Do doctors see social media in their practice future? My conversation with fellow physicians on Sermo.com

Poll: Do physicians see social networking in their future?..

I was recently asked by Adam Sharp, MD the Chief Medical Officer of Sermo, the physician-only online community at Sermo.com, to write a guest post of my choosing and facilitate a discussion about it for a few days. My choice? Social media, (based on the recent article colleagues and I co-published in The Permanente Journal). This post is about my experience and what I learned.

I know that only a minority of physicians are visible on social networks like Twitter.com, after all, a minority of them are even exchanging e-mail with patients, so there could be no doubt that this topic would be a controversial one with a community of 110,000 physicians, most of whom do not practice in integrated care systems.

And….I was proven correct. The Sermo platform allowed me to put together a nifty poll, which was very helpful. The results are posted in the graphic on the right, note that my hypothesis caused me to ask a question about the future rather than the present.

Being Sermoan isn’t easy

The life of a Sermoan (this community’s self-assigned title of its inhabitants) is not easy. I was one for 4 days, and, for me, it was challenging. The Sermo community is unique in that the participants are mostly anonymous – they use semi-descriptive handles. I think I was probably the only person that was not anonymous (my handle was “tedeytan”).

Adam and team have given me all of the text of the comments received, and I am going to post a few of them below, to show the spectrum of conversation. I’m not showing the most challenging of it, just a spectrum….It will help those who wonder, “why isn’t my doctor using social networks?”

See for yourself:

NO; NO; NO; NO> These are the answers to your 4 questions. “”To ensure that patients and their families have an active role in their own health care””>> they need to make an appointment; and keep it!!”

and

I agree with Holly Potter, VP of Public Relations at Kaiser Foundation Health Plan that social media tools have enormous potential to help an integrated healthcare system fulfill its purpose, especially in a fully accountable, coordinated care delivery system. Based on my years in self-employed private practice, in the currently fragmented, transaction-oriented care system, I donít think these interactive tools are as well suited to the purposes of self-employed physicians or those working in independent physician group practices.

and

Use FB for what? Telling pt they should take their meds and eat right and …… aim properly so that they dont piss on the rim???

1) I am not their nanny.

2) I am already sick and tired of patients not taking responsibility

3) Pt dont care

==============

When Kaiser makes its docs use FB to deliver care, it saves money. When we do that, we lose money.

=================

Even if I would get paid for it, I would not do it.

and

Ted..The problem is we are stretched to the limit with junk work ( NOT patient or medical problems of patient but the impact of third party systems). The typical answer of CMS or consultants  is hire more midlevels to do all the junk work. For example our hospital which is barely  sailing with its head above water has a “Thomson 100 team, a Press Ganey team.. Valuable tax payer dollars in a hospital wasted on bum work. I really studied the concept of patient centred practice. I hold a contrarian view and after consult code elimination by medicare,  actually trimmed my office size by 33%, changed policies to prevent loss of useful time. I am willing to push encrypted  records to patient ( takes  a mouse click)  but cannot afford to have endless twittter peeps with patient with every question they can think of as they converse with sister Susie on facebook. The distraction is bad for patient care or office functioning.

I do not even carry a cell phone with me after hours. I DO NOT even take any personal phone calls in working hours.  Even if I were paid, I want to have the choice of defining  my working hours. That is why like so many on SERMO   i am still self employed and not vertically aligned..

I learned a lot; however I wish I would have realized more of potential of the immense experience of the group. It took longer to understand these experiences because of the interstitial growling bordering on screaming. My other challenge is that I can’t discern if the commentary is representative of physicians at large or if it is maybe hyper-representative, due to its anonymous, uncensored nature.

Not easy for the other Sermoans, either

I did learn that the life of a Sermoan is not easy either, not because of Sermo, but because of being a physician today. Looking beyond the comments in my post and checking out the other forums, there was more than the occasional “I’m just stopping for a second to take a breath” tone in posts.

There were also stories of the challenged, pressurized world of the physician today, wrapped around quality requirements, patient satisfaction scores, business arrangements –  a whole host of things that society insist that they get “right,” in addition to the right diagnosis and treatment. For a physician who is on their own or in a small group (where 90% of Americans get their health care), it may be difficult just to understand the “why?” of these things, much less be able to master them and lead the health care system with them.

