Do you think it’s ethical for doctors to “advertise” their professional services on social media? How come healthcare institutions do it and we don’t ?
Somebody asked me these questions after my talk on medical professionalism on social media. Good questions, but very tough ones to answer. I clarified two things before I answered:
“Advertising” is different from “branding” in social media. The latter is more of establishing perceived value to patients and the public. (You can read more about branding in Marie Ennis O’Connor’s post here)
“Legal” and “ethical” are overlapping concepts but these two are different when taken into context. What’s legal may not always be ethical for everyone else in the healthcare community
Having been on social media for quite sometime, my answer to these have evolved over the years, but I’ll reserved that for another post. What interest me is this;
Healthcare professionals are beginning to ask questions now.
I have this feeling that since social media is pervasive and that everyone else in healthcare industry (including patients) are using it, healthcare professionals are catching up and are studying its potential in healthcare. The hint? Confusion. Social media for most HCPs is an entirely new environment. What better way to start threading this path than asking questions?
The closest professional industry I can think of that began branding their reputation and services on social media are the academicians. It’s an industry where advertising one’s professional services is also considered taboo among its ranks. Social media is deemed “less scholarly” by most academicians. Yet, some academicians began the slow process of building up perceived value on social media and expanded their reach to the public. Is this good? I don’t know. What I know is that the more conservative healthcare community is no different. Apart from the lack of time and that “less scholarly” attribute, ethical considerations plays a good deal of reason why healthcare professionals is playing catch up to social media healthcare branding.
But, I’ll be very interested in what you – colleagues and patients, would say about, physician branding on social media. Join us this Saturday June 27, 2014, 9PM Manila time as we discuss the ethics of healthcare professional’s branding on social media:
T1: As a physician do you consider physician branding on social media, legal? Ethical?Why?
T2. As a patient, would you seek clinic consult with a physician you found on social media?Why or why not?
T3. What do you think is the most important value that a physician should establish when branding on social media? Expertise? Patient care? Healthcare information?
Almost all healthcare stakeholders (patients, healthcare institutions, policy makers) began embracing social media as a tool to improve healthcare. All except healthcare professionals. As closing thoughts what take home message would you give healthcare professionals when they brand their services on social media?
Having been on social media for some time, I had my share of feedback for the quality of medical care I render. Yes, despite boundaries we define to keep our social media profiles “professional”, there are those who went beyond norms to convey a “feedback”. Social media has made that easier for patients. In my case, direct message is the most common method of feedback, followed by comments or likes of my social media postings. Comments, no matter how unrelated to my social media post, have undeniably inspired me to do even better in my clinical practice.
Imagine though if the message goes like this: ” Why do you have a long clinic waiting time?” or “I can’t afford your professional service. It is expensive”.
I can understand your reaction. “What the ???”
As a healthcare professional whose mantra is “to improve the quality of care”, a “negative” feedback like this hurts the most. It’s never easy dealing such feedback, but when you do, it’s also one of the most eye opening.
The authenticity and transparency of social media placed a balance to the equation of care by providing a platform for the patient’s voice. The quality of care mirror, isn’t limited to our peers or experts anymore. It went past beyond the structured patient personal satisfaction survey to the social media platforms- healthcare’s social mirror.
In this increasingly interconnected, social and consumer driven world, healthcare has no escape from this social mirror. Social media is a microscope where patients examine their healthcare providers and ostentatiously give their feedback not only to the healthcare community, but to the public as well.
Published simultaneously in Annals of Internal Medicine, The Lancet and theEuropean Journal of Internal Medicine, Harold C. Sox, MD, then editor of Annals of Internal Medicine, wrote, “I hope that we will look back upon its (the Charter’s) publication as a watershed event in medicine.”
The charter was created in response to the challenges of the new millennium that will impact medical professionalism- the internet and ten years later, social media. Included in this physician charter is a preamble and a set of responsibilities termed “commitments” to healthcare, our patients and humanity in general. One of these is the “commitment to improve quality of care“. Years after this charter’s creation, social media emerged as both an opportunity and challenge to medical professionalism.
This is the anchor to our topic on this Saturday’s tweet chat.
How patient’s social media feedback could improve healthcare professionals’ quality of care?
In theSpark Report, 60% of the physicians included in the study believe “social media improves the quality of care delivered to patients”. How they were able to measure this isn’t available publicly, but 60% is a huge majority.
Spark Report infographic showing 60% of doctors believe social media is improving quality of care
Another study by Timian et al measured hospital’s quality of care via facebook likes.
The results showed that Facebook “Likes” have a strong negative association with 30-day mortality rates and are positively associated with patient recommendation. These exploratory findings suggest that the number of Facebook “Likes” for a hospital may serve as an indicator of hospital quality and patient satisfaction.
