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Social media, online technologies hold promise for improved patient interaction
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The use of social media and Internet-based technology continues to grow around the world, most rapidly in Europe and the Asia-Pacific region, a development that could alter the physician-patient relationship.
Web-based technologies include social networking, video sharing and blogging. Internet usage has been increasing worldwide, with the fastest growth in the Asia region, at an estimated 893 million Internet users and 23% penetration rate as of March 2011. The region is followed by Europe, at an estimated 475 million users, or a 58.4% penetration as of 2010, according to Internet World Stats.
As the number of Internet users increases, medical professionals should be aware of how best to use social networking sites and other online technology to reach out to patients and each other. Concerns include privacy and time-management issues, while benefits include increased patient awareness of practice activities and shared information.
“As a medical professional, we don’t get to showcase our body of work by coming on screen or on stage, nor in the press media are we allowed very easily,” Ashvin Agarwal, MBBS, MS, a physician at Dr. Agarwal’s Eye Hospital in Chennai, India, said. “I feel that social media is a very clean and nice way to show yourself to your patients in exactly the same way as you would like to.”
 Jorge L. Alió, MD, PhD, said his practice has joined the social media milieu with Facebook and Twitter pages, thus reaching a wider audience. Image: Alió JL
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Jorge L. Alió, MD, PhD, OSN Europe Edition Editorial Board Member, said his practice in Spain has entered the realm of social media through Facebook and Twitter. The social media sites have expanded his practice’s audience, which has typically been older patients.
“With this service, we can offer better communication and better information for our patients through social media than the world that we have been using traditionally,” Dr. Alió said. “We have found that communication through newspapers is effective in middle to elderly patients, but it’s almost nil in young people, talking about below the age of 25. And these are the ones that we target with social media communications.”
Uday Devgan, MD, FACS, FRCS(Glasg), OSN U.S. Edition SuperSite Section Editor, has been using several social media platforms since they were first introduced.
A self-professed technology geek, Dr. Devgan has more than 500 Facebook friends and a YouTube channel that has garnered nearly 200,000 views. He also holds the distinction of being the OSN SuperSite’s first blogger. Blogging, he said, is not only an interesting form of new Internet technology, but also more useful in terms of connecting with patients and other ophthalmologists.
“My blog is focused. The reason I get so many readers is because it’s content that I find interesting and things that I’ve learned the hard way. An effective way of improving our surgical success is learning from mistakes and challenges in prior cases,” Dr. Devgan, whose practice is based in Los Angeles, U.S.A., said.
Popularity of social media
The presence of Dr. Agarwal’s Eye Hospital on social networking sites began in March with the launch of the hospital on Facebook, Twitter and YouTube. Dr. Agarwal said the launches offer multiple benefits to both patients and physicians.
 Ashvin Agarwal |
“[These sites are] fantastic connectors between a patient and a doctor, as I know a patient will feel connected as soon as he/she receives a good answer to his/her query,” Dr. Agarwal said. “I know I would. It is a really good peer connector as it helps resolve cases over the Net, especially if you are a doctor specializing in a specific field and need expert advice about a case out of your specialization.”
As of 2009, India ranked seventh in the world for Internet usage; the top three country users are China, the U.S. and Japan. The penetration rate for Facebook users in India is still low, at approximately 23 million members as of March. That is only a 1.9% penetration rate based on population. Dr. Agarwal said that Indian patients predominately use the Internet to search for medical information and not to communicate with physicians, but that could be changing.
“Social media started off with another site called Orkut, but Facebook became a huge revolution and has hit the jackpot in India,” he said. “It is a huge hit.”
In Europe, social networking usage overall is on a rapid upswing. In 2010, European nations experienced the highest percentage point gain, at 10.9%, of any region in the world for social networking monthly penetration, according to comScore. Approximately four out of every 10 Internet sessions in the region included a visit to a social networking site last year. There were approximately 162 million Facebook users, a 19.9% penetration rate, in Europe in 2010.
Physicians could capitalize on the surge of online interest in different ways. Blogs and YouTube videos can be popular with patients who want more in-depth information about techniques and surgeries, Oliver Findl, MD, said. He put an animation of cataract surgery on YouTube that was viewed by thousands of people without any promotion.
 Oliver Findl |
However, overall use of classic social media — networking sites such as Facebook, Twitter and country-specific sites — must be approached both realistically and with caution, Dr. Findl advised. He said that social media is used differently around the world and among generations. His practice does not have a presence on social media for a variety of reasons, including practicality issues and its time-consuming nature. He does have a private Facebook page, but for social purposes only.
“To be honest, I probably don’t go on more than once a month or twice a month, just to see what’s happening with my friends. … I don’t see having Facebook open on my laptop or PC in the background all the time. I don’t live in this situation. That might be different in California or at Harvard, because that’s obviously where things started. They may just be much more used to essentially being online all the time and having Facebook open and being on top of things. If you have that kind of lifestyle, then it’s probably OK to engage,” Dr. Findl said.
