David Kerr: The social media medical highway

David KerrShould doctors avoid fame or notoriety? More than 10 years ago I achieved a modest mixture of both after being asked to leave a public house one Sunday evening for no other reason than being a member of “a group of men.” In the immediate aftermath of the event whilst shopping in the local supermarket, there were the inevitable nudges and winks from people who (like me) found the incident somewhat amusing. However one elderly gentleman did approach me to offer his two-pennyworth. After agreeing on the peculiarity of the pub’s behaviour the same gentleman proceeded to ask me for specific medical advice in relation to his diabetes related foot problem, but only in a whisper so as not to be audible to the person working behind the counter. I had never met him before.

Today an incident such as my “group of men” experience would be immediately in the public domain through Twitter before even making it into the printed press. The story may also have gone “viral” in these parts via Facebook. Nowadays, the man in the supermarket could instead have posted his question on our clinic Facebook page or have started a thread on an online diabetes forum inviting comment from the 50,000 plus members. At the time of the original ad-hoc supermarket consultation my response was polite, short, and personal. If he had commented online and I felt obliged to respond then my reply would have to contain information that was “verifiable, and did not exploit patients’ vulnerability, or lack of medical knowledge” as well as maintaining patient confidentiality.

To help deal with these types of quandaries raised by social media, the Royal College of General Practitioners (RCGP) has recently published a “Social Media Highway Code.” The guidance recognises the potential benefits of the new media to improve access to healthcare services and in essence contains few surprises. It does however highlight the risks of online behaviour becoming “unprofessional” with the potential for posted material being sent to the media or one’s employers—the Medical Protection Society’s head of professional services is quoted as saying “doctors and medical students need to be conscious of the image they present online.”

Within this and other published guidelines from the British Medical Association there are two proverbial elephants in the room. Firstly, there is the question of online medical professionals being required to declare potential conflicts of interest, as bloggers and tweeters may have commercial interests in the topic under discussion. Due to the lack of regulations for the pharmaceutical industry in its dealings with social media the accepted approach for many companies at present is to avoid tweeting, blogging, or posting. However, others may be more “persuadable” to enter product specific discussions to the benefit of company and the detriment of commercial rivals? Secondly, the tone of documents such as the RCGP Highway Code perpetuates the message that it is almost impossible to separate professional and personal presence within social media and therefore the doctor (and medical student) is never completely off duty. Some may argue that this is good news by winding the clock back to the days when medicine was considered a vocation. Others may argue that this type of guidance from professional organisations is simply being used to control their members and will impede the benefits that participation in the new media brings with the move to democratisation of health.

One final observation from the RCGP is that “senior and more experienced doctors, who were not brought up in the online culture, may have a responsibility to become more technically skilled and social media savvy.” This will make job planning for our more Luddite colleagues rather interesting in the future.

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. You can follow him on Twiitter (@GoDiabetesMD) and Linkedin. He holds a small amount of stock in CellNovo (a new insulin pump company) and Axon Telehealth.