There is considerable debate in medical circles as to whether healthcare practitioners should embrace social media, but online aficionados say they welcome the opportunity to exchange information, educate, connect, and potentially attract more patients.
By P.K. Daniel
Type “orthopedic surgeons” in the Twitter search window and “Dr. David Geier” is featured at the top of the results page. He’s approaching 5000 followers and has tweeted more than 10,000 times. The Charleston, SC-based orthopedic surgeon and sports medicine specialist has this branding and social media thing down.
Geier has company. Nearly three-quarters of the 275 million Americans online use a social networking site of some kind. And he has an audience. Of those online, 72% use the Web to find health and wellness information.1 The figure is even higher–82%–for adults aged 50 years and older seeking medical answers.2
However, as a healthcare practitioner Geier represents a small demographic. Less than a quarter of physicians use social media on a daily basis for professional purposes.3 Even fewer are tweeting. Just one in 20 physicians uses Twitter in a professional capacity, according to a June survey by MedData Group.4
A 2012 survey conducted by the Journal of Medical Internet Research found that 117 (or 24.1%) of the 485 physicians who responded used social media to scan or explore medical information on a daily or more than daily basis, whereas 69 (14.2%) contributed new information on a daily basis. On a weekly basis or more, 296 (61%) scanned social media sites and 223 (46%) contributed to them.5
According to the Journal of Medical Regulation, there were 850,085 active physicians in 2010 in the US.6 And yet, just over a thousand are registered with TwitterDoctors.net, a database of physicians who tweet. While only 5% of all US physicians use Twitter for professional purposes, nearly one-third, or 32%, use LinkedIn, 21% use Facebook, and 10% use Google+. Twitter ranked even below YouTube, which is used by 8% of US doctors.7
To tweet or not to tweet?
There is considerable debate in medical circles as to whether physicians and other healthcare practitioners should embrace social media as a platform to explore and exchange medical information. Patient privacy (and complying with Health Insurance Portability and Accountability Act regulations) was the reason most cited by those physicians who are not using social media in the MedData Group survey.
Other reasons included concerns about time, liability, unfamiliarity with social media, and viewing it as having little value professionally.
“Unfortunately, not many of my colleagues are very active on Twitter,” said Sylvia L. Czuppon, PT, DPT, OCS, who is an assistant professor of physical therapy at the Washington University School of Medicine in St. Louis, MO. “Part of this is fear of the unknown, fear of being misrepresented, and not understanding the power of social media for patient and community education.”
For confidentiality reasons, Czuppon tries to avoid direct contact with current or former patients, although admittedly she has a few Twitter followers of this type.
But with nearly 200 million Americans looking online for information about their doctors, their diagnoses, and their treatment options, online aficionados say it’s an opportunity for healthcare providers to exchange information, educate, connect, and, potentially, attract more patients.
“[Patients] are paying attention to our digital presence–or online reputation,” said orthopedic surgeon Howard J. Luks, MD. “Having a digital presence is far more important for a physician than having a social presence. Having a website that is full of timely, interesting, and actionable information is what our patients are seeking and what they deserve.”
Luks, who is associate professor of orthopedic surgery at New York Medical College and chief of sports medicine and arthroscopy at Westchester Medical Center in Westchester, NY, has been active in digital and social media for about seven years. His website, which includes his blog, gets nearly 140,000 unique visitors each month. He has more than 16,000 followers on Twitter and has tweeted almost 37,000 times. He also has a Facebook Fan Page and is on LinkedIn, YouTube, Google+, and Vimeo.
A common theme among some proponents of utilizing social and digital media in healthcare is consumer education. A fringe benefit is added exposure for the practitioner.
Luks, who serves as an advisory board member of the Mayo Clinic Center for Social Media in Rochester, MN, said serving the educational needs of the public through his digital and social media presence has had a significantly positive effect on his practice and his reputation. Notably, he was named one of the Top 10 Social Healthmakers for Osteoarthritis by Sharecare, an online health and wellness engagement platform.
“Our increasingly [digitally] interconnected society has chosen social media as the means of sharing relevant information about food, friends, news, illnesses, doctors, and hospitals,” Luks said. “Therefore, the role of social media and a digital presence is changing constantly.”
Julie Eibensteiner, DPT, owner of Laurus Athletic Rehab & Performance in Minneapolis, MN, has an affinity for Facebook because of its relative ease of posting educational information for patients in a user-friendly manner. However, she also has found a home on Twitter. She has tweeted 17,000 times since joining in 2010 and has more than 2500 followers.
“The education piece is huge on the rehab side of things, and the more often you can get [information] in front of patients that connects with them, it’s a good thing,” Eibensteiner said. “Your patients can get to know your personality a little bit better while still maintaining professionalism. That helps build good relationships and rapport with your patients, which is another big piece of a successful rehab.”
