Everybody is not doing it – in Canada at least

Three years ago, the Canadian Medical Association conducted a poll of some of its members about their use of social media and their views about the main social media platforms. For advocates of the use of social media in health care the results were dispiriting. In fact, the only area where the more than 600 practising physicians, residents and medical students were in agreement was about the potential for professional or legal risks from social media use.

Fast forward three years to today and a repeat of the survey has yielded similar findings showing little has changed when it comes to Canadian doctors either using social media or seeing any potential benefit from the use of social media professionally.

Only 9.2% of the 884 respondents indicated they used Twitter for professional purposes (or professional and personal use combined), 4.3% for Facebook and 19% for LinkedIn. Only 3.5% said they blogged for professional purposes or both professional and personal reasons and the number using Instagram for professional purposes was a miniscule 0.3%.

Attitudes about social media mirror these numbers.

A whopping 89.5% felt the use of social media in medicine poses professional or legal risks, with this percentage being even higher among medical students. Similarly, 38.9% felt social media is of little value in day-to-day medical practice versus 35% who felt there was value and 26.1% who just didn’t know.

Those who did use social media for professional purposes were much more likely to use it for networking with peers and/or patients than as a source of information for their practice (52% vs. 25%).

Dozens of comments made on the survey overwhelmingly confirmed the lack of interest most doctors have in using social media in their practices. A sample:

• Social media is like the Wild West – unregulated and full of unknown risks
• Social media generally are time wasters
• I don’t want to become a Twitter slave
• How I pity a physician who mentally, professionally and socially engage 24/7, let them do it at their own peril …

It is worth contrasting these findings and perspectives with the outlooks of many Canadian physicians who are actively and very positively using social media channels such as Twitter to engage with peers and patients, create global networks of informed health care advocates, and develop timely sources of valuable medical information to inform their work.

In many instances, I believe, responses to the CMA poll represent a very fundamental misunderstanding of how social media can and should be used in health care – not to deliver individual patient care but rather to broadly communicate ideas and views and gather useful information.

For many practising physicians, social media may well not be useful avenues to pursue for improving patient care. But the reality is social media channels are an integral part of society today and should you choose not be use these avenues of communication the least you can do is gain a better understanding of what you are choosing not to use.

“Digital connectivity is not going to go away. It is part of our reality,” is how Dr. Doug Ward, a medical resident put it during a debate at the Canadian Conference on Physician Health last fall.

While arguably not rigorously scientific, the CMA poll provides the best data we currently have on Canadian physician attitudes about social media and the findings provide a reality check against other surveys – mainly from other jurisdictions – indicating the majority of the medical profession are out there tweeting, making videos and/or posting to Facebook as part of their work.

For those of us who are strong believers in the ability of social media to improve health outcomes – I finish with a quote Canadian singer/songwriter Neil Young:  “In the field of opportunity, it’s ploughing time again.”

How human can your doctor be?

I mean, how many of us can honestly say that at one time or another he hasn’t felt sexually attracted to mice. I know I have. It’s like murder – make a thing illegal and it acquires a mystique… Look at arson – I mean, how many of us can honestly say that at one time or another he hasn’t set fire to some great public building. I know I have – Actor playing a psychiatrist in Monty Python’ Flying Circus

Does medical student behavior as seen on social media networks reflect the degree of professionalism they will bring to medicine and if so should or does it influence whether patients will choose that particular person as his or her physician?

These are the type of intriguing questions raised by new research conducted at the University of Michigan and just published in Medical Education (gated to subscribers only) by Dr. Anuja Jain and colleagues with an accompanying commentary by Cardiff-based medical education expert Dr. Anne Marie Cunningham.

The conclusions from the study looking at how students, faculty members and the public judge Facebook postings by medical students are open to a myriad of interpretations and, as with much good research, raise many more questions than they answer.

