By Erica Noonan, MA
The tools of the modern doctor’s kit: white coat, stethoscope, and Twitter. And if not Twitter, then Facebook, LinkedIn, Instagram, or other online forums. Industry estimates suggest more than 90 percent of physicians in the US are actively using at least one social media platform to interact with colleagues as well as patients.
These electronic forums — and the tools that physicians use to access them — serve the same purposes as traditional medical communities. They have become integral to advancing medical education, as well as facilitating cultural evolution within the profession, says
Kathryn Hughes, MD, an acute care surgeon at Falmouth Hospital.
“The reach [of online forums] in the medical community is broad, global, and across the entire arc of the medical experience, from student, to resident, to attendings, to thought leaders and industry leaders,” says Dr. Hughes. “It encompasses the entire spectrum of the hospital experience as well as colleges and universities and medical programs.”
General interest physician-only communities, such as Doximity and Sermo, are one manifestation of physicians’ online networking; Doximity estimates that 70 percent of US physicians have used the platform at least once. These forums are complemented by social media initiatives that bring physicians together, often in special interest communities. Facebook’s Physician Moms Group, for example, has become a dynamic forum for women physicians. “These are very fluid and nimble communities that can lay the groundwork for the next community to be created. Significant and real collaboration grows out of them, and they are a powerful way to form connections,” says Dr. Hughes. She and other physicians spoke to Vital Signs about the value of Twitter.
Enduring Goals, Changing Means
More than a century ago, surgeons came together in person to collaborate, support each other, set standards for the profession, and bond over shared experiences, says Dr. Hughes. “Flash-forward to a new millennium. Problems, benefits, and all of the good and all of the bad are bigger in this new electronic format, but they aren’t different.”
In 2015, the American Association of Medical Society Executives noted, “[T]he mechanisms and ways that [medical] communities come together have changed a great deal. New technologies allow physician communities to be built online as in-person networking opportunities are harder to fit into members’ schedules.” In addition, young physicians are technologically savvy and would likely be active on social media platforms regardless of their career choices.
Some physicians find that online interaction can substitute for, or at least complement, face-to-face connections. Michael S. Sinha, MD, JD, MPH, says, “It’s nice to reconnect with the online colleagues you’ve made on a periodic basis. You often feel like you get to know people, even if you’ve never met in real life.”
Moving Medical Culture Forward
The influence of such networks has grown rapidly. Social media helps explore the ways that issues of broad topical currency play out in the practice of medicine. With women accounting for more than half of incoming US medical students in 2017, for example, online physician communities are dynamic forums for discussing diversity and inclusion.
“Virtual discussions have led to an increase in awareness of issues related to gender parity in medicine,” wrote
Julie K. Silver, MD, associate professor and associate chair in the Department of Physical Medicine and Rehabilitation at Harvard Medical School, and co-author of a June 2018 article in the New England Journal of Medicine on the role of social media in advancing women physicians’ careers. “Social media may play a role in supporting these female students, just as it has begun to support women physicians of all career stages, helping them overcome traditional barriers to professional development.”
Dr. Hughes, chair of the MMS Committee on Women’s Health, was a pioneer of the hashtag #Ilooklikeasurgeon, which first appeared in 2015 in an effort to highlight women’s contributions to the heavily male-dominated field of surgery. The hashtag went viral. (The theme was immortalized in popular culture by an April 2017 New Yorker
cover showing four masked female faces gazing down at a patient in an operating theatre.)
Facilitating Patient Care
Online networks can facilitate clinical learning. The use of hashtags on some social media platforms enables users to find relevant content and conversations. Dr. Sinha, a research fellow at Harvard Medical School, routinely engages in several e-communities on Twitter, including #WomenInMedicine, #HMIChat (transforming health care delivery and medical education), #PWChat (physician well-being), #JHMChat (care for hospitalized patients), and #MedEd (medical education).
Matthew Katz, MD, a Lowell radiation oncologist, turned to Twitter more than four years ago as a means to keep current efficiently with cutting-edge academic research. Dr. Katz initiated a monthly journal discussion for tweeting oncologists, engaging article authors and introducing them and their research to the e-community. He facilitates chats that often attract 50–100 colleagues, researchers, and patients interested in treatment developments related to breast, lung, and brain tumors. Dr. Katz, who is also a regular user of Doximity, is a past chair of the MMS Committee on Communication, which is developing an updated guide to social media for physicians (available imminently on
massmed.org).
Patient-Physician Learning
Online learning communities can include patients, says Dr. Sinha. “When patients join the chats, especially topical chats centered around specific diseases like #lcsm (lung cancer), #obsm (obesity), or #bcsm (breast cancer), those perspectives and contributions are tremendously insightful and important for physicians.”
This multidimensionality of online communities is a major benefit to medicine, he says. “Increasingly, it’ll be a way for physicians and patients to engage with one another, to educate one another, and to establish meaningful relationships. It’s certainly not an appropriate venue for establishing a patient-physician relationship, but if used correctly, e-communities like Twitter can allow physicians to walk in patients’ shoes, and vice versa. That’s critically important in health care today,” said Dr. Sinha.
Challenges and Pitfalls
Online forums are not without hazards. Social media can be a time sink; it is important to be conscious of the return on investment. “You have to do it in a way that adds to your clinical practice of medicine,” says Dr. Katz. In addition, any mistakes made in such forums are public.
Protecting Patient Privacy
Participating physicians have the added responsibility of constant vigilance about patient privacy laws. Many physicians who are active on Twitter make a point not to reply to posts soliciting medical or legal advice, and place such disclaimers on their profiles, says Dr. Sinha. “Above all, it’s important for physicians to avoid disclosing identifiable information about patients — and not just because HIPAA says we should. It’s more about respect for patient dignity and personal privacy.”
Online medical communities are working on these challenges. “Social media are potentially very powerful tools for communication, and I am hopeful we’ll figure out through better research a way to use them both ethically and effectively, but I don’t think we are there yet,” Dr. Katz says.
That said, there’s no going back. “We’ve barely scratched the surface of the potential for how social media can be used to bring us together to disseminate information and improve clinical practice,” says Dr. Hughes. “We are in the early stages of seeing where this can take us. I’m an optimist.”
