Health care social networking basics for doctors

Originally published in HCPLive.com

by Enoch Choi, MD

Patients have embraced social networking tools that allow them to share information, offer support, and compare healthcare experiences. Physicians should also use these tools to connect with their patients and local communities and provide general medical information.

Health care social networking basics for doctors Healthcare social networking has made impressive inroads into the mainstream, as like-minded folks find each other online and chat about their passions. From politics to personal, from professionals to patients, the Internet has exploded with people talking about their health and healthcare. Perhaps the economic downturn has rekindled peoples’ appreciation for those things that make life worthwhile—our families and communities—and refocused their interest in improving their health. I know from personal experience that a great shock can help you value what you have more—I recently successfully resuscitated an acquaintance’s child from near drowning and have been hugging my children every chance I get. I see friends reacting to the economic downturn in a similar fashion, reinvesting in their health as they watch their 401(k) and housing values shrink. Many of them are participating in online discussions as part of their investigations into how to improve their health.

President Obama’s proposal to overhaul the healthcare system unleashed a torrent of activity on e-mail lists, blogs, Facebook, and Twitter as citizens think that this time, something may really change. What’s amazing is that this energy has not been unique to the online space. You know that people are really worked up when they vote in record numbers and when large numbers of citizens show up to support or heckle in town hall meetings. This shows how effective online organizing can be; we’ve crossed the chasm from silly flash-mobs to impacting politics-as-usual. Maybe healthcare social networking isn’t just all talk.

Connecting online
Social media and social networking are not only about politics; they can also be about actual medical care. As people use social networks to ask about health, they find others with the same conditions, and at the same stage of treatment. Most folks are asking about what they can expect in terms of prognosis and possible complications. People tend to talk about common illnesses in public spaces like blogs and Facebook, but for more complex conditions, some patients often prefer private e-mail lists such as Yahoo Groups, where they feel more secure to reveal details. Others get very specific in public forums about how a particular treatment or medication could help them with their symptoms. Some patients choose to record online diaries that contain detailed data about their treatment and response, through online resources such as Google Health, Microsoft HealthVault, PatientsLikeMe, and personal health applications at MedHelp. With the latter two, records can only be viewed with the user’s consent; information stored in Microsoft HealthVault and Google Health is completely private.

The healthcare social networking format that I see used most often is quick updates from friends on their Facebook or Twitter pages announcing that they’re sick, which prompts other friends to offer comfort and suggest remedies. I’ve taken to commenting as well, offering suggestions on what friends can do at home to help with colds and other minor injuries. This is the same kind of health education you can find from books like the , or iPhone resources such as Medzio, but tailored specifically to what my friend has said online. I don’t practice medicine online—I don’t diagnose or prescribe or tell them what to do. I offer options based on their symptoms and point out things they should be more concerned about. It’s like what I imagine happened when our communities were much smaller and folks knew their local doc and asked quick questions at the grocery store or at church. Now, it happens online with more depth in places like the “Expert Forums” at MedHelp.org and at Yahoo Answers, where you can ask physicians these kinds of questions, sometimes for a fee. The great thing is that all of these conversations are archived publicly, enabling anyone with these conditions to benefit from reading about them.

I see the most questions of this sort in private e-mail lists, such as the Palo Alto Menlo Park Parents Club, where more than 4,000 parents with children up to age five ask each other about local providers and how they care for certain illnesses. These parents with kids younger than elementary school age don’t yet have PTA networks on which to rely, and many of them have recently moved to the area and are looking for testimonials from like-minded parents. As providers realize that their reputation can be made or broken online, they’re starting to engage and respond to questions and complaints in these online venues. My own experience is that parents come and seek me out for urgent care since they know that I’ve been open online and am trusted by that community.

