Last night Susannah Fox put up the Bat Signal.  It seems she’s been charged with addressing the American College of Surgeons next month and she’s looking for some creative input from the medical social community.  Not surprising, really.  Interest in social media among physician groups is growing fast.

I thought it might be worth sharing a few random thoughts on the care and handling of the physician audience.

Doctors think in 1.0

Remember that the average physician is naïve when it comes to social media and its role in health.  Most physicians see e-patients strictly as consumers.  The concept of true socialization and active involvement by patients and physicians will likely be foreign to your audience.

With that said, you’ll get more mileage with a thorough, basic discussion of what this is all about and why it will change healthcare more than you will with a detailed how-to-do-it dialog.

A doctor is a doctor

Don’t sweat the audience.  While you could probably come up with some tailored, specific examples for surgeons or OBs, the core social issues for physicians are not specialty-specific at the introductory level.  In social terms, a doctor’s a doctor.

Raise your expectations

Based on their anemic adoption we sometimes think that doctors are resistant to the idea of social media.   I remember speaking this summer to one of the local medical societies in West Texas.  The audience was much older than I had expected and as I waited I prepared myself for resistance to what I had to say.  But, in fact, the opposite happened.  This audience of older generation physicians saw social as a way to potentially bring medicine back to its focus on connecting with patients.  Who knew?

Even if slow to adopt, physicians are intrigued and increasingly interested in social media’s potential.  We’re a malleable group.

Manage their expectations

It should be understood that we haven’t figured out where and how doctors should make social work for them.  Let’s face it, it’s time consuming and the applications that measurably impact care are few and far between.  The power lies in the potential that comes once we have the entire physician population in the loop.

And be careful of selling the fantasy:  While it makes great fodder for the media, selling “live tweets from the OR” as the saving grace of the next medical generation won’t win over any physician audience.

What keeps doctors up at night

As you think about your physician audience, consider why none of them have blogs or are found on Twitter:  1) Physicians naturally have issues with transparency 2) they haven’t got time and 3) they have concerns over liability and privacy.

But transparency is generational.  Time you can’t fix.  And issues surrounding patient engagement in the public forum are educational.

This patient contact issue and the theoretical potential for liability is a huge preoccupation.  I’ve found that a lot of physicians believe that their social entree obligates them to discuss patient issues in public.  I always convey my bias (possibly a slowly evolving standard):  discussion of patient-specific issues in public forums is off limits; discussion of patient non-specific issues is encouraged. Any attempt at patient-initiated discussion of specific medical issues immediately goes offline and onto the EMR for issues of record, liability and safety.

Doctor-patient dialog surrounding individual care should be limited to HIPAA compliant networks that integrate with the EMR.  I like to cite HelloHealth as an early example of this model.  The screen grabs always wow the crowd.

And if you can discuss an ethical dilemma or two you’ll have the academic elements of your audience drooling.  Bring towels.

Physicians have an obligation to be in the online space

Maybe I get away with it because I wear a stethoscope, but I always tell doctors that they have an obligation to participate in the dialog.  I always use autism and vaccines as the example.  The search engines in this regard are ruled by a loud, vocal minority linking vaccines and autism.  Consider that the American Academy of Pediatrics has 60,000 pediatricians.  If each of them were involved in the creation of some kind of content with reliable information, we would rule the search enginges.  Powerful stuff.  Always has an impact.

Think mobile

It’s estimated that some 81% of physicians will own a smart phone next year and mobile may be the segue into soft social adoption for many MDs.  Touch mobile and win your physician audience.

Tweet by example

One of the most powerful take home messages I pass to physician audiences is to study other doctors who are in the space.  Spend time watching and listening before taking the leap into the public forum.  I encourage people to look at what other doctors are doing and see how it applies to their setting.

Remind them to cultivate their digital footprint

I look at my role with physician audiences as one where I seek to motivate and empower.  And that’s when I feel rewarded. The idea that they can potentially control their digital footprint has huge value.  Ask the audience to do a vanity search and remind them that their reputation is under the control of sites like Healthgrades.  Remind them that they themselves are actually in control what people see when they are searched.

I encourage them to get started with a LinkedIn profile for one thing.  It’s soft social and a nice entrée into an online identity.