Greaves’ study used social media to detect poor quality of care by harnessing the cloud of patient experience. Cloud of experience meant “unstructured descriptions of patient experience on the internet”. The limitation of this study was that measures wasn’t measurable as of that time. It showed though some variable association between patient experience and quality of care.
Could social media really improve a healthcare professional’s quality of care? That we will try to answer in this Saturday’s chat.
Join us this Saturday 9Pm Manila time as we discuss how patient’s social media feedback could improve an individual healthcare professional’s quality of care.
T1: Will patient social media feedback improve healthcare professionals quality of care?Why or why not? T2: What aspect of care would patient’s social media feedback impact the most? The least? Positively? Negatively? T3: What social media feedback method would most likely improve quality of care by HCPs? Comments, tweets?Private?/Public?
Closing thoughts: Your take home message about how could patient’s social media feedback could improve on the quality of care by healthcare professionals.
Resources:
Medical Professionalism in the New Millennium: A Physician Charter. Ann Intern Med. 2002;136(3):243-246 http://annals.org/article.aspx?articleid=474090
Spark Report by Demi & Cooper Advertising and DC Interactive Group http://thesparkreport.com/infographic-social-mobile-healthcare/
Timian A, Rupcic S, Kachnowski S, Luisi P.Do patients “like” good care? measuring hospital quality via Facebook; Am J Med Qual. 2013 Sep-Oct;28(5):374-82 http://www.ncbi.nlm.nih.gov/pubmed/23378059
Greaves F1, Ramirez-Cano D, Millett C, Darzi A, Donaldson; Harnessing the cloud of patient experience: using social media to detect poor quality healthcare. BMJ Qual Saf. 2013 Mar;22(3):251-5. http://www.ncbi.nlm.nih.gov/pubmed/23349387
(The #HealthXPh team was invited to speak on the topic “Leading in Social Media” at the 45th Philippine College of Physicians Annual Convention at the Grand Ballroom of Marriott Hotel in Manila. I was with with Dr. Narciso Tapia in the first panel to talk about Medical Professionalism in Social Media , while Dr. Iris Isip Tan and Dr. Helen Madamba boot-camped the audience on #HealthXPh and tweetchat. Dr. Gia Sison moderated both sessions. H/T to a great #HealthXPh team! )
I talked about medical professionalism in social media before but this time will be unlike anything I’ve said before. A year into evangelising social media and medical professionalism, I observed misconceptions that hindered physicians from embracing a well meaning policy and guideline about social media. Take note that these are my personal observations, and all my thoughts are usually from experiences, deep into the “trenches” of engaging healthcare professionals and patients, and sometimes backed up by scientific studies available. Before our biggest problem was internet and social media penetration among healthcare professionals in the Philippines. Today, with the proliferation of mobile smartphones and expanding internet connectivity, the biggest hindrance I think are misconceptions about social media.
I will step back a bit, dive into some basic concepts in social media and leave the medical professionalism proper to my colleague, Dr. Tapia. I felt we cannot just put forward any social media policy without healthcare professionals understanding concepts basic to social media and how it relates to us, humans. (I discussed the first two concepts in my previous post, here .)
Social media conversations are human conversations.
Many still believe social media engagements are NOT actually human conversations. That social media post are just rants, to private spaces, to a dissociated digital self, is not quite true. Consider the messages you sent to your love ones, or the greetings you posted on your friends timeline and even the rallying videos posted to jumpstart the Arab Spring. Do you think those are just rants to a digital self?
Conversations on social media are human conversations. Never forget that. -Dr. Remo Aguilar @bonedoc#pcp15#healthxph
— Iris Thiele Isip Tan (@endocrine_witch) May 11, 2015
Whether you like it or not, at the other end of that social media space are human beings. Social media conversations are human conversations. The rules of engagement is similar to a person-to-person communication, albeit on a different platform. Social media has made it possible for connected others to “listen” to those conversations. The lack of context across this communication channel seem a challenge, but again humans have edged out these barriers before- telephone conversations, emails and even on SMS. That’s what makes it both exciting and challenging.
Offline self is not my online self.
One common misconception about social media is the assumed dissociation between the offline and online self. That with social media, the online persona can be built or manipulated to be different from the offline self. Well, here’s to prove that’s not entirely true. A University of Texas study found out that what Facebook users “project” online are merely reflections of their offline self! Researchers examined the “big five personality traits – openness, conscientiousness, extraversion, agreeableness and neuroticism” and “self-reported Facebook-related behaviours.” and found a number of links between observable information on Facebook profiles and the users’ actual personalities. The study concluded that they didn’t see any difference in the online and offline behaviour of these Facebook users.
