Social media connects physicians and patients, but guidelines may be necessary

Social media has become a mainstay of both personal and professional communication because it is a fast, effective way to reach a large number of people.

Some physicians were early adopters of the Web-based technologies, which include social networking, video sharing and blogging, to name a few.

Uday Devgan, MD, FACS, FRCS(Glasg), OSN 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. Dr. Devgan also holds the distinction of being the OSN SuperSite’s first blogger.

Blogging, he said, is not only a more interesting form of social media, 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 said.

Uday Devgan, MD, FACS, FRCS(Glasg), is the OSN SuperSite’s first blogger and the OSN SuperSite.com’s Section Editor. Image: Devgan U

His blog, which focuses on premium IOLs, ranks significantly higher than the average for time spent on the OSN SuperSite and serves as just one example of the current power of social media.

In November, the American Medical Association created a policy about professionalism in the use of social media. Its guidelines include maintaining standards of confidentiality, using privacy settings to safeguard personal information and maintaining appropriate boundaries of the patient-physician relationship. In addition, the guidelines suggest that physicians bring any perceived unprofessional content on behalf of their colleagues to their attention and, if the colleagues do not take action, bring the matter to the appropriate authorities. Lastly, the guidelines advise physicians that their actions online may negatively affect their reputations and medical career.

From the Mayo Clinic creating a Center for Social Media to a 2009 Manhattan Research survey revealing that 35% of the U.S. adult population uses social media outlets for health and medical purposes, mounting evidence suggests one certainty: Social media is here to stay.

Empowered patients

In 2004, Kevin Pho, MD, an internist in private practice in Nashua, N.H., launched a blog to discuss breaking medical news. At first, his expectations were low.

Now, Dr. Pho’s blog, KevinMD.com, averages 310,000 page views per month. It has launched him to superstar status in the realm of physician bloggers. His online presence has expanded to popular social networking sites, including Facebook and Twitter, and he is regularly sought out for commentary in national media.

According to Dr. Pho, social media has made health care more transparent.

“By definition, social media encourages a two-way interaction, so it gives patients a voice. Not only can patients look behind the curtain and see what a physician thinks, but they can also respond to it,” he said. “There is a lot more interaction, and that barrier between the patient and health care provider has come down with the advent of social media.”

In the past, the physician was the sole controller of health information, but social media has changed this dynamic, according to Bryan Vartabedian, MD, a pediatrician at Texas Children’s Hospital who runs a blog called 33charts.com.

“The biggest thing that social media has done is to empower patients,” Dr. Vartabedian 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.”

A lot of inaccurate information exists on the Internet, and social media is one way for physicians to provide reputable sources of information to their patients, Dr. Pho said. Social media also provides an avenue for patients to give feedback on the physician’s viewpoints.

Kevin Pho

“Having that guidance on the Internet is tremendously helpful for both the physician and the patient,” Dr. Pho said. “If patients don’t like what you have to say, they’re more inclined to say so via social media. Seeing things from a patient’s perspective is definitely illuminating, and it helps me become a better doctor.”

Rob Lamberts, MD, a primary care physician in Augusta, Ga., until recently maintained the blog Musings of a Distractible Mind (distractible.org), through which he talked about a variety of issues, not just medical topics. Many people, including physicians in academic medicine, do not understand the issues unique to private practice, where physicians see patients all day, every day. He said his blog has given him the chance to state opinions on a scale that he never could have imagined.

“The biggest change is that patients are communicating with people other than their own doctors, including other patients with the same disease or other doctors with various viewpoints. People get a truer perspective of things,” Dr. Lamberts said.

Drawing the line

Although using social media has many benefits, the physicians who were interviewed said it is important to take many things into account when maintaining an online presence. Whether they are using social media as a personal or a professional network, there remain high standards of professionalism to which all physicians should adhere.

Dr. Vartabedian said that 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. However, interacting with patients in this manner via social media is not advised.

“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.”

Bryan Vartabedian

Dr. Vartabedian advised 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.

Dr. Vartabedian 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 people speak to their own ophthalmologists.

He does not, however, view all online communication as a liability. In fact, Dr. Devgan provides his e-mail 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 e-mails 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.

Privacy

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 ensures patients that their health information will remain confidential. But as careful as physicians may be in their social media realm, it is still possible for health information to be divulged unintentionally.

“Ironically, the whole issue of anonymous blogging is more dangerous than blogging under your real name, as it makes it seem like you would be freer to share private information,” Dr. Lamberts said. “The blogs I’ve read that are the most audacious, and that make me cringe from a privacy standpoint, are not those of the bloggers whose names are out there. They are the bloggers who feel safe behind the guise of anonymity.”

Dr. Lamberts compared communication on Facebook and Twitter to elevator talk and discussing patient information where other people can hear.

“We are taught through all of our training that we have to be careful what we say, especially in public places,” Dr. Lamberts said. “Twitter, for example, is a very dangerous place, and although you may not mention a particular patient’s name, there’s always the chance for misunderstanding.”

Dr. Vartabedian said physicians may say things on a social media platform that may be HIPAA compliant and not identify a patient by name. However, physicians need to go above and beyond the HIPAA guidelines and probably avoid the discussion of any patient-specific matters via social media.

“If I see a patient with a rare disorder, technically I could discuss the case on Twitter without mentioning the patient’s name,” Dr. Vartabedian said. “It may be HIPAA compliant, but ethically, if the mother of my patient saw that I had written about it in a public platform, how would she feel? I think it represents a serious breach in the relationship we share.”

On the other hand, not all physicians are so hesitant to discuss interesting cases online. Dr. Devgan, for example, posts photos and videos of challenging cases to his blog in order to elicit feedback from other ophthalmologists. He said outside perspectives are valuable because they can reveal the cause of a condition or a treatment option that he may not have considered.

Dr. Devgan’s social media behavior remains compliant with HIPAA guidelines because he does not mention patient names or discuss personal medical information publicly. However, it is clear that social media has complicated patient privacy issues, and more definitive guidelines may be necessary to determine what is and is not appropriate.

Getting involved

Physicians are encouraged to determine the goal of their social media presence, whether it is promoting their practice, promoting themselves and speakers, or advocating an issue they are passionate about, Dr. Vartabedian said. Once that is figured out, physicians need to 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. 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 Courtney Preston and Emily Shafer

Should private practices adopt their own social media guidelines?

• Uday Devgan, MD, FACS, FRCS(Glasg), can be reached at Devgan Eye, 11600 Wilshire Blvd., Suite 200, Los Angeles, CA 90025; 800-337-1969; fax: 310-388-3028; e-mail: devgan@gmail.com.
• Rob Lamberts, MD, can be reached at Evans Medical Group, 465 N. Belair Road, Suite 1B, Evans, GA 30809; 706-868-3100; e-mail: dr.rob.questions@gmail.com.
• Kevin Pho, MD, can be reached at Nashua Medical Group, 173 Daniel Webster Highway, Nashua, NH 03060; 603-891-4512; e-mail: kevinmd@gmail.com.
• Bryan Vartabedian, MD, can be reached at Texas Children’s Hospital, 17198 St. Luke’s Way, Suite 300, The Woodlands, TX 77384; 936-321-0808; e-mail: fox42@me.com.
• Disclosures: None of the physicians have direct financial interests in the companies or organizations mentioned in this article.