Doctors and social media: Navigating difficult waters

By David Lynch - 08th Jan 2023 | 308 views

doctors and social media

With changes in social media guidance for doctors due later this year, both in Ireland and the UK, David Lynch examines the challenges and opportunities that online platforms provide medical professionals

Social media is a fast-flowing river,” according to Dr Michael O’Brien, a registrar currently working in paediatric liaison psychiatry in Children’s Health Ireland at Crumlin. “Better you swim with it than try to swim against it.” 

Dr O’Brien co-authored a 2020 paper in the Irish Medical Journal (IMJ) titled ‘Social media spread during Covid-19: The pros and cons of likes and shares’, which was published in the early months of the then emerging crisis.

Now it is almost three years since the pandemic began and most experts believe that engagement by doctors with social media has only intensified during this time.

There is a sense that regulators and health management are often playing catch up with the rapidly evolving nature of the platforms. However, this year will see both the Irish Medical Council and the UK’s General Medical Council, review and update their guidance for doctors on social media use (see panel)

Just like their international colleagues, many doctors in Ireland maintain active Twitter, Facebook, TikTok, and other social media accounts. They can garner thousands of followers, engaging in a mix of public discussions, patient advocacy, and non-medical observations. But the specific professional challenges and benefits created by social media can often be more complicated for doctors than general users.  

Engaging

“In my opinion, there are two main challenges or pitfalls that medical professionals need to consider,” Dr David Stukus, Professor of Clinical Paediatrics at the Nationwide Children’s Hospital and The Ohio State University College of Medicine in the US, told the Medical Independent (MI). Dr Stukus is the co-author of the book Social Media for Medical Professionals: Strategies for Successfully Engaging in an Online World (Springer, 2019).

“First, they need to consider if and how their involvement on social media may impact their employment or professional status. This requires an understanding of any social media guidelines set forth by their employer and most importantly, they need to act professionally online.”

The second consideration, according to Dr Stukus, is “actively thinking through one’s personal time commitment and how engaging on social media will impact… work-life balance”.

Dr Stukus stated there are many benefits for medical professionals in using social media. They include networking, maintaining relevance in an online world, and promoting evidence-based information on a large scale.

“However, the biggest benefit, in my experience, is the knowledge gained from an enhanced understanding of the types of information and misinformation our patients are receiving,” he said.

“This can then be used as anticipatory guidance during in-person clinical encounters.”

New year, new media, new start?

It is that time of the year when many people pledge to make some positive changes in personal behaviour.

New Year’s resolutions around exercise or diet, for example, have long been popular. However, in recent years, more people have begun to question whether they should make alterations to their social media habits.

Prof Brendan Kelly is the author of The Science of Happiness (Gill Books, 2021) and Coping with Coronavirus: How to stay calm and protect your mental health – A psychological toolkit (Irish Academic Press, 2020). Prof Kelly offered three tips to doctors and others who may be planning a re-think of their social media use in 2023.

1. “Be consciously aware of the power of social information before signing up to new platforms or groups,” Prof Kelly told the Medical Independent.

“If you were considering taking a new medication with known addictive potential, you would ask yourself, ‘Might this medication be addictive for me and, if so, do the benefits of the medication outweigh that risk?’

“Ask yourself the same question about any new social media platforms or social media groups you are considering joining. Will signing up really serve me, or am I doing it out of habit or compulsion?”

2. “Step back and be mindful of the impact of social media in your life overall. Limit the times you use it, as best as possible,” advised Prof Kelly. “Stick to a rigid ‘No phones in the bedroom’ policy. Switch off notifications during busy times and, before you switch them back on, ask yourself if you really missed them.”

3. “If you have children, remember that they might not seem to listen to your advice about using their phones, but they will copy your behaviour,” said Prof Kelly. “So, if we model good behaviour for children, they will learn better habits around social media.”

Misinformation

Dr Stukus’s book on medical professionals and social media was published in 2019, before the shadow that Covid-19 cast upon global health. Has the experience of the pandemic had an impact on how doctors engage with social media?

“Absolutely,” he said, “the pandemic has fundamentally changed how the entire world uses social media.”

“More medical professionals are engaged on social media, which is a great change. Unfortunately, much of our time is now spent combating rampant misinformation that has negatively impacted public health and personal medical decision-making.”