Czuppon also sees social media’s role in orthopedics as a tool with which to educate, communicate, and collaborate.
“I think there is a great opportunity to educate the public regarding topics such as the importance of exercise, injury prevention, and rehabilitation,” she said.
More than half—57.5%—of the Journal of Medical Internet Research study respondents perceived social media as beneficial, engaging, and a good way to get current, high-quality information.5 Also, 57.9% said social media enabled them to care for patients more effectively, and 60% said it improved the quality of patient care they delivered.
“I think social media and any form of communication is important,” said Geier. “In sports medicine, we are devoting more efforts to preventing sports injuries and not just treating them once they occur. If we can communicate these tips for athletes, parents, and coaches to prevent injuries in sports and exercise, we should. Social media helps us reach many more people than we can in our clinics.”
Geier also sees the importance of interacting with the public online, whether it is with colleagues in the same field or with potential patients. However, he is cautious about interacting with current patients, and instead refers them to traditional methods of communication through his practice.
“I do think providing the public with health information discussed in easy-to-understand language from a qualified medical professional is extremely valuable, as a huge percentage of adults go online looking for health information,” Geier said.
Although Geier doesn’t use social media for patient interaction, he says he has patients who have chosen him after reading his articles online or listening to his podcasts.
“They often tell me that they liked the way I explained injuries and surgeries, and chose to see me for that reason,” he said. “In that sense, it does help potential patients develop a relationship that can one day become an effective doctor-patient relationship.”
Geier attributes, indirectly, an increase in patient volume to his social media efforts.
“I don’t use my website or other social media accounts to promote my practice or to convince people to choose me as their orthopedic surgeon,” he said. “[However], the articles I write and post on my website help people learn how I discuss injuries, so they often become comfortable with me and choose to see me when they need a surgeon down the road.
“Plus, my efforts writing articles on my website and recording my podcast have led to other opportunities, such as my regular newspaper column for the newspaper here in Charleston and regular TV and radio interviews. I expect those opportunities have increased requests for appointments as well.”
Angela Smalley, MS, BOCPD, COF, who is in private practice in the Buffalo, NY, area, is the author of the “Walk well stay well” blog. She, however, is not too concerned about recruiting new patients from her social media endeavors.
“My current patients tell me that they appreciate the fact that my posts are not just commercials for my own business but are more general information that they can find useful,” Smalley said. “Prospective patients can reference my writing and tweeting as evidence that I am maintaining and constantly updating my knowledge. They can therefore feel confident that their treatment will reflect the newest and best techniques available.”
Besides the ability to impart such information to the public and potential patients, digital and social media is a networking and educational breeding ground for medical professionals.
“I have gotten a chance to interact, discuss, learn, and have my brain stretched from people I would never have otherwise met,” Eibensteiner said. “It’s been extremely positive.”
Czuppon sees the potential impact of social media on healthcare and views this new tool as a “great opportunity to connect with researchers, practitioners, and academics across the globe to spread ideas, encourage collaboration,” she said. “I think this facilitates how quickly we can progress in the field.”
While Czuppon originally joined Twitter to just see what all the hype was about, she quickly found that she could connect with people interested in similar areas of interest—anterior cruciate ligament injuries and other sports injuries, and particularly injury and reinjury prevention.
“And not just in the US, but across the world,” she said. “I think we often get trapped in our own ideas and practice bubbles, and Twitter was a fantastic way to break loose from this and consider other approaches to treatment.”
Eibensteiner also uses Twitter for information gathering and interaction with others.
“I learned very quickly if I followed credible accounts I would have instant access to current research and interactions with those in my field and complementary fields without having to go through lit searches,” she said. “Instead of having to cast a wide net to see what’s being said about your area of research, it is a lot easier when a lot of the most recent research shows up on your computer screen or phone simply by getting on Twitter and checking the newsfeed during the day. It is such a time saver and invaluable for a clinician seeing patients daily as well.”
Smalley values the interaction with other practitioners and the discovery of new research trends that social media has provided. She also said social media has the added benefit of being able to position a business, or the practitioner in private practice, as a subject-matter expert.
“This is achieved through sharing information with other professionals, creating accessible resources for patients, [and] carefully considering the impression that is created by each social media interaction,” she said. “This allows referral sources to understand your area of expertise.”
Luks’ echoed that sentiment. “[Social media] can bring you the attention you are seeking on a particular injury or topic,” said Luks.
Tricks and tips
To best position oneself in the spheres of Twitter, blogging, and the like, and reap the benefits, the key is knowing the tricks of the trade. The tip that gets the first nod is time. For the 51% who cited time limitations as a challenge, seasoned user Geier says to make time. He spends 10 to 20 hours per week writing articles, a newspaper column, and his blog (“Sports Medicine Simplified”), producing podcast episodes, tweeting, and posting to Facebook.
