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Social media: Orthopedists discuss its role as surgeon’s friend, foe or both

Issue: April 2012

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Introduction

Social media is a component of the information age that has transformed our lives, and the popularity and usage of this technology is growing. Younger physicians in particular are likely to investigate possible useful roles for social media in their professional practices. Physician participation in social media presents novel opportunities that can enhance our professional lives and improve communication. On the other hand, as with any technology there are attendant risks.

In this Orthopedics Today Round Table discussion, orthopedic surgeons with expertise in social media offer their insights and perspectives concerning physician participation in social media. The goal of this presentation is to educate and inform readers so that effective and safe use of social media technology is possible, while minimizing risks. Your comments and views are most welcome.

B. Sonny Bal, MD, JD, MBA
Moderator 

B. Sonny Bal, MD, JD, MBA: When you think about social media and orthopedic surgeons, what particular websites or resources come to mind that would be of interest to our orthopedic colleagues?

Adam D. Soyer, DO: The websites that I have found most useful include www.aaos.org and www.beckerorthopedicsandspine.com. The American Academy of Orthopedic Surgeons (AAOS) has been actively developing new products in social media platforms for its membership. Becker’s website provides the latest information on the practice and business of medicine. For professional networks, www.orthomind.com is a leading orthopedic social network.

There are numerous specialty-specific online forums (e.g., hand) as well as state medical society forums with restricted access requiring membership.

Shawn W. Palmer, DO: Orthomind.com is the only social media outlet I utilize as an orthopedic surgeon. There must be a protected environment that ensures confidentiality while also allowing for open exchange of ideas that can be challenged when necessary. The use of open sites, such as Facebook or LinkedIn for anything more than general advertising of a practice website, seems loaded with risk.

Howard J. Luks MD: At its heart, digital or social media is about people. It is about relationships, and it is about communication. Establishing a digital media presence, rooted as a social media presence is about educating, engaging, growing your audience, improving outcomes, improving compliance and potentially improving the bottom line of your practice.

The objectives of each orthopedist who chooses to establish a presence in social media are going to vary. As such, we will have colleagues who are interested in “inbound” objectives, “outbound” objectives, educational outreach, reputation management or simply advertising their services. The websites or online resources available are plentiful and would depend on the orthopedist’s underlying goals.

For online collaboration and education among colleagues, by far the best resources available are Orthomind and Doximity. For those who seek to educate patients, improve their online reputation, humanize their organization and foster their relevance – then an online website or blog with deep Web 2.0 integration with Facebook, Twitter and YouTube will prove invaluable. Websites such as HealthTap, ShareCare and Avvo also provide orthopedists with the ability to increase their online presence, educate the population at large and potentially even drive traffic to their office based on the geolocation services available on these sites.

Jon Hyman, MD: When I think the of term “social media” I think of two types of websites. The first, and more popular type, is for the general consumption of content. So you have good resource sites that host videos like YouTube, VuMedi and AAOS, or host largely text-based information like Orthopaedia and Orthogate.

The second type of “social media” site that would be of interest to orthopedic surgeons is less about content and more about collaborative practice communities. Such sites include Sermo and Doximity for the general physician community and OrthoMind.com for orthopedic surgeons.

Orrin I. Franko, MD: With regard to orthopedic social media, the most developed site is www.OrthoMind.com, based on its restricted access limited to orthopedic surgeons. General social media sites, such as Twitter and Facebook, are popular sites with orthopedic content as well. One study I performed examined the presence of orthopedic surgeons on Twitter and found that while a minority of orthopedists are self-identified on Twitter, an active orthopedic community does exist (www.ncbi.nlm.nih.gov/pubmed/22050252). However, other general medical social media sites, such as www.Sermo.com, have been focusing on expanding their orthopedic users.

Bal: What particular concerns or risks do you foresee related to our orthopedic colleagues participating in social media today? What particular benefits of social media might apply uniquely to our profession?

Soyer: The greatest concern I have with our orthopedic colleagues participating in social media is that they will develop a degree of comfort with their responses, become too cavalier and potentially violate privacy and HIPAA regulations. My other concern would be physician participation in nonprofessional forums where the distinction between patient/physician relationship and neutral commentary is unclear resulting in liability issues.