I empathize and I appreciate the frankness with which these experiences are shared.

What’s the potential?

I come from the organized medical group world, where ability to control destiny, and to learn how to lead and learn, is a requirement. I think it has to be this way for medical groups and for all of society. Why?Because physicians can and should lead the health system, with great care and compassion.

With this in mind, I glass-half-fully (or really 3/4 fully) believe that there is huge potential in a community like Sermo, because I think it could provide the ability to lead, supported by self-determination and a common purpose among the most educated and revered by the population. I would think about changing the anonymity aspect. I would think about engaging this group differently, providing more information and resources about self-organization and collaboration. This is what happens in the physical work world that I am a part of – could Sermo provide or connect people to this this in the virtual world?

Comments on all of the above are welcome – since this blog is not Sermo.com, I’m going to request that comments not be anonymous and that they be professional :).

Right now, I agree with my fellow discussants that there isn’t much incentive for the average physician to participate; that doesn’t mean we shouldn’t explore whether it is effective for us and what we need to use it well (before it uses us in an unhealthy way). I’ll close with this final comment that closed the thread. I appreciate the energy, hard work, and especially the time of my colleagues on Sermo in having the conversation.

Over time, the rest of the medical community will understand how social media ought to fit into patient communication. Kaiser, Mayo, and others are leaders in the field right now and others will eventually follow. 

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38 thoughts on “Do doctors see social media in their practice future? My conversation with fellow physicians on Sermo.com”

  1. Question is how representative these unhappy doctors are. The respondents you quoted don't seem very appealing to have as physicians, even during regular office hours. We'll be discussing these issues in Paris on June 22-23 2011 at http://www.doctors20.com . Does it tempt you to come on by? All the best, Denise Silber

  2. While I agree that anonymity can be counterproductive to necessary discussions about potential physician uses of social media technologies, I know the concerns expressed are valid concerns of many physicians.

    My father, Kenneth Holt, is a GI doc in private practice in Southern California. I sent him your post and we discussed. His group implemented an EMR many years ago. He said:

    "I think the docs are going to have to get by the immediate hurdles of all the new demands with the EMR before they are ready for more. The average PCP is seeing 25-30 pts per day and can barely get down with that. By the end of the day they probably have another 1-2 hours of work. Social media may have some use for the concierge type practice. For me I want my patients to have access to me for emergencies and essential questions only."

    Perhaps the language we use around "social media" is part of the problem? Discussions of doctors twittering and Facebooking is overwhelming and seemingly fraught with risks. That doesn't mean there isn't a place for social media technologies (maybe it's not Twitter and Facebook?) to improve efficiency, communication, and the patient experience.

    1. Dear Erica,

      I am flattered to know that this experience created a conversation in your household and that as a result, you are assisting the medical profession as an interested expert in figuring out the right way to use this communication technology! As we alluded to in our journal paper, we think that patients and physicians alike are interested in reducing communication gaps so that they can perform better for themselves and for others. We are not sure in 2011 how to do this using this technology given all of the competing demands that your father mentions, which are real.

      All ideas are welcome, thanks for taking a look and for bringing the discussion home,

      Ted

  3. Dear Ted:

    I was one of the Sermoans you mention. And I do think that some of the comments did get ugly. But honestly, it seemed to me that you were rather too sensitive. When you open a discussion about certain subjects with a passionate group, you have to expect some heated arguments. Anyway, here is an interesting poll of potential patients' expectation of their doctors' use of social media, titled…

    Americans not ready to use social media to talk to their doc
    http://healthcareitnews.com/news/poll-84-percent-

    So it seems that not only doctors but patients also feel that serious issues cannot and should not be addressed via Twitter and FB.

    1. Hi Arvind – thanks for speaking up. Dialog is SO important in these things.

      Having managed online forums for 22 years myself, I respectfully disagree that you have to expect heat like Ted described. IMO there's no excuse for being uncivil, and anonymous forums are hotbeds of it. I've never been on Sermo, not being an MD, but experience elsewhere makes me ask: has anything constructive ever arisen from a Sermo talk? (I don't know.)