The concept between the offline vs the online self in social media is difficult to delineate @bonedoc#pcp15 — Dr. Gia Sison (@giasison) May 11, 2015
Another study among job applicants with Facebook accounts, found the same conclusion. No difference.
Your online persona reflects on your offline self. -Dr. Remo Aguilar @bonedoc at #pcp15#healthxph — Iris Thiele Isip Tan (@endocrine_witch) May 11, 2015
These studies showed online social networks are not an escape from reality, but rather a microcosm of peoples’ larger social worlds and an extension of offline behaviours. The trickiest of these concepts of course is social media privacy.
Social Media Privacy
Let me begin by saying Social media is an anti thema to privacy. Social media by design encourages sharing of personal information. If you look closely, the success of social media platform is gauged at how successful it is in cajoling consumers to share personal information. Information that form basis of their business model. The more we share personal information-location, likes, curate our news feed, the better for their consumer driven online businesses. I’m not saying this business model bad, I just want to point out that social media privacy settings are never entirely private. This is what healthcare professionals should be aware of. The ease of sharing information online also increases the likelihood of leaking information and compromise privacy. If you take note at the evolving social media platforms, the privacy settings gets more complex with less and less data secured. Ever wondered how your newsfeed is “curated” to tailor fit your likes? Or how those pop up ads seem nearer to your “liking”? Again, if you think your social media post are private, you should think again.
Sharing information between people creates communities. That’s a good thing. But it also erases privacy and personal boundaries. In highly regulated industries like healthcare, breaches of patient privacy and confidentiality, have far more damaging effects for both the healthcare professional and their patients!
To think that social media privacy settings are protecting your information, securely 24/7, is like letting a hungry wolf guard your sheep. Social media platforms wants our personal information simply because it is where it derive its revenues. It is what sustains the platform. Thats not entirely a bad business idea, but in healthcare industry, we should be very careful about any of our social media post.
These three aforementioned concepts are important in formalizing our behaviour, as healthcare professionals, on social media. Privacy in this digital age, is but an idea, a context within a bigger public space. Social media post are never entirely private, but you have the power to minimize information leaks especially if you are a healthcare professional. Your online self is just a reflection of your offline self. The doctor offline is the same doctor online. The public will always perceive it as such. Lastly, social media conversations are human conversations. Minus the context, it has the attributes of human conversations on a digital platform.
These are realities. Let’s deal with it. By understanding these three concepts, we are at least ready to consider any medical professionalism policy on social media. I highly encourage everyone to read and support our social media manifesto here.
The #HealthXPh Social Media Medical Professionalism Manifesto
Here’s a very interesting take on social media and medical professionalism by #HealthXPh co founder Dr. Iris Isip Tan on slideshare.
(H/T to Dr. Iris Isip Tan and Dr. Gia Sison for live tweeting my speech, Dr. Tapia and Dr. Madamba for the very informative panel discussions)
RESOURCE:
Samuel D. Gosling, Adam A Augustine, Simine Vazire, Nicholas Holtzman, and Sam Gaddis. Manifestations of Personality in Online Social Networks: Self-Reported Facebook-Related Behaviors and Observable Profile Information; Cyberpsychology, Behavior, and Social Networking. September 2011, 14(9): 483-488. doi:10.1089/cyber.2010.0087.
http://online.liebertpub.com/doi/abs/10.1089/cyber.2010.0087
(Note: This post is also published at HealthXPh.net )
Two years ago, only a few healthcare professionals are using social media. Not so these days. The rule is , if you’re not on social media, you are the “exception”.
The growing popularity of social media and smartphone brought innovations in healthcare. Healthcare became “social”. The classic patient- provider relationship grew into networks or communities of collaborating patients, providers and healthcare institutions. Social media provided additional tools and avenues for learning diseases, get psychosocial support or spread advocacies.
But the ease of sharing in social media placed “privilege” healthcare information at risk of being “leaked” into public space. The ramifications of such breach in patient privacy and confidentiality is still isn’t fully understood. What is clear is it violates the patients rights and does not look very good for the healthcare provider. Thus the concern now is shifting from just “access”, to responsible use of social media.
How do we then evaluate if any social media post violates patient privacy? How does the post breaches the confidentiality clause inherent in patient- provider relationship? In the Philippines, the lack of social media guidelines (self or institutionally driven) creates confusion. (Note: It is for this reason that #HealthXPh spearheaded and is continually advocating a crowd sourced Social Media and Medical Professionalism Manifesto. You should sign here if you support this advocacy too!)
