Patients social media use raises practical issues for doctors

Ethical concerns come into play when physicians become part of health conversations on Facebook and other sites.

By — Posted March 28, 2011

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Patients using social media to check in on what their friends and family are doing are starting to use the sites as sources of information for something else -- health care.

National Research Corp., a health care research company based in Lincoln, Neb., recently surveyed more than 22,000 Americans and found that nearly 16% use social media sites as a source of health care information. Of those, 94% said Facebook was their preferred source, followed by YouTube with 32% and Twitter with 18%.

The company did not ask patients why they used social media as a health information source. However, analysts say that because people are spending more time on social media sites, they have begun to include questions and research about health care as a part of that experience. They say many like having an instant conversation online, rather than merely reading what someone has posted on a website.

"For many people, social media -- or Facebook in particular -- is the Internet," said Jennifer Dyer, MD, MPH, a pediatric endocrinologist and an assistant professor of pediatrics at the Research Institute at Nationwide Children's Hospital in Columbus, Ohio.

On a scale of 1 to 5, with 5 being the highest, 82.3% of those surveyed who used social media trusted the information on a level of 3 or higher, and 78.8% gave a level of 3 or higher to the likelihood of social media influencing their health care decisions.

Physicians can ask patients about what health websites they consult and give their patients a list of recommended sites. However, the dynamic is different with social media -- and so are the moral and ethical expectations and obligations.

For example, American Medical Association policy discourages physicians from socially interacting with patients on social media, though professional sites are encouraged. The Association has had policy, even before social media was an issue, that physicians should not practice medicine online with patients when there has been no previous face-to-face relationship.

But experts say physicians concerned about what patients might find on social media can come up with ways to become involved in their health conversations.

For example, a physician can have a Facebook page that is actively updated and maintained so that when patients have general health or wellness questions, they can ask the doctor instead of throwing it out to everyone they know on Facebook. It also can be a place where physicians share what they consider quality research and educational material. Patients would be amenable to what a physician has to say on social media, given that the National Research survey found that hospitals and physicians are patients' most trusted sources of health information.

"I do think, as a physician and a communicator, it's an ethical duty ... for everyone to contribute something to this massive pool of information -- where everyone is looking -- that is accurate information," Dr. Dyer said. She and her hospital have presences on multiple social media sites, and she said often patients say it's more convenient to get in touch with her through those means rather than by email.

The National Research survey did not ask specifically what social media presences the respondents checked out, what advice they were seeking or from whom. But there is plenty of evidence that social media users are following health-related feeds.

The American Cancer Society has more than 228,000 "likes" on its Facebook presence, meaning the number of Facebook users who follow its updates. The Centers for Disease Control and Prevention has about 82,000 likes on Facebook, and the American Diabetes Assn. has more than 72,000.

The amount of health information varies by the site. The American Diabetes Assn.'s Facebook page includes a 10-question test to see if a person is at risk for type 2 diabetes. Hospital and physician social media sites might mix general health observations with news about their organizations.

Setting up a presence on a social media site doesn't mean soliciting patients to come to the site with the promise of a diagnosis. But it can help steer patients to helpful information. For example, at Tufts Medical Center in Boston, the Facebook page also serves as a referral outlet to its other online educational resources, said Tim Brennan, public affairs and marketing manager for Tufts.

Though physicians are not expected to be the "rulers of the Internet" and monitor their patients' every move or be available for every question they have, they can offer assistance when needed, Dr. Dyer said.

Take a recently reported case from the United Kingdom. Rahul Velineni, a physician from the Princess of Wales Hospital in Bridgend, Wales, saw a Facebook status update of an old school friend saying he was having severe stomach pains and trouble walking. The doctor suspected appendicitis and shared his concerns with his friend. The friend did have appendicitis and that by the time doctors operated, the appendix had perforated.

Howard Brody, MD, PhD, director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston, said the scenario represents an ethical question that goes beyond social media, or even the fact that the person who offered the advice was a doctor.

"There's a general sort of ethical obligation to help other people out," Dr. Brody said. A physician may have knowledge relevant to a certain situation, he said.

"If you stumble upon information that they could really use to protect themselves, not to share it would be ethically questionable," he said.

On the other hand, offering specific medical advice can cross ethical boundaries, Dr. Dyer said.

"If someone says, 'How much Tylenol do I take?' and they are not your patient, you can't say, because you don't know if they have a liver condition or anything about them," she said. "It's not too different from someone at the airport that you happen to be sitting next to asking, 'Should I do this or that?' Most doctors are not going to practice medicine on someone they do not know."

What Tufts Medical Center and other hospitals and physicians have found is that they don't have to provide answers to every question to keep patients coming back to their Facebook page, Brennan said. The community shares its expertise and experiences. The hospital or physician practice simply acts as a host that brings the community together.

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High confidence in information

National Research Corp. surveyed more than 22,000 Americans and asked about their use of social media sites to collect health information. Nearly 16% said they use social media and find it a trustworthy source.

Form of social media used

Facebook: 94%
YouTube: 32%
Twitter: 18%
MySpace: 18%
FourSquare: 2%

Level of trust in social media

5 (very high): 13%
4: 20%
3: 44%
2: 15%
1 (very low): 8%

Likelihood of social media to influence health care decisions

5 (very high): 12%
4: 18%
3: 36%
2: 13%
1 (very low): 21%

Source: National Research Corp.'s Ticker Survey, February

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