      On The Health Care Blog I see a whole lot of food fighting, too, and that's supposed to be a grownup forum – or used to be, anyway.

      Anyway: re the consumer survey you cite, I want to note that I have less confidence in a PR firm's survey than I do in the research of a firm like Pew Research, which publishes full details of its methodology, sampling process, all the raw data received, everything, so others can scrutinize, slice-and-dice, everything.

      I'm especially unhappy with the conclusions the PR firm drew. Googling beyond the superficial Healthcare IT News piece, I found the survey's press release on the PR firm's site, which says,

      “It appears consumers are willing to move administrative experiences such as bill payment and records access online, but when it comes to conferring with their healthcare providers, people still prefer more traditional communications,” says Capstrat President, Karen Albritton.

      Yet Q13 of the tabulated survey results (PDF) says 55% would like online advice from nurses, which is exactly what many practices offer today – successfully. Perhaps Albritton doesn't consider nurses healthcare providers?

      Other problems: it was apparently a robotic survey (some questions have "press 1 if…"); there's no way to tell the abandonment rate (because raw data wasn't published), much less segment the abandonment; no way to segment any of the answers by any geographic factors, or segment the questions by age…. all things I'd love to do.

      Anyway, all this doesn't change the essential issues:

      – Social media are another channel of communication. Nothing more, nothing less.

      – Physicians are under a lot of stress, and I wish their life was easier

      – The world is changing.

      All in all, I'm reminded of a JAMA article in 1922, which I've been told about but haven't found, warning of the evils of another new form of communication: the telephone.

      1. Dave:

        I agree about the need for civility, but to expect it all the time would really be a recipe for disappointment. If you are truly looking for raw opinion, sometimes they are rather rough, but it takes talent to take the message home.

        As far as I know, HealthcareIT News is a promotional magazine for IT and social media. So for them to publish this survey tells me more than I expected. Of course, if one is biased, one cannot accept anything to the contrary. But an open mind will help. Social media is simply an inappropriate avenue to discuss personal medical problems, plain and simple. No amount of money would make me offer medical advice via Twitter.

        Just checking, do you ever get legal or accounting/tax advice via FB or Twitter? And if so, do you get charged for it and do you have to sign a legal release for such advice?

        1. Dear Arvind,

          First, thanks for following me from Sermo to discuss this further, I appreciate that you're a busy physician.

          I think both your comment about the discussion being ugly and the focusing on my feelings ("you're being too sensitive") describe an undercurrent of ad hominem type arguments, which ultimately obscure the points being made, and the learning. That's what I meant above.

          I think my sensitivity is less the issue than how the comments made would be perceived by patients. Thanks for stopping by, feel free to browse around :),

          Ted

          1. I appreciate your offer Ted. As you know I have embraced use of the internet to communicate with my patients individually since 2003. However, I would never befriend a patient on FB or Twitter. As a comparative example, there is almost never a time when I visit a local grocery store that I don't meet a patient of mine. When that happens, I simply connect with them as another human/acquaintance, never as their doctor. Public social media is similar to the store, so that's why I have reservations.

  4. Dave – a great point well made:

    "Just checking, do you ever get legal or accounting/tax advice via FB or Twitter? And if so, do you get charged for it and do you have to sign a legal release for such advice?"

    No I don't! I have never considered doctors use of social media in this way. Of course, I email my company lawyer and accountant constantly. I only occasionally phone them, rarely see them face to face and, yes, they charge me for their remote advice.

    Erica raised the critical issue:

    "Perhaps the language we use around “social media” is part of the problem?… That doesn’t mean there isn’t a place for social media technologies (maybe it’s not Twitter and Facebook?) to improve efficiency, communication, and the patient experience."

    I can see a future where email is replaced by social media technologies for complex discussions. Email isn't very good at these, particularly if you carry the discussion on for long periods. You get multiple, fragmented conversations spread through multiple emails with long chains, varying subjects lines and in different email accounts. Social media technology provides efficient, consolidated discussions. These could also be public (when appropriate) for others to learn from.

    Perhaps healthcare professionals will simply use FB for public health activities (and their own personal lives). Twitter is good for building your professional reputation. Something I'm seeing more and more physicians doing very well.

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