When Hospitals Engage by Megaphone

iStock_000017138912SmallLast fall while teaching at the Mayo Clinic Center for Social Media Residency, I sat with an hospital admin who asked me about her facility’s twitter and Facebook feeds.  I told her it was a remarkable coincidence that everything created and shared was about her facility.  She suggested it was because so many remarkable achievements came from her hospital.

Surprising response?  Not really.  This strong sense of self is the rule rather than the exception.  And so organizations learn to engage by megaphone. Volume, it seems, is the greatest metric of success.  And as long as unidirectional output can be formatted as a graph on a Powerpoint slide, the beat goes on.

As it turns out, no one listens.  People care about themselves, not minimally invasive surgical centers.

Discouraging?  It should be empowering, actually.  The web is the great equalizer.  And it turns out that a hospital of any size is in a position to emerge as the biggest hospital in the public eye by creating material that allows health consumers to genuinely think and understand.  When your approach to content begins with consumer needs, only then do you stand a chance of patients seeing what you have to offer.

People care about themselves, not bariatric surgery centers.  And as long as you push lap bands with a megaphone, folks will cover their ears and vote with their feet.

Should We Screen Doctors for Social Judgment?


It’s a recurring story that played itself out again recently.  A medical student takes pictures of a patient and posts them on Facebook.  This time the alleged victim is an inebriated supermodel and the student, one who defied direct orders to cease and desist.  The result is a $1.5m lawsuit, an embarrassed institution, a ruined career, and most importantly, a patient violated in the most humiliating way.

I’ve always believed that we’re obligated to train the next generation in professionalism and the use of social media.  But after reading this story, I have to wonder whether any amount of training would have made a difference.  You can’t fix stupid.  Perhaps we should screen for it.

While reading my initial thought was that this story is one that’s stale and overplayed.  But thinking better of it, we apparently need to keep hearing it.

You Can’t Stop Public Conversation

I hear occasionally of medical schools that prohibit students from blogging or using tools like Twitter.   But those trying to legislate the conversation don’t realize how fragmented our channels of dialog have become.

And the rules that are created never really make sense.

Blogging is prohibited but long comments are fine.  Twitter is verboten while Instagram, Path, Pinterest, Google+ are seem to fall quietly under the wire.  Nervous admins seem to forget about Foursquare and its capacity for dialog.  What if a student wants to share their opinion of the latest James Patterson novel on Goodreads?  And if blogging and Twitter are the problem, then what about something like Tumblr? It’s somewhere between a microblog and a blog.  I’ve yet to see a policy on Snapchat.

Inconsistent, byzantine rules that are out of touch with the way the world connects only work to make leaders look painfully disconnected.

We can’t stop the conversation.  Instead we should be training doctors in the pros and cons of public dialog, irrespective of platform.

Should Doctors Friend Patients on Facebook?

imgres[I’m creating some physician teaching material and I could use some input on doctor-patient connections on social sites.  What am I missing? What have I overstated]

Should you friend your patients on Facebook, or other social sites?  Or if you’re a medical student on your pediatrics rotation and a young mother friends you, how should you respond?

Here are few things to consider:

It’s not a matter of if, but when.  It’s important to understand that solicitations for connection on public social channels will happen.  The only way to avoid this is to avoid putting yourself anywhere where you can be seen.  This isn’t an option.  At some point you’ll have to face the issue of who you are willing to talk to and when.  Remember that while Facebook may be the most frequently accessed network by millennial moms, you’ll can be approached on Instagram, Pinterest, Goodreads and any number of others.

Here’s what I do.  I’ve chosen to restrict Facebook to generally personal information for friends and close colleagues.  Most of what I share there is from my personal life so when patients make a friend request, I decline.  While there’s nothing there that I have a problem with my patients viewing, they just don’t know me well enough to gain from pictures of my vacation or Christmas morning.

You must get to the idea of how and with whom you see yourself using different applications for dialog.  You must decide where you are going to draw the line with certain people in your life.

It’s important to understand that despite my individual ‘no patient policy’ I still see my Facebook page as very public.  I don’t live under any kind of illusion that this area is a walled off garden for my dark side or hard-edged opinions on politics.  I understand that every picture or comment that I make is one screen grab from my next employer.

