The petri dish of social media, Facebook, Twitter, Instagram, and YouTube is alive, vibrating, whirring, and stirring every second of every minute of every hour. But unlike the Brownian motion we observe under the harsh glare of a microscope, cyberspace is no longer a random bombardment of information. Some medical professionals have successfully harnessed this energy and taken it to a more deliberate level with purpose and impact.
The "Fab Four" of medical cyber communication hosted an afternoon session on the topic at the ACC Scientific Sessions . Drs Kevin Campbell, Westby Fisher, Dave Albert, and Andrew Freeman are incessant social-media utilizers. They filled one of four time slots dedicated to the topic at this year's meeting, proving that physician interest in what cyberspace has to offer is growing. It is a cautionary tale, however, as some stalwarts of medical ethics are nervous about the explosion of public communication among patients and their providers. Furthermore, in the more sinister dark shadows of cyberspace lurk opportunists who hope to twist to their advantage what is undeniably one of the most powerful tools in the realm of medical information sharing.
Following this year's meeting, my husband and I enjoyed a brief visit to the Jefferson Memorial. Engraved on the wall behind the towering dark statue of our nation's third president is a timeless and relevant 200-year-old statement. Despite the absence of the words "laptop, smartphone, or computer" in the daily vernacular of his time, Jefferson still aptly addressed the growing pains that humanity faces today:
"I am not an advocate for frequent changes in laws and constitutions, but laws and institutions must go hand in hand with the progress of the human mind. As that becomes more developed, more enlightened, as new discoveries are made, new truths discovered, and manners and opinions change with the change of circumstances, institutions must advance also to keep pace with the times."
The institution to which that statement is readily applied is medicine. It runs huffing and puffing to catch up with how we physicians and providers choose to communicate among ourselves and with our patients.
The Do's and Don'ts
Dr. Kevin Campbell, an electrophysiologist and consultant for Fox News, Nancy Grace, the Doctors, and Bloomberg News, started by saying, "This is not a fad. It doesn't replace traditional advertising, and it's 'free.' Like a box of free puppies—you still have to feed and care for it." He pointed out that YouTube, Facebook, Twitter, and blogs take the traditional way of making a statement one-to-one and broadcast it with a "megaphone." He then displayed impressive demographics: the average Facebook user spends more time on Facebook than Google and all other websites. Proof that this mode of communication has saturated our daily lives is that about 250 million users log in every single day, 75% via their mobile phone. He then explained how professionals utilize their web space. "You can respond to inquiries, ads, fans, post on other pages, and share links." Then he advised, "You should feed your blog posts weekly and you should integrate your FB pages and your blog Twitter as well. Remember, "friend pages" are for individuals but "fan pages" are for business, he added.
Dr Campbell noted that there are "meaningful-use" criteria for social media and several how-tos:
Treat: Do not engage in a doctor-patient relationship.
Teach: Provide timely and credible education.
Consult: Share medical information and knowledge (he referenced his discussions on the Riata lead recall).
Market: Tell people what makes you special.
Become an expert or KOL (key opinion leader): Establish a national/international expert status to enhance your reputation.
And he's done just that, but he's really about much more. He's all about helping his patients and other physicians. He gave a great example: "We have [cyber] support groups for device patients who don't have transportation [to a physical meeting]. A physician moderates it. It's a place where patients can air feelings and complaints postimplant and can meet other patients and form friendships."
Dr Campbell pointed out that social media is not just for patients or healthcare providers. Within an organization, it can improve internal communication and morale. It can boost employee involvement in company initiatives and engage personal growth. He is convinced that social media is a tool that can help patients to take control of their lives and improve healthcare. He advised that "social media is important and here to stay. . . . The time to get involved is now. It might pay us to think about that."
The Eyes of the World Are Upon You
Dr Dave Albert, founder of AliveCor and inventor of the iPhone ECG, described his first dalliance with social media. After his son helped him upload a demonstration of the iPhone ECG on YouTube, the rhythm strip seen around the world awoke the sleeping FDA giant and prompted legislation on the issue. Device companies and government officials came calling, and a friend reminded him of the double-edged sword of seamless information sharing.
After he'd opened his door to figurative guns drawn, Dr Albert learned about the peaks and nadirs of advancing new ideas and solutions before one's cyber-ducks are in a row. He can now boast of the recording of your heart rhythm with an FDA-cleared mobile device that can be purchased by the public and shared with their physicians.
