Discussing social media with physicians on Sermo

I was recently asked by Adam Sharp, MD the Chief Medical Officer of Sermo, the physician-only online community at Sermo.com, to write a guest post of my choosing and facilitate a discussion about it for a few days. My choice? Social media, (based on the recent article colleagues and I co-published in The Permanente Journal). This post is about my experience and what I learned.

I know that only a minority of physicians are visible on social networks like Twitter.com, after all, a minority of them are even exchanging e-mail with patients, so there could be no doubt that this topic would be a controversial one with a community of 110,000 physicians, most of whom do not practice in integrated care systems.

And … I was proven correct. The Sermo platform allowed me to put together a nifty poll, which was very helpful. The results are posted in the graphic below, note that my hypothesis caused me to ask a question about the future rather than the present.

Discussing social media with physicians on SermoBeing Sermoan isn’t easy

The life of a Sermoan (this community’s self-assigned title of its inhabitants) is not easy. I was one for 4 days, and, for me, it was challenging. The Sermo community is unique in that the participants are mostly anonymous – they use semi-descriptive handles. I think I was probably the only person that was not anonymous (my handle was “tedeytan”).

Adam and team have given me all of the text of the comments received, and I am going to post a few of them below, to show the spectrum of conversation. I’m not showing the most challenging of it, just a spectrum….It will help those who wonder, “why isn’t my doctor using social networks?”

See for yourself:

NO; NO; NO; NO> These are the answers to your 4 questions. “”To ensure that patients and their families have an active role in their own health care””>> they need to make an appointment; and keep it!!”

and

I agree with Holly Potter, VP of Public Relations at Kaiser Foundation Health Plan that social media tools have enormous potential to help an integrated healthcare system fulfill its purpose, especially in a fully accountable, coordinated care delivery system. Based on my years in self-employed private practice, in the currently fragmented, transaction-oriented care system, I donít think these interactive tools are as well suited to the purposes of self-employed physicians or those working in independent physician group practices.

and

Use FB for what? Telling pt they should take their meds and eat right and …… aim properly so that they dont piss on the rim???

1) I am not their nanny.

2) I am already sick and tired of patients not taking responsibility

3) Pt dont care

==============

When Kaiser makes its docs use FB to deliver care, it saves money. When we do that, we lose money.

=================

Even if I would get paid for it, I would not do it.

and

Ted..The problem is we are stretched to the limit with junk work ( NOT patient or medical problems of patient but the impact of third party systems). The typical answer of CMS or consultants  is hire more midlevels to do all the junk work. For example our hospital which is barely  sailing with its head above water has a “Thomson 100 team, a Press Ganey team.. Valuable tax payer dollars in a hospital wasted on bum work. I really studied the concept of patient centred practice. I hold a contrarian view and after consult code elimination by medicare,  actually trimmed my office size by 33%, changed policies to prevent loss of useful time. I am willing to push encrypted  records to patient ( takes  a mouse click)  but cannot afford to have endless twittter peeps with patient with every question they can think of as they converse with sister Susie on facebook. The distraction is bad for patient care or office functioning.

I do not even carry a cell phone with me after hours. I DO NOT even take any personal phone calls in working hours.  Even if I were paid, I want to have the choice of defining  my working hours. That is why like so many on SERMO   i am still self employed and not vertically aligned..

I learned a lot; however I wish I would have realized more of potential of the immense experience of the group. It took longer to understand these experiences because of the interstitial growling bordering on screaming. My other challenge is that I can’t discern if the commentary is representative of physicians at large or if it is maybe hyper-representative, due to its anonymous, uncensored nature.

Not easy for the other Sermoans, either

I did learn that the life of a Sermoan is not easy either, not because of Sermo, but because of being a physician today. Looking beyond the comments in my post and checking out the other forums, there was more than the occasional “I’m just stopping for a second to take a breath” tone in posts.

There were also stories of the challenged, pressurized world of the physician today, wrapped around quality requirements, patient satisfaction scores, business arrangements –  a whole host of things that society insist that they get “right,” in addition to the right diagnosis and treatment. For a physician who is on their own or in a small group (where 90% of Americans get their health care), it may be difficult just to understand the “why?” of these things, much less be able to master them and lead the health care system with them.

I empathize and I appreciate the frankness with which these experiences are shared.

What’s the potential?