I do have a number of patients who follow me on Twitter.  I have no problem with them seeing what I share in technology and doctoring (what my Twitter feed is about).  In fact, my Twitter feed is a type of public curation where I share things.  I have little in the way of public exchange and when it happens, its really transient.  Since few patients curate content and links surrounding technology and the emerging role of the doctor, I follow few, if any, patients.

Honestly, they’ll get over you.  Many of us live with the distorted view that friend requests are rude or awkward to reject.  A lot of doctors I’ve spoken to have concerns that their patients are going to be angry or upset with the rejection.  My experience with patients in this situation is that they completely understand.  Even if they don’t, you have to define what you’re comfortable with and those around you are going to have to accept it.

Think about where you might be able to engage them.  When you tell patients that you’re not willing to connect with them on your personal Facebook page, think where you might be able to engage them.  Remind them, for example, that your practice has a page and you would love to share stuff there.  If you have a patient-focused blog, your comment area may be a place to interact and have dialog.

So rather than planting a flat rejection on the patient who wants to connect, offer them a place to have some interaction with you.

Plenty of doctors let their patients in.  It’s important to understand that you don’t have to restrict your conversations.  I have colleagues who open up their personal world to their patients.  They find that it enriches the relationship they share and feel that it represents the most honest, transparent means of operating in the networked world.  You have to decide what works for you.  Avoid the temptation to do just as I do.

Your institution may make the decision for you.  Many institutions or hospitals have policies that prohibit doctor-patient contact on public networks.  I think that these are problematic since, like the grocery store encounter, it may be difficult to avoid contact in certain circumstances.  I also think that the right kind of contact can be enriching for both a provider and patient.  Most of these policies are driven by the fear that there may be care-specific dialog taking place that can’t be monitored.  While this is a reasonable concern, it can be handled with basic education and training surrounding conversations and context.  There’s no reason why doctors and patients shouldn’t have certain conversations in public, be it at the soccer field or on Twitter.  But, unfortunately, you’re unlikely to change minds anytime soon.  Check with institutional policies and be smart.

Things might be different for students, residents and trainees.  For trainees I would recommend the most conservative posture and avoid relationships.  Remember that when it comes to your deans and program leadership, perception trumps reality.  Even the most appropriate conversations clipped out of context may be perceived as problematic.  Once you are evolved in your career you will be better able to make decisions regarding the kinds of relationships you want and where.  Concerning the young mother who friends you during your pediatrics rotation, simply explain the situation that you don’t connect with patients (or parents).  My experience has been that they always understand.

Online Doctors

I frequently hear the term online doctor.  When I hear it I have to wonder if there are offline doctors in contrast?

Increasingly our networks are moving digital.  Most docs use FB.  Twitter use is in line with the general population.  And it’s hard to believe that there’s any doctor who doesn’t consume information from the web.  I suspect that at some level we’re all online doctors.

The term suggests that our online and offline worlds are separate.  Nathan Jurgenson has called this digital dualism.  His description is a bit heavy but worth a peek if you’re into this sort of thing.  I have to agree that the divide between virtual and IRL will ultimately fade and the ‘online’ modifier will become a charming bit of history.

Until then, perhaps we should somehow start discriminating doctors who quietly consume from those who curate, create, converse and contribute.  Because in 2012 vernacular, these are our online doctors.

Can Google Plus Focus Our Signal?

I think perhaps our biggest challenge going forward is attention crash.  Too much input.  Too much noise.  We’re trying to listen to too much.  The problem is that as information explodes, we don’t scale.  Keeping our eye on everything simply isn’t sustainable.

Twitter gave many of us our first taste of real-time input.  We were told that ‘listening to everyone’ else was our way to be heard.  Twitter was the early 21st century’s party line.  A message roulette of sorts.  Facebook has had its lessons.  After too many connections we discovered just how difficult it can be to tell loose acquaintances that their stuff just isn’t that important to us.

I finally see people around me coming to the realization that they need filters.  They need a better signal.

I’ve been monkeying around with Google+ and I think it puts us a little closer to where we need be.  Google forces filtering on the side of the sender and the receiver.  After all, not all messages are appropriate for everyone in our broadcast area.  And not all inputs (or circles) are appropriate for us all the time.  G+ is more intentional and gives us the option for more control.  It offers a step towards controlling the noise.  I’m not sure that this is the place for me, but it’s definitely interesting.

