Why you shouldn’t give medical advice on Twitter

A few weeks ago I was following an online discussion conducted by a widely followed health site.

During the discussion, they had a physician who was giving out wellness advice to users via Twitter.

That physician had one tweet in particular that terrified me.

Why you shouldnt give medical advice on Twitter

Why you shouldnt give medical advice on Twitter

As the above screenshot shows, one tweet mentioned that when in doubt regarding a heart attack, you should call 911. Appropriate advice. However, the physician then sent out another tweet stating, “If movement, deep breaths, swallowing makes pain worse or better, it is NOT a heart attack”. Based on the number of followers of the health site promoting the tweetchat, up to 150,000 Twitter users saw these tweets in their timeline. The physician even had followers responding in thanks, an acknowledgment they will probably follow the advice.

If you were to tell any emergency medicine physician or cardiologist that symptoms such as movement, deep breaths, swallowing making pain worse or better is “NOT” a heart attack – we would not agree. Sure, it might be atypical chest pain, but we would certainly never say “NOT a heart attack”. There is good data that older patients, women, and patients with comorbidities like diabetes are more likely to present with symptoms other than “typical” chest pain(1).

I would want an EKG and chest x-ray at a minimum. Heart attacks can present in a myriad of atypical ways and one of the biggest challenges in medicine is figuring out coronary etiology of chest pain versus atypical. This doesn’t even take into account pleuritic chest pain (pain with deep breaths), which can be secondary to a pulmonary embolism. An individual might read the tweet dismissing pleuritic chest pain as a benign etiology, not realizing that even though they might not be having a heart attack, they could have a life threatening pulmonary embolism.

Anyone who is complaining of chest pain and thinks they are having a heart attack needs to go to their local ER. Any physician who deals with chest pain on a daily basis will tell you that.

As physicians, we need to make sure we are using social media tools appropriately, and not over-extending their usage. Twitter has 140 characters, not nearly enough to explain the nuances of chest pain.

We also need to be cognizant that what we say will be treated as golden due to the “MD” after our names and recognize that while social media enables us to do significant good, it can also cause significant harm if we aren’t careful. After some thought, I’ve devised a crude rule for physicians when it comes to giving medical advice via social media to the public.

The rule is: Only give medical advice that you feel comfortable giving to a malpractice lawyer. Would you put it past them to be trolling Twitter?

Iltifat Husain is founder and editor, iMedicalApps.com, where this article originally appeared.  He can be reached on Twitter @IltifatMD.

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  • Chiked

    “The rule is: Only give medical advice that you feel comfortable giving to a malpractice lawyer. Would you put it past them to be trolling Twitter?”

    In which case, forget social media sites like twitter. 140 characters will never do justice to any medical discussion. Email barely does.

    I think that for physicians to take advantage of social media especially, which I highly recommend, their patients/followers will all have to agree to waive their right to sue. There is no way around it….and it will be good for doctors overall. Otherwise physicians will have to remain chained to the traditional medical model which is now run by corporate America.

  • Dr. Jess

    The only advice I would give to patients on Twitter is to take any medical advice you find on Twitter with a grain of salt. Or three.

  • rrpersaud

    Twitter is definitely *not* the place to give specific medical advice, and this is doubly true when that advice could result in a patient forgoing an assessment of a very serious condition.

    I think it’s best to err on the side of caution and only give non-specific advice. Always tell patients to speak to their healthcare provider/go to the local ER.

  • Anthony D

    Simple rule ever since the Information Era started and after watching the 1995 cyber thriller “The Net”.

    The less people know about you, THE BETTER!!!

  • carolynthomas

    Oh my Lord.

    Dr. H, I had to go have a wee lie-down after reading that “not a heart attack” tweet. Wrong on so many levels, not to mention clearly dispensing medical advice via Twitter which is just plain downright stupid.

    I’m not a physician – merely a dull-witted heart attack survivor – but I can tell you flat out that I’m aware of just about every possible symptom imaginable as a first sign of myocardial infarction. I’ve met women heart attack survivors whose only cardiac symptom was upper back pain, or a persistent cough, or “tingling” around the lips. And remember that up to 40% of us will experience NO chest symptoms at all during an MI. None. Zero. Nada.

    Perhaps your charitably-blacked-out tweet-dispensing doc was actually the E.R. physician who took one look at me five years ago (while presenting with textbook MI symptoms of chest pain, nausea, sweating and pain radiating down my left arm) and pronounced: “YOU are in the right demographic for GERD!” before sending me home.

    That is some kind of magical medical skill – when you can with certainty diagnose a patient from across the room or across the Twitterverse. Both can have deadly outcomes. More on this at: “Stupid Things That Doctors Say To Heart Patients” – http://myheartsisters.org/2011/01/13/stupid-things-doctors-say-heart-patients/

    • carolynthomas

      PS: And another thing: why black out the identities of doctors who engage in online behaviour like this – or the “widely-followed health site” that supports them? We patients deserve to know exactly who to steer clear of, and the “widely followed health site” should be outed.

      • Dana

        If you’re interested enough, you can go to Twitter search and find who wrote that tweet. As I see you did ;-)

  • http://drpauldorio.com Paul Dorio

    One thing I can state for sure: Whenever one is dogmatic, one is sure to be wrong. Another comment I might add is that the tweeting doctor is not necessarily a bad doctor. What is more likely is that he is a bit naive as to the far-reaching nature of Twitter comments. He should examine carefully his tweets before sending them out. Having said that, no matter how careful one is, one will sometimes find that a delivered comment/tweet/email/etc should have been edited better. G-d willing, we will have liability reform. I also hope that readers attempt to understand that ANYTHING that is said or written should be interpreted VERY CAREFULLY. In today’s world, it is not just a tweeting doctor who might deliver incorrect or partially correct advice due to the limited nature of the form of communication being used. There are many other types of caretakers who may give you advice – nurses, nurse practitioners, physician assistants, chiropractors, etc. Pay attention to the source as well as the information.

  • Sara Stein MD

    Oh dear. That’s advice. I teach providers to give INFORMATION and RESOURCES on social media. The purpose is to educate, not treat. That’s what the clinic or the office or the hospital is for! Yes, naive in regards to how seriously people take information from doctors online. Very seriously.

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