1. Social Media and the
Evolution of Medical
Professionalism
Matthew Katz, MD
April 19, 2012

2. Disclosures
• Doctor at Radiation Oncology Associates, PA
- Practice in MA, NH
• Volunteer for
- American Society of Radiation Oncology
- Massachusetts Medical Society
- Mayo Clinic Center for Social Media
•Financial disclosures:
- Consultant for clinical trial, Augmenix, Inc.

3. Overview
• Definition
• Challenge of social media
• Risks and benefits
• Current guidelines
• Redefining professionalism

4. What is a professional?
• Professional:
– “conforming to the technical or ethical standards
of a profession”
– “participating for gain or livelihood in an activity
or field of endeavor often engaged in by
amateurs”
Merriam-Webster.com, accessed 9/19/11

7. Social Media are
Communication Tools
• Global reach
• Easy access
• Little technical expertise needed
• Immediate impact
• Dynamic content
Wikipedia, http://bit.ly/mZcwaH
accessed 9/17/2011

8. Social Media
• Presents perplexing challenge
• Transforming the way we interact
• Patients online for healthcare beyond the exam
room

9. Facebook: 845 million and growing
via Infographicslab.com

10. via pleaseenjoy.com

11. Risks of Social Media
• Reputation
– Expertise
– Patient satisfaction
• Medicolegal
• Patient harm
– Privacy violation
– Damage to doctor-patient relationship
• Boundaries
• Blurring of personal and professional spheres

12. Reputation in Health 2.0

13. Medical Professionalism
• Survey of U.S. medical school deans
– 60% of respondents confirmed medical students posted
unprofessional online content
• Profanity/discriminatory ~50%
• Sexually suggestive/intoxication ~40%
– Only 38% had social media policy in place
• Study of U Florida medical students/residents
– 44% had Facebook account
– 83% posted personal information, 70% had photos with
alcohol
Chretien et al, JAMA 2009
Thompson et al, J Gen Intern Med 2008

14. Medicolegal Risks
• Disclosure of patient information
– Statutory risk
– Common law risk
• “Friending” patients
– Established
– Non-established
• Surfing social media sites of established patients
• Physician as employer: social media risks
• Malpractice & risk management
Terry Wall, ASTRO Annual Meeting 2011

15. Medical Blogs: Privacy and Marketing
Lagu et al, J Gen Intern Med 2008

16. Why Risk Getting Involved?

17. Risk of Non-Participation:
Who will interact with patients?
• Pharmaceutical companies
• Insurance companies
• Health-oriented social networks
• Self-help/advocacy groups

18. PatientsLikeMe
• Established initially to
help patients with ALS
• >100,000 people with
500+ conditions
• Patients can include a
lot of health data
PatientsLikeMe.com, accessed 9/4/2011

19. Platform or Researcher?
• PatientsLikeMe has published 15 peer-reviewed
articles researching its own community
• J Med Internet Res 2010 12(2):e19
– “As an internal research project without external sponsors, and with no
anticipated adverse consequences for participation, institutional review
board (IRB) approval was not sought for this project.”
• Also published in Nature Biotechnology, Eur J
Neurology
– no comment on any IRB review

20. What harms may come?
• ? Breach of
trust/privacy
• Purchasers of data
may not report
potential health
risks/benefits to users
•"We're a business, and
the reality is that
someone came in and
stole from us,” Jamie
Heywood
Wall Street Journal, 10/12/2010

21. Anorexia and the Internet
• Medical evidence
– Body image distortion
– Increased morbidity and mortality
• Pre-internet: Isolating, hidden disease

22. Pro-Ana: “Support” Groups

23. Pro-ana websites
• 12% of adolescent girls, 5% boys have looked at
them
• “Tips and tricks” include:
– Caloric restriction/dieting (29%)
– Distraction (14%)
– Lying (11%)
Custers et al, Eur Eat Disord Rev 2009
Harshbarger et al, Int J Eat Disord 2009

24. Benefits of Social Media
• Collaboration
– Conducting research
– Clinical guidelines
– Donations for cancer care
• Connect with patients, others
– Market your organization
– Enhance therapeutic relationship
– Share your research
• Education
– Patients
– Colleagues, CME
• Reputation Management

25. Collaborative Research with Amateurs
“Gamers produced an accurate model of the
enzyme in just three weeks”
Yahoo!News, 9/18/2011

27. Education

29. Reputation: We are public figures
• UK survey of 953 respondents in general public
• Professionalism based upon
– clinician
– workmanship
– citizen
• Respondents expected doctors to be:
– confident
– reliable
– composed
– accountable
– dedicated
Chandratilake et al, Clin Med 2010

30. Reputation Management
Non-anonymous handle of @subatomicdoc affects search engines

31. Digital Professionalism:
Where do we want to go?
• Guidelines
• Historical perspective

32. American Medical Association
• Patient privacy and confidentiality must be maintained in all
environments, including online
• Monitor own Internet presence to ensure personal and
professional information is accurate and appropriate
• Maintain appropriate boundaries of the patient-physician
relationship in accordance with professional ethical
guidelines
• Confront medical colleagues that post unprofessional
content
• Actions online and content posted may negatively affect
their reputations among patients and colleagues and can
undermine public trust in the medical profession
Adopted 11/2010

33. Posted 6/20/2011

34. World Health Organization

36. We are not on Medicine 2.0

37. Evolution of Healers
v. Era Example Divine Healer/W Knowledge Scientific
ounded Method
Dyad
1.0 Prehistoric Shaman + +
2.0 400 B.C. Galen + + +
3.0 18th-19th c. Virchow + + +
4.0 20th c. Osler + +
In 2011, v4.0 is a century old

38. V 3.0: Medicine in 19th century
1846 Ether for anesthesia for H&N surgery
1858 Virchow’s Cellular Pathology
1859 Darwin’s On the Origin of Species
1860s Claude Bernard  Experimental medicine
1870s Pasteur  Germ theory, anthrax vaccine
1895 Roentgen’s discovery of x-ray
1899 Aspirin

39. V 4.0: Flexner Report (1911)
• Medical school education
– 4 years
– Merged into university
– Standardized quality
• Implications for professionalism
– Scientific method and knowledge trump caring
– Marginalized other approaches

40. Reimaging Digital Professionalism

41. Medicine 5.0
v. Era Example Divine Healer/W Knowledge Scientific
ounded Method
Dyad
1.0 Prehistoric Shaman + +
2.0 400 B.C. Galen + + +
3.0 18th-19th c. Virchow + + +
4.0 20th Osler + +
5.0 21st ? + + +
Professional = an interactive intermediary in health

42. Ethos of Digital Professionalism
• Traditional
– Autonomy
– Beneficence
– Justice
• New
– Integrity
– Connectedness

43. Integrity & Connectedness
• Integrity
 Being ‘whole’
 Honesty
 Transparency of intent
 Willingness to change
• Connectedness
 Centered on relationships
 Links professionalism to how we interact
 De-emphasizes knowledge, expertise
 Challenges notion of objectivity

44. M.D. = Master Dilettante
• Talented at absorbing salient information
• Integrating practical information and applying it
• Free from need for ‘complete’ knowledge
– Able to take diverse data, synthesize it
• Focus on education,care for patient and caregivers
– Values
– Understanding = listening to each other

45. Oath of Maimonides
“May the love for my art actuate me at all
times… Grant me the strength, time and
opportunity always to correct what I have
acquired, always to extend its domain”

46. Social media can extend our domain
• We are healers and teachers
• Professionalism must evolve to adapt
• Failure risks becoming irrelevant
• Re-embrace millennia tradition of
caring

47. Merci