Dr Wes Fisher, of North Shore University Health in Evanston, IL, has run a successful blog for years aptly entitled "Dr Wes: Musings in the life of an internist, cardiologist, and cardiac electrophysiologist." Known as "the blogfather," who blogged before blogging was cool, he views social media as a "tugboat [that] we might be able to steer a little bit." Is it too risky for doctors? He suggested we heed the rules he adopted from the Mayo Clinic: "Don't lie. Don't pry. Don't cheat. You can't delete. Don't steal, and don't reveal," adding that, "I like blogging. Just be out there. I don't recommend being anonymous."
With regard to liability, Dr Fisher recommends that you moderate the commentary. "You will have wackos, dangerous wackos." And he warned about copyright and intellectual issues. While it's cool to grab information and post it, if your blog carries advertisements, you are more likely to be vulnerable to copyright infringement. Images are limited to fair use. He then added, "Parody is okay, but satire may not be. Parody copies from the object it mocks, but satire uses recognizable objects to mock something else or society in general."
The Disappearing ICD "Explosion"
Dr Fisher got into a bit of a cyber-skirmish when he published a case study in September 2010 regarding a report in Europace of a spontaneous implantable cardiac device explosion. "I put this on my blog and posted two pictures: one of a wound burn and the second of a melted device. Within six hours the link to the article disappeared," he told us. The link had gone viral and racked up 10K views in six hours. The author of the Europace report later changed the description of the event and said it wasn't an explosion, it was "venting"—a comment that triggered a conversation about device companies and their influence on the media. The company literally showed up at the author's door. He took the images down because he didn't want to get brought down for copyright infringement. "Truth is the best defense, but it can be incredibly expensive to prove," concluded Dr Fisher.
Dr Andrew Freeman, of Denver National Jewish Health, is the chair of the early-careers section at the ACC. He has used his prowess in social media to organize patient gatherings, a credible and helpful medical flash mob if you will. He uses it to talk up health-related chatter and to encourage others to join a health-related cause. He encouraged us to consider using LinkedIn to build a network and to "reach out when you need to." He frequents YouTube's massive video library and encourages others to do so because it is a way for patients and physicians "to try before you buy." His "walk with a doc meet-up" brought 150 people to walk with doctors, get to know them, and get information while they got fit. The benefit to doctors, he said, was "exposure, exposure, exposure! It's a means to market to thousands of people for almost nothing. It's a billboard. It brings people into your practice and provides excellent customer service," he concluded.
Heavy Is the Hand That Moves the Mouse
Because of their Facebook, Twitter, and Instagram activities, as well as their pervasive presence in the blogosphere, these professionals have been lauded, lampooned, chastised, respected, hated, and loved, sometimes simultaneously by the same person. Although they have slightly different approaches, they share a common belief: As a healthcare provider, the choice to use social media as either a telephone or a megaphone must be weighed carefully. The impact of its instant reach has the power to bolster or destroy. There are HIPAA considerations and liability issues with a healthy dose of accountability that will be brought to bear if there are any challenges to a particular post.
To deny the reach of social media would be like denying the impact the automobile or television has had on human civilization. It is the wheel of communication reinvented. We must keep in mind that Facebook especially is the ultimate eyewitness because Facebook does not lie and that truth and consequences are as intertwined in cyberspace as the latticework of our DNA. This is dogma for every blog post, tweet, and video. Like the use of fire, fuel, or nuclear power, the choice to use this cyber amplifier comes with great responsibility. I acknowledge that "heavy is the hand that moves the mouse," but there is so much good that can be done through communication of any type, I embrace the use of social media wholeheartedly. I recently tweeted back to Dr Kevin that I try to be "as available as AAA to my pts for appts & advice." Anytime I'm queried on the private side of Facebook, I do it discreetly and with disclaimers to seek emergency attention if symptoms are worrisome or the condition changes.
But those of us who use cyber communication on a near-daily basis will all agree: One must be sincere. One must be accountable, and one must always tell the truth, or consequences will certainly follow.
© 2014 WebMD, LLC
Cite this: Social Media for Docs: Truth and Consequences - Medscape - Apr 22, 2014.
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