Navigating the Social Media Highway

In May 2010, Michael Laccheo, MD, a rheumatology fellow at the University of Iowa in Iowa City, diagnosed one of his favorite patients with a rare disease, one that’s been referenced fewer than 50 times in the medical literature. After the visit, he second-guessed himself a bit: Did he effectively explain the complex diagnosis and related treatment?

He didn’t share his reflections, though, at a dinner party or while riding an elevator with a physician colleague, but rather to a potentially much wider audience. “Sometimes, the hardest thing about my job is explaining very complicated concepts that most doctors don’t even understand to those without a medical background,” he wrote in his blog, www.laccheo.com/blog. “If I’m rambling on, speaking over your head, or you need a double espresso to keep yourself awake, just stop me and let me know.”

Although the patient could have recognized herself between the pixels, Dr. Laccheo wasn’t particularly worried about sharing the story on his public blog. The patient had already contacted a popular daytime talk show to share her story. However, Dr. Laccheo, who like other rheumatologists is trying to navigate his own path on the social media highway, says that he wouldn’t have been similarly revealing on his Facebook page.

In fact, he tightly restricts that page to friends and family. Even a passing Facebook comment, such as griping about a difficult day, could be misinterpreted, he says. “If a patient who has seen me in the office today sees that [comment], he might think, ‘Oh, is he talking about me? Was he not focused? Was he having a bad day when he saw me?’ ”

As social media avenues proliferate, so do the related opportunities and pitfalls, according to several rheumatologists and other health professionals interviewed here. On the plus side, communication forums like blogging, Facebook, and Twitter can provide an online calling card for physicians, with myriad avenues to promote expertise and to build relationships with current and potential patients. Strengthening rapport with patients could be particularly helpful in a specialty like rheumatology, given the chronic nature of many of the illnesses involved, they say.

But social media tools also can disrupt an already overbooked day and, if care is not practiced, they can erode doctor–patient boundaries. To provide some guidance, the American Medical Association issued a social media policy on how to guard against jeopardizing either patient or physician privacy.¹

Dr. Laccheo believes that two distinct physician camps are emerging. One group uses the online tools to directly communicate with patients through high-profile blogs or Facebook sites that might attract numerous followers. “But I think that’s actually scaring physicians off from social media in general,” he says. “They’re already overwhelmed by the amount of work they have to do.”

The second group, in which Dr. Laccheo classifies himself, recognizes that physicians can harness social media to put their best professional presence forward, amid a world in which patients are already picking up data—right or wrong—about doctors and diseases online. “There is a lot of information out there that’s not good,” he says. “This is an easy way for doctors to raise the level of conversation.”

Online Face Forward

Julie Levengood, MD, who studied journalism in college, decided to apply her writing passions after she noticed a relative scarcity of rheumatology blogs. “I thought maybe this is a way to get a little further with patient education than you can in a 15-minute appointment,” says Dr. Levengood, a rheumatologist at the Fallon Clinic, a large multispecialty group in Worcester, Mass.

On her blog, http://thedoctorsrheum.word press.com, Dr. Levengood doesn’t discuss individual patients without altering identifiable details, and then only if the anecdote is relevant to a larger discussion. She also posts medical information, such as a recent newspaper article about osteoporosis diagnosis, along with her own physician perspective. One post in 2010 discussed why clinicians might struggle with faithful hand washing. In another, she speculated as to why real-world doctors—unlike those coiffed for television shows—aren’t known for their stylish dressing. “As I once tweeted, ‘A long white coat hides many a fashion don’t,’ ” she writes.

Although Dr. Levengood limits the personal details she shares, some of her personality shines through, most notably her culinary interests. During the 2010 ACR/ARHP Annual Scientific Meeting in Atlanta, she posted about several meals, including a salmon dish served on red pumpkin curry rice. On a prior Chicago trip to attend a wedding, Dr. Levengood snagged a seat at a high-profile restaurant that featured the cooking of “Top Chef” winner Rick Bayless. “A scallop dish with shellfish consomme was out of this world, and I am NOT a fan of shellfish!” she wrote.

Dr. Levengood also posts and follows threads on Twitter, describing it as an easy way to learn about other medical specialties, as well as rheumatology. Wary physicians can start slow, she advises, by signing onto some feeds and visiting a few blogs. “It can be done with very little outward investment of time, other than reading these like you would read emails and [medical] journals.”

But some rheumatologists aren’t as enthusiastic. Michael Lockshin, MD, abandoned his Twitter connection, finding it too intrusive, in part because he keeps his smartphone handy during office hours in case his family needs to reach him.

In short, the online twittering became irritating, says Dr. Lockshin, director of the Barbara Volcker Center and Rheumatic Diseases at the Hospital for Special Surgery in New York City. “When I’m working with patients, I need isolated time,” he says. “First of all, I’m not interested particularly in telling people what I’m doing every few minutes. And most of the stuff that I’ve seen on Twitter is pretty unimportant and not helpful to me.”

