Editors’ Note: Social media in medicine is a hot topic. Questions from doctors abound. What’s the best way to get started? How can I be “social” and not violate patient privacy? What’s the real value? How do I find time?

On Friday, October 18, Kevin Pho, M.D., founder of  kevinmd.com, and Susannah Fox, associate director of digital strategy at the Pew Internet Project visited Einstein. In two insightful presentations, they discussed the rapidly changing communications landscape and expectations and behaviors of patients in a digital and increasingly mobile age. They also explored the opportunities that social media provides to engage patients – and the responsibilities doctors have to create or curate content that improves patient understanding and decision-making.

The talks are part of faculty development associated with a grant from the Josiah Macy Jr. Foundation awarded to Einstein in 2012 to promote online professionalism among faculty and students.

What follows is the full presentation by Susannah Fox and an excerpt from Dr. Pho’s presentation, followed by a Q & A with Dr. Pho that first ran on Oct. 10.

Daniel Myers, M.S.W., Elizabeth Kitsis, M.D., Susannah Fox, Kevin Pho, M.D., and Martha Grayson, M.D., at an Oct. 18 Einstein faculty development symposium.

Q & A with Kevin Pho, M.D.

1. What is the best way for doctors to gather information about which social media platforms their patients use regularly and consider influential? Should doctors inquire about social media use as part of intake questions with new patients? Should such questions be included as part of any follow-up visits?

The best source for data on social media use is the Pew Internet & American Life Project. It regularly performs surveys that provide current demographic data on social media use. For instance, this past August it looked at Twitter, finding that 18% of Internet users are on Twitter, and that Internet users ages 18–29 are most likely to use Twitter. In 2012, it found that 67% of online Americans use Facebook.

Some doctors should always inquire about social media use in their patients. Pediatricians, for instance. Guidelines from the American Academy of Pediatrics now recommend that questions regarding social media use should be routinely asked to child and adolescent patients. Phenomena such as cyberbullying, “Facebook depression,” sexting and exposure to inappropriate content are all issues about which pediatricians are uniquely positioned to educate patients and their families.

To my knowledge, there are no guidelines for internal medicine physicians like me to include social media as part of intake questions. I do so if time allows, or if patients ask me directly. Rather than focus on social media specifically, a broader approach to how to search for reliable health information and interpret what patients read online is more helpful, and should be regularly included as more patients consult Google first before visiting their doctors. 

2. Given that HIPAA prevents doctors from revealing identifiable personal details of their patients’ cases, what types of information can doctors communicate through social media that advance knowledge, provide guidance and broaden perspective—without any breaches in confidentiality?

Social media are ideal to connect with patients collectively, but not individually. So, when educating patients on a social network, speak to them as a group. With health news stories breaking on a daily basis, there is ample opportunity for providers to get online and share their perspective.

Consider cancer screening. Over the years, there have been continual changes in breast cancer and prostate cancer screening guidelines. And this confuses patients. I often have men in the exam room asking, “Should I be checking my PSA, or not?”

I don’t blame them. The mixed messages that are often reported make cancer screening anything but black and white.

I use KevinMD.com as a forum for cancer screening experts and other primary care doctors to share their expertise. They often talk about issues that aren’t often reported, such as the implications of a false positive cancer screening test. This is information that patients need in order to make an informed cancer screening decision.

Speaking to patients as a collective on social media should steer providers away from any privacy risks.

If an unknown patient reaches out and asks a personal health question to a doctor on social media, the physician should not answer. Instead, take that conversation offline with a standard response that asks the patient to call the office and make an appointment, or if an emergency, to call 911 or go to the emergency department. 

3.  For a doctor who wants to choose a single social media platform to focus on first—which do you recommend? Why might someone choose Twitter or Facebook over a blog, or vice versa?

The first social media platform a doctor should choose is LinkedIn.

Spend about 30 minutes or so and create a LinkedIn profile, which is a digital version of your CV. The benefit is that LinkedIn profiles get ranked high on a Google result page, so when patients Google you, a LinkedIn page tends to get seen first, above, say, a profile from a physician rating site.

And if that’s all a doctor has time for, that’s fine. That simple act will already put him or her ahead of many of his or her peers.

Twitter, Facebook and blogs all have different strengths, which a doctor can use depending on what his or her goals are.

