Are medical trainees and doctors prepared for the new social media frontier?
Instagram and Twitter are turning some doctors into celebrities. Take “Dr. Mike” – also known as Mikhail Varshaski, a family doctor with 2.6 million Instagram followers. That’s more than some Hollywood celebrities such as George Clooney or Meghan Markle. Thanks to the popularity of social media platforms, Dr. Mikes are becoming more common.
As Ali Damji, a resident in the Department of Family and Community Medicine at the University of Toronto, says, “I think that medical education needs to accept that there is a new reality here. So far we have approached social media from a professional and regulatory framework —in other words, what doctors shouldn’t be doing on social media. While this is important, we also now need to be focusing on what doctors should be doing on social media and the most effective ways to use this tool to serve our patients.”
Doctors are using social media to stay informed, discuss issues with other health-care professionals, and promote their own findings and educational materials. It can also be a great tool for advocacy, where physicians can share articles and discuss issues with many beyond their usual geographical areas and outside of their regular circles.
“I use social media—Twitter exclusively—for a few reasons. The most important is to learn, and it’s a tremendous tool for that. By ‘learning’ I mean keeping abreast of medical advances, but also re-learning things I’ve forgotten. Sadly, that list is growing by the year,” says David Juurlink, an internist and clinical pharmacologist at Sunnybrook Health Science Center. “And as a researcher I’ve increasingly used Twitter to help disseminate our findings, as well as to publicize other studies I’ve read that seem worth sharing. For example, last May I tweeted a thread to provide some context for, and increase the reach of, a newly published study. Partly as a result of that thread, the article now has one of New England Journal of Medicine’s highest Altmetric values ever.”
Irfan Dhalla, Vice-President of Evidence Development and Standards at Health Quality Ontario, says he uses it to get feedback. “A current goal [in using social media] is sharing what we are doing at Health Quality Ontario, and interacting with people who have questions or suggestions about our work,” he says.
It can also help physicians educate the public about their health, says Melanie Bechard, a paediatrics resident at The Hospital for Sick Children and President of Resident Doctors of Canada. “These platforms allow us to reach beyond our usual patient rosters to provide health information to patients and families within the comfort of their homes, providing more equitable access to this content in innovative and engaging formats,” she says.
Should medical trainees use social media?
Medical trainees are in a formative stage of both establishing their professional identities in the medical world and as doctors in the social media world. As such, their conduct on social media is usually subject to scrutiny. In a recent extreme case, two medical trainees in Mexico posted an inappropriate picture of them holding an amputated foot on Twitter, an action that brought them to court.
Several associations, universities, departments and divisions have created guidelines for appropriate use of social media by medial trainees. These include the Canadian Federation of Medical Students, the Canadian Medical Association, the Postgraduate Medical Education office and the Division of Plastic and Reconstructive Surgery at the University of Toronto. These guidelines are centered on the basic rules of social media engagement by trainees such as respect of patient confidentiality, appropriate credential use, and promotion of professionalism online.
“We should encourage responsible use by trainees and educate them on how to do this,” says Jamil Ahmad, Plastic Surgery Staff Physician at the Plastic Surgery Clinic in Toronto.
But several areas of concern are not discussed in these guidelines. First, the separation between personal and professional identity remains an area of debate. “Personal and professional boundaries are blurred on social media… Even if you think it is a personal conversation, it represents you professionally as well,” warns Damji.
Another concern is when the respectful exchange of ideas leads to intimidation, harassment and cyberbullying. “While most staff physicians and trainees are conscious of the risks of social media, it has been disheartening to see instances where trainees have been exposed to profane and vitriolic statements from their senior colleagues. This bullying jeopardizes the public perception of the entire profession,” says Bechard.
In February, this became a headline in the Toronto Star after some physicians were targets of cyberbullying over disagreements around physician service agreement negotiations. One disturbing, misogynistic comment from a physician stated: “You are a c—. Crash and burn as you deserve to do!!”
Even without malicious intent, discussions and posts on social media can lead to misunderstandings.
“It’s easy to be misunderstood since you only have 140 characters to make your point. And it’s all in writing, so the tone you intend in a tweet may not be the tone people perceive,” says Alainna Jamal, an MD Candidate at the University of Toronto’s Faculty of Medicine.
Finally, social media can disrupt the traditional hierarchy of learning from staff physician to trainee. Trainees can quickly become powerful influencers online, giving them a “louder” voice on social media than more senior physicians. On social media, years of experience can be replaced by number of followers.
These areas of contention need to be further evaluated, and recommendations should be made to guide trainees in those gray areas.
“Black and white perspectives on social media don’t acknowledge that it’s the new reality for medical trainees,” says Bechard. “Fostering discussions and providing tangible examples of both effective and ineffective social media use throughout medical training would be very helpful.”
As trainees are “doctors-in-training,” their use of social media is one of the spheres in which guidance and education are needed to ensure proper use. As Bechard observes, “Like any tool, social media has its risks and rewards – mastering it is an ongoing process of discovery.”
At the same time, established physicians face many of the same challenges, and would also benefit from more guidance as this becomes increasingly important.
“Social media is a reality,” says Ahmad. “I think it’s an evolving form of communication – just like email was 20 years ago.”
Helene Retrouvey is a third year resident in the Division of Plastic and Reconstructive Surgery at the University of Toronto. Annie Wang is a fourth year medical student at the University of Toronto.