As regular readers already know, I’ve told some embarrassingly cringe-worthy tales about how some health care professionals are using social media (here, here and here, for example).  In Doctors Behaving Badly Online, I cited studies by Washington, DC researcher Dr. Katherine Chretien and her findings of physicians’ “unprofessional” posts on Twitter featuring “very naughty words, potential violations of patients’ privacy, and discriminatory statements.”

Two years ago, when the British Medical Association warned U.K. docs and med students NOT to make “informal, personal or derogatory comments” online about their patients, I became even more alarmed. Why, I wondered at the time, is it even necessary to issue this warning to intelligent, educated brainiacs with the letters MD (or rather, in the U.K., the letters MBBS) after their names?

There are still regrettable cases coming to light about Doctors Behaving Badly Online, but lately, I’ve been rethinking my former suspicion that many health care providers simply have no business wading into social media. And the reason for the rethink is this: physicians are, in essence, abdicating their role as our medical educators.

And while truly embarrassing examples abound on social media – leading me to caution doctors until recently that just because everybody else you know is on social media, doesn’t mean that YOU need to be, too – it’s also true that a growing number of docs are getting it right.

(This can’t be said, unfortunately, for Dr. Vinaya Puppala of Northwestern Memorial Hospital in Chicago, who in June took photographs of a young inebriated female patient “while she was on the hospital bed, crying and attached to an IV,” according to a lawsuit this patient has filed against Dr. P and the hospital.  The good doctor then posted photographs of this patient on Instagram and Facebook accounts, accompanied by “statements of commentary” about the patient’s condition, and then refused to delete the photographs when asked to do so by hospital security, according to the complaint).

A cautionary lesson here for all health care providers on social media: Don’t be stupid.

But just because Dr. Puppala and others are allegedly engaging in such career-damaging stupidity online, does it mean that other docs should steer clear, too?

Throw in the anti-aging gospel of wildly popular cardiologist-turned-medical hypester Dr. Oz and his truly awful TV ratings-bait like “Four Libido Super-Foods That Will Save your Relationship” – and you have the recipe for a wholesale hostile rejection of sound medical knowledge around every corner.

Comments and web links supporting such rejection are being sent to me almost daily by my readers. Because I’ve covered many issues here surrounding industry influence on medical practice, some see me as their unelected voice of the anti-everything movement. Their comments are often accompanied by conspiratorial “What Your Doctors Don’t Want You To Know About ___” accusations, or hate-filled rants on physicians and modern health care, or praise for the Dr. Oz “miracle cures” now being flogged by quack fraudsters.

In short, there is far too much unadulterated trash masquerading as reliable health care information out there for experienced health care professionals to sit silently on the sidelines while viral misinformation continues to spread.

I now believe that unless more of those who actually know what they’re talking about step forward to help balance the onslaught of rampant bafflegab out there, health misinformation that goes viral will become the rule, not the regrettable exception.

As a concerned heart patient and blogger, I’ve observed a one-sided tidal wave of online health misinformation that’s being met with an underpowered, willingly un-armed response from those on the other side – the ones who are actually most likely to have a credible voice if only they were willing to use it.

And as Kathleen Hoffman, PhD summed up nicely in last month’s Health Communication, Health Literacy, & Social Science tweetchat (#hclitss), there are at least five good reasons for doctors to become active in social media, based on the online experience so far of radiation oncologist Dr. Matthew Katz (on Twitter as @subatomicdoc):

• learning from patients
• teaching patients
• continuing medical education
• learning about your profession
• exchanging information with other healthcare providers

There are already a number of health care professionals who are doing this online in a big way. For example:

• For every concerned parent who buys Jenny McCarthy‘s vaccination advice online (described as “trading in her experience for expertise”), there are Real Live Pediatricians like Wendy Sue Swanson, MD (aka the Seattle Children’s Hospital’s Seattle Mama Doc) providing solid information for parents in order to balance McCarthy’s error-filled theories. She’s active on both her blog and Twitter.

• For every commercial health food website pushing unregulated supplements to treat and even “cure” cardiac arrhythmias like atrial fibrillation, there are Real Live Cardiologists like Kentucky electrophysiologist John Mandrola, MD who blogs wisely on what works – and what doesn’t – for people diagnosed with AFib and other cardiac issues. He’s on Twitter as @DrJohnM.
  

• For every shill selling questionable online medical miracles, there are Real Live Pharmacists like Vancouver’s James McCormack, PharmD, a professor at the University of British Columbia, who – along with family physician Mike Allan, MD – produces Best Science Medicine online podcasts they call “BS without the BS”. James also tweets as @medmyth, and teaches courses (“healthy skepticism when it comes to the use of new and old medications”) for docs, nurses, nurse-practitioners, pharmacists, and med students (their next one’s coming up in beautiful Vancouver, B.C. Canada on April 11/12, 2014).  Sign up here already.