How it’ll all shake out isn’t clear.  I suspect that the draw of tighter control won’t be enough to pull the average college student or mother of four away from Facebook.  Twitter isn’t going anywhere.  There’ll always be demand for the party line.  And I suspect that as the social world continues to fragment, the digital biosphere will segregate by species.  As these properties age and fall from grace, they will evolve to comprise some kind of social media long-tail.

Either way I think we’re all (along with our tools) getting closer to understanding that listening and broadcasting to 20,000 folks is not the most efficient means of getting and sharing information.  Maybe it’s the beginning of the end of an era.

Book Notes: The Filter Bubble

I recently read The Filter Bubble – What the Internet is hiding from you by Eli Pariser.  As you’re probably aware, Google looks at your search
history and takes it into consideration in subsequent queries.  While over time our search becomes refined and personalized, Pariser argues that this happens at the expense of making our world view increasingly myopic.  If you’re a card carrying member of the NRA, for example, you’re more likely to see content with conservative values than your liberal friend. This ‘filter bubble’ is facilitated by megasites like Google, Amazon and Facebook.  We also create our own bubb

Pariser argues: “personalization filters serve up a kind of invisible autopropaganda, indoctrinating us with our own ideas, amplifying our desire for things that are familiar and leaving us oblivious to the dangers lurking in the dark territory of the unknown.”  Yikes.

The Filter Bubble offers passing lip service to the glaring reality that we’ve always lived by the filter.  As a child, The Boston Globe and Walter Cronkhite decided for us what was important.  And who would ever argue that the New York Times isn’t a filter?  Admittedly we can refine our inputs now like never before, the point remains that biased curation may not necessarily be a novel concept.

And Pariser makes certain assumptions about the searching public.  He sees the search world as made up of iterant intellectuals looking to create epic change for humanity.  In fact, most of us are just looking for a cheap flight.  While I like to see myself as something of a flaneur, I don’t consider my serendipity Google’s responsibility.

While filtration and curation will become increasingly important going forward, The Filter Bubble sheds light on the tension between our drive to create a refined signal and the need to see the world for what it is.  This book has made me think about the bubble that I have created for myself (in fact, when I finished the book I immediately felt the urge to renew my subscription to The Economist – love the way it renders on my iPad).

I found this quote to be important:

“Ultimately, democracy works only if we citizens are capable of thinking beyond our narrow self-interest. But to do so, we need a shared view of the world we cohabit. We need to come into contact with other peoples’ lives and needs and desires. The filter bubble pushes us in the opposite direction—it creates the impression that our narrow self-interest is all that exists. And while this is great for getting people to shop online, it’s not great for getting people to make better decisions together.”

Despite my spotty criticism,  The Filter Bubble is a very important book.  I highly recommend it.

The links to Amazon represent affiliate links.

The 21st Century Physician Spokesperson

I spoke with a physician friend recently about an offer to serve as a spokesperson for a small nutrition company.  After getting off the phone I thought about the future of the spokesperson.

I can’t help but think that the way it’s been done for a couple of generations is now out of synch with the way the world shares information.  Company hires PR firm.  Firm hires media ready expert.  PR firm issues press release and waits for MSM.  PR firm connects expert with interested MSM.  Printed quotes ensue.

Perhaps today’s spokesperson should be working multiple social channels.  Maybe the spokesperson of today should live among the media, or the people formerly known as the audience.  The spokesperson’s speaking should probably occur on Twitter, Facebook, Quora and the comment sections of the busiest blogs.  And YouTube is always willing to accept what the television networks find unappealing.

Rather than waiting to be quoted, we should create opportunities using the power entrusted to all of us.

My critique is tongue-in-cheek, of course.  The smartest organizations already meet the new media where they’re at.  I’ve yet to see this happen as much with physician spokespersons.  But maybe I’m looking in the wrong places.

Unprofessional Physician Behavior on Twitter

I woke up this morning to a couple of DMs from physicians alerting me to the Twitter thread seen below (tweets read bottom to top).  Is it unprofessional?  Decide for yourself.

Whether you change details or not, the use of the social space at the comical expense of those we’re called to treat is irresponsible.  While the detailed depiction of the patient’s problem is bad enough, the suggestion that you would have somehow ‘fixed’ the situation long before 36 hours is reprehensible.  This is something I’d expect from a frat house, not a treating physician.  Of course this level of dialog could only be sustained by someone hiding conveniently behind the cloak of anonymity.  Case in point for putting your name and maskless face behind everything you say.

