Beware Social Media’s Pitfalls

Lest anyone get the wrong idea, social media can do harm as well as good. Social media's power is awesome, but as the brilliant superhero Spiderman says, with great power comes great responsibility.

If you read my column last week, you know that clinicians and patients, speaking in their authentic voices, can trump formulaic marketing materials. But the need to employ a metric ton of common sense and discretion is greater than ever.

The challenge for health leaders is to instill that common sense and discretion into every employee, since social media is nonhierarchical by its nature, and tweets, blogs and Facebook posts don't work if they need to be preapproved (and they won't scale either).

The wake-up call for social media in healthcare probably occurred five years ago in Boston. Ivy League-educated pediatrician Robert P. Lindeman, MD, on the witness stand, confessed that he was also a blogger known as Flea. Lindeman was defending himself in a malpractice suit involving the death of a patient.

Incredibly, Lindeman had been blogging details of the case under the online identity of Flea, and that revelation cost him dearly, according to the Boston Globe, which reported that Lindeman ended up paying a substantial settlement in the case.

According to Bryan Vartabedian, MD, news of this prompted medical bloggers online at the time, to shut down their online activities.  "Even the ones who were doing everything just right, wiped their presence, did a scorched earth policy and took themselves right off" the Web.

Vartabedian spoke at the same Association of American Medical Colleges meeting where the Mayo Clinic's Farris Timimi MD spoke and informed my column last week. Vartabedian is assistant professor of pediatrics at the Baylor College of Medicine, and an attending physician at Texas Childrens Hospital. He's also been present in the health blogosphere since 2006, and writes about the intersection of medicine, social media, and technology at 33charts.com.

Physicians "are being completely redefined" by a number of forces, social media being one of them, Vartabedian says.

"Patients are changing dramatically, and they in turn are changing us," Vartabedian told the AAMC crowd. "The encounter with the physician is slowly emerging as a smaller and smaller piece of a patient's quest to get better."

Instead of patients going to doctors who then find information, information is now finding patients, who then take that to doctors, Vartabedian says. And now, technology that patients carry with them is generating more information. In the next two years, patients' very behavior will increasingly be recorded and fed to big data systems for analysis, he says.

I can relate. Last month, as part of a competition at the Health 2.0 conference in San Francisco, I and three other journalists received FitBits, which we wore for the next three days, in a competition for charity.

The FitBit has become the newest executive accessory of choice in Silicon Valley, and has effectively become the iPod of the quantified self movement, in terms of ubiquity. It clips onto a belt or other part of your clothing, and passively records the daily number of steps taken and floors climbed, and from that and other information about you can calculate the number of calories burned.

So at a time when we marvel at the power of the phones we carry around, even smaller devices are starting to accompany us, and social media lets us share our most personal data with whomever we wish.

A survey last year by the American College of Surgeons showed that 20 percent of surgeons were using Twitter. "Half of those surgeons were using it only rarely, which you and I know means they weren't using it at all," Vartabedian says. But what the survey didn't reveal is what the active surgeon-Tweeps are using it for: doctor-to-doctor dialogues? Doctor-to-patient? Telling jokes? In any event, more of them are using their real names than before.

Several social media networks exist for doctor-to-doctor communications: QuantiaMD, Doximity, and Sermo. Then there are what Vartabedian calls "doctors in the wild" using Twitter and Facebook.

"It is increasingly becoming difficult to separate your personal and professional lives online, despite how you may try," Vartabedian says. But we all must realize that anything we post on Facebook, no matter how limited its scope to a restricted set of friends, "lives on at the pleasure of the person who receives it."

Vartabedian also points out that clinicians "are still way worse in the elevator than we are online" about revealing PHI, and remember than anything overheard there is Twitter fodder.

Speaking to the great responsibility point, Vartabedian contends physicians are complicit in the controversy surrounding the unproven, but social media-fueled association between the MMR vaccine and autism. "There are 65,000 pediatricians in the American Academy of Pediatrics," he says.

"If all of us just once a year had created a small piece of content, be it a blog post, even a comment, we would have ruled the search engines, and none of this really ever would have happened."

"When we think about social media, and when your institution talks to you about social media, almost invariably it will be viewed from the perspective of risk. All we see is the risk associated with it, and all your orientation and your programs, everything will center on risk and nothing will center on opportunity."

As a way forward, Vartabedian is working with the AAMC in the early stages of developing a toolkit to improve social media training in medical schools. If you are interested in helping him, please contact the AAMC.