“In terms of time management, I would point out that we are all busy with patients in clinic and surgery and hectic personal lives,” said Geier, who also is the chair of the public relations committee for the American Orthopaedic Society for Sports Medicine. “We can all find time to write blog posts, interact in TweetChats or participate in Facebook discussions, but we have to make the time.”
Geier’s six tips for the online practitioner:
- Discuss interesting or difficult cases
- Be aware of what’s trending
- Promote local health events
- Participate in TweetChats, and
- Share health information with a larger audience.
Luks advised avoiding such topics as politics and protected health information. Luks said he tries to make sure his blog includes information relevant to both consumers and his colleagues. He recently chimed in on a hot-topic discussion about icing with a blog titled “To Ice or Not To Ice.” Earlier, he addressed a concern of many athletes: “Can I Return to Sports After My ACL Reconstruction?”
“Newsjacking,” which is injecting one’s ideas into a breaking news story to generate media coverage and social media engagement, can be a very useful tool when entering the social sphere or blogging.
In a good use of newsjacking, the Radiological Society of North America capitalized on the blackout during the 2013 Super Bowl with its Facebook posting that read: “Well, at least radiologists can work in the dark. #superbowl13.” It got people talking, as well as 700 likes and more than 400 shares.
“With Twitter, it’s simple to ‘schedule’ tweets, and because of the one-hundred and forty character limit, it’s pretty easy to quickly convey a message,” Czuppon said. “However, this simplicity also can lead to easy misinterpretation of statements.”
Because she works for an academic institution, Czuppon says she has to be careful that the statements she makes are not construed to be the beliefs of the university or her clinic, but are her own. And, like many individuals, she has both a personal and professional Twitter account.
Geier manages his accounts himself. However, he hired consultants to set up his website, and again to redesign it.
“I oversee all aspects of what I do on my website, podcast, and social media accounts,” he said. “I do have a virtual assistant that helps to post my blog posts on my site and schedule the tweets that I write, but I create all of the content. In my opinion, there is value in working with a marketing consultant to help physicians get started and set up the website and accounts, but they need to learn how to do it themselves and not completely delegate it to a consultant.”
Because Smalley uses each social media interaction as a learning experience, she doesn’t use a social media consultant.
“I am the one that needs to know what it going on,” Smalley said. “I have worked for a few organizations that chose to assign this task to a ‘marketing’ staff member. I felt that the content was often inferior because the staff member was not the expert in the subject matter. Online content is often much more permanent and pervasive than people realize. I feel that it is super important to represent myself, rather than passing along that responsibility.”
Smalley said she spends about an hour each day maintaining a presence on Twitter and answering comments on her blog.
“I link my blog posts and some tweets to my Facebook account to keep postings fresh there as well,” she said.
Robert J. Butler, PT, PhD, is an assistant professor of physical therapy at Duke University School of Medicine in Durham, NC. While hesitant about the practice, he said the responsibility of managing social media in his department is a shared one.
“It is a slippery slope placing marketers in charge of topics associated with promoting evidence-based practice [EBP], since EBP is not as attractive as the recent story on the five best things you can do to cure pathology X,” said Butler. “We try to have a collaborative approach where we promote the areas that differentiate us in the marketplace along with the topics that provide a lot of activity on social media.”
Healthcare social media consulting company Symplur is working to make Twitter more accessible for the healthcare community through the creation of the Healthcare Hashtag Project. It is the first directory of healthcare-related Twitter hashtags and chats. It’s a streamlined resource for academics, healthcare practitioners, patients, and others. For example, entering “orthopedics” in the search window provides several Tweet hashtag suggestions, including
#socialortho, which happens to be an alert about a Tweet Chat called Social Media Saturday co-moderated by Geier.
For the medical professional who is apprehensive about “socializing” publicly, there are several physician-only online communities, such as orthomind.com and doximity.com. They tend to be viewed as safer while also providing a higher-quality source of medical information than the more public applications such as Twitter, LinkedIn, or Facebook.
There are thousands of members on orthomind.com, which was created by orthopedic surgeons and restricted to orthopedic surgeons. The platforms allow orthopedic surgeons to collaborate privately and share information, such as emerging trends.
Forty percent of US physicians use doximity.com, the largest medical network. The platform enables physicians to “connect with other healthcare professionals, securely collaborate on patient treatment, grow their practices and discover new career opportunities.”
There are also numerous specialty-specific online forums, as well as state medical society forums with restricted access requiring membership.
The amount of information available on social media exceeds the cognitive capacity of any one practitioner, but the benefits of social media can also feel very personal.
“By having a network of like-minded individuals or people who share a common goal, we may serendipitously encounter an article or discussion about an injury pattern that we find interesting,” Luks said. “Any time a patient gets a chance to learn that we are people, too—that we share common issues, goals, and events to celebrate—it closes the gap that exists in the patient-physician relationship. It can foster trust.”
Follow P.K. Daniel on Twitter at @pkdaniel.
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