Concerning doctors and public dialog, if the crowd doesn’t look after things, someone else will.  But I shouldn’t complain.  This sort of stuff gives me fodder for my next presentation.

What say you?

Comments to this post without a proper name and link to a digital property (Blog, Facebook, Twitter, etc) that identifies you as a palpable human being will be deleted.

Comments are now closed.  There are an amazing variety of views below as well as a number of ongoing conversations throughout the infosphere.

Facebook and the Rhode Island Doctor

As we work to get our fellow physicians to emerge from the shadows, the last thing we need is a social health horror story.  This week a Rhode Island physician was formally reprimanded for breaching patient confidentiality on Facebook.  You can get catch up with the core story on MSNBC or read KevinMD’s nice analysis.

Look for a screen grab of the MSNBC headline at a compliance lecture near you (pointer slapping against screen: “This is what happens when doctors use Facebook“).

A few thoughts of my own:

Don’t assume ill intent. While it’s never Kosher to disclose protected health information, we don’t know the nature of the dialog in this case. This may have been innocent mistake made while sharing a remarkable experience. On the other hand, it could have represented poor professional judgment.

Irony. The world clamors for doctors to be more engaged. But when (not if) we make a mistake our names are at risk of going viral.  And yes, the bar should be set higher for us.  I just wonder if news like this represents the best way to handle a profession’s social growing pains. This story represents one more reasons for doctors to hide under their exam tables.

It’s the medium, not the message.  Unfortunately disclosure of protected health information occurs more often than we’d like to admit. But when was the last time we saw MSNBC headline a patient privacy violation made on the radio?  Anything Facebook is newsworthy.  Ultimately this story’s more about the medium, less the transgression.

How do you define a jury of your peers? When it comes to the definition of unprofessional digital behavior, I’m concerned that early adopting doctors may not be given the benefit of the doubt when it comes to professional review. In fact, peer review by those who think that Twitter is something done by delinquent teens may not really represent peer review.  Expect physician transgressions on public platforms to evoke extraordinary consequences.

Could this be a teachable moment? With the blessing of her hospital’s compliance officer, a guest post on 33 charts or KevinMD, for example, would turn a negative into a positive. Think how an open dialog of this case could influence medical students and the discussion surrounding digital professionalism.  And everyone loves redemption. Westerly Hospital, you have my number.

Here’s an absolute: if you don’t talk about patients it’s impossible to commit a health privacy violation (or correct me if I’m wrong).

This is just one casualty of an evolving communication medium.  Expect more.

Defining Online Professional Behavior

This week a reporter cornered me on the issue of professional behavior in the social space.  How is it defined?  I didn’t have an answer.  But it’s something that I think about.

Perhaps there isn’t much to think about.  As a ‘representative’ of my hospital and a physician to the children in my community, how I behave in public isn’t any different than a decade ago.  Social media is just another public space.  Sometimes it’s easy to forget that we’re in public.  When I’m wrapped up in a Twitter thread it’s easy to forget that the world is watching.  But the solution is simple: always remember that the world is watching.

On Twitter I think and behave as I do in public:  Very much myself but considerate of those around me.  I always think about how I might be perceived.

Here’s a better question, online or off:  What is professional behavior?  I have a pediatrician friend who, along with the rest of his staff, wears polo shirts and khaki shorts in the summer.  The kids love it.  One of my buttoned-down colleagues suggested that this type of dress is ‘unprofessional.’  Or take a handful of physicians and ask them to review a year of 33 charts posts and my Twitter feed.  I can assure you that some will identify elements that they find ‘unprofessional.’  I believe I keep things above board.

This is all so subjective.

The reporter was also interested in how I separate my professional and personal identities in the online space.  I’m not sure the two can be properly divided.  The line is increasingly smudged.  I try to keep Facebook as something of a personal space.  I think it was Charlene Li who suggested that she only friends people she knows well enough to have over for dinner.  That’s evolving as my rule as well.  But independent of how I define ‘well enough,’ Facebook is still a public space.  My comments and photos can be copied to just about anywhere.

Social media has not forced the need for new standards of physician conduct.  We just need to be smarter than we were before.  Everyone’s watching.