February 24, 2016

The Social-Media-Savvy Pediatrician: Do We Physicians Recognize our Own Risks?

Rupal Christine Gupta, MD FAAP
Medical Editor, Nemours Center for Children’s Health Media / KidsHealth
Staff Pediatrician, Nemours Children’s Clinic at Thomas Jefferson University
Twitter: @Doc2Mom

As physicians we frequently talk about how our patients use media for health information. We furrow our brows and ask: Are they thinking critically about what they read, watch, and share?

Well, now that I use social media just as much as the next person, I have come to realize that I need a dose of my own medicine. We doctors need to ask ourselves the same question.

I recently watched a dust-up in one of the physician-mother groups on Facebook that I follow.

A physician posted an online petition involving breastfeeding, formula feeding, and neurological issues - all emotional topics that have profound impacts on children's health.

The post, which promotes a practice not considered standard of care, has gone viral in several circles – and had spread to responses in a variety of blogs and Facebook groups, even spurring a post on the Academy of Breastfeeding Medicine’s blog. Misinformation has spread rampant. Mothers - who feel strongly about their own choices and methods – are standing in opposition to one another. Camps of people are spouting vitriol. Reason is low and emotions are high. The resulting posts? Non-evidence based approaches, anecdotal basis for opinions, name-calling. Who are the culprits but physicians? We should know better.

It's natural for doctors to want to create professional villages through online platforms. We seek one another's help. We also trust one another. We look to the people with whom we graduated from medical school with a mixture of friendship, respect, and awe, and we have chosen to extend this respect to people from other institutions and create social networks around these various allegiances. So our groups are not just professional, they are personal. In these online landscapes, doctors may easily decide to share even more: not only information about our families and personal photographs, but also opinions for which there is scant evidence.

This particular conversation about infant feeding practices reminded me all too well of the professional responsibility we have as physicians. When we post our opinions online, we can't just shoot from the hip. We must pause to consider what we are saying, why we're saying it, and how it might be interpreted by the audience. Who's the audience? Well, it might start out being just our cozy physician group on social media, but it can ultimately include anyone and everyone, including our patients.

Here are some ways to stay above the fray:

Join social media groups with attentive moderators:
Active moderators can make or break a Facebook group, and can help prevent healthy  discourse from derailing into unproductive, hurtful conversations. If it looks like things are spinning out of control and you believe you can help, offer the group’s administrators to moderate – your assistance may be welcome. For example, in the past I have voluntarily moderated a small literary-minded group of 20-somethings on a “message board” – social media at the dawn of the Internet. My participation kept us all in check and helped weed out spam. A caveat: the identity of administrators may not always be clear (an obvious red flag). If you have a group and want provide administrator names, pin it to the top of your group’s social media page.  Groups that are not part of a social media service – such as a listserv or a Reddit – should list a contact method prominently.

Look for a group that has a clear mission:
Our Internet village’s value comes from having a clear purpose and acceptable line of messaging for the group. When the expectations are made clear to members of how to source and what types of questions/issues to bring up, the group can function much more healthfully and productively.

Join groups that vet members:
The best Facebook groups will ask members for contact information and will vet their identities before allowing them into the group. The Internet as we know is a Wild West, but if you vet the identities of your own group members you will be doing your participants a great service. You’ll be giving them a healthier environment reliant on mutual trust, responsibility, and higher quality of information shared. Groups in which people share their real names are a plus: Kovic et al. in 2008 noted that medical bloggers who posted under their real name were more likely to link to sources than bloggers who used pseudonyms. Although this may not have been studied yet for social media, personal experience shows me that those who post using real names tend to be more reliable.

For example, Dr. MILK (Physician Mothers Interested in Lactation Knowledge) is a social media group that caters to physicians.  The group invites its participants, their identities and roles are verified through their website, and posts must focus solely on breastfeeding and related questions. There are times that posts here go outside of that realm, and it falls on the moderators to bring the ever-expanding audience back to the core mission.

Represent yourself well:
We all know to think before we post, but it's easy to slip, especially within more personal networks. This litmus test works: Ask, “How would I feel if this post appeared in the newspaper and was read by my grandmother (or my new patient or my department chair).”

We live in a time where people are actively searching and studying posts and tweets released by doctors and analyzing them for their veracity. Let’s make sure we’re sharing what we want to share. If we do this right, we'll be enriched by each others' knowledge and experience while steering those who listen to us toward better health.