• For every new bestselling miracle diet book flogged online, there are Real Live Obesity Specialists like Dr. Yoni Freedhoff who teaches at the University of Ottawa. He also teaches us about our relationship with food and the food industry’s relationship with the food we choose. His blog Weighty Matters includes clever little online videos on topics like How to Make Your Own Homemade Nutella, and his posts on Twitter (@YoniFreedhoff) teach us gems like this one:

There are many, many more health care professionals leaving an impressive mark on social media’s role in medical education – but we need even more.

If you believe that you’re just too darned busy to start blogging, Tweeting, podcasting or otherwise participating in social media like Drs. Freedhof, McCormack, Allan, Mandrola or Swanson et al, please note that this small sampling includes those who are very busy people just like you.

What all doctors do have is the ability to at the very least start separating out the wheat from the chaff by compiling a basic list of credible online health resources you could recommend.

Depending on your area of practice, this list should include both general medical Q&As as well as specific sites devoted to specific diagnoses. Start the old-fashioned way by posting this list in your office, or hand it out when patients ask you to recommend reliable resources.  According to a Pew Internet and American Life Project report, 80% of us use the internet to “prepare for or recover from” our doctor visits. And a reported two-thirds of patients say they want their doctors to recommend reliable website resources for them. Start making that list of your own recommendations.

Because if doctors don’t do the recommending, their patients will seek out the Jenny McCarthys out there who will.

Drs. Ben Gerber and Arnold Eiser, in their paper published in The Journal of Medical Internet Research in 2001, recommended that physicians offer an “internet prescription” to their patients:

“Patients will likely seek a second opinion on the internet. Recommend websites to the patient!

Doctors, you don’t have to write blog articles, but you should keep a running list of ones you’d recommend. You don’t have to join Twitter to create gems of original 140-character wisdom, but you could join Twitter to reTweet links to credible online articles you think your general public audience or peers would find useful. In fact, about 40% of those who are active on Twitter (meaning they log on every day) do not post – they just read what others are Tweeting. So begin there.

While I’m primarly addressing physicians here, I would also love to see more nurses, nurse-practitioners, pharmacists and other health care professionals share their specific expertise and knowledge using social media as their vehicle for health care education.

I propose that one way to regain some balance here is to start small by launching a minimal social media presence, and then grow your online participation as you get more comfortable. If you still need convincing, Pat Rich (@cmaer) of the Canadian Medical Association recommends that you spend five minutes watching this video from Ali Jalali, MD (@ARJalali) of the University of Ottawa’s Faculty of Medicine, who reminds his medical colleagues of a crucially important fact:

“Your patients, your students and your residents are already on social media, and they may not be safe on it.

“It’s part of your social accountability to be there to help them.”

And please docs, since we’re talking about enhancing credibility here – use your own name on social media.

If you’re thinking about launching a blog, remember that writing skills do matter. So does grammar, punctuation, and a neat turn of phrase. Read some of the blog essays of writer/oncologists Dr. James Salwitz or Dr. Elaine Schattner to see how it’s done well.

As I’ve mercilessly warned on this site, you do NOT get a free pass to ignore the basic difference between what’s appropriate in privately griping to your pals around the water cooler and what’s not appropriate in posting the same sentiment online for all the world to see. Common sense and common courtesy go a long way here, folks.

I also like the advice of Ali Almossawi , author of the book called An Illustrated Book of Bad Arguments. He writes:

“Reading about things that one should not do is actually a useful learning experience.”

In the spirit of that advice, never forget Dr. Farris Timimi‘s brilliant 12-word rule of health care social media:

“Don’t Lie. Don’t Pry. Don’t Cheat. Can’t Delete. Don’t Steal. Don’t Reveal.”

Dr. Timimi (@FarrisTimimi) is the medical director for the Mayo Clinic Center for Social Media. He likes to refer to social media participation as a “conversation” for which doctors should know the risks and behave accordingly, but not be so risk-averse that they do not participate.

Rather than abdicate the role of health care educator, docs who are struggling with the whole idea of social media might do well to embrace this participation. Start by browsing what’s out there to help discover your own niche.

Check out those health care providers whose work you respect – see what they’re up to online.  Learn the tools. Do some homework. Get some basic social media tips here. Or seek out health care institutions that already have solid social media strategies in place, like Mayo Clinic’s Social Media Health Network (that offers One-Day Social Media Residency courses).

As Dr. Timimi adds:

“The biggest risk in health care social media is not participating in the conversation.”

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Carolyn Thomas is a heart attack survivor, women’s health activist and speaker who blogs about women’s heart disease at Heart Sisters and about non-heart stuff at The Ethical Nag: Marketing Ethics for the Easily Swayed. You can often find her on Twitter or in short Vimeo films like this 4-minute one about women’s priorities in life. She has quit the time-suck that is Facebook.

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See also:

• Should doctors use their real names on social media?
• The cardiac miracle cure? Vitamin C, lysine and Dr. W. Gifford-Jones
• 10 tips: Social Media Highway Code for doctors
• “Distracted Doctoring” – updating your Facebook status in the O.R.
• Smartphones make Top 10 Health Tech Hazards List
• Why some people should avoid social media completely

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