Social media ‘tears down walls’ in medicine

The social media landscape is changing constantly and influencing all realms of society — and health care is no exception.

Approximately seven out of 10 Americans use social media to connect with one another, engage with news content and share information as well as for entertainment, according to statistics from Pew Research Center.

Social media — which includes online platforms ranging from Twitter and Facebook to personal blogs, websites and forums — is increasingly being used to enhance communication among physicians, patients and advocacy groups, including those involved in cancer care.

Source: Intermountain Healthcare.

Social media has been gaining traction in oncology for years, with evidence suggesting more clinicians are engaging online than ever before, according to Mark A. Lewis, MD, director of gastrointestinal oncology at Intermountain Healthcare in Utah.

“It was once seen as frivolous to engage in conversations online, but now there is a critical mass of oncologists who are well-respected with whom anyone can engage online,” Lewis said during an interview with HemOnc Today. “Everyone can benefit from social media, and it is a platform that encourages dialogue. A rising tide lifts all boats — with progress and better understanding, social media has become an effective way to share information in parallel with the peer-reviewed literature.”

HemOnc Today spoke with social media gurus within the oncology community about the do’s and don’ts of social media in medicine, how the changing social media landscape is affecting cancer care, and how physicians can leverage social media to their benefit.

Providing perspective

Experts with whom HemOnc Today spoke agreed unanimously that the potential benefits of social media are vast and include the ability to educate, share good practices and provide access to medical meetings.

Shaalan Beg, MD, associate professor in the department of gastrointestinal oncology and medical director of the Clinical Research Office at The University of Texas Southwestern Medical Center, said social media democratizes communication in medicine.

“Social media tears down walls and allows communication to take place — social media increases patient engagement by gathering messages from physician experts, societies and journals and delivers the information directly to patients,” Beg told HemOnc Today. “There also is communication within the medical community. Health professionals who may not have otherwise communicated are able to speak with one another.”

Don S. Dizon, MD, FACP, FASCO, professor of medicine at Brown University, echoed this sentiment.

“When people engage in social media, they form new relationships they may not have had otherwise. For example, I have had the chance to connect with colleagues in Eastern Europe through a global gynecologic tumor board hosted on YouTube; I am certain I would never have met them otherwise,” Dizon told HemOnc Today. “In addition, the social media landscape is dramatically changing medicine and oncology by providing perspective outside of the hallowed halls of the hospital by involving patients, advocates and the public.”

According to Dizon and colleagues in an article published in Journal of Oncology Practice, the three main purposes for which physicians use social media are professional education and development, public health messaging or education, and, although the least common, direct engagement with patients for clinical care.

Given that after receiving a cancer diagnosis, patients may be inclined to research their disease and prognosis online, social media can provide a platform for physicians to ensure that accurate information is available, according to Dizon and colleagues.

“Social media represents a key teaching opportunity for oncology professionals to disseminate credible, evidence-based information,” they wrote. “Social media could also provide a key mechanism to heighten awareness of clinical trials in oncology and drive participation.”

Of all the social media platforms, Twitter appears most popular among medical professionals.

“Twitter works for medicine because it is succinct,” Aaron T. Gerds, MD, MS, physician in the department of hematology and medical oncology at Cleveland Clinic Taussig Cancer Institute, told HemOnc Today. “As physicians, we are busy answering phone calls and emails and writing notes — we do not have a lot of time between seeing patients — so the messages that we consume on social media need to be succinct. Twitter makes for efficient use of time.”

However, social media is not synonymous with any one platform, as it’s a forum that continues to multiply, Dizon said.

“If one forum is not suitable to one’s personality or the way they work, this does not mean that there is not something out there that may work better for them,” he said. “My advice is to try out different social media platforms and see what fits for the individual. If something does not fit, then do not feel pressured to engage in that medium, but keep an open mind and know there are other platforms out there.”

Social media also builds connections at medical meetings and provides information for those not able to attend in person.

Evidence suggests that use of social media for this purpose is growing.

Dahiya and colleagues reported an overall increasing trend in the use of annual meeting hashtags on Twitter.

In their study, presented in 2015 at ASH Annual Meeting and Exposition, investigators examined the use of the meeting’s hashtag on Twitter over 4 years — #ASH11, #ASH12, #ASH13 and #ASH14 — using data from Symplur LLC, which offers analytics of global Twitter-based conversations.

Results showed the number of tweets sent using the annual meeting’s hashtag doubled each year, with more than 72 million impressions during 2014 alone. Moreover, nearly 4,000 individual Twitter accounts were used during the meeting, and the number of tweets per participant remained relatively constant during the 4 annual meeting years.

“Twitter is a very powerful tool that amplifies the content of scientific meetings,” the researchers wrote, adding that further research should focus on identifying trends and influencers, as well as evaluating the impact and value of tweets.

Additional research from Chaudry and colleagues suggested that tweets sent out during the 2011 and 2012 ASCO Annual Meetings were often “robust and clinically relevant,” with clinicians discussing whether results were clinically meaningful and the impact of adverse event profiles.

Social media allows for published results to be communicated instantly and reviewed by the public and has been dubbed the ultimate peer review, Gerds said.