Spread the word
Healthcare social networking can be particularly effective in getting the word out about hot-button public health topics. Information about H1N1 (the artist previously known as “swine flu” before being hog-tied), has flowed so much more freely than information about SARS did seven years ago. This time, the CDC updated its website regularly and provided webinars and conference calls for physicians and the public. Even local health departments started using Twitter to tell folks about the rapidly changing response. From this information, local schools and parents could understand the real risks involved (not terrible to date, thank God) and avoid further school closures and panic. I tweeted and used my Facebook updates to share guidelines for when it is appropriate to come in to be seen for urgent care, since so many people were coming in with very mild symptoms without fever, or with no symptoms at all, just because they’d recently traveled to Mexico.

Using social media to spread the word about public service announcements is particularly potent. I recently posted a shocking video depicting a gruesome accident due to texting while driving. In just a few minutes, hundreds of my friends viewed it, and a dozen commented and reposted it to their own friends. I connected with a fraction of the millions that have viewed it on Fox TV, but in a much more personal way. A fellow physician commented that the video was “so 20th century. Nowadays, we should say ‘Don’t tweet and drive!’”

Nonprofit engagement
Health nonprofit organizations are also engaging the social networking enthusiasm of their members. Though applications like Facebook Causes and Kiva allow for direct cash donations, you can make a greater impact by getting the word out about an organization’s message through online handouts, photos, YouTube videos, and invitations to events and fundraisers. The Leukemia & Lymphoma Society’s Team In Training program has been especially effective in engaging supporters through social networks.

A day doesn’t go by without a local chapter of a nonprofit inviting me to a meeting, training, or fundraiser. To prepare for a debrief for the families who witnessed my resuscitation of a child from near drowning, I’m relying on online materials from Johnson & Johnson and Kidpower in order to encourage parents to watch their kids more safely and empower their kids to stay safe in the water. I haven’t even moderated the discussion yet, and parents are commenting enthusiastically online in anticipation of our meeting.

Have some fun
Exercise video games are a really fun way to use healthcare social networking. I may not have time to hit the gym most days, but I always seem to find time to play my Nintendo Wii, whether it be Wii Fit, EA Sports Active, Punch-Out, or just to compete to be the biggest loser with Jillian Michaels Fitness Ultimatum (God knows I need to lose a few…). Even if no one else at home wants to join me, by becoming online “buddies” with other Wii-owning friends, I can feel like I’m part of a larger exercise community. It’s more fun working out with EA Sports Active with one of my kids, but seeing friends working out seems to kick my butt into gear more effectively. Wii Fit, which focuses on improving balance rather than increasing aerobic endurance, can help elders who are at risk of developing balance issues resulting in falls and possible hip fractures. I dream of a future where elders not only chat about their golf handicap or how well their doubles game went, but also become Wii buddies and brag about their low “Wii Fit Age.”

New iPhone applications also offer an easy way to track your fitness goals and show your friends how fit you’re getting. I’d like to see iPhone apps that use the accelerometer in the iPhone to track your exercise.

Academics, however, are expressing some caution with regard to social networking and personal health information. In an e-mail to students and faculty of Harvard Medical School, Dean for Medical Education Jules Dienstag wrote: “Caution is recommended . . . in using social networking sites such as Facebook or MySpace. Items that represent unprofessional behavior that are posted by you on such networking sites reflect poorly on you and the medical profession. Such items may become public and could subject you to unintended exposure and consequences.” For physicians, it’s clear that you should only practice medicine online through HIPAA-compliant private and secure portals that allow you to e-prescribe and provide care that is linked to your EMR, like we do at Palo Alto Medical Foundation. What’s not clear is how your other public expressions, health-related or not, reflect on you. I only post things online that I’d be happy for anyone to know about, even when posting in a purportedly private place like a closed e-mail list or with Facebook friends. You never know who could copy some incriminating photo to send to your boss. (Not that I participate in any activities I want to hide, of course!)

With the anticipation of increased competition in the wake of healthcare reform, I believe physicians will have to engage online and become more transparent. An excellent example of what I believe to be the future is www.askdrwu.com, the website of surgeons Drs. Calvin Lee and Tammy Wu, who publish their statistics so you can see their experience and success rates. Educated patients will increasingly demand to know complication rates, and will spread the word about great surgeons who embrace transparency like these two old college friends of mine. The future looks bright for patients in terms of learning about safety and quality, and healthcare social networking will be a central part of that future.