Social media is a powerful resource and can benefit orthopedic surgeons in several ways:

First, social media can be used to improve our practices’ marketability by establishing a web presence. Second, social media can improve our clinical practice through professional discussion forums. Third, social media will enable nonclinical professional networking that will provide resources to improve the business of medicine. Finally, social media participation will provide us with insight into the rapidly changing health care environment, which can be then used to improve health care delivery.

Palmer: Risks of social media deal mostly with confidentiality — not just with patient information, but with the disclosure of outcomes that may be considered adverse. The benefit of being able to obtain a “curbside” consult with hundreds of colleagues from across the globe is also the risk of exposing a poor outcome that could be used for harm to a reputation or worse, such as for legal liability gain.

Luks: As someone who has enabled and prepared a number of orthopedic surgeons for a digital media presence, a clear set of roadblocks or concerns have emerged that are usually rooted in a lack of understanding of what a social media presence entails. The basic tenet of a social media presence is engagement. This requires proper off-line preparation and a significant amount of due diligence before you decide to venture online. You need to determine who in your office is going to participate in your initiative, what your message is, who your audience is and what is going to serve as your anchor, foundation or homebase. You also need to determine whether you are going to produce original content, who is going to manage the preparation of that content, review the content and, perhaps most importantly, who is going to monitor the various social media properties you reside on so that you can address any questions or comments that arise. One of the worst mistakes you can make when venturing online is to forget to engage the audience you are seeking to reach.

While there are a number of roadblocks or potholes that exist when seeking to establish a digital media presence, with the proper degree of preparation, they are easily handled. When preparing for a social media presence, your office must prepare a concise and clear set of guidelines. Anyone who will be allowed to interact on your social media properties must clearly understand the privacy laws that exist and the information they are allowed to share.

Hyman: Let me mention the benefits first from what I have observed first hand. In a site like OrthoMind.com for example, many surgeons privately and efficiently discuss the business of orthopedics, challenging cases, research questions, medical device issues, surgical techniques and practice management. By allowing surgeons to do the same things they do in their practices: stay current with literature, CME opportunities, rate and review orthopedic products and services and so on, they have realized increasing value by interacting online.

The primary perceived risk is time. Engaging in social media can take time, but it does not have to be burdensome. The current web tools have made interacting with peers online efficient and streamlined. But as long as surgeons have limited time and the false perception that these sites consume their time instead of saving them time, they will remain apprehensive.

The secondary perceived risk is compliance. Many surgeons are concerned about how they expose themselves legally by sharing clinical information online. There are many ways to collaborate without disclosing patient-specific identifying information, yet surgeons are reluctant in our heavily litigious climate.

In my opinion, both of these risks are well managed by offering surgeons monitored platforms that enable fast, efficient and HIPAA-compliant interaction. These tools exist and are in use.

Franko: In our increasingly mobile society, surgeons may find it more difficult to find time to discuss issues, concerns and topics with colleagues that go beyond a patient’s exam room. Thus, social media outlets can facilitate the distribution of information (articles or newsletters) to a massive and relevant audience instantaneously. Surgeons are then provided with a platform to discuss and share their opinions among colleagues. This offers an unprecedented opportunity to create an online community, if used correctly. As hospitals, practices and insurance companies continue to consolidate and gain power as bargaining bodies, surgeons will have no choice but to do the same.

Concerns and risks include the fact that digital communication only works if used appropriately. Meaning, we as a society are slowly learning how best to use discussion forums and live feeds to ensure that posts are relevant, appropriate and constructive. When anonymous individuals begin trolling (deliberately posting a provocative message with the intention of disrupting the conversation) on message boards, the utility drops drastically. In addition, surgeons must be aware of which social media outlets are private, limited or public. While obvious HIPAA violations are not too common, surgeons must also be aware that their reputations and personal security may be at risk.

Bal: Do sites that restrict access to a particular profession or to a particular class of people offer more protection and privacy for professionals wanting to participate in social media?

Soyer: I would say, conceptually, yes. Engagement in social media can be mutually beneficial to a focused group with similar backgrounds, experiences and levels of expertise. There should be a certain sense of security within these interactions. However, unless there is anonymity, the participants cannot be assured that their responses will not be used maliciously. Anonymity, unfortunately, defeats the purpose of this professional discourse since the participants usually are interested in the reputation and experience level of their responders.

