Doctors and social media: Navigating difficult waters

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.”

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”.