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4/10/2014
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Social Media and Clinical Practice
Cresta W Jones MD
Objectives
• Introduction - social media/Web 2.0
• Clinical use of social media
• Optimal professional use
• Optimal personal use
Medicine and the Digital Age
• Internet - improved medical information
• 42% adults online info (2010)
• Timely dissemination of information
• Misrepresentation and misleading information
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“Googler” patient
Autism and induction of labor
• Aug 2013- JAMA Pediatrics epidemiologic analysis using multivariable logistic regression
• Increased odds of autism with induced and/or augmented labor
• Oxytocin specifically examined
• Article stressed findings should not change clinical practice
Autism and induction of labor
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You can’t ignore it!
• 75% hospitals - Facebook page or Twitter feed
• Past 10 years, women constitue majority of users online
• Over the age of 18 yrs
• Using social networking sites
Social Media
• Internet based applications that allow creation and exchange of user generated content.
• Social programming for everyone -interaction user + internet transformed from read-only to read-write-participate
• “Web 2.0”Lupianez-Villanueva et al.
2009
Internet 1.0 Social Media
Millions users Billions users
Read only content Read-write web
Web portal/home page Dynamic sites
One way communication 2 way communication
Passive Active
Static resources Dynamic resources
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Patients E- Patients
Passive role Active/engaged role
Provided with information Seek out information
Top down healthcare delivery
Partner in healthcare
Paternalistic medicine Participatory medicine
E - patient
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Medicine 2.0
• 61% of adults health information online
• 60% info online affected decision on how to treat medicine condition
• 53% ask MD new questions OR get second opinion
The Rise of the E-patient, pewinternet.org 2012
Medicine 2.0
• Even if you aren’t using social media...
• Your patients are!
• 1 in 4 people > 65yrs now on social media
• Social media overtaken pornography as #1 activity on the web
Kaplan and Haenlein, 2010
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Top Social Media Sites ebizma.com 2/2014
• Linked In
• Tumblr
• Flicker
• VK
• My Space
• Largest social network in the world
• Personal and professional use
• Status updates disseminated to friends, those who like you page
• Information access limits available
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• Microblog
• 140 character updates “tweets”
• “Follow” people or groups
• Handle - twitter username
• e.g. @mcwobgyn
• Hashtag - marks keywords for search
• e.g. #mcwobgyn
BLOG
• Website of regularly updated journal type entries
• “Web log”
• Reverse chronological order
• Access - anyone internet availability
Blogs
• Can be written by anyone
• No access limits
• Health blog recommendations
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• Video sharing site
• Registered users - upload and share
• No registration to view
Clinical applications of social media
• Establish online presence
• Direct communication with patients
• Identify ‘hot topics’
• Relationship development
• Subtle practice marketing
• Current use 67% physicians professionally
Patient benefits
• Health information - wide range conditions
• Answers to medical questions
• Special needs - video with low literacy
• Social support/influence
• Reduce stigma about certain conditions
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Patient pitfalls
• Quality concerns
• Patient disclosure
• Harmful, incorrect advice
• Disclosure of personal info online
• Deterrent for health professional visits
Provider pitfalls
• Medical Liability
• Bad publicity
• Political involvement
• Maintain professionalism
• Speak in lay terms?
