Tuesday, June 15, 2010

Medicine to Social Media: Get Over Yourself

I have noticed an interesting psychodynamic to most medical bloggers, social media enthusiasts, and internet-savvy individuals use social media:

... we all are narcissists.

We love our blogs, our posts, our "wall," our "followers," our "subscribers," our "friends", and our "unique visitors." Just look at people constantly checking their Blackberry's and iPhones at the dinner table. We are, after all, creating a 'community' of sorts all around us that never stops. We know that without others liking our comments or content, we receive no viewer traffic. Without noticeable traffic, we die.

Really, that's as deep as social media gets.

Of course it takes some gonads to say this. It is far easier to say that I give up my time, energy, and insights selfishly so the world can share my brilliant (and not-so-brilliant) exposés. That would sound far "cooler" and more hip in today's "e-mo-tional" electronic world. While I would hope there might be a modicum of usefulness for others when I participate in social media, the reality is that I've found I like to write. I like to find the story behind the story. I like to make friends. And I like to feel I'm adding a physician's voice, however small, to the increasingly overcrowded health care internet din. I realize that like it or not, for our younger generation who have grown up comfortable with this online world, to not have an internet presence is to not exist.

Now before I have the world of social media descend upon me like a hoard of locusts, let me say public sharing of information may not be a bad thing. There are times when we need companions. There is even quite a bit of useful information out there. For patients, the value of this information or of having "friends" in a time of crisis is incredibly important. Some feel it's so important that the enthusiasm for social media has spawned and entirely new internet breed: the socially-empowered "e-patient." And thousands of commercial interests are more than happy to facilitate their empowerment.

But I find it funny that social media "experts" continue to ponder why doctors don't "engage" more in social media. After all, it's the rage, right? Come on guys, get with the program! What are you really like? You need an online presence in today's internet world. So frenetic is the trend that nearly every major (solvent) hospital and hospital system is paying large sums of money for their public relations and marketing departments to employ social media "specialists" to develop Facebook pages, live-tweet the day's events, and engage their patient communities in the daily news at the hospital. Come join the latest web-chats, tweet-a-thons...whatever. Marketing plans. All to keep their patients coming back for more.

But for doctors, they understand that medicine is an intensely private affair. There is no place for narcissism during a patient visit. Medicine is also very ugly at times: bloody stools, discharges, lesions and psychiatric issues come to mind. Not that these ailments can't be found on YouTube. They can. And sometimes these not-so-pretty issues present very real challenges for diagnosis and treatment for doctors. One might think that the instantaneous communication afforded by social media would be the perfect place for "on-line collaboration." Yet in reality, using social media, even doctor-limited online forums, might be the worst place a doctor could ask for advice, especially when uniquely identifiable issues specific to an patient are discussed with others in such a potentially public, legally-discoverable way. For many doctors, the legal, ethical and political climate is simply not conducive to permitting patient-specific discussions on the internet.

Nor should it be.

And this doesn't even begin to address the issue of time. Participating in extra discussions outside of patient care takes time, and for people who create original content rather than link-bait, it takes lots of time. Worse, few of us can type, so even the requirement to enter five passwords at five different sites presents challenges for those already struggling to get their paperwork done before heading home.

So as we move forward in this increasingly connected internet-facilitated medical world, the limitations of social media will continue to present challenges for doctors and the developers who strive to develop niche sites catered to them. No matter how you parse it, doctors don't avoid the internet and social media because they're simply Luddites, they avoid the internet because they enjoy the benefits of anonymity, privacy, efficiency and legal protection that comes with dropping off the grid.

Now excuse me while I check my Sitemeter stats again.



Gregg Masters said...

Needed to see and read this today, Dr. Wes! T'was both timely and disarming honesty for mois, that assisted in my temporary liberation from and acute episode of self centered fear. Thanks for showing the gonads!

Maya Linson said...

Dr. Wes - I see many of your points - and thoroughly enjoyed your sarcasm. But I have much to say about the value of social media for patients ... you write about the value for physicians (and the limitations) - but for patients, there is a lot to be said about social media. Check out the Pew research on digital media and patients suffering from chronic diseases. Or the studies being done at the Univ of Washington and other schools on cancer patients and online social networks. It's true - right now, the majority of this stuff is anecdotal evidence of patients having better outcomes because of the support systems afforded by social media. But I think the future will bring a lot more data to the table. It may not mean doctors should be tweeting their way through the workday - in fact I hope it doesnt! But it might mean that experts in their field should be participating in health care conversations online to help prevent misinformation or help shed light on serious health issues. Anyhow, wanted to say I appreciate your view, but find the situation far more complex than simply wondering why doctors dont engage more online ... (That in and of itself isn't exactly a mystery for this social media "expert"!)

pacificpsych said...