I have read cases of attorneys ‘phishing’ social media forums for information that would benefit their cases. Even if the social media forum is restricted, we cannot be certain that our discussion group peers are not participating for the sole purpose of gathering information for legal reasons (i.e., orthopedic surgeons testifying against orthopedic surgeons in malpractice cases). Therefore, despite access restriction, I still recommend that participants in social media exercise caution in their engagement and only use trusted sources.

Palmer: Restricted access is critical for the use of social media as a professional tool. If anything other than general advertising is to be accomplished, there must be the ability to know exactly who is in your online community.

Luks: I personally feel that there is a tremendous opportunity for specialty or profession specific sites such as Orthomind and Doximity. Physicians need a venue or online platform where they can discuss issues that clearly should remain behind a firewall and protected from the public’s view. That being said, we must not be misled into thinking that we do not need to obey privacy laws. One should never mention anything online that you would not want your worst enemy or the patient in the next room to hear you saying.

Hyman: In general, yes. Obviously the more limited the community, the more narrow the areas of expertise. In this context, staying smaller and more secure has some real merit. Some sites boast of privacy or physician-only exclusivity, but they are actually ‘open’ and do not employ a verification process. This lack of true protection has allowed rapid growth in numbers of members, but many of those members are not truly physicians. Since doctors have unique risks and responsibilities, it is particularly important that physicians can trust the integrity and security of the site and feel comfortable with those in the online community with them.

Having a global community is useful, and international membership fosters education for example, cultural nuances and variations in practice. However, it is still valuable to U.S. surgeons, for example, to have a large proportion of other U.S.-based surgeons with whom to collaborate in particular, as it relates to health care reform and the business of orthopedics.

Franko: Absolutely. I think the discussions within private vs. public sites are dramatically different. This is based both on the comfort of the individual posting (knowing who will be reading their posts), as well as the content of the feed. If surgeons suspect that posts are being created by individuals who may not be a medical professional, this influences their decisions to participate in the conversation. Even discussions among orthopedic surgeons alone vs. a group of physicians that includes internists and emergency providers can be dramatically different. I think it is important that surgeons have a “safe space” to discuss their profession privately and among peers. While the public is often critical of how much privacy exists in the “virtual” realm, I think we are all learning to trust online forums to a greater degree.

Bal: Where do you see the future of social media in terms of the professional lives of our orthopedic colleagues?

Soyer: I believe that social media will continue to become increasingly important in our clinical and nonclinical/business practices. Social media will be instrumental in influencing the change in the direction of health care to a more patient-centered model. Ideally, this model will improve health care delivery while improving practice efficiency and outcomes.

Presently, our patients are actively engaged in social media and they continue to have a major impact on our professional reputations. It is conceivable that our future success may hinge on our online reputation. Changes in health care that will require quality metrics and outcomes reporting for reimbursement will result in more of our professional data becoming available to ePatients. The dissemination of this data in social media forums has the potential to adversely affect physicians’ reputations depending on interpretation. As a result, reputation management will become an important component of our future social media campaigns.

Palmer: In my practice of nine surgeons, we have found tremendous benefit to our own internal “social media.” The ability to text a photo of an X-ray while on call or send out a group email with daily updates on patient concerns, office needs or hospital rounds has made a tremendous difference in efficiency and patient satisfaction. I no longer have a mailbox stuffed with weeks-old memos. I get messages instantly and often return patient calls or report test results within minutes rather than days.

Luks: More than 1 billion people simply cannot be wrong. The most commonly “liked” objects on Facebook right now are medications. The largest growing demographic on Facebook are women older than 40 years. Recent surveys have clearly shown that upwards of 75% of patients are researching their physicians and/or institution and disease process prior to arriving at our offices. A recent poll of patients revealed that the quality of the content and appearance of our websites entered into the patients’ decision-making process as to whether or not they were going to call the offices for appointments.

Every week, there is another disease-specific, patient-centric website appearing on the Internet. Patients are discussing their diseases, and they are talking about us. It behooves us be part of this discussion. It is imperative that we seek to provide useful content, control our message, foster our relevance, observe, maintain and manage our online reputation, and learn about any brewing firestorm long before it has an effect on the bottom line of our practice.