In Ireland, the UK, and elsewhere, educational, representative, and regulatory medical bodies are often regarded as being behind the curve when providing guidance to doctors about their use of social media. Is this the same in the US?

“I am not aware of any federal or overarching guidance in the US,” said Dr Stukus. “But most hospital systems and employers have some form of social media guidelines that their employees must adhere towards…. As far as best practices, that has been lacking, which is one of the main reasons we decided to write a book to help others.”

Anxiety  

In the early months of the pandemic, the paper that Dr O’Brien co-authored in the IMJ noted that, while dissemination of the significant risks of SARS-CoV-2 to the public “is appropriate”, excessive disease-related information was “likely to cause increased levels of stress, anxiety, and worry”.

Looking back on the course of the Covid-19 crisis, did the exposure to constant information on social media impact doctors as well as the public? 

“I absolutely believe that social media contributed to increased levels of stress and anxiety among doctors, particularly in the early stages,” Dr O’Brien told MI.

“It’s easy to forget the context. We now know that despite the devastating effects of Covid, it didn’t reach the catastrophic levels mooted at the very beginning.”

He recalled that the initial weeks of the pandemic was marked by “a huge amount of discussion on social media among doctors” in March 2020 about “literal war-
like circumstances”. 

“It was fully anticipated that there would be implementation of field hospitals. We were advised formally by the HSE that doctors may be reallocated or repurposed based on patient need. Naturally, this was discussed endlessly on social media. I read about the possibility, nay likelihood, of psychiatry doctors being thrust into a situation where they would be managing complex advanced coronary and respiratory life support – a practice far removed from our daily scope of expertise.”

He also recalled there was advice circulating on triaging with the necessity for ruthless efficiency for the greater good.

“You will recall that the hot topic word at that stage was ‘respirators’ and the shortage thereof. Discussion of allocation of these expected finite resources circulated with ever-increasing frequency and urgency.”

Dramatic

Dr O’Brien added that, as is often the case with social media, “there is an artificially rapid cultural transmission.” He compared this to a child’s game of whispering to each other “until a mundane comment has been morphed into a spurious distortion of the initial intent”.

“A truth is posted on social media in good faith by a reliable source, and repeatedly shared, again in good faith. However, the message slightly distorts each time it is shared.”

According to Dr O’Brien, the human brain has developed to be drawn to information proportionate to its perceived risk. So the more “dramatic and catastrophised” the information, the more it spreads.

“In this context, doctors and other healthcare workers were not only getting an increasingly distorted view of the potential severity of the circumstance, but they were also negatively affected by another unfortunate quirk of social media, [which is] the difficulty in conveying and perceiving the nuance of emotion,” he said.

“The relative brevity of social media posts, their text-only nature, and people’s reluctance to share their true emotions online, left doctors with a sense that any understandable emotion they were experiencing, from anticipatory anxiety to downright fear, was not shared among their colleagues online.

“There was a perception that everyone was discussing Covid in an unemotional, matter-of-fact way. This contributed to a sense of isolation. Speaking face-to-face allows one to pick up on intonations of the voice, facial expressions that convey concern; whereas, in the online space, this is lost.” 

Mental health

Understanding of, and research into, the mental health impact of social media use is growing.

“Excessive or injudicious use of social media is associated with problems relating to anxiety, depressive symptoms and, perhaps most of all, sleep, [such as] difficulties falling asleep and having unrefreshing sleep,” Prof Brendan Kelly, Professor of Psychiatry at Trinity College Dublin and Consultant Psychiatrist at Tallaght University Hospital, told MI

“This is a real problem for doctors, especially those who work nights at hospitals or on-call in general practice,” according to Prof Kelly, who is also a columnist with this paper.

“We all need more sleep, but compulsive scrolling on social media presents a huge challenge to this. Social information can be irresistible, no matter how trivial.”

On the other hand, he noted that the “main mental health benefit offered by social media is its unique power to connect us with friends and colleagues, so we can share information and collegial support”.

“It also helps people who are troubled, but isolated, to find other people who share their interests or problems, and so feel less alone. Social media can be a powerful force for good in the world.”

Respect

MI columnist and GP Dr Sarah Fitzgibbon has gathered over 5,300 followers on Twitter. She is also the founder of Women in Medicine in Ireland Network (WiMIN), which has nearly 6,500 followers on Twitter and is active on other social media platforms.