I’m not Joe MD

In a strange way I have to warn you to be careful of my advice.  Docs like myself and Howard Luks and others see the world through a very different lens than the average internist or general surgeon in middle America (who I refer to as Joe MD).  When thinking about our approach to the digitally naive physician we have to be careful about how we apply what we know about those of us who have already arrived.  Keep it basic and remember where they’re at.

Finally, I should say that Susannah Fox’s willingness to reach out to the physician community is a testimony to her understanding of how this social stuff is all supposed to work.  Even when we don’t know exactly how to approach something, there’s always someone who does.

I could go on all day.  What else would you add?

 

As doctors we used to think that the Internet was an evil, dirty place.  At once point it was.  Look at the story of vaccines and autism.  What started as a fraudulent MMR-autism connection by Andrew Wakefield was ultimately buoyed up and fueled by the mob.  The vaccine-autism connection will down in history as one of the health infosphere’s greatest failures.

The racket held Google’s spiders at gunpoint.  “Communities” like Age of Autism (look for Hell to freeze over when you find a link here) served as the center of community for a pseudo-empowered group of parents brainwashed into thinking that the best course of action was to threaten heroes like CHOP’s Paul Offit and pediatricians who had spent the better part of two generations struggling against deadly childhood diseases.  Brainwashed young parents echoed the conspiratorial voices of a vocal minority fueled by corrupt information.  It was a generation of young parents lost in hyperspace and disconnected from reality.

Call it bad crowdsourcing with dangerous implications.  Epidemic groupthink under the auspices of Jenny McCarthy.

CNN recently declared the vaccine-autism connection finally over.  While I’d like to agree, the vaccine-autism connection was dead before it ever began.  But Age of Autism trudges on like a drunk zombie tragically disconnected from the rest of the world, still angry and playing the victim of monsters like me.

Whenever I hear ‘information is good’ I think of the great autism-vaccine hoax of the early 21^st century.  All I can think about is the number of young, impressionable parents who fell as frightened victims to the echo of misinformation.

Let it be a lesson to all of us who turn to the hive for information.

 

There’s a conversation brewing over use of the term ‘e e-patient.’  The online health revolution is over, it’s been suggested.  Web use, after all, has become so widely adopted  that the term ‘e-patient’ may have more historical meaning.  Dropping the ‘e’ might indicate that we’ve arrived.

I’m not so sure.

Perhaps the revolution we thought was going on never entirely took off.  Or maybe it’s all about how you define the revolution.

Here’s what I see:  Day in and day out over weeks and months hundreds of patients visit my clinic.  I talk to them candidly about the tools they use and how technology and community is changing how they see their problems.  I do the same with friends and family members.  And like it or not, they’re a lot closer to 1.0 than many of us would like to think.

Crowdsourcing, record portability, user-generated health and even simple patient communities are things that many are likely unable to define, and even less likely to use.  I’m saying nothing of their capacity.  Many patients I speak with have no idea of their capacity.  And empowerment is irrelevant to a patient unaware of their potential.

We need to be careful not to assume that the voice of a remarkably engaged minority of patients represents the voice and understanding of patients everywhere.

There’s a lot more work to be done before claiming any kind of victory.  I wouldn’t be quick to drop the ‘e’ in e-patient and may suggest that in many cases it has yet to be added.

 

Maybe not according to this report from the CDC.  They studied internet use with respect to adherence behavior and a number of health-related outcomes.  It suggests that folks who diss the doc in favor of the Internet may not do as well as we think.

This quote caught me:

The data also revealed that personal determinants such as neuroticism (reflects anxiety and emotionality) and health-related poorer quality of life differentiated internet-instigated non-adherent respondents from their counterparts.

More plainly put:  If you trust your life to an anonymous guy on twitter with the handle @YourHealthGuru, you might not do as well as if you partnered with a trained professional.

Or perhaps I’m reading too much into the study.

While this would appear to be a turd in the social health punchbowl, we have to be careful about drawing firm conclusions from isolated studies.  There’s a lot to be said for the benefits of community.  But just keep in mind that there’s a chance that it may not be all that we make of it here in our shiny social bubble.

The authors conclude by offering a few tips for health marketing professionals.  Among them:  Avoid fear appeals and message styles that stimulate psychological reactance.