Many patients are becoming web savvy. They are being turned off by much of the commercialized nonsense that exists online today. They are hungry for information, and they are searching for it. Whether we agree with this trend or not is not particularly relevant. Patients are searching for information on Facebook. They are interacting with one another on Twitter. About 12% to 15% of patients who enter my office mention the Internet, Facebook or my website as the reason why they are present in my office.

A properly constructed web presence will also enable numerous efficiencies that will contribute to the bottom line of your practice as we face ongoing fiscal instability in the health care space. Patients who have actively explored your website, watched your videos and read through your comments and content will be prepared for their visits. This will result in a far more effective and efficient visit, and will also contribute to improving the patient’s experience — and thus, their desire to recommend you to their friends and acquaintances. I personally feel that to ignore the intersection of health care and social media, is to ignore your own potential relevance as a health care practitioner during the next decade.

Hyman: Social media platforms will play an increasing role in our practices. These tools are paradigm shifting and in some ways disruptive technologies, analogous to other tools/tech that were slowly adopted in orthopedics such as artificial joints, the arthroscope, orthobiologics and others.

Unlike scalpels and drills, these Internet media tools do not dull with time. They get sharper and more beneficial the more we use them. “Social media” tools are already becoming an extension of the exam room, board room, operating room (OR) and OR lounge. Tools like iPads, OrthoMind.com, Skype, data clouds and others are ultimately going to make our professional lives and our patients lives better.

Franko: I think the modern pressures facing physicians require individuals to connect, discuss and collaborate with colleagues but simultaneously discourage communication via time constraints and over-committed schedules. Thus, I think social media will serve as the platform that allows physicians to connect with each other, develop strong networks and communicate in ways that would not otherwise be possible. This applies to busy surgeons to an even greater degree based on the rapid pace of technological development.

For more information:

• B. Sonny Bal, MD, JD, MBA, is an associate professor of hip and knee replacement in the department of orthopedic surgery, University of Missory School of Medicine. He can be reached at Missouri Orthopedic Institute, 1100 Virginia Ave., Columbia, MO 65212; 573-882-6762; email: balb@health.missouri.edu.
• Orrin I. Franko, MD, is a third year orthopedic resident at University of California, San Diego. His interest in technology and social media has resulted in peer-review publications examining smartphones, tablets, and Twitter among orthopedic surgeons. He is the founder of www.TopOrthoApps.com, a website dedicated to reviewing mobile apps for orthopedic surgeons, and he serves on the board of www.OrthoMind.com, a social media website for orthopedic surgeons and residents. He can be reached at orrin@toporthoapps.com.
• Jon Hyman, MD, is an orthopedic surgeon specializing in Sports Medicine and Hip Arthroscopy. He can be reached at 3903 South Cobb Drive, Suite 220, Smyrna, GA 30080; 770-363-8770; email: hymanteam@gmail.com.
• Howard J. Luks MD, is an external Board Member for the Mayo Clinic Center For Social Media and Chief Sports Medicine, Principal at Symplur.com and an Associate Professor of Orthopedic Surgery at New York Medical College. He can be reached at University Orthopedics, PC, 19 Bradhurst Ave., Hawthorne, NY 10532; 914-789-2735; email: hjluks@gmail.com; Twitter:@hjluks www.hjl20.com
• Shawn W. Palmer, DO, is a joint replacement surgeon at Midwest Bone and Joint Institute 2350 Royal Blvd., Suite 200, Elgin, IL 60123; 847- 931-5300; email: drswpalmer@gmail.com.
• Adam D. Soyer, DO, can be reached at Department of Orthopedic Surgery, Mid Hudson Medical Group, PC, 30 Columbia St., Poughkeepsie, NY 12501; 845-202-6066; email: asoyer@mhmgpc.com.
• Disclosures: Bal serves on the corporate board of OrthoMind.com; Franko is on the board of OrthoMind.com; Hyman is a teaching consultant for Smith & Nephew and is on the advisory board of OrthoMind.com; Luks has financial disclosures with Principal, Symplur LLC and HJL20.com; Palmer and Soyer have no relevant financial disclosures.