In Our Brave New World, Health 2.0 Is Changing How Physicians Communicate with Patients

This is the dawning of the age of… Twitter

The boom of social networking should make it easier for physicians and patients to communicate with one another. But reimbursement, liability, and privacy concerns are getting in the way. How can these obstacles be overcome? Read on.

After years of tentatively dipping its toes into the pool, the medical community is finally starting to embrace social media. In recent years, the industry has seen a rise in physician blogs that offer perspective on pertinent issues in a patient-friendly voice; the proliferation of networks offering a forum for physician-to-physician communication (Sermo, Ozmosis, SocialMD, and Doctor Networking, to name a few); and the increasing use of pharma customer service portals, all of which have all been key factors in social media’s growing acceptance by physicians.

But perhaps the most signifi cant driver is the fact that patients are utilizing the Internet more than ever to educate themselves. In a 2009 study, the Pew Internet & American Life Project (http://tinyurl. com/mohzd4) estimated the number of US adults who search the Web for health information at 61%, up from 25% in 2000.

In other words, social media is not just for kids anymore. In fact, many believe that the technology that was made popular largely by teenagers has the potential to signifi cantly impact the way medicine is practiced.

“It’s evolved quite a bit. Now we’re seeing the medical community embrace other forms of social media like Facebook and Twitter,” says Kevin Pho, MD, a primary care physician in Nashua, NH, and an active blogger on the HCPLive network (www.kevinmd.com). “And we’re seeing that larger organizations like hospitals and health insurance companies have blogs because it’s a great way to communicate with their constituents.”

For Pho, whose blog has been cited by major news outlets, an online presence provides an opportunity to “pull back the curtain,” and “help guide patients to reputable sources of health information.” Since 2004, Pho has used his blog as a platform to give a physician’s perspective on breaking medical news, and to share his opinion on topics like healthcare reform. As a result, he says the bond with his patients has become stronger.

But, as is often the case with new technologies, there are obstacles. And Pho believes that if the right steps aren’t taken, the same barriers that have hindered e-mail consultation may prevent social media from reaching its potential. “Statistics say less than one-third of physicians use e-mail, and it’s primarily for three reasons,” he says, citing reimbursement, liability, and privacy. “And those issues still apply with Facebook and Twitter.”

So what’s a doc to do?

While social media certainly holds a great deal of promise in terms of exposure, it can also be a minefield. But by adhering to a few basic rules, physicians can effectively leverage these online tools and stay out of hot water.

First and foremost, says Pho, “You have to respect patient privacy laws and HIPAA regulations. With Twitter, it’s essentially an instant message, so it’s very easy to slip up and reveal some identifying patient information.” The easy solution? Don’t answer specific patient questions, he says. Rather, limit content to general information on health conditions or commentary on issues like mammogram screening guidelines. “There is a line that has to be drawn, because it’s possible to give advice to patients who you don’t really know, and that’s dangerous from a liability standpoint.”

In fact, Bryan Vartabedian, MD, attending physician, Texas Children’s Hospital, Houston, believes it’s a good rule of thumb to heavily scrutinize any content before posting; his blog at www.33Charts.com focuses on the intersection of medicine and social media. For Vartabedian, the key is to recognize that “whenever I step into the social space, whether it’s on Twitter or on my blog, a lot of people are reading it—my patients, my boss, and hospital administrators,” he says. So, before publishing any text, he strongly advises giving it a final edit. “I’m very, very careful about what I say, just as far as my own personal brand and my own image.”

Doctors with (some) borders

Pho and Vartabedian caution physicians to establish limits as to how they will interact with patients. For instance, with e-mail consultations, physicians need to decide upfront how many messages can be sent during a specific period, what word count should be, and what types of questions are acceptable. “There need to be very strict guidelines, because ultimately, someone is going to have to be responsible on the receiving end of an e-mail—the staff has to answer it, and it has to be part of the legal record,” says Vartabedian. “And the same goes with the open, public social platforms. We have to have rules and regulations about what our patients can say to us and how they can engage in the social space. because it’s the sort of thing where if you unleash this, you create this really massive fl ow of information that you’re just not prepared to deal with.”

