Opposing views on social media in medicine

doctor image

Lots of news this weekend on practicing medicine online, everywhere from the LA Times to the Mayo Clinic.

One doctor leverages social media for the good of her practice, and her patients:

In October 2009, she started a texting program and asked three 17-year-old high school seniors and their parents to get involved. They agreed.

Since then, Dyer has texted each teen every Thursday at 5 p.m. She begins with this introduction, “Hi, this is Dr. Dyer.” After they respond, she’ll ask them a personal question—such as, “How was lacrosse practice?” or “How were finals?”Once getting a response back, she asks: “How are you doing with your boluses? How are your blood sugars? Are they high or low?”

After three months, she says, the results have been successful. Before, the teens would usually miss taking about half of their boluses each week. Now, she says, teens miss only about three boluses each week.

Another doctor questions how much work he’s doing for free, after hours, and at what cost:

But medical care based on electronic communications is commandeering doctors’ personal lives. Our instantaneous availability is breathlessly touted by health care systems eager to serve their patient customers… To preserve their personal life and get home at a reasonable hour each day, test reviews and patient communications are increasingly performed from home – all for free. Worse, our similarly web-enabled patient population has learned that many of their health care issues can now be addressed online free of charge – just send a two-page e-mail – who needs an office visit?

One doctor doesn’t use email:

Until this happens – until we are somehow paid for giving care outside of the office – this useful technology will remain unused.  Is it greedy to not want to give things away for free?  Is it greedy for me to not want to spend less time with my family, make less money, or spend less time with patients?  Is it greedy to think I am worth $20?

While still others share their notes online with their patients:

I’d reported a crusty lesion on my forehead at the hairline. I’d had the same kind of lesion last year, and the dermatologist had frozen it off. (I have a history of skin cancer.) This time, the need to handle it had slipped my (ever slippery) mind.

Several weeks had already gone by so I emailed Dr. Sands (in the PatientSite secure portal) asking if I should insist on a fast appointment. He said no.

Notice that all this happened without any phone calls, because I could do it online. And that means it all happened sooner (act in the moment, no phone tag). And it captured the action in the moment when I thought of it.

Many hospitals wrestle with Facebook:

In the incident at St. Mary Medical Center, nurses and staff posted a photograph of Wells on their public Facebook accounts for about two days before fellow staffers reported them to hospital officials, according to an employee who saw the photo and Facebook posts. Hospital staffers also circulated the photo in text messages, said the employee, who asked not to be identified for fear of being fired…

News of the Facebook posting at St. Mary coincided with the hospital’s launch of a massive online marketing campaign last month that will include a new Facebook page, Twitter account and appearances by doctors on YouTube.

While one hospital starts a social media education and training center:

“We see immense opportunities to use internal social networking tools for collaboration among our employees to improve patient care, education, research and administration,” Aase explains. “As we find new applications, we plan to conduct research into their effects so we can measure any cost savings, efficiency gains and improved effectiveness. And when we do, we’ll be sharing those findings externally to help the whole health system improve.”

Librarians are involved, too, and struggle to coordinate their work with research teams:

I was impressed by the level of involvement of the clinical librarians and the time they put not only in searching, but also in presenting the data, in ranking the references according to study design, publication type, and date and in annotating the references. I hope they prune the results as well, because applying this procedure to 1000 or more references is no kidding. And, although it may be ideal for the library users, not all librarians work like this. I know of no Dutch librarian who does. Because of the workload such a ready made wiki may not be feasible for many librarians.

Lots of problems that have yet to be resolved. It’s a learning process and setting boundaries is going to be an increasingly important priority in this space in years to come. The convenience of social media can obviously lead to overwork and a shift in work-life balance. I would love to be a librarian available 24 hours a day via email, Twitter and Facebook, and in many respects, I am willing to try. But I still need to make dinner, read books, and take time for myself. Where do we draw the line?

UPDATE: “Blocking Facebook won’t stop stupidity.” Great responses to the LA Times by two other venerable blogging doctors.

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