Issue 35 / 10 September 2012

LIKE it or not, social media is here to stay. Facebook, Twitter and YouTube (among others) have changed the way we communicate, with implications for our professional as well as personal lives.

The potential impact on medical professionalism led to the development, by the Australian Medical Association Council of Doctors in Training, New Zealand Medical Association Doctors-in-Training Council, Australian Medical Students’ Association and New Zealand Medical Students’ Association, of Social media and the medical profession. These guidelines advise doctors about the potential hazards of engagement with various social media platforms.

The document was initially criticised for a failure to expound the benefits of social media. While these concerns were valid, the emphasis on professionalism was deliberate. At that stage, little had been written about the potential for social media to blur the boundaries between personal and professional activities.

There are now many examples of the effective application of social media in health care. It has brought a new dimension to interactions between health professionals, patients and the broader public.

Doctors are using social media to broadcast health advice, gauge patient sentiment and, in some instances, augment traditional models of care. There is also a well established role in public health and advocacy.

For patients, social media provides a vehicle to access health information, evaluate health care providers and connect with support groups. It is proving a powerful tool to increase health literacy.

There is an increasing amount of literature relating to social media strategy but most emanates from the corporate sector, which has adopted social media as a core marketing and communication platform.

Not all of this advice can, or should, be applied to the health care context.

Patients are not consumers. Purchasing a television is an active choice, but ill health is not. Funding models and behaviour patterns for health care are highly varied, but they rarely follow the classic model of “consumer-driven purchasing”.

McKinsey Consulting recently published an article titled “Demystifying social media”, which provides some interesting insights into how the corporate sector uses social media to engage with consumers.

While the article provides some relevant advice for practitioners of both medicine and social media, its central strategy of “monitor, respond, amplify and lead” does not translate perfectly into a health care framework.

The McKinsey piece describes Gatorade’s social media “war room”, in which various dashboards display real-time information on the company’s engagement with the online community. These systems of “monitoring” and “consumer sentiment analysis” are to be commended both commercially and technologically. However, there would be deep public concern if individual health disclosures were stealthily collected in order to influence market decisions.

A patient may be content to post health-related information on a message board for the purposes of peer support or knowledge acquisition, but they could reasonably expect that their data wouldn’t be “mined” and repurposed by another individual or organisation.

Notwithstanding that expectation, online health queries have been used constructively to enhance disease control efforts. Google flu trends is a frequently cited example.

The second plank in the McKinsey advice is “respond”, which encourages direct and reciprocal engagement with consumers. This may be a useful tactic for clinicians to employ in the privacy of a consultation room, but discourse over the public airways might be stretching the bounds of professional communication.

“Amplification” — using social media interactions to encourage consumers to disseminate a message — might work in a public health context, but cajoling patients to share their health experiences for ulterior gains raises serious ethical questions.

A “Post to Facebook” button might have a place in an online DVD store, but enticing a patient to share the histology of their recently resected caecal tumour is not exactly appropriate.

The final pillar of McKinsey’s approach is a call to “lead”, which encourages the use of social media to facilitate long-term behaviour change. Applied to health care, this strategy could be effectively used to reinforce positive health practices.

However, using social media to explicitly promote certain medical interventions such as surgical procedures or pharmaceuticals would challenge existing paradigms.

While these examples might be facetious, they are illustrative of the potential pitfalls in applying generic social media strategies to health care.

Social media will be as useful, or as harmful, as clinicians and health care organisations choose to make it. While the applications and benefits are clear, the cautionary messages in Social media and the medical profession remain relevant.

For those interested in the area, it is worth interrogating #hcsmanz on Twitter. It provides a useful insight into the local “buzz”.

Dr Stewart Morrison is an orthopaedic registrar with an interest in social media and eHealth. Dr Rob Mitchell is an emergency registrar at Townsville Hospital and immediate past chair of the AMA Council of Doctors in Training.

Posted 10 September 2012

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One thought on “Stewart Morrison

  1. David Corbet says:

    Stewart and Rob have provided a broad overview in regards to medical practitioners using social media but have failed to mention that a lot of social media use in health care is being driven by patients. With community driven website such as http://patientslikeme.com/ proliferating, and already pushing at the boundaries of clinical privacy and data mining, it is worth considering that to not engage proactively with social media doctors are at risk of missing potential opportunities for providing better health care to patients. I also believe that patients are able to contribute to the discussion about the appropriateness of disclosure, the ethical questions raised by the authors, and provide information about what they hope to gain from using social media in terms of their health care.

    I agree with the assertion that a corporate approach to social media should not be used as a model for health care. But there are other examples of how people are thinking about and using social media in healthcare, with organisations such as the Mayo Clinic providing a inspiring lead with a dedicated centre for social media. They have an innovative approach that could be used as a model for organisations in Australia – and they have a no nonsense approach to appropriate use of social media. See their 12 word social media policy, for example.

    For further information about patient use of social media, PricewaterhouseCoopers (PwC) have done a survey and interactive analyses about patient interest and engagement with social media, which can be found here: http://www.pwc.com/us/en/health-industries/publications/health-care-social-media.jhtml
    They also have a PDF report that provides an excellent snapshot, with some great case studies, of how healthcare organisations are using social media in the USA. If you trawl through the figures from the report, 61% of respondents would trust information on social media coming from a doctor. And 41% would be likely to share information directly with a doctor via social media. It also shows that community based sites have 24 times the activity of provider based sites. All of this points to patients driving demand and, more importantly, the need for health care individuals, organisations and regulatory bodies to find ways to utilise this opportunity for innovation and patient engagement. The PwC report discusses a Listen, Participate and Engage business model for healthcare which suggests the use of social media for active monitoring, proactive publication, and active interaction both one to one and one to many.

    If you have been following the #hcsmanz hashtag on Twitter you would be aware that AHPRA have recently created a draft policy for use of social media. This draft is open for public comment. Currently it seems to be replicating a number of areas of legislation that already exist in regards to advertising, and also borrows heavily from the AMA guidelines. You can read more about this on Croakey: http://blogs.crikey.com.au/croakey/2012/09/07/more-feedback-to-ahpra-on-planned-social-media-policy-for-health-professionals-get-with-the-times/

    While risk mitigation is a reasonable approach to providing guidelines and even for examining potential use of any new technology, there is a lot to be said for engaging with the benefits and exploring the possibilities. Focusing on the pitfalls means our gaze will always be downwards, I wonder what would happen if we all tried to look up a bit more.

    Dr David Corbet

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