Vartabedian believes that while services like Twitter can be very effective for such purposes as disseminating quick information about topics like H1N1 vaccines and providing links to other sites, it’s not the appropriate venue to discuss personal health matters. “I feel pretty strongly that in the current climate, we shouldn’t be having that kind of engagement in the social space,” he says.

And although Vartabedian does see potential value in using Facebook to market a practice, he says that “You have to decide where you’re going to spend your time. Obviously, the cultivation of relationships takes time and energy and it’s something that a lot of physicians just don’t have the capacity to do.”

Therefore, he recommends that physicians institute—and stick to—a budget specifying how much time is devoted to social media, and within that, how that time will be divided among the different platforms. The key, says Vartabedian, is to do the legwork ahead of time and to be realistic about time demands. “The bottom line is that doctors just aren’t available all the time to have these dialogues with patients. We have to structure our day. Despite all of these incredible tools that we have in front of us, where the rubber meets the road is where we make contact with our patients in-person.”

And while he stresses that tools like social media sites and e-mail are no substitute for face- to-face meetings between patients and healthcare professionals, Vartabedian believes they can help break down the communication walls that exist between the two groups. “I think we’re going to see far more real-time interaction between physician practices and patients,” he says.

As the medical community continues to embrace social media on a broader scale, one of the ways in which the technology could be leveraged is to help manage chronic conditions, according to Pho. He believes the potential is there within the next few years for healthcare professionals to use Twitter to remind patients to take medications or check on their progress with smoking cessation. It’s just one of many reasons why he predicts social media will continue to evolve.

“It’s really to a physician’s advantage to have some type of social media presence,” he says, not just from a marketing standpoint, but “because it’s also our responsibility to guide patients who are looking for health information. Either we can guide them to the right sources, or we can give them some perspective on some of the information that’s out there.”

Tweet Sheet: Advice from the Experts

Bloggers Kevin Pho, MD (www.KevinMD.com) and Bryan Vartabedian, MD, (www.33Charts.com) offer the following advice for healthcare professionals who are looking to establish an online presence.

Start with a blog

Vartabedian: “I would recommend that physicians begin by using a blog as kind of an anchor in the social media space. A blog can be a repository of ideas, for information about your practice, and more. Once that’s established, you can then use these other tools to kind of feed around it.” (Vartabedian’s blog links to his Twitter and Facebook pages.)

Separation is key

Pho: “If a doctor were to use Facebook, I think it’s important that you have a separate page purely for professional purposes. The last thing doctors want is to have patients read all about them. That’s really a breach of the professional relationship. I think doctors need to make the delineation and separate personal information from sharing professional opinion.”

Make Twitter work for you

Vartabedian: “I don’t use Twitter as a tool for my practice; I use it to engage with other medical professionals who are into social health. On my Twitter feed, I’m getting links about things that are happening and important articles and I’ve worked hard to really tailor who I follow and that really helps me out. So I would advise that doctors be selective and choose only those who are within their sphere of infl uence.”

Just do it

Pho: “My advice is to go for it. I think that it’s really to a physician’s advantage to have a presence on Facebook and Twitter. You can put as much or as little time into it as you want. Like everything else, the more you put into it, the more you’ll get out of it, but it takes very little time to set up a Facebook or Twitter account—minutes, literally. And participating is very, very easy. I think that it’s only going to benefi t physicians in the future, because more patients are going to be on the Web. And I think as doctors we need to be there along with them.”

The Trends, They Are-A-Changing

Statistics from two reports (http://tinyurl.com/mohzd4, http://tinyurl.com/yjqus9n) by the Pew Internet & American Life Project, an initiative of the Washington, DC-based Pew Research Center, reveal some interesting trends in health information and social media.

Where patients go to find information:

• 53% of e-patients consult Wikipedia
• 39% use social networking sites like Facebook or MySpace
• 37% read a medical/health-related blog
• 12% use Twitter to provide updates

What patients do with information found online:

• 60% of e-patients say the information they found online affected a decision about how to treat an illness or condition
• 53% say it led them to ask a doctor new questions or get a second opinion from another doctor
• 38% say it affected a decision about whether to see a doctor
• 38% say it changed the way they cope with a chronic condition
• 35% search the Web to obtain information about doctors

Kate Huvane Gamble is a freelance medical writer and former MDNG editor.