Lewis agreed, adding that this year’s ASCO Annual Meeting had more Twitter engagement and involvement than ever before.

“These conferences are really wonderful for those who can attend in person,” he said. “However, it is a luxury to be able to travel and it comes with significant cost. In some ways, social media is democratizing conference attendance because the research presented is broadcast and those who are not able to attend in person can participate online. This is a second coming of the Gutenberg press — the freedom to share ideas has never been more widespread. Social media is a very powerful tool and the more physicians use it, the more they will see clear benefit.”

Fluid landscape

Despite these benefits, experts also identified several major “don’ts” of social media in medicine.

These include disclosing private health information, descending to a level of discourse of insults and criticism, and impulse posting when angry or tired.

“There are many challenges with social media in medicine, and we need to always keep in mind that what we put out into the social media world is public,” Gerds said. “What one puts out into the social media world can echo throughout time in both a positive and negative way. Most physicians are concerned about opening up to the public and taking missteps online, whether it is with colleagues or patients. However, simple guidelines can dictate how we carry ourselves on social media.”

For instance, ASCO has compiled a list of 10 social media tips for members. Among the recommendations is to get involved and take advantage of what social media has to offer, engaging frequently with various platforms.

However, the recommendations also suggest physicians always identify themselves; protect patient confidentiality and privacy; contextualize their activities, distinguishing between personal and institutional viewpoints; disclose potential conflicts of interest; respect copyrights; remain professional, especially with patients; and be aware of institutional guidelines on the use of social media.

“Having a presence on social media does not obviate our standards of professionalism — we must always respect our code of ethics and protect patient confidentiality,” Lewis said. “It is very easy to fire off a tweet and accidently divulge protected health information via images, for example.

“Another pitfall that is less clear on how to handle is where the lines of the rules of engagement with others online fall,” he added. “Not everyone is a fan of physicians or oncologists, so dialogue can get pretty contentious. It is important that we always take the high road and not engage in insults or get baited by ‘online trolls.’ As much as we want our voices in the conversation, we must always maintain decorum.”

The AMA has put forth a code of medical ethics relating to professionalism in social media use. The association encourages physicians to:

• be cognizant of standards of patient privacy and confidentiality, and refrain from posting identifiable patient information online;
• follow ethics guidance regarding confidentiality, privacy and informed consent;
• use privacy settings to safeguard personal information when using the internet for social networking, keeping in mind that privacy settings are not absolute;
• maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethics guidance;
• consider separating personal and professional content;
• bring unprofessional content posted by colleagues to their attention, or report the matter to appropriate authorities; and
• recognize that actions online may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers, and can undermine public trust in the medical profession.

Earlier this year, the Association for Healthcare Social Media, a 501(c)(3) nonprofit organization, was created to support health care providers on social media.

The organization provides resources to help physicians who use social media understand HIPAA concerns, how to disclose conflicts of interest, industry relationships, and how to cite medical literature so patients and the general public can easily digest it.

“Physicians should always keep in mind that if there is ever a situation where one feels uncomfortable, where an individual patient’s privacy may be violated, or if a social media conversation is not productive or collaborative, then do not actively engage in it,” Lewis said. “However, social media can help us overcome the negative way that many people view oncologists — as monsters or in cahoots with the pharmaceutical industry to suppress cure for profit. There are a lot of people who believe this. We are people, too, and having a presence on social media in the long run can work for our betterment.”

Patient aspect

A key facet to utilizing social media in medicine is understanding its impact on patients, who also may be members of a tweeting physician’s audience.

For one, physician engagement in social media has the potential to increase patient participation in clinical trials.

“For the most part, there is far more to be gained with using social media for clinical trial awareness,” Lewis said. “However, we still have to be careful to not coerce and not overpromise, because not every trial is appropriate for every patient.”

The use of social media can broaden the scope of information about clinical trials and research in general, experts said. A simple search on social media platforms for hashtags associated with a specific cancer type, for example, allows for identification of appropriate and available clinical trials.

Beg hosts a monthly Twitter chat for patients with the Let’s Win Pancreatic Cancer organization, during which they frequently discuss clinical trials and enrollment in the pancreatic cancer space.

“I receive emails all the time from patients after they have read or heard about clinical trials on the Twitter chat,” he said. “Physicians may also find out about clinical trials outside of their specific institution via social media. I have been invited to participate in other investigators’ clinical trials based upon them hearing about me through my social media presence. These are all positive examples of ways that social media can impact clinical trials.”

Social media also bolsters the impact of clinical research, Gerds said.

“Once clinical trials are completed and results are published, there can be ongoing discussion about those results and how to apply them to patients moving forward — social media can impact clinical research along the entire trajectory,” he said.

With that said, physicians should always keep both their patient and physician audiences in mind when posting on social media.

“When I first started using Twitter, most of my posts were geared toward other physicians, but when I realized there were a lot of patients following me, I changed my approach,” Gerds said. “With any type of media, the first rule is to know your audience, and it is a great exercise to constantly review your audience.”

