear from you, if you are a health care provider who engages frequently in social media, or you are a patient (well, we are all patients, aren’t we) who uses social media to gain information, contact providers, or for any other reason related to your health or that of your child.

Do you believe the risks are large?

How would you feel if some private information about you found its way on to the internet, even if you were not “identifiable” (example, a picture of a rash on your forearm, showing that part only)? Do your doctors use email or any other electronic methods to communicate with you? If you or your children are Carilion Clinic patients, do you use MyChart? Is it useful to you? Does your doctor respond?

We are at a crossroads.

Patients want complete access to their medical information at exactly the same time as providers who share that information in a non-secure way can be prosecuted by the law. Do you see an answer that will meet everyone's needs?

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