Stewart Morrison

LIKE it or not, social media is here to stay. Facebook, Twitter and YouTube (among others) have changed the way we communicate, with implications for our professional as well as personal lives.

The potential impact on medical professionalism led to the development, by the Australian Medical Association Council of Doctors in Training, New Zealand Medical Association Doctors-in-Training Council, Australian Medical Students’ Association and New Zealand Medical Students’ Association, of Social media and the medical profession. These guidelines advise doctors about the potential hazards of engagement with various social media platforms.

The document was initially criticised for a failure to expound the benefits of social media. While these concerns were valid, the emphasis on professionalism was deliberate. At that stage, little had been written about the potential for social media to blur the boundaries between personal and professional activities.

There are now many examples of the effective application of social media in health care. It has brought a new dimension to interactions between health professionals, patients and the broader public.

Doctors are using social media to broadcast health advice, gauge patient sentiment and, in some instances, augment traditional models of care. There is also a well established role in public health and advocacy.

For patients, social media provides a vehicle to access health information, evaluate health care providers and connect with support groups. It is proving a powerful tool to increase health literacy.

There is an increasing amount of literature relating to social media strategy but most emanates from the corporate sector, which has adopted social media as a core marketing and communication platform.

Not all of this advice can, or should, be applied to the health care context.

Patients are not consumers. Purchasing a television is an active choice, but ill health is not. Funding models and behaviour patterns for health care are highly varied, but they rarely follow the classic model of “consumer-driven purchasing”.

McKinsey Consulting recently published an article titled “Demystifying social media”, which provides some interesting insights into how the corporate sector uses social media to engage with consumers.

While the article provides some relevant advice for practitioners of both medicine and social media, its central strategy of “monitor, respond, amplify and lead” does not translate perfectly into a health care framework.

The McKinsey piece describes Gatorade’s social media “war room”, in which various dashboards display real-time information on the company’s engagement with the online community. These systems of “monitoring” and “consumer sentiment analysis” are to be commended both commercially and technologically. However, there would be deep public concern if individual health disclosures were stealthily collected in order to influence market decisions.

A patient may be content to post health-related information on a message board for the purposes of peer support or knowledge acquisition, but they could reasonably expect that their data wouldn’t be “mined” and repurposed by another individual or organisation.

Notwithstanding that expectation, online health queries have been used constructively to enhance disease control efforts. Google flu trends is a frequently cited example.

The second plank in the McKinsey advice is “respond”, which encourages direct and reciprocal engagement with consumers. This may be a useful tactic for clinicians to employ in the privacy of a consultation room, but discourse over the public airways might be stretching the bounds of professional communication.

“Amplification” — using social media interactions to encourage consumers to disseminate a message — might work in a public health context, but cajoling patients to share their health experiences for ulterior gains raises serious ethical questions.

A “Post to Facebook” button might have a place in an online DVD store, but enticing a patient to share the histology of their recently resected caecal tumour is not exactly appropriate.

The final pillar of McKinsey’s approach is a call to “lead”, which encourages the use of social media to facilitate long-term behaviour change. Applied to health care, this strategy could be effectively used to reinforce positive health practices.

However, using social media to explicitly promote certain medical interventions such as surgical procedures or pharmaceuticals would challenge existing paradigms.

While these examples might be facetious, they are illustrative of the potential pitfalls in applying generic social media strategies to health care.

Social media will be as useful, or as harmful, as clinicians and health care organisations choose to make it. While the applications and benefits are clear, the cautionary messages in Social media and the medical profession remain relevant.

For those interested in the area, it is worth interrogating #hcsmanz on Twitter. It provides a useful insight into the local “buzz”.

Dr Stewart Morrison is an orthopaedic registrar with an interest in social media and eHealth. Dr Rob Mitchell is an emergency registrar at Townsville Hospital and immediate past chair of the AMA Council of Doctors in Training.

Posted 10 September 2012

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