Time requirement
Both Dr. Findl and Dr. Alió emphasized the time required to update social media sites because of their interactive nature. Facebook, which includes a profile page of each member that allows for short posts called status updates, is typically open to those who “friend” or become fans of that particular person, organization or practice. This design potentially sets up privacy and confidentiality issues, both clinicians said.
“The problem that I see is that if you are trying to promote a practice on one of these social media, obviously the idea is connectivity and speed,” Dr. Findl said. “If you put something out there, people will respond, patients, colleagues, whoever. And if you are not able to … keep it up to date and read what’s being posted not on an hourly but a daily basis, I think you may run into a problem where things will be posted which you might find neither adequate nor accurate for your site.”
Dr. Alió also expressed concern about the need to properly monitor medical social media sites. He said physicians should understand before they set up a Facebook or Twitter page that there is a considerable time commitment needed to create and follow content. Many surgeons are already short on free time, he said.
In Dr. Alió’s practice, social media sites are maintained by the communication department. In Dr. Agarwal’s Eye Hospital, Facebook updates, including surgical videos and photos, are made on a regular basis by three information technology (IT) employees. The IT group works with the hospital’s team of 10 physicians from differing departments to respond to patients’ questions.
“It definitely chews into your time during business hours and sometimes also private hours too, so it’s more emailing, more replying to patients,” Dr. Agarwal said.
In smaller clinics, hiring someone specifically for or delegating the task of social media updates might not be possible because of affordability and time constraints, Dr. Findl said.
“At the end of the day, it will always be a lot of work for somebody who has medical knowledge to actually give a proper answer to the questions or the ideas which are posted,” he said.
Privacy concerns
Although using social media has benefits, it is important to take multiple aspects into account when maintaining an online presence. Whether clinicians are using social media as a personal or a professional network, there remain high standards of professionalism to which all physicians should adhere, and physicians must take care to not reveal patient details online.
Dr. Agarwal said that patient privacy is an important issue for Dr. Agarwal’s Eye Hospital. The hospital is registered on Facebook as a company and not as an individual, he said.
“What we do as soon as we get a query from a patient is, the IT personnel connects the patient to one of the 10 doctors of the team in the hospital who have Facebook accounts, and they take the query forward from there, usually through messages in Facebook, but there are other options of giving away your email ID to the patient and wait till they reply on the email,” he said.
According to Bryan Vartabedian, MD, a pediatrician at Texas Children’s Hospital, U.S.A., who runs a blog called 33charts.com, about once a month, either an established patient or a new patient will attempt to reach out for medical advice through one of his social media accounts. Interacting with patients in this manner via social media is not advised, he said.
 Bryan Vartabedian |
“Physicians should not be having direct dialogue with patients in public places, even if it is the patient who initiates the dialogue,” Dr. Vartabedian said. “Anything that you would not do in public as a physician is what you should not do on a social media platform.”
He recommended that physicians immediately take the dialogue offline by prompting the patient to reach them via telephone. He also suggested that physicians discuss with patients why it is not a good idea to have this type of discussion in a public forum because many people do not understand the privacy issues surrounding the public forums in social media.
He recalled a scenario in which a potential new patient contacted him on Facebook and described a problem with her child. Upon reading the child’s symptoms, Dr. Vartabedian realized that the infant was sick. Rather than continue the discussion online, he asked the mother to call him at the office, and care for the infant progressed from there.
“This represented a dilemma for me because I do not like to entice these patient interactions in a public space, but here is a case where I did not know what would happen to the baby if I didn’t answer that Facebook message,” Dr. Vartabedian said. “As patients and doctors commingle, there are going to be more and more subtle dilemmas like this.”
Because of his prolific online presence, Dr. Devgan is frequently contacted by people who are not current patients at his Los Angeles practice. While physicians in California cannot give medical advice without a good faith examination of the patient, Dr. Devgan said he will offer general information and recommend that people speak to their own ophthalmologists.
Dr. Devgan does not, however, view all online communication as a liability. In fact, he provides his email address to all of his patients in case they need clinical or surgical advice after they leave the office.
“My line is, ‘If you’re like me, 5 minutes after you leave here, you’re going to think of three more questions,’” he said.
Dr. Devgan personally responds to patient emails within 24 hours of receiving them because it is more efficient than playing “phone tag” when a patient has an immediate issue, he said. However, like Dr. Vartabedian, he discourages Facebook communication in order to avoid issues regarding patient privacy, an especially important factor for physicians to consider when using social media.
Empowering patients, physicians
Even with multiple concerns about social media’s role in medicine, the possibilities are endless regarding education and communication with patients, creating the potential for a more open dialogue that fully incorporates the new digital age, Dr. Agarwal said.