I use Twitter mainly to listen and curate information. I have a Twitter list of 40 or so healthcare personalities I follow several times daily, and it’s an invaluable resource for me to filter the hundreds of health stories that percolate up every day. Other doctors use Twitter to share interesting articles they have read, or participate with other individuals who share similar interests on Twitter chats.

Facebook tends to have a younger demographic, so some practices, like MacArthur Obgyn, use Facebook to educate teenagers on issues such as STDs and teenage pregnancy.

I consider the self-hosted blog to be the “hub” of a social media presence. The reason is that you own the content and have complete control of its presentation. Contrast that to Twitter or Facebook, where your content resides on their servers, and you are at the whim of their constantly changing privacy settings and terms of agreement.

However, I appreciate that people may consume information only on specific social media platforms, so I engage users beyond my blog. My posts are syndicated on Facebook and Twitter, where people can read KevinMD.com and continue the conversation even if they don’t visit the site.

4. For many doctors and other busy healthcare professionals, the challenge isn’t so much “getting on social” but “staying active” on social. How can doctors find time in demanding schedules to grow and maintain their social media presence?

I don’t have a problem with doctors not staying active. I disagree that the challenge of getting doctors on social media has been met. I speak to hundreds of doctors every year who don’t yet see the value of social media in the healthcare setting. Convincing them to spend 30 minutes to create an online presence with LinkedIn is a victory in itself.

Staying active requires buy-in from healthcare leaders and administrators. The reason why the Mayo Clinic is so successful with physician social media engagement is that social media are part of its DNA, from the CEO on down. Unfortunately, the Mayo Clinic is more the exception than the rule.

For doctors to stay active on social media, it needs to be part of the job description. Doctors need protected social media time, where they can write blog posts or create videos to be shared. Social media cannot be “one more thing to do,” added onto a physician’s plate. Replacing a half-day session a week of seeing patients with social media time to create content would be a reasonable goal. Healthcare leaders and administrators are the ones who can make that happen.

In the current fee-for-service (FFS) payment system, this can be challenging, but health reform is promoting new models that are shifting away from FFS and better valuing communication with patients. Perhaps in the coming years, when payment isn’t tied to the number of patients seen, communicating with patients can be emphasized, whether it’s through a phone call, email, or social media. 

5. What tools do you find most helpful in maintaining an active, engaged Twitter presence? An active, engaged Facebook presence? An active blog?

The key to maintaining engagement is a regular posting schedule. I schedule posts on KevinMD.com up to two weeks in advance, and they’re published seven times throughout the day.

As I continue to see patients full time in my primary care clinic, I acknowledge that I’m not utilizing Facebook and Twitter to their fullest potential by actively conversing on those platforms.

That said, there is value to syndicating KevinMD.com posts on Twitter or Facebook. As I mentioned previously, some people consume content only on those specific sites or don’t read blogs.

Buffer is an invaluable tool to schedule posts on the major social media platforms. Once a post is published on my blog, it can be syndicated on Twitter or Facebook according to a customized schedule.

To manage Twitter, I use Hootsuite, where my mentions, Twitter lists and hashtags can be followed on a single screen. That window stays open throughout the day, and is checked regularly on my mobile devices. 

6. It’s 2018. You’re a practicing physician. What is the “norm” for your relationship with your patients on social media?

I see future trends as an evolution of something current, rather than a singular disruptive change that can transform healthcare overnight. Remember that Facebook didn’t invent the social network; it was an evolution of Friendster. And Apple’s iPad only refined the tablet, which was originally introduced by Microsoft in 2002.

With that in mind, I see doctors and patients communicating on closed social networks that are an evolution of what patient portals are today. Healthcare is consolidating rapidly because of reform, and most patients eventually will be part of large, integrated healthcare systems. Picture Kaiser Permanente replicated nationwide. Those systems are, in essence, communities that can be united by a social network. Medical team members within that community would have access to patients’ charts and can interact with patients using social media concepts that are used today.

Open social media platforms, of course, will evolve, and will continue to play a role in educating the public at large. But privacy and security are big concerns in healthcare, and I don’t envision a scenario anytime soon where a doctor can diagnose and treat individual patients over an open social network like Facebook or Twitter.