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What am I doing?

You're blogging, dummy.

No, I mean what am I, as a doctor, doing writing in this blog?  Why do I do a podcast?  Why do I do Twitter and Facebook?

Because you are pathetic and can't find real friends, and real things to do.

I know that!  No, I am looking deeper as to what the role of social media is in medicine.  I've been asked by numerous people recently about my opinion on this issue.  Aside from proving that the end of civilization is at hand, it has provoked me to think a little deeper about the deeper meaning of what I am doing.  I've been blogging for nearly 4 years (Blog-o-versary is May 21), and yet the question is: what is the point?  What is the overall purpose of medicine's presence in the social media universe?

Whoa.  That's deep stuff.  I'll keep quiet while you talk.

Thanks.

In my musings on the subject of social media, I am moved to an even more basic question: what is the purpose of healthcare?  The measure of the contribution of social media gives to healthcare will be based on its alignment with the purpose of healthcare.  Yes, there is an aspect of blogging, Facebook, and Twitter that is personal, but one of the main reasons I get the attention I do is the fact that I am a doctor.  I speak from the doctor's perspective, expose the thought process (albeit a little demented) of a doctor, and try to influence the overall discussion about the delivery of healthcare in America.

So what is the purpose of healthcare?  The answer is in the word "healthcare": giving care to patients.  The patients get care that doctors, nurses, and others give.  The patient and the caregivers are costars in the drama, the absence of either making the discussion irrelevant.  Patients don't just have needs, they want those needs met.  Being a doctor is pretty much meaningless without patients (it does let you impress people at parties with your fancy Latin and Greek words, though).  The interface of caregiver and those needing that care is what medicine is.  The effectiveness of  the exchange between the two (or more) people will be the measure of the care.

Social media, then, should also be measured by this exchange.  Does it influence the exchange between patients and medical professionals?  Does it help patients get better care?  Does it help doctors be better doctors?  Does it improve the relationship between doctors and nurses?

It does as long as they don't read your blog.

Hey, I thought you said you would keep quiet!

I couldn't resist.

Resist.

The answer to those last questions is this: sometimes.  Sometimes it improves care and sometimes it makes it worse.  Just like there are healthy exchanges in the hospital or medical office, there are healthy and unhealthy interactions using social media.  There are a number of areas in which that exchange can succeed or fail.

  1. Is the information good or bad?  Is it biased by desire for financial gain or personal crusade?  Both doctors and patients can become sources of information, and the quality of that information is highly variable.  The problem is that if a person trusts bad information, it is not just their knowledge that is harmed, they can be physically harmed.
  2. Is the content constructive or destructive?  Some doctors blast patients, and some patients blast doctors.  While the Internet is an open venue for venting frustration, there are some who cross the line and undermine or even betray trust.
  3. Is the virtual interaction appropriate?  As the House Call Doctor, I get asked a lot of specific questions that are beyond what I should be doing.  I don't want to undermine the relationship a person has with their doctor, I want to enhance it by informing the patient.  Social media can do either.
  4. Are risks being taken?  A big danger of interactions on the Internet is that they are recorded for posterity.  Patient privacy can be breached, and medical mistakes can be recorded.  Bob Coffield, an attorney in West Virginia who is especially interested in social media, has speculated that Twitter is akin to the elevator in the hospital.  Others can listen in and get wrong ideas or draw wrong conclusions.  This may be a bigger risk than we realize.

Obviously, I think social media is worth it (since I am deeply involved in it).  The benefits clearly outweigh the risks, but the risks should be seriously considered and minimized as much as possible.  Here are the benefits I see from social media:

  1. I have a voice - I have the ability to express myself where previously I had little say.  The biggest benefit of SM is the empowerment of those who had no voice in the past.  Instead of just hearing the medical lobbyists, academic physicians, or medical media's perspectives, people have the ability to hear from real doctors, nurses, and patients about what it's like in their shoes.  This is especially powerful when contrasted to the political grandstanding in Washington.
  2. It humanizes medicine - I am just a guy who is a doctor.  The black box of our medical knowledge is gone, with the access everyone has to copious amounts of medical information.  So now we can let down that air of mystery and relate to people as people.  I am compelled by the humanity of the relationship between doctors, nurses, and patients, and think that truly embracing and understanding it will be a big step forward in care.
  3. I have made friends - I am interacting with people from all over the world, and I really like a lot of them.  I would never have had this opportunity without social media.
  4. Opportunities - I was hired by Macmillan for my podcast because of my blog.  I have gotten a chance to express my opinions on NPR, in the NY Times, New England Journal of Medicine, and in many other venues.  I greatly appreciate the opportunities it has given me.
  5. I have fun - I've discovered my ability to write and have had a chance to express my sense of humor.  I've learned about things I would never have known from other bloggers, and have truly enjoyed interaction with my readers.

In the balance, social media has the same risks as medicine in the office.  The negative is that it is recorded and transmitted over the world.  The positive is that it gives the opportunity to give and take with people from all over the world.  It's a medium, and so is neither good nor bad in and of itself.  The content of that medium is what makes it helpful or harmful.  All in all, I think the potential benefit is much bigger than the risk.

So do you think llamas are helpful or harmful?

Sigh.

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