I once asked a provider his reaction to a negative comment about a seemingly “innocuous”, run of the mill work scene (an OR picture with the patient’s belly inside the picture) he posted in his facebook timeline. His answer is classic:
“It’s my personal account anyway. I can do whatever I want there. Besides, the privacy settings are strictly limited to my friends only. “
There is confusion on what constitute private space on social media. Also, many believe (though I probably could not prove this now) there’s a dichotomy between “personal” and “professional” social media profiles. There are still HCPs believing one profile does not overlap each other even though both represent only one and the same person.
We at #HealthXPh would like to move forward the discussion of medical professionalism and social media guidelines in the Philippines. The healthcare social media manifesto is a work in progress. We are asking for your opinion. Join us this Saturday April 25, 2015 9:00 PM Manila time, as we discuss healthcare social media profiles and industry guidelines.
T1: Should personal social media accounts of HCPs be exempted from social media policy or guidelines?
T2: Who do you think should enforce healthcare social media guidelines?Government? HCP governing bodies, like PMA, PNA? Why?
T3: Will social media policy stifle the use of social media in healthcare? If yes, how?
Should healthcare professionals be on social media?
I’ve been asked this question countless times before and answered it in several forums. I said YEShealthcare professionals should be cautiously on social media in last year’s Philippine College of Physicians convention (Facebook for physicians; Use, Misuse, Abuse, Confused) . I said YES, HCPs should be on social media responsibly on #healthXPh‘s regular twitter chat (post and the chat transcript ) and recently, I answered a resounding YES, HCPs should be on social media, when an audience asked a similar question during the Healthcare Social Media Summit 2015 (#hcsmPH) in Cebu.
Before explaining my answer, let me digress a bit and explore the reason why healthcare professionals are NOT on social media.
I asked a physician in the Philippines why he is not on social media (as a physician). This physician has a huge private practice and is a consultant in some well known healthcare institutions in a city. He answered me this:
“I don’t want to be known as a physician on social media. I’m pretty scared of what get posted on my profile. It might backfire on me. Anybody can throw malicious comments on me, or hack my account and wreak havoc on my profile! My healthcare institution also forbid us to post anything related to work without clearing it from them first. Healthcare is my work so I need to ask them first every time I post on social media! That’s crazy! Besides, I was quite successful with my practice without social media, why would I need one now?”
Such is a classic answer from a professional working in a highly regulated industry. Physicians and lawyers are examples of people working in a highly regulated industry. Highly regulated industries like law and healthcare have strict privacy and confidentially rules governing sharing of information . The ease of sharing private and confidential information on social media is what healthcare professionals and healthcare institutions is apprehensive about. This distrust for social media and the people using it stem from some well known misconceptions about social media.
Social media is person to person (P2P)
That social media is just for marketing, branding and showing off is not true. Social media is a person to person (P2P) network. We tend to forget that both ends of social media conversations and networks are people. We connect with people and build networks tru social media, just like what we do everyday, even at work. It is interesting to note that in highly regulated industries like healthcare, we service people! How can healthcare miss the world of social media then if we are to service real people or connect with them?
This is one very good point from Mark Schaefer (@markschaefer) in his book Tao of Twitter. Highly regulated industries allows the people in it to attend conventions, workshops, seminars etc. What do they do in those events? Meet like minded people, learn from industry experts, expand networks, sometimes build brands, market etc. All of these we can do in social media too, often without leaving the comforts of our home or the workplace.
So why are healthcare professionals missing the world of social media? Apprehensions? Misconceptions?
Social media is public space, no matter how private your settings are.
“I have social media profiles but its personal and secret to only a few friends.” Added my friend above. He has a social media account after all, only that it is a personal, “private” account. A word of caution about privacy settings. In the evolving social media and digital world, any post on internet particularly on social media, is a post on public space. What you privately post now, will come out on public searches tomorrow.
So while my physician friend is on social media (albeit privately), why is he still missing out a lot on the power of social media in healthcare? Remember, humans are basically social. Social media as it is evolving right now is really a person to person conversation, human connections. Therefore, authenticity is an important value.
That’s why I’m advocating HCPs should be on social media (if they’re not yet on it) and act as they would do daily, at work, when you connect with people or talk to them. That is with authenticity as a healthcare professional. Social media should just be an extension of your offline pprofession and you should act like one, accordingly.
Note: To guide healthcare professionals, how to act on social media, #HealthXPh summed up a crowdsource social media manifesto for healthcare professionals and publish it here. Sign to show support!
Again, I say yes, healthcare professionals should be in social media. What we do at work- “authentic helpfulness” ( to borrow @markschaefer term), talking to real people, of building networks and learning from our patients and colleagues, social media has an entire world of new tools to enhance this. That’s never been for show off in the first place!
