Doctors Wary of Social Media Exposure But See Value in Dialogue

Deanna Attai, MD

Online forums have peeled away some of the barriers to understanding her patients, says Deanna Attai, MD, a well-known clinical professor of surgery at the David Geffen School of Medicine at the University of California Los Angeles. Attai is co-moderator of the Breast Cancer Social Media (BCSM) Twitter community, a regular Monday open forum.

“When you see two women in the middle of the night having a real raw conversation about their chemotherapy side effects, it is very different from what you see in the office,” says Attai.

Social media — which broadly defined encompasses many different forms of Web-based exchange – has the potential to make a deep imprint on oncology practice, but many clinicians are still reluctant to participate, physicians interviewed by Oncology Business Management say.

In some instances the reasons for holding back are a lack of time and skepticism that an investment in posting online will advance their practices in any material way or contribute much toward patient welfare, says Don Dizon, MD, an oncologist at Massachusetts General Hospital and chair of the Social Media Working Group for ASCO, which is tasked with evaluating and guiding social media participation within the society and for its members.

Many use social media to further their professional education and stay current, but a huge concern among physicians is the danger of compromising their reputations as community professionals and potentially violating patient privacy rights. For example, Attai noted that an innocent post could lead to a harsh response from a special interest group. “That’s not something we expect as physicians, and we don’t really know how to deal with it,” she says.

Nevertheless, many practices from the administrative end have embraced the potential of social media and are encouraging their physicians to participate. “There’s a heavy investment in a social media presence at the institution level,” says Dizon. “It’s all about exposure and making sure that name recognition is increased in a comparatively more competitive environment for patient attention.”

These institutions all have the same problem, though. “Every single one of them, I believe, is struggling with how to get buy-in from their providers,” says Dizon. “What’s happening [online] isn’t necessarily reflected at the physician level in any of those institutions or health practices. You cannot force someone to join Twitter or Facebook or write a blog, and you certainly can’t post in someone’s name, because that would be unethical.”

No Credit for Tweeting

Academics don’t receive credit for tweeting, and they may feel that writing a grant application is a far better use of time, Dizon says. Physicians, meanwhile, may be pulled in many directions by their workplace obligations. They may have to see inpatients or do administrative shifts in a hospital. “It’s all about work-life balance. If you’re doing so much at work already, how much time do you have to devote to something else?” he asks.

This situation is frustrating for administrators, who feel that participating in social media is important for establishing a practice in the community and for building brand. “One of the questions I am always fielding is, ‘How do we get our people to tweet?’ And I don’t think anyone at the institutional level or at the marketing level of any one institution or practice has the answer for that,” says Dizon.

Don Dizon, MD

Attai is in the camp of social media converts who believe that patient confidentiality can be respected with proper training and that, although physicians are busy, social media is something they can do if they are dedicated. “As with anything, you have to figure out how involved you want to be, how important it is to you, and then figure out how to manage your time. It took me a little while to learn,” she says.

Recognizing the growing influence of social media in oncology, ASCO put out a set of guidelines for physicians in 2012.1 Dizon was the lead author. The report noted the inherent risks of publishing material online, while praising the value of disseminating good quality medical information that would serve as a useful resource to doctors, patients, and others. Although physicians use social media in different ways, the report said, giving patient advice directly over the Web is least often done, and the authors expressed doubt that that it can be done in a manner that satisfies patient privacy and regulatory requirements.

A World of Patient Experience

Talking about the ways that social media has changed her practice, Attai says it has exposed her to a world of patient experience that was not available to her by seeing patients for 15 minute appointments only. That, in turn, has made her a better, more empathetic doctor. “It’s changed the way I listen. It’s changed the way I ask questions,” she says. However, she said her patient interaction online has not significantly improved her practice revenues, nor did she expect it to.

Dizon agrees that for him, too, the information exchange via social media has been paramount in terms of value. “You’re getting voices not only from the folks you agree with professionally, you’re getting the patient voice and the advocate voice. You’re getting a 360-degree view of any one topic, so that is, for providers, the benefit of social media. Whether or not that is enough remains to be seen.”

Social media may not have made a huge difference in the amount of patient traffic that walks in through Attai’s doors at UCLA Health Burbank Breast Care, but some patients do seek her out, having heard about her through Twitter or other online forums. Attai takes that as a sign of how much better informed patients are today, and how much research they are doing independently to learn about their disease and about available treatment. This in turn has made physicians much more careful about reputation, their online image, and their so-called bedside manner, says Attai.

The old stereotype of a paternal physician who always knows what’s best for the patient is not entirely a fiction. Those doctors still do exist, but the internet and the social media revolution have turned them into an endangered species, says Attai. “One of the things that comes up a lot on BCSM is ‘How do I get a second opinion?’ ‘How do I ask?’ ‘I’m afraid that I’ll hurt the doctor’s feelings.’ You’ll have all the patients as well as the doctors rushing in, saying ‘This isn’t about you. This isn’t about the doctor’s feelings.’” Attai recalls having had a few of those doctors when she was younger and feeling somewhat intimidated before she decided to go elsewhere for treatment. “Patients are taking ownership, and I think that is good, because they are with their problem 24/7. It is up to them to find a set of care providers they can work with and develop a relationship with,” she said.

The Importance of a Digital Presence

These Web-empowered patients increase the pressure on physicians to make themselves known over social media, Attai notes. “I think more and more it’s going to become essential that physicians have something. It doesn’t mean you have to do a website. It doesn’t mean you have to go on Twitter or Facebook, but putting out some sort of your own content that links back to you as a physician, I think, is going to be more and more important going forward.”

ASCO has been involved on Twitter and Facebook with online populations of its members and with the general public, and those efforts have been highly successful, particularly online tumor board platforms, which are designed for clinicians though anybody who reads the site can offer input, says Dizon.

“It was in the context of having all of these social media channels that the questions came up: Are we using them effectively, and are the messages coming from ASCO consistent, and also, can we utilize these better, and then finally, can we encourage our membership in a more thoughtful way to engage in these platforms?” says Dizon. “Because, the God’s honest truth is, while there will be people who are engaged in social media, it is the minority of folks who are currently in clinical practice."

Another problem with trying to promote the use of social media in oncology is that some forums essentially fly above the radar of those they are intended to reach. “A lot of what happens on Twitter stays on Twitter,” says Dizon. “I sometimes feel that those of us who believe in the power of social media and believe in the power of patient engagement are speaking only to one another, isolated in an echo chamber, and I’m left wondering whether or not we’re really influencing the larger conversation of change.”

This is a perception that ASCO is trying to explore and understand better in its attempt to develop a plan to expand the use of social media among oncologists, Dizon says. “We’re sending a very large signal to oncology, but also beyond oncology, to medicine in general, that we believe this is not a space that we should ignore.”

In five years’ time things will be very different, Dizon believes. He thinks part of the slowness of adoption in oncology is a generational issue where doctors who grew up with pens and yellow pads are still using those by force of habit, whereas some newer doctors are “designing their own apps.”

“We’re now going to come to the era where you’re looking at wearables and data coming from all over the place,” says Dizon. “I think in the era of big data, the social media space will become a part of regular practice. It’s all a part of the tech revolution in medicine that is happening now. I bet it’s going to be a lot harder not to get involved.”

Dizon D, Graham D, Thompson MA, Johnson LJ, Johnston C, Fisch MJ, et al. Practical guidance: the use of social media in oncology practice. J Oncol Pract. 2012;8(5):e114-e124. http://jop.ascopubs.org/content/8/5/e114.full. Accessed June 10, 2015.