I come from the organized medical group world, where ability to control destiny, and to learn how to lead and learn, is a requirement. I think it has to be this way for medical groups and for all of society. Why? Because physicians can and should lead the health system, with great care and compassion.

With this in mind, I glass-half-fully (or really 3/4 fully) believe that there is huge potential in a community like Sermo, because I think it could provide the ability to lead, supported by self-determination and a common purpose among the most educated and revered by the population. I would think about changing the anonymity aspect. I would think about engaging this group differently, providing more information and resources about self-organization and collaboration. This is what happens in the physical work world that I am a part of – could Sermo provide or connect people to this this in the virtual world?

Right now, I agree with my fellow discussants that there isn’t much incentive for the average physician to participate; that doesn’t mean we shouldn’t explore whether it is effective for us and what we need to use it well (before it uses us in an unhealthy way). I’ll close with this final comment that closed the thread. I appreciate the energy, hard work, and especially the time of my colleagues on Sermo in having the conversation.

Over time, the rest of the medical community will understand how social media ought to fit into patient communication. Kaiser, Mayo, and others are leaders in the field right now and others will eventually follow.

Ted Eytan is a family physician who blogs at his self-titled site, Ted Eytan, MD.

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  • http://thoughtbroadcast.com SteveBMD

    Sermo is not a physician-only community.

    Sermo generates revenue by selling access to its site to “healthcare institutions, financial services firms and government agencies.” See this link on their site: http://sermo.com/client/research/overview

    Unfortunately, this is not made clear to doctors when they sign up or participate. Instead, doctors are led to believe that this is like an “online doctors’ lounge.” A better description would be a doctors lounge with insurance companies, pharma companies, market researchers, and government agencies peeking through the window.

    • http://budurl.com/sermo Joe Hage

      Steve, yes, that came out loud and clear in “The Twitter Chat that Killed Sermo” during the #MedDevice chat.

      http://budurl.com/sermo

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    It’s funny (or sad) that you chose Sermo to test your assumptions, since it is basically a service to large pharmaceutical corporations, and makes its fortunes by supplying them a view of physicians interacting in their “natural habitat” for the purpose of increasing corporate profits. If social media in medicine is, or should be, or will be, in any way useful, it should not be in any way associated with such ventures.
    And since “using” was mentioned, frankly, I have no understanding of why physicians allow themselves to be used this way.

  • http://www.tedeytan.com Ted Eytan

    Dear Margalit,

    I didn’t choose Sermo to test assumptions – I was asked by Adam Sharp, MD if I would like to dialogue with the physicians on Sermo.com and I said I would be happy to. I dialogue with others as well, and on my blog you’ll find posts about my discussions with medical students and even a dean of a medical school. Check ‘em out:

    http://tedeytan.com/tag/medical-education

    My interest is in communication, not necessarily in finding the “right” audience to believe what I believe in. Regardless of the environment that they’re in, these individuals are still physicians and Iearned a lot from the interaction. Isn’t that the goal?

    Best,

    Ted

    • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

      Thank you for the clarification, Dr. Eytan.
      Yes, they are physicians and yes, there is always something to learn from any interaction.
      I just find the sheer existence of something like Sermo disturbing, and although I admit to this being a paranoid thought, I wonder if big pharma was curious whether social media is something they should look into, and what better way to find out then ask you to initiate a conversation… I guess there was no harm done even if that was the case… Anyway, Kevin’s blog here is a much better place to have conversations, IMHO :-)

  • http://offwhitecoat.wordpress.com The Scrivener

    I’m not a physician yet, but I share a lot of these concerns. I fully support online scheduling and brief email questions (e.g. med interactions) but I don’t exactly see how an individual practice could benefit from Twitter. The information tsunami effectively devalues any one tweet, FB post, etc. Even in aggregate, the mind shuts off to the repeated stimulus. As we students like to say, it’s not high-yield.

    I’d rather spend 5 minutes talking to someone face to face about their smoking habit than send a daily 5 second tweeted reminder not to light up. Maybe in those 5 minutes, I could even convince them that “dialogue” is not a verb!

  • http://www.healthcaremarketingcoe.com/medical-practice-marketing/ Simon Sikorski, M.D. Twitter @medmarketingcoe

    The key question we need to ask Sermoans and others criticizing social media (Blogs, twitter, facebook, forums, etc):

    How are patients finding doctors who CAN help?