Those who do want to follow Twitter feeds on their mobile devices but don’t want to be interrupted every time a new tweet is posted can modify the notifications settings on their device to turn off alerts.

Connection and Disruption

Dr. Lockshin isn’t reluctant to talk with patients through cyberspace. He frequently prefers e-mail to phone communication, because he can respond while a patient is getting dressed or during other small time windows. He might assist with a medication refill or peer at a downloaded photo of a swollen joint. “I have answered [patients’] very intimate sexual [medical] questions on e-mail, as long as they understand that e-mails are not as private as they think they are,” he says.

But like his Twitter experience, Dr. Lockshin’s professional foray into Facebook proved to be difficult. He created a page several years ago, largely to help promote his book, “Dancing at the River’s Edge: A Patient and Her Doctor Negotiate Life with Chronic Illness” (Schaffner Press, Inc., 2009). However, friend-related logistics soon became thorny, he says.

Initially, he accepted patient “friend” requests. “But it was quickly out of hand—too many people had access to me,” he says. Plus, he became uneasy about how private the messages that patients were sending truly were, even those sent directly to him through Facebook’s messaging system. Or, he’d be contacted by patients he didn’t know, those living in remote parts of the country, with specific health questions.

Now Dr. Lockshin’s wife helps him manage the site and forwards messages to him. If he does respond, he uses e-mail and not Facebook.

Social media can pose some professional risks if physicians aren’t cautious, according to a study published in the Journal of General Internal Medicine.² The researchers, who reviewed the Facebook status of 812 medical students or residents, found that nearly half—44.5%—had opened an account. Of those who did, 37.5% opted to keep their pages private. On the publicly accessible sites, researchers saw problematic photos or postings, including excessive drinking and potentially inflammatory sexist comments.

In their social media policy, the American Medical Association provides some recommendations for managing your online presence. Among their suggestions:

• Separate personal and professional content online;
• Monitor one’s own online “reputation” by checking for inaccurate or inappropriate information posted by others; and
• Recognize that online communication can potentially harm relationships with patients or colleagues.

Raising the Bar?

But it is feasible for physicians to develop a Facebook presence that interacts with patients, while still keeping the connection at arm’s length, says Prashanth Sunkureddi, MD, clinical assistant professor at the University of Texas Medical Branch in Galveston and a rheumatologist in private practice in Houston. His professional Facebook page, which he launched within the last two years, discusses rheumatology information and fields patient questions.

“It’s partially a marketing tool,” he says. “It’s partially a tool to advertise things we do in the office, events. It’s also a social tool, if you will. It’s a way to interact with people from around the world with whom I may not otherwise have the opportunity to interact with.”

Some patients might post to ask if they can get an earlier appointment—something his office tries to accommodate—or to thank Dr. Sunkureddi for relieving their discomfort. Other queries are more pointed. In one recent post, someone asked if Dr. Sunkureddi was the same doctor who had co-authored a 2005 medical report about lupus and eosinophilic enteritis and, if so, could he answer some questions privately.

Dr. Sunkureddi responded on his Facebook page, www.facebook.com/pages/Dr-Prashanth-Sunkureddi/133004582207, saying there was little published information on the subject and, after briefly referencing another paper in a medical journal, wrote that he hoped that his paper “can provide some guidance for your doctors on the workup for this condition.”

Regarding medical specifics, he says: “I try to give very general scientific answers, the conventional thinking on that topic, rather than giving any direct advice, per se.”

To date, Dr. Sunkureddi hasn’t gotten any negative comments on his Facebook page. “To be frank, I would probably delete it.” Neither has he become embroiled in a lengthy back-and-forth online discussion with a patient. “People do seem to understand these boundaries well,” he says.

Occasionally, he’ll get a new patient who liked the way he handled a question through Facebook and books an appointment. Potential patients also come across the page as they weigh which local rheumatologist to consult, he says. “These days, people go online to search about their doctor.”

The patient exchanges, by being so public, can’t help but be influential, he says. “This kind of raises the ante. This makes you want to constantly improve your own performance and that of your practice. It certainly increases the pressure on me to do my best.”

Charlotte Huff is a freelance journalist based in Fort Worth, Texas.

References

1. American Medical Association. AMA Policy: Professionalism in the use of social media. www.ama-assn.org/ama/pub/meeting/professionalism-social-media.shtml. Published Nov. 8, 2010. Accessed Nov. 14, 2010.
2. Thompson LA, Dawson K, Ferdig R, et al. The Intersection of Online Social Networking with Medical Professionalism. J Gen Intern Med. 23:954-957.
3. Facebook. Statistics. www.facebook.com/press/info.php?statistics. Accessed Nov. 14, 2010.