Using social media clinically
• Have a plan - committee, vision, timeline
• Have time
• Know what’s out there
• Know what you can do
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Institutional Policies
• Institution Social Media Policy
• Departmental Guidelines
• Platform Terms of use - profile site
• Approval, response - posts
• Sites to follow
What works: MCW experience
• Social Media Committee
• Departmental Plan - policies, platforms, timeline, staff engagement
• Facebook, Twitter (YouTube)
• Ongoing project
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Supporting E-patients
• US health information
• 61% adults search online
• 39% use social media
• UK - Facebook #4 popular sites for health information
• Direct patients to reputable sites
Moorhead et al, J Med Internet Res 2013
How to assess Medical Websites
• Website source
• Get a second opinion - check another site
• Manufacturer’s site - different agenda
• Check date
• Consult your doctor
• cancer.gov
• cdc.gov
• familydoctor.org (AAFP)
• healthfinder.gov
• mayoclinic.com
• medlineplus.gov
www.mlanet.org
• netwellness.org
• kidshealth.org
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Supporting E-patients• Online resources for most common
diagnosis
• Reputable sites for patient search
• Education information with links
• Handout with links for most common issues
• Ongoing work
Supporting E-patients
• First trimester screen
• americanpregnancy.org
• mayoclinic.org
• webmd.com
• Search sites as ‘first trimester screen’
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Medical apps
Tripp et al, Women Birth 2013
• Pregnancy related apps
• iTunes - 1059
• Google Play - 497
• Informative, interactive
Professional use of social media
• Understand how Web 2.0 can benefit you
• Have a plan to develop and disseminate yourself and your practice
• Identify and avoid online pitfalls
• Work to create e-patients
Personal Use of Social Media
• Component of modern social interactions
• Connect family, friends
• Can still be identified as a professional
• When do you represent your employer?
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Personal Social Media Security
• Understand platform security
• Strict settings to block patient access
• Differs on each platform
• Often resets periodically to less secure
Personal Best Practice
• Don’t discuss patients online, even in medical terms
• Don’t give medical advice
• No photos of patients or babies
• Don’t post anything you don’t want the entire world to read
ACOG Today, Nov 2012
Personal Social Media
Best Practices• Cautious humor, political opinions
• Employer guidelines
• Liability carrier - social media coverage or guidelines
ACOG Today, Nov 2012
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“Friending” a patient
• Mr. Foot is a 52 yr old male, with a chronic nonhealing wound of his lower leg.. requiring numerous serial visits to your office. Initially, visits focused on creating and maintaining an effective treatment plan. Once the plan was established, the office visits deviated more towards social conversation.....
Payette et al, J Am Acad Dermatol 2013
“Friending” a patient
• On one particular follow up visit, when you ask the patient how he is doing, Mr. Foot reponds: “You’d know if you ‘friended’ me on Facebook”.
• What should you do?
Payette et al, J Am Acad Dermatol 2013
“Friending” a patient
• May be seen as enhancement in trust and strengthening of relationship
• Casual communication may blur the provider-patient boundary
• Maintaining a professional relationship with a patient must be maintained, even with social media
Payette et al, J Am Acad Dermatol 2013
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“Friending” a patient
• Answer - Inform the patient that because of HIPAA issues and their patient and care provider relationship, he cannot accept his Facebook request.
Payette et al, J Am Acad Dermatol 2013
Online identity crisis
• Should you separate your personal and professional identies?
• Yes - Separate identity in personal use
• e.g. facebook - middle/maiden name as last name
• No - use personal sites with caution
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• “Manage patient-physician boundaries online by separating professional and personal identities”
DeCamp et al, JAMA 8/2013
Online identity crisis
• Online identity separation operationally difficult
• Lack of consensus with active users
• Inconsistent with professional identity
• Potential Harms
DeCamp et al, JAMA 2013
Online identity crisis
• “ a simpler approach that avoids these pitfalls asks physicians not whether potential social media content is personal or professional but whether is it appropriate for a public space”
DeCamp et al, JAMA 2013
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Liability pitfalls
• Dr. Alexandra Than
• Social media post regarding trauma case
• No patient identifiers
• Fired from hospital practice
• Formal reprimand - state medical board
Liability pitfalls
• Small details matter - date, doctor, hospital name
• Posts online are searchable, never truly deleted
• Understand privacy settings - revisit on scheduled basis
Okay to post?
• “Still feeling the effects of the weekend -had a great time with old friends!”
• “Long night - three C/S and a forceps delivery - time for a nap”
• “Heard about your rough night at work -hope things get better”
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Personal Use of Social Media
• Widespread use among healthcare professionals
• Differing beliefs on separation from professional profile
• Understand and utilize safeguards to protect yourself and your patients
Conclusion
• Social media/Web 2.0 - powerful tool for information dissemination
• Engage a new and current patient population
• Professional involvement must be approached with caution
• Personal use involves forethought as a medical professional