    Sure, every doctor prefers to spend the time with the patient face to face rather than discuss via tweets. That’s a no-brainer.

    But at a time when less than 5% of doctors can be found on the internet there seems to be a major disconnect. Some companies report 30% of doctors have online presence – well guess what, that CV on a hospital website does not count. Who reads that? The doctor-review companies don’t count either.

    My advice: You don’t have to spend considerable amount of time on social media channels to be able to reach patients. Just establish ANY online presence to start!

    Get a website, a blog – at good companies there are no maintenance fees. Don’t pay for ridiculous services like scheduling, social networks, fee-based directories… you don’t need them. Most of the time, especially in areas of the country where there isn’t much competition… all you need is a website for patients to start noticing.

    Stop complaining you’re not seeing enough patients for your specialties, that your practices are not doing well … and believe me when I say your patients are on the internet.

    Do you know any physician with a strong online presence that is struggling? Connect the dots.

    I think that the primary discussions and questions on social media should first and foremost address the fact that patients are online. The second discussion should be about the different ways available to reach them. The third discussion should be about which one of those ways fits your personal lifestyle and work best.

    Social media (with blogs as exception) are still too hyped-up.

    At a time when less than 5% of physicians have a website, I truly think social media “experts” and “gurus” should stop for a second and think about that.

    Get doctors to believe in what they should be doing first. Don’t preach social media for doctors who don’t have the support infrastructure (websites, blogs) to refer to. If docs join twitter and facebook without these basic requirements what kind of ROI can they expect?

  • http://www.drdialogue.com Juliet K. Mavromatis, MD

    Ted,
    I enjoyed your post. I don’t use Sermo, though I use Facebook and Twitter professionally. I wish more of my patients would follow my professional facebook page. Today I posted about the FDA’s warning yesterday about simvastatin dosing. I believe that it could be a much more effective and interactive format to communicate information than posting a mass email to all of my patients. I’m not sure that I see any difference in social media’s utility amongst independent versus employed physicians. I’m in solo practice–I was in a group practice for 12 years previously. Actually I am more tempted to use Sermo now that I no longer have immediate colleagues, with whom to confer.

  • Marc Gorayeb, MD

    Many issues need to be raised and discussed in this sphere, not the least of which is privacy and security. The fact that patients may be willing to trust the security of internet communications doesn’t give physicians license to use these methods of communication. How do you really know that the person you are communicating with is actually your patient and your patient alone?

  • http://www.drdialogue.com Juliet K. Mavromatis, MD

    @ Marc Not sure I understand your last question: “How do you really know that the person you are communicating with is actually your patient and your patient alone?” What issue in the blog or comments was it responding to ?

    • Marc Gorayeb, MD

      If you plan to go beyond hosting a web site or blog, and decide to communicate with individual patients by FB, Twitter, or possibly even email, then it is your responsibility to make sure that the communications are either secure or sufficiently generic so as not to risk disclosing patient-specific information. And if your communications are that generic, then how useful can they be, other than for marketing purposes? There are already innumberable medical web sites.

  • doctor1991

    Thanks for your column. I look through a number of forums (when I have the time) and enjoy Sermo very much. I have learned so much- not just about public policy, but also about patient care issues. The opinions and discussion can get very raw. I have also seen incredible support and encouragement for colleagues down on their luck, and there are a lot these days. As far as social media use, I think almost everyone has a practice website with general information, but as far as answering specific medical questions, I would be very cautious, especially in this HIPPA influenced, politically correct world we live in. As for comments from Margalit Gur-Arie, I have found Sermo very beneficial for myself. If you are not a doctor and therefore don’t participate yourself (and therefore are not familiar with the content), you are not in a position to judge.

  • Reality

    What’s fascinating is that social media had no concrete relevance to the real world of practicing medicine. For the everyday doc in the trenches–not the so called academic, insurance company liaison, or ACO type pseudo-intellect opportunist–practicing medicine is about autonomy to make the right decisions and the doctor-patient relationship. Its not about technology or social media.

    I lie awake at times amazed at all the leeches nowadays who don’t know much about the art and science of practicing medicine yet

  • Reality

    (continued)

    … yet they’ve built a career out of telling doctors what to do.

    Technology, if designed intelligently and used rationally, has the potential to make things more effieicent. Unfortunately, we’re not there yet and Twitter and Facebook ain’t that kind of technology.