I continue to be really impressed by the work of the CDC.  This study was conducted by the ‘Strategic and Proactive Communication Branch in the Division of Communication Services’.  Didn’t even know we had one.

 

I regularly talk to my patients/parents about social health. What parents do, what they think and how they socially experience their child’s problems has become an interest of mine.

I can hear it now: “Of course patients won’t discuss their social health activities with you, you’re a doctor.” Perhaps, but I don’t think so. Actually, I’ve had some very interesting open dialog with a few of my long-term parents. Many have children suffering with chronic diseases such as crohn’s disease, eosinophilic enteropathy and the like. The relationships I cultivate are open and the nature of my dialog has been just as consistently open as other aspects of our relationship.

Interestingly, while nearly all have used search to understand their disease, most have never connected with other disease sufferers in the online space. The concept of crowdsourcing is met with puzzled looks.

Sure they’re e-patients.  But I would characterize most of my patients as e-patients. The question is, what does that really mean? The definition is admittedly broad. For example, how is an e-patient who simply seeks information online discriminated from the e-patient who seeks the independent capacity to prescribe medications or genuine dependence on the hive to make difficult personal health decisions? To that end, has Health 2.0 really seen adoption once you leave the narrow online reverbosphere of opinion?

As far as social health among the parents of children with digestive diseases in The Woodlands, Texas I might suggest that true engagement is a rarity.

To some extent, I wonder if a lot of the dialog about social health and the mass exodus towards individual empowerment is overstated. Not that it isn’t important or won’t evolve to become more important, I just wonder if those of us who think about this are living in a bubble.

 

Last year some 36,000 people died in the United States as a result of influenza. This year a new strain kills a few and the world is turned upside down. But swine flu hasn’t made it into history the way the media had predicted.

So far it appears that the only epidemic was one of hysteria created by the media – both online and off.  This week CNN’s hyped coverage did its part to keep viewers glued to their sets. From the furrowed brow of Anderson Cooper to the dramatic orchestral music used to tease segments, CNN recognized the story of swine flu more as an opportunity grab viewers rather than a chance to allay the fears of innocent viewers who didn’t know better.

On social media platforms the subject was equally seductive.  As a trending topic on Twitter last week, swine flu related topics represented 5 out of 10 trending buzzwords on Twitter. In the reverbosphere of the blog world, posts about swine flu won immediate attention.  And unfortunately, physicians were equally complicit in the gang-bang of new media hype that drove this story to stratospheric levels.

While there is a lot that remains to be learned about this strain of influenza, there’s more we need to learn about how we relay health information to one another.

On Twitter everyone’s a health journalist … unfortunately. And teasing reliable public health information from hype is something that very few have the capacity to discern. Anyone among us who re-tweeted, posted, speculated, or linked information that wasn’t directly from trusted sources such as the CDC was complicit in what’s been created.

There are very few among us who truly understand the myths and realities of a threat of this nature. Before we hit ‘update,’ we all should insist that it’s only those few expert bodies who should serve as the source of when to go on with out lives and when to stick out heads in the sand. All of us need to understand the impact of seemingly innocent reverberation.

While we would all like to believe that crowdsourcing is a viable means to good health information, the Aporkalypse is a clear example of how the mob and the media haven’t a clue.

 

So the other night I was contemplating my dilemma about switching from Typepad to WordPress. I floated the question out on Twitter and received within 10 minutes about 13 responses (via feed and DM) on what I should do. Most of these responses were from smart folks who know more than I do. Not all agreed but the majority offered similar advice. There was some consensus on how I might approach the situation.

Why don’t doctors do this? There are 60,000 Fellows in the American Academy of Pediatrics, for example. Assuming all maintained Twitter accounts, at any given time there would be a boatload of babydocs available for dialogue. Then consider the case of a solo doc the Texas Panhandle who finds himself with a simple dilemma or question that needs immediate feedback. Depending on the human filter tailored by that pediatrician, consensus would be close at hand.

Doctors should be crowdsourcing. And crowdsourcing for our benefit and the benefit our patients, not as a Pharma-fueled vehicle for monetization. Given microblog space limitations and the obvious concerns of patient privacy, this platform would work for simple, direct questions that don’t disclose unique patient information.

Why wait? If every pediatrician in the AAP jumped in today we could give it a dry run.