To her mind, the biggest challenge for doctors when engaging with social media is “maintaining professionalism by ensuring patient confidentiality and avoiding the denigration of named people”. “Values, such as respect, integrity, justice, and honesty are important to patients, and these should be maintained by doctors when they are communicating publicly through social media,” Dr Fitzgibbon told MI.

However, she noted there is also a myriad of benefits from social media for those working in medicine. These benefits include its ability to connect like-minded professionals to share data and knowledge. The relationships created through social media can serve to expand and enhance patient care.

Her own experience with WiMIN over the last five years served as a concrete example of where social media can be helpful.

“I set up a network for female doctors and medical students, which now has 750 subscribers, having started from a single tweet in December 2017,” she said.

“Since then, the WiMIN social media accounts have celebrated over 200 women physicians with our #SundayWiMIN campaign, which marks the contribution of past and present doctors and medical students in all areas of medical specialism, as well as many with distinguished sporting, artistic, and altruistic achievements.

“We have also supported female doctors and medical students through conferences, mentoring, media training, research support, and advocacy.”

Looking back over the activities of WiMIN, Dr Fitzgibbon concluded that “none of that would have been possible without social media”.

On the wider issue of specific guidance for doctors and medical professionals regarding how to use these online platforms, Dr Fitzgibbon said that there may be generational aspects to this issue.

“Doctors who are not digital natives may find social media intimidating or scary, while those who are born into social media use may find their older colleagues’ suspicion of it obstructive or backward,” she said.

“There is limited constructive advice from our professional bodies about the pros and cons of social media and more specifically about how best to use it to communicate effectively…. The opportunities for patient and public involvement and inclusion in healthcare planning are being missed because policy-makers and clinical leaders are too scared to embrace social media.”

Behaviour

In October 2021, a qualitative study of how general practitioners and medical students in Ireland negotiate public-professional and private-personal realms using social media was published in BMJ Open. Written by a number of Irish-based academics, including Dr Andrew O’Regan, a GP and lecturer in the School of Medicine, Health Research Institute, University of Limerick, the paper noted that “students and GPs view social media as a positive resource for the medical profession”.

However, the paper also concluded that guidance “is required for students and medical practitioners on how to establish reasonable boundaries between their personal and professional presence on social media and in their private life so that poorly judged use of social media does not negatively affect career prospects and professional efficacy”.

According to the paper, the general practitioners and third year medical students who participated in the study found that  while educational and networking benefits to the profession exist, they “expressed unease about boundary setting and staying safe on these platforms”.

The authors of the BMJ Open paper noted that research is warranted to identify how best to teach safe practices for engaging with social media.

“Clear and dynamic guidelines for medical students and GPs are needed for ethical social media use in the medical profession due to the rapidly changing speed and scope of social media.”

Addictive

In general, Dr O’Brien described social media as an “addictive entity”. But like many addictive entities, it has “positive” aspects.

“I liken social media to sugar or caffeine,” he said. “The beleaguered and exhausted doctor on-call can attain notable and reliable short-term benefits from sugar and caffeine. The spikes in energy from a sugary caffeinated drink can facilitate improved performance in the short-term, though it is merely compensating for an underlying tiredness and erodes health in the long-term.”

He compared this to the context of how well informed an individual or society is through online platforms, such as Twitter.

“Social media affords genuine spikes in knowledge via nuggets of information,” he said. “However, without the underlying foundation of context and explanation, the collective knowledge deteriorates.”

“The irony holds that continuously replenishing a fragile knowledge-base with snippets of information makes people feel more well-informed, but insidiously erodes their true understanding.”

The paper he co-authored in the IMJ in 2020 noted advice given by the World Health Organisation during the early pandemic regarding social media usage. Are there any lessons that can be learned from what the paper described as “the first pandemic of the digital age”?

“While there are lessons that can be learned, I don’t know if much should or could be changed in terms of approach,” said Dr O’Brien.

“The pitfalls of social media are identifiable, but unavoidable,” he said.  “There is no way to eliminate misinformation or indeed disinformation from spreading.”

He added that the general approach should be to attempt to counteract misinformation with reliable information from trusted sources. 

“To that end, social media should be embraced, even by governments and state bodies,” said Dr O’Brien.

