As I mentioned in my recent post, physicians are not as well represented in the weekly HCSM Twitter conversations as other professions are. My ears perked up, when during September 5th’s conversation when the first topic was “Is it OK for a doctor to talk to patients online? When? What if they’re not his/her own patients? What sites are OK vs. not?” As an physician actively participating in the dialogue who is also active on Twitter and in the blogosphere, this topic is very relevant to me. The discussion that ensued followed two general paths, discussing when and how physicians should engage patients on-line in general, and when and how doctors should enter and participate in online patient communities.
For me, the answer to the first issue was fairly clear: I think physicians have every right to interact with patients online, and I don’t think it matters if the interaction is with one’s own patients or not. So long as physicians are interacting as people–not in a professional capacity–then we should feel free to converse with whomever we choose. The necessary balance (for me, at least) is to be a resource to the community as a health care provider without offering diagnosis or treatment online. I can provide information so long as I do not practice medicine. If someone asks me something about a medical condition, I feel safe speaking in general terms, referring them to trusted resources on-line (FamilyDoctor.org, for example), and referring them back to their own provider. This is the same thing that I would do if someone I met in the grocery store asked me something of a medical nature.
There seemed to be a general consensus in favor of that approach, but with some provisos. @sixuntilme noted “I like the concept of docs talking to patients online. Preferably after they cover their rear, liability-wise”. @scottkjohnson added “I think marketing = no, specific medical advice = no, general information sharing = probably ok. Building relationships is good” and “Specific patient advice?In their office. General advice (ie, you should probably see your HCP)?More flexible.”
There were some concerns, though, both from providers and from other participants. @latta expressed their concern that if a provider gave medical information on-line, even in a general form, and a patient had a bad outcome then the transcript of that information could come back to haunt the provider. Those concerns are valid, but I think one can communicate as a physician on a public forum so long there are guidelines in place. Of course, there are no formal guidelines in place, so each of us has to make our own decisions. My rules are to “be general, guide patients toward trusted resources, and emphasize the need for evaluation by a physician.” This seems like a safe approach. And there are potential significant rewards as expressed by @hillarts: “The more drs communicate, the less nervous everyone will be, and the liability issue will be less of a concern”, and “Several studies have shown that drs. that are more open and transparent with their patients get sued less often”. I think the best approach is to proceed with caution, but to become part of conversations and to contribute to dialogue. It seems that many of the HCSM participants felt the same way.
The discussion of where physicians should interact with patients quickly focused on the roles physicians could/should play in online patient communities. Here the verdict was decidedly mixed. There was a great deal of concern about the appropriateness of physicians participating in these communities, especially if there is the perception that physicians are trying to advertise or influence discussion without disclosing their identities. @danamlewis noted that “Personally, I think online communications are peachy..when I say so. I’m iffy on docs going in2 communities 2 ‘market themselves’ 2 me”, and @MuhammadInc agreed that “Doctors should not be using these communities as a marketing venue.” @ePatientDave commented that “ACOR communities are quite careful about avoiding docs who might sabotage or skew. It’s happened, I hear”. @MeredithGould asked “Isn’t it your experience that those into self-promotion usually reveal that & are monitored by the community?”, and noted that “I think anyone who participates in an online community ought to disclose his/her agenda — if there is one.” Previous HCSM discussions indicated that doctors should not participate as doctors (as opposed to participating as patients if they have a specific illness) unless officially invited do to so. @MeredithGould’s final thought which seemed to summarize much of the discussion: “How’s this for a guideline: Either be a positive contribution to community and commit to learning or shut up and go away!”
Physician involvement online is necessary, and will become increasingly so. In the absence of any formal guidelines we must all follow our own consciences–both as physicians and as online patients. Physicians can judiciously engage in social media dialogue, and can participate in online patient communities within the norms those communities establish. This is a good start, and I do believe that further involvement will break down barriers and establish norms that protect all involved.
So, physicians: get to it!