“All patients see their loved ones go inside the operating room and the red light blink on as soon as the surgery commences, but only the ones with the badges or the scrubs know what’s happening during the surgery,” he said. “All of them get to see YouTube videos a day prior to their operation, but a surgery that has happened in the same hospital would be a tough one to find. Hence, to ease their discomfort whilst sitting outside the operating room, the least we can do is to show them surgeries that have taken place within the same premise.”
In the past, the physician was the sole controller of health information, but social media and Internet technologies have changed that dynamic, Dr. Vartabedian said.
“The biggest thing that social media has done is to empower patients,” he said. “For the better part of modern civilization, health information has been under tight control of physicians. With the open access, patients now have unlimited access to information, which puts them in a unique position. The role of the physician is being completely redefined in the face of social media.”
Social media could also be useful for physician-to-physician interaction, as in the case of the European Society of Cataract and Refractive Surgeons’ Young Ophthalmologists’ Facebook page. The page was designed so that young European ophthalmologists could meet in a social media forum to discuss experiences and exchange tips and hints. Dr. Findl said social media was designed to be this kind of tool, a form of connection between people socially, but it does not always readily lend itself to the physician-patient or physician-physician relationship.
Dr. Alió cautioned that confidentiality is a serious issue on social media sites for physician-to-physician interaction. He uses other methods of communication to discuss sensitive medical issues with fellow surgeons. The medical and legal concerns with social media and medicine are all the more relevant today with malpractice lawsuits and medical guidelines about patient information dissemination, he said.
He said a professional networking format, specifically designed for the safe exchange of files and information between physicians, is needed. Physicians would do best not to exchange sensitive information in the potentially open settings offered in current social media.
“Our concerns and our needs for the future are how to implement and to make faster communications for sharing medical files and medical issues in respect to confidentiality and only allowing access to those that have our reliability of confidentiality,” Dr. Alió said. “Anonymous access to this information is not acceptable at all professionally in the medical practice and is not to be involved at all with these media. We need different types of platforms.”
Getting involved
Physicians are encouraged to determine the goal of their social media/online presence, whether it is promoting their practice, promoting themselves and speakers, or advocating an issue that they are passionate about, Dr. Vartabedian said. Once that is determined, physicians should define where they want their presence, such as a blog, Facebook and/or Twitter.
“I frequently encourage doctors to make a decision about where they want to live in the social media world,” he said. “For me, I live on my blog, which is the hub of my social media existence. Twitter and Facebook are outposts for what I do on my blog.”
Dr. Findl advised physicians who are cautious or unsure about joining a social media site to explore other online technology options. Websites and blogs are still viable ways to reach out to patients.
“I still think for medical information, people will go on websites,” he said. “If you want to be interactive, you can put a blog on your website, maybe with a forum. I think that’s [a good idea] because there you don’t need to respond immediately, but if you respond a few days later, a few weeks later, maybe it’s sufficient. If you have a ‘frequently asked questions’ page on your website, chances are quite high that most patient questions are addressed, and it’s better to control.”
Dr. Devgan said he devotes the majority of his social media time to blogging, noting that, in his opinion, Facebook and Twitter are not as useful for ophthalmology practices. However, he said the main advantage of all social media platforms is the speed with which information can be disseminated.
“Social media is hyper-effective … connecting a group of like-minded people very quickly and very efficiently and with multiple forms of media,” Dr. Devgan said. – by Erin L. Boyle, Courtney Preston and Emily Shafer
Should
private practices adopt their own social media guidelines?
- Ashvin Agarwal, MBBS, MS, can be reached at Dr. Agarwal’s Eye Hospital, 19, Cathedral Road, Chennai 600086; +91-98404-30100; email: agarwal_ashvin@hotmail.com.
- Jorge L. Alió, MD, PhD, can be reached at Vissum Corporation, Avenida de Denia, s/n, 03016 Alicante, Spain; +34-965150025; fax: +34-965151501; email: jlalio@vissum.com.
- Uday Devgan, MD, FACS, FRCS(Glasg), can be reached at Devgan Eye, 11600 Wilshire Blvd., Suite 200, Los Angeles, CA 90025, U.S.A.; +1-800-337-1969; fax: +1-310-388-3028; email: devgan@gmail.com.
- Oliver Findl, MD, is chair of the Department of Ophthalmology, Hanusch Hospital, Vienna, and Consultant Ophthalmic Surgeon at Moorfields Eye Hospital, London. He is also the founder and chair of Vienna Institute for Research in Ocular Surgery. He can be reached at oliver@findl.at.
- Bryan Vartabedian, MD, can be reached at Texas Children’s Hospital, 17198 St. Luke’s Way, Suite 300, The Woodlands, TX 77384, U.S.A.; +1-936-321-0808; email: fox42@me.com.
- Disclosures: None of the physicians have direct financial interests in the companies or organizations mentioned in this article.