Your first sentence should read 'dynamic'. Psychodynamic is simply wrong...sorry...couldn't help myself...had to comment... :)

Everyone has narcissistic traits. Not at all sure the social media people are more so than others. Unless you just talk and don't listen. Drs who are not online in some capacity, strike me as a bit backward...a bit 1900s...a bit out of touch with reality...even the American Psychoanalytic Association now has a Facebook page. Still waiting for the British Psychoanalytic to show up...

I agree about privacy though. That's a tough thing to get over, especially for those of us who by nature are more private.

Anonymous said...

Interesting perspective, Dr. Wes, especially since you used a "blog" to communicate the lack of value for such things in medicine. Respectfully, I say that you are kidding yourself to think that patients do not want to engage in their healthcare via interactive web tools (whether email, following advice by own doc on Twitter, etc.). In fact, the numbers say just the opposite. You being a specialist puts a slight twist on that, but I represent a primary care practice who uses these services with great success and growing patient satisfaction. Patients DO want to be able to contact the physician's office quickly and get a reasonably quick response. We do this in a way that is measurable and cost-effective. There are reasons that major healthcare systems are investing more time and resources into patient relationships (and why we are, as well): 1) enhanced patient care & documented exchanges of information and 2) as insurers push significant costs back to the consumer/patient, the patient choice will rule the day. We want to be that paying patient's choice. If that means we answer a secured and encrypted email, so be it. Our "marketing/outreach" efforts via social media have resulted 35% increase in patient traffic-- and cost us relatively little.

Jay said...

Interesting post, Wes.

I guess now is as good a time as any to let you know that I've proposed you to serve on a panel symposium at next year's HRS scientific sessions.

I've suggested a panel on New Media in Electrophysiology and nominated you, John Mandrola (Dr. John M), Rich Fogoros (DrRich of The Covert Rationing Blog) and Steve Stiles of TheHeart.org.

I've taken the liberty of proposing myself as a session chair along with William Stevenson of Circulation-EP.

I'm hopeful that the panel will be accepted. I'm amazed how poorly new and social media has been embraced by the EP community. You guys are all doing great work and deserve a chance to get the word out.

Hope to see you in SF.


DrWes said...


Secure e-mails are one thing and help patient doctor communication -but social, public e-mail and tweets, etc. are another. Even with secure e-mail, I have already experienced multi-page diatribes that ask all kinds of complicated questions that could be far easier addressed face-to-face. We must acknowledge limitations (and as you note, benefits) of this form of doctor-patient communication.

Still, the point of this post was really intended to address why I feel more doctors do not participate in these forms of patient communication rather than to deride the value of the medium to patients and doctors. Maybe secure video streams will improve things - I don't know - but as long as there are the legal and privacy issues hanging over the more public forms of interaction, doctors will be resistant to use them.

DrWes said...


That session could be fun! Nothing but a bunch of narcissistic slackers all the way around, I see...


Thanks for the invite and count me in. Hope it works out.

Anonymous said...

Dr. Wes: Keep blogging. Do you know how hard it is for a citizen to find out the truth about surgical results? My area of interest is cardiac ablation for afib. You have been enlightening. I thank you for that.

Unknown said...

Well said!

Unknown said...

Well said!

Mike Cadogan said...

Dr Wes
I agree with most of your points, but for mine, the foray into the underworld of social media has been an enlightening and liberating experience.

I love reading physician anecdotes, experiences and case-based blogs, and this has inspired me to share similar stories for educational purposes.
I love the frank, open and sometimes harrowing comments, descriptions and experiences of patients and reading their side of the doctor-patient relationship.
I love the opportunity to debate, comment and interact with other physicians who have given up their time to share their experiences and thoughts and to express their ideals.
I now interact with people from all round the Globe, and although these 'friends' are virtual - they still afford comfort in collaboration, interpolation and juxtaposition...this conversational expansion has enhanced my local work practice by helping me rise above the petty bickering and political inanity of water cooler gossip.

I gave up explaining to colleagues what I do and why I do it a long time ago. I believe the ride we are taking is not purely a narcissistic extension of our individual dictum but more an opportunity to broaden our horizons, embrace difference and promulgate evidentiality.

Blogging can be lonely. Especially lonely if we constantly rely on viewer stats, page rank and comment counts to justify the time we take to document our cogitations …but I am surfing the blogging wave to taste the salt water; feel the rush of wind in my face; and brush up against dolphins…not to observe from the beach, ice cream in hand, blistered by the rays of apathy and indifference.