Enoch Choi is an MDNG editorial board member, partner at Palo Alto Medical Foundation Urgent Care, and adjunct clinical instructor in internal medicine at Stanford Medical School. Connect with Dr. Choi at Facebook, Twitter, and LinkedIn.

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  • http://mattfredric.blogspot.com/ Matt Fredric

    Hi Enoch,

    I liked what you wrote. It seemed like an honest and thorough explanation of your experiences with how social media is affecting and interacting with your industry – a topic I just became fascinated with yesterday.

    Thanks for contributing to this e-world we now live in!

  • Nuclear Fire

    While I like social networking sites for personal social uses and the idea of social networking is interesting as applied to the medical world, I wonder as to it’s utility when most doctors are reporting that they do not have enough time with individual patients and patients are complaining about long waits to get into see physicians, should a doctor be spending an hour a day on tumblr/facebook (which won’t generate revenue to hire more nurses etc.) instead of spending time seeing another few patients or being with his already neglected family?

  • R Watkins

    Exactly right, Nuclear.

  • http://www.clmi-training.com Safty Training Videos

    I agree that video games are a way of social networking.

  • http://mattfredric.blogspot.com/ Matt Fredric

    What’s an example of using a video game for social networking? Like playing halo? (Forgive me but I don’t get the chance to play video games often so it might be obvious if I did.)

    And about Doctor’s spending an hour a day to network, what if that hour was spent during a time that could not be used for patient time? Kaiser has this system that your MD will e-mail you advice – perhaps the efforts made to make the doctor available will draw in more “customers” and thus more more money on nurses? Thoughts Nuclear Fire? And keep in mind that I am a patient, and that’s my only experience with the industry.

  • http://www.twitter.com/enochchoi enoch choi

    Nuclear & Watkins, it’s certainly won’t be seen as valuable for doctors that feel like they have enough patients, but for many physicians, they would like to see more of a particular kind of patient (Even if they’re in an HMO, it’s up to the patient to ask to see you). Social Networking helps doctors see more of the patients they’re interested in seeing.

  • http://curbside.posterous.com Nuclear Fire

    @ choi: I see your point. If you’re needing to recruit patients, especially if you are in something rare and referring physicians are unaware of it or if you’re attempting to modify your practice mix it could be a useful form of advertising. My view was limited by my own experience where both patients and referring physicians are fighting to get patients a consult as soon as possible and the waiting list is too long. Perhaps in the future if I wanted to tailor my practice to more patients with vasculitis, participating in those kind of forums would be a way to skew my patient mix. Thank you.

    @ Fredric: I’m not sure I have any time that “could not be used for patient time.” Unlike personal social networking, where I might update my twitter status while walking to my car, if I’m doing anything involving patient care, I’m going to be doing it sitting at my desk, not distracted by other things, with ready access to their chart and my reference materials. Even though we’re just physicians and may even be somewhat anonymous online, I tend to take even the simplest questions very seriously.

    I also don’t tend to think much of “multi-tasking.” I like to focus completely on what I’m doing. Any time spent doing one task is time I don’t spend doing another. I’m sure many patients would like to be able to twitter/facebook me questions but if I then told them I’d have to cut 10% of my patients in order to have the time to do that, they probably would not want to be part of that 10%. Time is limited so how best to allocate it. Maybe it would be better to see less patients and be more availble to the fewer I’d have.

    The truth is I like the idea of SN in medicine, I’m just not sure about it’s implementation, so I’m playing devil’s advocate hoping someone else can help convince me how it can be effective and useful.

  • http://dental.mktg-101.com Anthony

    Thank you for this post. It’s great to hear an authoritative voice promoting the use of Social Media in medicine. I’ve been advocating it’s use in the Dental community myself. The Web is changing the way we all live, including the way we find our healthcare providers.

    Anthony Curtis
    @AnthonyCurtis (Twitter)
    http://dental.mktg-101.com (Web)