Through an online survey, the researchers evaluated the perceived appropriateness of a number of mock med student Facebook screenshots showing students drinking, smoking dope, and interacting with students of the opposite or same sex. Subjects were then asked if they would be ‘comfortable’ having the students who posted the content as their future physician.

Jain and colleagues main finding was that thresholds of acceptable behavior differed. All three groups rated screenshots containing derogatory or private information about patients as being most unacceptable followed by images suggesting marijuana use, while images of intimate heterosexual couples were rated as most appropriate. Medical students were more accepting of the postings of same-sex relationships, alcohol use, partial nudity and partying than either the faculty or the public.

In her commentary, Cunningham quotes J. Duffin and talks about the danger of producing “vanilla physicians” as a result of medical students feeling constrained from showing diverse backgrounds or attitudes.

While noting that doctors both online and off must respect the dignity of patients or colleagues, she asks whether regulating med student behavior in social media risks reversing the trend of humanizing medicine and having doctors who are “fallible but professional.”

One major caveat of the research that the researchers themselves noted is the assumption in the survey that all these Facebook profiles and postings tested would be accessible for general viewing. I think this is a big flaw as it runs counter to the behavior of any savvy student or user of social media who is careful to control their privacy settings.

I also think the study mixes clearly unprofessional behavior such as revealing confidential patient information and illegal activity (smoking marijuana) with activity that some may only find counter to their own values (alcohol use, same sex relationships).

While this type of research is timely I don’t think society can yet answer the question of whether the public does or should use social media postings by students to make decisions about that person’s suitability as his or her physician. And while it might be nice to have a family physician who shares your views on life, in Canada, at least, the reality is that such discriminatory taste is a luxury given the availability of family doctors.

Medical students mirror their generation and that generation using social media platforms extensively as a window to their lives. When those students become physicians many of their patients will have the same attitudes and I think many of the issues surrounding appropriateness of posting may become moot.

(Comments on the Article abstract can be posted here and Dr. Cunningham’s views can also be read here)

 

#hcsmca – What Next?

Last month, I posted a commentary musing aloud about the challenges in maintaining the vibrant #hcsmca community (#hcsmca: Is Yesterday’s Future Ready for Tomorrow)

This post is to serve notice for what I hope will be a wide-ranging discussion for addressing some of those challenges scheduled for the regular #hcsmca tweet chat at 1 pm EST, Wednesday, Jan. 8.

I noted in my earlier post that while this community focusing on the use of social media in health care in Canada has been hugely successful under the direction of founder Colleen Young, some recent weekly chats have been poorly attended and there has been a general decline in use of the hashtag for discussing developments in this area.

In response to that earlier post I received thoughtful responses from other #hcsmca stalwarts. Dave Bourne (@d_bourne) noted my perception may not reflect the views of others who are more new to social media, while Aliana Cyr (@AlianaBCyr) talked of how her own interests and expertise in social media has matured so some of the more general chats on #hcsmca are now less relevant.

I want to reiterate that given the lack of formal governance or resourcing to maintain #hcsmca, the success of the hashtag – and those of its cousins #hcsm #hcsmanz and #hcsmeu (to name a few) – has been exceptional.

I think this is important because as we continue to struggle to show the value of social media in health care delivery and with only a small percentage of health care providers making use of social media tools, there continues to be a strong need for an anchor such as #hcsmca to inform and educate both neophytes and social media ‘experts’.

But I repeat that I do think there are questions that need to be asked about how and why such a community with only a virtual existence and broad mandate that includes all areas of social media and health care can continue to thrive and remain relevant.

Personally – and these are only my own views – I believe we need to:

• Keep referencing social media discussions about health care in Canada with the #hcsmca hashtag and encourage others to do so
• Strengthen the ties between the strong hcsm communities and tweet chats (#hcldr comes to mind)
• Discuss the ongoing viability of a purely volunteer-driven Twitter-based community
• Revisit the tradition of weekly tweetchats

I invite both anyone with prior involvement with #hcsmca and those to whom the hashtag is a new discovery, to participate in the discussion next week.