While social media and its intersection with medicine may evoke both interest and anxiety among physicians, medical organizations are paying increasing attention to its potential. Therefore, I was not surprised to find that the American College of Chest Physicians, one such organization has been actively growing its social media presence recently, chose this topic for a plenary address at this year’s CHEST Conference. The keynote speaker was one of the most influential physicians on social media today, Dr Kevin Pho (left in picture). Pho was born in the United States, but grew up in Toronto, before returning to the U.S. to complete medical school and specialty training in Internal Medicine at Boston University, after which he set up practice in New Hampshire. His foray into social media began in 2004 when he created his medical blog, KevinMD.com, which subsequently has become one of the most prominent and popular examples of its type. He joined Twitter in 2007, where his presence has been equally strong, amassing 112,000 current followers.
Pho presented a compelling and entertaining case for why physicians need to participate actively on social media. Here are his reasons:
1. We’re way behind. Physicians in particular lag behind much of the rest of society in their adoption of social media. As Pho said, “A few years ago, the only people who had pagers were doctors and drug dealers. Today, it’s just doctors.”
2. Medical misinformation has become widespread as the public increasingly turns to the internet for answers. Pho summarized the problem aptly: “The internet allows people who took their last science course in high school to go toe to toe with experts”. He cites the pervasive myth of a link between vaccines and autism as a key example of dangerous misinformation that, despite having been completely debunked by physicians and scientists, continues to flourish online, where the voices of these experts are all too thin on the ground. The implications of Pho’s concerns are obvious: our key role as patient educators is being systematically undermined as technology has freed everyone to find information, reliable or not, much more easily elsewhere. Unless physicians begin to compete en masse on the same battleground, we risk being drowned out by myths, fears and vested interests.
3. People don’t remember evidence, they remember stories. Logical fallacies and erroneous conclusions about health can achieve public credibility because they are often wrapped up in a compelling story or anecdote. This creates an apparent dilemma for health professionals: having been trained in evidence-based practice, we know the biases inherent in anecdotes, yet it seems clear that we won’t win hearts and minds with facts and figures alone. Instead, recognizing that stories have more power for the public than evidence, we must share our own stories, with messages that are congruent with the evidence.
4. When physicians do engage online, we are powerful voices. Blogs, media articles and interviews by physicians tend to garner a lot of public attention and to be ranked highly by search engines like Google. And some physicians have become very creative at using popular forms of social media to make powerful health messages go viral. Pho cited the example of Dr Zubin Damania, a specialist in internal medicine based in Las Vegas who has become an internet celebrity by creating rap videos, under the name ZDoggMD, often with public health messages: a video about testicular self-examination, featuring Damania dressed as Michael Jackson (complete with sparkling exam glove!), has been especially popular. A less sensational homegrown example that comes to mind is the popular whiteboard videos produced by Toronto family physician Dr Mike Evans.
5. Social media can be a valuable and efficient tool for continuing medical education. Twitter, in particular, can be powerful in this way, as it allows the user to create curated lists specifically tailored to personal needs and interests. This allows physicians to follow key organizations, journals and thought leaders in medicine. My personal experience seems to confirm the value of this. I joined Twitter just over a year ago, rather reluctantly in fact, but motivated at that time by the intersection of my role as an editor with the expansion of CMAJ’s social media presence, and also by the creation of a Twitter spinoff of a monthly journal club for Respirology trainees that I have overseen for the last decade. Being a physician on Twitter has taught me several things. As I predicted, I have been unable to refrain from becoming an active contributor of Twitter content, which probably says more about me than about Twitter itself (many of my colleagues and trainees are content merely to follow). Twitter has enable me to make many pleasant (and a few unpleasant) and unexpected connections with people whom I otherwise would probably not have encountered. And I now get information faster than ever before on a whole variety of things that are important to me. I find this offsets the extra time spent every day checking Twitter: because it’s such a concise medium, you can learn all you need to know about many things quickly, but also flag those things you need to read about in detail. I find I actually keep up with the medical literature even better now than when I was limited to more primitive media like e-mail or (heaven forbid) print journals.
6. If physicians don’t join online media because they choose to, they will soon join because they have to. Pho argued that connecting with patients online is fast becoming a health care imperative. This rings true to me – it seems in the last few years more and more patients want to communicate with me by e-mail, requiring me to engage with the benefits and risks inherent in that.
7. Physicians must take control of establishing and protecting their online reputation. Pho advised: “Google yourself at least once a week and see what comes up. Because that’s what patients are seeing.” I took his advice. I was glad to see that my profile at CMAJ came up first, then my profile at the University of Toronto. Then a bunch of stuff I’ve published (I was a bit surprised that a 2009 piece on investing in health research came up highest among the editorials I’ve written – I learned something already). Then – wait a minute – a profile on me from an organization I’ve never signed up with, providing a fairly detailed description of my activities, all compiled from the web. All fairly positive and accurate, fortunately – except that it says I live in Maryland (huh?). A physician rating website comes up, but I have no ratings. Pho’s point is clear – we need to stay aware and take control of the face we present to the world, a world that is increasingly online and out of our direction, but not beyond our influence. He suggests that physicians start to shape their online presence by creating profiles on sites like LinkedIn and Google My Business.
8. Risks associated with online activity (i.e. that anything you post is public and persists indefinitely) can be managed with thoughtful use. Ensuring this is essential, however, and is congruent with our duties of professionalism and confidentiality. As Pho said, “We need to be as professional on the web as we are in the room in front of patients”. But he also argued that the biggest risk of social media is not using it at all, thereby failing to connect with and educate the public adequately.
9. Sharing stories online allows the public to see that doctors are human too. This may be an important way to recalibrate public perceptions of physicians and expectations of us by illustrating why we do what we do.
10. Using social media is a good introduction to learning to work with the media in general. Pho underscored the importance of this: “It is essential for physicians to develop media skills if we hope to have a say in health care.”
For physicians seeking further guidance about how social media affects them, Pho has published a book entitled “Establishing, Managing and Protecting Your Online Reputation”. A unique and reader-friendly handbook, its topics range from how physicians should create our digital footprint to how we can connect and be heard to make a difference in health care.
Pho is right – we need to embrace social media, whether we like or not. Once we do, we probably will like it. And both we and our patients will be better off for it.