“Nefarious actors and ill-informed influencers will always utilise new forms of media before more established institutions. This results in inherent bias. Years ago services like Twitter would have lacked perceived legitimacy, and so governments and health services would have avoided them. Slowly, it was adopted as a legitimate medium.

“Then we see the likes of TikTok and its meteoric rise in popularity. Again, it is seen as a service only used by young people and early adopters, before slowly transitioning into the mainstream.”

His advice to health authorities is “to embrace and use new methods of communication from the get-go”.

Updated guidance on social media for doctors due in 2023

By this summer the Irish Medical
Council will update its guidance for doctors and social media use, this newspaper has been informed.

The Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners (Amended) 8th Edition, which was published in 2019, currently contains the most up-to-date guidance for medical practitioners on the use of social media. However, the coming months will see significant new developments in this area.

“The guide is currently under review, with a new edition expected to be finalised in mid-2023, which will contain updated guidance across a range of areas, including social media,” a Medical Council spokesperson told the Medical Independent (MI).  

Writing in MI in July, Ms Dee Duffy, Legal Counsel at Medisec, outlined that the current Medical Council guide, at paragraph 20, acknowledges that social media provides new ways for doctors to communicate with patients, colleagues and the public, but states that doctors should still maintain the professional standards expected in other forms of communication.

“The guide further provides that when engaging in social media, doctors should always consider the possible impact on colleagues, patients or the public’s perception of the profession, before publishing comments,” she wrote.

“It is specifically stated that doctors should be respectful and avoid abusive, unsustainable or malicious comments and ensure comments are not defamatory or otherwise in breach of the law.”

The guide also states that doctors should always identify themselves by name, if giving clinical advice online. 

“Doctors are generally held in a position of trust so it is very important to consider how comments or posts could be interpreted as representing the views of the profession and prior to publishing, you should always consider how information or images you post might be viewed by patients, colleagues, and the general public,” advised Ms Duffy.

Section 20.5 of the current Medical Council guide recognises that closed professional networks “are a useful way to share experiences and case studies, set up expert or learning groups, and get advice or help”.

However, the Medical Council document goes on to say that when using professional networks, “as far as possible, you should not give information that would identify patients.”

“You should also take reasonable steps to check that the network you are using has effective security settings and privacy policies, to minimise the risk of information about patients becoming more widely available,” according to the guide.

Asked if the Medical Council has ever received complaints regarding doctors’ use of social media, or if any doctor ever has been sanctioned by the Council over social media use, the spokesperson said at the moment there is no exact data on this.

“The Medical Council does not currently capture social media as a category of complaint, these complaints would be recorded under ‘communication’,” the spokesperson said.

“However, a large number of our complaints do relate to the category
of ‘communication’.

“For example, in 2020, of 279 complaints received, 105 were in relation to communication. Complaints relating to ‘communication’ could relate to a disagreement, breakdown in doctor-patient relationship, inappropriate comments, social media comments, and other issues related to ‘communications’.”

The UK’s General Medical Council (GMC) is also looking closely at social media.

“Earlier this year [2022], we consulted widely about potential updates to our core guidance for doctors, Good medical practice. Part of that consultation related to doctors’ use of social media,” a GMC spokesperson told this newspaper.

The existing version of Good medical practice “already makes clear that doctors must be honest and trustworthy in their communications”, said the spokesperson, “and reminds them to be aware that when using social media that communications intended for friends or family may become more widely available.”

The spokesperson added that the GMC also had a “more detailed guidance” on doctors’ use of social media, which came into effect in 2013.

“As outlined in the consultation,
we have now emphasised that our social media guidance applies to all forms of communication; written, spoken, and digital.”

The spokesperson said the GMC would use the feedback from the consultation “to develop the guidance further”, before publishing it later this year.

In Ireland, the IMO published a position paper on social media in 2013, but the union had not responded to queries as to whether any update of this document is expected in the coming period.

Articles citied

1. Marshal M, Niranjan V, Spain E,
et al. ‘Doctors can’t be doctors all of the time: A qualitative study of how general practitioners and medical students negotiate public-professional and private-personal realms using social media’, BMJ Open, 2021.

2. O’Brien M, Moore K, McNicholas F.
‘Social media spread during Covid-19: The pros and cons of likes and share’, Irish Medical Journal, 2020.

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