Surbhi Sidana, MD, assistant professor of medicine at Stanford University School of Medicine, agreed.

“One’s audience can change at any time on social media,” Sidana told HemOnc Today. “We have to constantly be mindful of our audience. When posting something on social media, keep in mind that there are a lot of consumers who are listening and reading what you are saying. Be mindful of this always.”

Leveraging social media

Among the ways physicians can use social media to their advantage is for career advancement.

Those who are integral to the promotions process are increasingly recognizing social media as a key element of the academic package, Gerds said.

“Some centers have even gone as far as crediting academic clinicians with their social media expertise,” Gerds said. “Just as one receives credit for publishing research and seeing patients and involvement in projects, clinicians can also receive credit by being incredibly active and influential on social media.”

Although academic communities may still be figuring out how a social media presence contributes to a physician’s measurable status, “we are still in an environment where peer-reviewed literature and citations thereof remain where the majority of physicians’ value is judged,” Lewis said.

“It is not a pure binary decision. A physician may still publish a paper and still be active on social media,” he said. “In fact, there have been examples recently where a paper is published in a journal and the author uses their social media presence to promote the published paper. Twitter is an amazing neurocircuitry — the good stuff bubbles to the top. If someone tweets something that is interesting, people are inclined to retweet it and the signal gets stronger.”

Lewis recommends using some form of social media to curate journal articles that will help in clinical practice, then absorb that information to interact later when ready.

“When one finally gets up the confidence to start sharing their own opinion — they should,” he said. “Social media is a great tool and, when used properly, is a phenomenal way to filter things to our benefit. We trust other respective colleagues and if they think something is of merit, we will most often listen and pay more attention to it. Although most institutions have not yet identified how social media could lead to career advancement, certain institutions do require physicians to have a presence on certain social media platforms.”

Dizon agreed.

“It has become increasingly beneficial to a physician’s career to have a social media presence,” he said. “There are anecdotal stories of chairs of departments who are supportive of social media activities, but they are still the minority. Our job as physicians and oncologists on social media is to promote best practice, but also serve as a ‘think tank’ for how to leverage social media analytics and correlate this with some sort of tangible outcome that will matter to our departments and divisions across medical institutions.”

Creating a professional standing on social media is a form of leveraging oneself as an expert and creating a personal brand, Sidana said.

“Social media in medicine allows us to connect more rapidly with other like-minded professionals, and even patients,” she said. “Some institutions use a physician’s social media professional engagement for promotions, which is a great idea. The role of social media in medicine will only continue to increase — it is a fluid environment. As time moves forward, we will see more and more patients connecting with physicians for a quick second opinion or to discover the latest information in a specific field. Social media in medicine is here to stay.” – by Jennifer Southall

Click here to read the , “Is social media a ‘slippery slope’ in medicine that should be avoided?”

References:

AMA. Professionalism in the use of social media: Code of ethics opinions 2.3.2. Available at: www.ama-assn.org/delivering-care/ethics/professionalism-use-social-media. Accessed Sept. 20, 2019.

ASCO. Ten tips for use of social media. Available at: www.asco.org/sites/new-www.asco.org/files/content-files/about-asco/documents/2015-Ten-Tips-for-Use-of-Social-Media-for-Oncologists.pdf. Accessed Sept. 20, 2019.

Bibault JE, et al. Adv Radiat Oncol. 2017;doi:10.1016/j.adro.2017.04.009.

Chaudhry A, et al. J Oncol Pract. 2012;doi:10.1200/JOP.2011.000483.

Dahiya S, et al. Abstract 4469. Presented at: ASH Annual Meeting and Exposition; Dec. 5-8, 2015; Orlando.

Dizon DS, et al. J Oncol Pract. 2012;doi:10.1200/JOP.2012.000610.

Pew Research Center. Social media fact sheet. Available at: pewresearch-org-preprod.go-vip.co/pewinternet/fact-sheet/social-media/. Accessed Sept. 20, 2019.

Additional resource:

ASH “How I Tweet” videos are available at: www.youtube.com/playlist?list=PL4C8vBKsIWMoriO_SJe8i1snCTKan_rMK.

For more information:

Shaalan Beg, MD, can be reached at The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390; email: muhammad.beg@utsouthwestern.edu; Twitter: @ShaalanBeg.

Don S. Dizon, MD, FACP, FASCO, can be reached at Lifespan Cancer Institute, Rhode Island Hospital, 593 Eddy St., George 302, Providence, RI 02903; email: don_dizon@brown.edu; Twitter: @drdonsdizon.

Aaron T. Gerds, MD, MS, can be reached at Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave., Cleveland, OH 44106; email: gerdsa@ccf.org; Twitter: @AaronGerds.

Mark A. Lewis, MD, can be reached at Intermountain Healthcare, 5171 S. Cottonwood St., Bldg. 1, Suite 610, Murray, UT 84017; Twitter: @marklewismd.

Surbhi Sidana, MD, can be reached at Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305; email: surbhi.sidana@stanford.edu; Twitter: @SurbhiSidanaMD.

Disclosures: Beg, Dizon, Gerds, Lewis and Sidana report no relevant financial disclosures.