David Kerr: Loose lips sink ships

David KerrLoose lips sink ships was coined as a slogan during WWII as part of the US Office of War Information’s attempt to limit the possibility of people inadvertently giving useful information to enemy spies. Unguarded comments by healthcare professionals hit the headlines in recent weeks after medics were reprimanded for using derogatory terms about hospital departments and other healthcare professionals on twitter. In one sense this was a déjà vu as many older clinicians might remember the impact of the satirical novel The House of God by Samuel Shem and its negative description of patients in hospital. Although hugely controversial, The House of God was compulsory reading for any new doctor on “the firm” at the time.

A recent survey suggested that more than 65% of physicians in the US use social media sites for professional purposes. They are especially keen on professional physician to physician communities as well as referring patients to online communities of individuals with similar medical conditions (e.g. http://www.patientslikeme.com/). However the physicians use of social media to communicate directly with their patients was still uncommon. A third of physicians reported receiving an invitation to “friend” a patient on Facebook, but not surprisingly, 75% of those doctors declined the invitations. Although there is agreement that online interactions have the potential to improve access and enhance care, there remain concerns about privacy, liability, and being paid for the time spent involved in online “doctoring.”

Recently, the structure of online health related social media sites has also come under scrutiny. Fifteen high profile diabetes related online social network sites with memberships ranging from 3000 to more than 300,000 patients and relatives have been compared (Arch Intern Med 2011;171:1589-91). It seems that there are huge variations in quality oversight and expert participation in these sites raising concerns about content accuracy and the evidence base upon which advice is offered. It is also noteworthy that industry advertising was permitted on all but 3 of the sites for patients with the main advertisers being from the Pharma and medical device industries. Likewise sources of funding varied from foundation sponsorship, industry sponsorship, advertisements, voluntary donations, and web host sponsorships with only 3 sites having no industry sponsorship.

Also in the news, the start-up company, Healthtap, have launched a mobile app which allows users to ask questions for free to more than 5,000 licensed US doctors covering 82 healthcare areas. The app uses “gamification” techniques allowing the doctors to be awarded points the more helpful they are. One major carrot for the doctor is the potential to gather more patients in the virtual and real worlds and also to enhance their reputation by gaining “thanks” from patients and “agrees” from colleagues. It is also suggested that by putting frequently answered questions the doctor will be able to “improve the quality of care by making their wisdom accessible beyond doctor visits and do good in the world by making your knowledge available to all.” Quite how the Healthtap express app as it is known is going to deal with the issue of conflict of interest as well as the predatory instincts of medical litigation lawyers is unclear at the moment.

There is still no sign of the regulatory authorities producing definitive guidelines for the use of social media by Pharma and medical device industries. Until then perhaps the onus is on clinicians to keep abreast of what is being said in the online world of their specialty – it might eventually be included in the process of revalidation.

David Kerr wears many hats, sometimes at the same time – Diabetologist, editor of Diabetes Digest, researcher, and founder of VoyageMD.com, a free service for travellers with diabetes. He has received consultancy fees and honoraria for participating in advisory boards for Medtronic, Roche, Lifescan, and Abbott Diabetes Care. He also holds a small amount of stock in CellNovo (a new insulin pump company) and Axon Telehealth.

See also: