Why social media gives your doctor an ulcer

Social search and question-and-answer sites are full of queries about how to treat injuries or deal with illnesses. It seems like an opportunity for physicians chime in, but there are roadblocks.

Some runner out there was a little overeager. A member of question-and-answer site Quora used the service to pose a burning question about a potentially reckless activity: "How do you train for a marathon with a stress fracture in your ankle or foot?" Seriously? Ouch.

Luckily, there happened to be a sports therapist who was reading. "There (are) plenty of marathons left in the world for you to do when the stress fracture has healed," the therapist warned. "The amount of training required for a marathon means that this will severely stress the bone if it's already overloaded, and could even lead to long term problems that stop you running altogether. Get professional assessment, let it heal, and plan the next marathon."

Let's hope the would-be marathoner read that Quora answer. Some of the other advice offered would be sure make your average high school cross-country coach cringe, from "It's all about visualization" to "upper body workouts to burn calories." The Web is full of questionable medical advice for both injury and illness, and while Quora's quality control features tend to filter out a lot of it, no social-media site or publishing platform is immune (so to speak). So why haven't medical professionals taken this as an opportunity to make some worthwhile contributions to the social Web and improve their individual reputations at the same time?

Well, it's complicated.

"I think there's a lot of confusion about what doctors can and can't do, and what is actually a breach of the patient-doctor relationship, and where the privacy boundaries are," explained Unity Stoakes, a co-founder of health search start-up Organized Wisdom, which attempts to provide Quora-like reputation vetting and promote results based on which ones have experts' seals of approval. "Most doctors that I've spoken to who are very active online have said that they believe there's a lot of unjustified fear about the associated risks with participation. Really, it's more about common sense and following best practices than actual risks."

Social media and the medical profession have not fully looked one another in the eye. It was not until last November that the American Medical Association (AMA) released any kind of document about best practices or guidance for physicians' use of social media; the document, "Professionalism in the Use of Social Media," is primarily concerned with privacy, reputation management, and doctors' social-media interactions with their own patients. A clause about combating "unprofessional" content (which would seemingly encompass bad medical advice) is restricted to flagging one's own colleagues' work.

Still, the AMA acknowledged that social media offers plenty of promises for doctors. "Participating in social networking and other similar Internet opportunities can support physicians' personal expression, enable individual physicians to have a professional presence online, foster collegiality and camaraderie within the profession, provide opportunity to widely disseminate public health messages and other health communication," the document explained.

Doctors wary
Physicians and other health professionals have nevertheless been slow to adopt social media in their professional lives, in a health industry where insurance reform and electronic records tend to dominate debate over the future of the practice. But, as Stoakes argues, the result has been that there's a lot of terrible medical advice online, a problem that can be tied directly to the rise of "content farms" on the Web--which mean that in a search query for a medical issue, online stalwart WebMD (which has its fair share of critics) may be supplemented with some seriously dubious advice. "We call it the online health gap, that scary place between when the consumer searches and when they actually get to the doctor," Stoakes explained. "There's a massive amount of clutter and misinformation that's growing every day as a result of content farms and these sites that are putting out unverified information. Some of it can be quite dangerous."

Getting doctors into the social-media conversation could mitigate this problem.

Oliver Kharraz, a doctor who co-founded medical booking service ZocDoc, said that in countries like Denmark you're far more likely to find doctors engaging with patients online. "I think we have to look a little beyond the borders of our own nation," the New York-based Kharraz said. "This is happening in sort of isolated pockets where trust has been established between the doctor and the patient, and where the legal framework actually allows them to do it. I think that's what's holding doctors back in many instances is that you have very little knowledge about the patient holistically."

That's a valid point, as many doctors may be reluctant to provide any kind of advice to someone whom they know only through a Quora post or Facebook Questions query. Another challenge is that doctors may be concerned that participating in social media is a stigma--that if they were quality practitioners, they wouldn't have time to be messing around on social networks, and that there's something suspect about a doctor who advertises his or her services too much. When Jay Parkinson, a Brooklyn, N.Y.-based physician, launched a blog in 2007 and began conducting patient consultations via Skype, it was considered extremely unusual. It still is. Parkinson said that he also used to blog about his day-to-day practice; he no longer does.

"I took a lot of heat from it among doctors, old doctors, and I actually stopped doing it because I thought I'd rather blog about the health care industry rather than what I was doing in my practice," Parkinson told CNET. He also said that a doctor with a social-media presence may be more exposed to scrutiny from state authorities with the power to revoke a medical license. "Doctors are guilty until proven innocent in the eyes of the state. It has nothing to do with malpractice or anything like that...It's your life on the line; it's your livelihood."

It's also, Parkinson pointed out, historically frowned-upon for a physician to advertise much or maintain a promotional presence, stemming from the understanding that a quality doctor will not need to advertise. "There's a stigma against them," Parkinson said. "Most doctors think that too much self-promotion is a bad thing, that if you provide a worthwhile service and you're not a quack, your practice should grow on its own."

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Gradual emergence
But the medical profession's emergence into the social media world is progressing, however slowly. Some doctors provide medical advice anonymously, like the urgent care physician who goes by the pseudonym "Dr. Cranquis" (rhymes with "cranky") and answers all variety of basic medical questions and occasionally provides medical war stories. A sample: "My P.A. saw a toddler with a dental abscess today. Yep, you guessed it: the kid was drinking Coca-Cola out of his sippy-cup."

On Thursday, a reader asked if the blog's popular feature of posting "Grey's Anatomy"-worthy injuries constituted a Health Insurance Portability and Accountability Act (HIPAA) violation. "Cranquis" responded, "Social media gives a new wrinkle to the age-old question: What's the difference between walking into a crowded E.R. with a gruesome wound and being seen by random strangers in the waiting room, versus your doctor taking a picture of your gruesome wound (with your permission) and then showing it to all of his buddies (online vs. offline)?"

The anonymous doctor continued: "It would be a very different situation if: I posted this picture under my real name, I told you what clinic I worked at, I identified the date when the picture was taken, and I included the patient's face or other identifying info in the picture." Patients are asked if their non-identifiable photos may be shared online, "Cranquis" assured.

But Organized Wisdom's Stoakes said that doctors may eventually be forced to interact with social media more because even if they aren't online, their reputations are. "The first place people go before a doctor visit is they Google their doctor, they go to Yelp, they go online to search," Stoakes said. "At a minimum, a doctor should be aware of what's being said about them. Is the information even correct? They have to be participating on some level."

Meanwhile, back in the muck and mire of social media, the Quora query "Does whiskey help a sore throat?" is probably in need of some physician attention.

But unfortunately for the likes of "Dr. Cranquis," Quora has a real-names-only policy.

 

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