Friend Me, M.D.!

Remember an innocent time when your professional image could neatly fit on a business card? Patients could know your office telephone number, your credentials perhaps and maybe even an email address if you so desired. And that was it!

Usher in the era of online social networking (Facebook, Twitter, YouTube, etc.) and the professional/personal lines are virtually undetectable. Things have in fact run quite amuck, with patients "friending" their docs, personal information spreading like wildfire and even pictures from the company party springing up in the strangest of places.

But social media isn't all negative. Enterprising physicians have found numerous ways to promote their practice, educate patients, and become recognized authorities in their specialties. Broadcasting surgeries, authoring blogs and creating interactive social pages are, of course, today's cheapest form of advertising because they are after all, free!

Keeping Up With the Social Scene

With monthly web traffic in the hundreds of millions, it's obvious sites like Facebook and YouTube need no great explanation. But how are physicians and businesses within the orthopedic community using these online tools?

The AAOS (American Academy of Orthopaedic Surgeons) has created an application on Facebook called "Healthy Bones" that goes beyond just "wall posts." Instead it's an interactive app that solicits subscribers, providing information to the public on a host of orthopedic topics. Users can choose from subjects such as exercise or injury and have health tips added to their Facebook home page. The AAOS also has a separate profile created just for its annual conference, which posts updates about the meeting.

Clinics and physicians are also utilizing Facebook in a similar fashion. The Orthopedics Sports Clinic in Houston, Texas, for instance, created a group page that now boasts over 200 members. Here they post promotional photos of their aesthetically-pleasing clinic, bios of staffers and workout tips on their wall. It should be noted that members of the group (and anyone with a Facebook account can become a member) has the ability to post content and comments on the group's wall.

The Texas Back Institute took a different approach to Facebook, going with the less interactive "page" format that doesn't allow anyone but the institute's moderators to post content. But what the page lacks in interactivity it makes up for in PR. Photos show everything from an SPCA donation drive with cuddly puppies to the doctors running in "A Race for a Cure."

You can also read interviews with the doctors from the Back Institute on their page and get a smooth sales pitch from status updates like "Have you been putting off seeing a spine surgeon because you don't want surgery? Well 90% of Texas Back Institute patients never need surgery. Call us today to discuss your treatment options!" With over a thousand people following the page, that message is getting through to many potential patients.

Operating Room/Creative Commons

Twitter has also offered promotional possibilities for physicians. Although "tweeting" from the OR
might be the most cutting-edge trend at the moment thanks to a few enterprising hospitals, individual practices are also choosing to provide steady news streams about their practice.  

Protecting Everyone's Privacy

So that's the good news about social networking. But there's a flip-side and much of the concern has to do with maintaining the all-important physician/patient role and keeping the privacy of both safe. It's become a bit of a hot button issue, with the New England Journal of Medicine among others, publishing articles warning physicians about social carelessness in cyberspace. Let's just say the first lesson is obvious: Don't friend a patient! As Katherine Chretien, Assistant Professor of Medicine at George Washington University says in her Op/Ed piece for USA Today:

Having a so-called dual relationship with a patient—that is, a financial, social or professional relationship in addition to the therapeutic relationship—can lead to serious ethical issues and potentially impair professional judgment. We need professional boundaries to do our job well.

The major concern, however, isn't with just the patient/doctor dynamic; things become downright scary when regulations and laws come into play. With HIPPA looming large, just a few wrong moves in cyber space could spell big real-world trouble. Medical societies are scrambling (some might say after having waited too long) to come up with guidelines for their physician communities. Search the AAOS site for advice, for instance, and all you'll find are results for the society's own social pages. For now, doctors are left to rely on common sense and conservative action. But here are a few ground rules, just to make sure you're covered:

• If you have a personal Facebook page, make sure your privacy settings are doing all they can. Don't allow sensitive information or photos to be viewed by anyone other than "just friends."
• Make sure you know who someone is before you confirm a friendship so you can ensure he or she is not a patient.
• Let patients know in a newsletter or other practice publication that it is your policy not to friend patients in order to maintain proper practices. Use this opportunity to point them in the direction of your blog, website or Facebook group.
• If you are going to have a page for your practice, understand the time investment, particularly when it comes to monitoring.

Corporate Networking Compliance

It's not just doctors that have to contend with sticky online social issues. Medical device companies also have to be extra careful with FDA compliance also thrown into the mix. Mark Gardner, attorney with DuVal & Associates, P.A. of Minneapolis, Minnesota, counsels companies in proper compliance and offers presentations on appropriate social networking to businesses. He says the use of social media is considered direct-to-consumer advertising and therefore is subject to FDA regulations. "Despite these concerns, companies are attracted to the interactive nature of social media, " says Gardner. "After a company has decided how they participate in social media we determine their responsibilities given the FDA regulations.

"First we consider if the content they want to provide is compliant with the Food, Drug & Cosmetic Act—is it truthful, not misleading and fairly balanced? Next we consider their obligations under the law weighing three important elements—content, participation and control. These elements are assessed against one another." Gardner adds that even if the company in question didn't supply certain content, the company still may have an obligation for it. "If they control the Facebook page and are making posts to it, then they clearly are impacted by the regulations."

Gardner says social networking has raised some unique issues for FDA-regulated companies. "Posts outside of the company’s control on Facebook, Twitter or YouTube can create legal issues. For example, companies need to have a plan in place if a patient posts a serious complaint about a product on the company’s Facebook page. Does this create an MDR [Medical Device Report]? Is there a legal obligation under FDA law to report? Who’s monitoring the channels for such complaints? Are they monitoring 24-7-365? Is that necessary?" It's a dilemma for everyone involved. Allowing users to comments eliminates some safety nets, but it also quashes the interactivity that makes these sites so alluring in the first place.

Physicians, hospitals and businesses can all take a note from Gardner's advice. He says it's important not to jump too quickly into social media (even though it seems like everyone is doing it!). "Many sales and marketing departments are running quickly into these media without looking back. They appreciate the lack of control from regulatory and legal. This bliss is usually shortly lived. Use of social media requires balance. Legal and regulatory departments need to recognize the speed at which social media is progressing and appreciate its dynamic nature, yet sales and marketing needs to appreciate the exposure created."

Gardner concludes by saying that without proper controls, social media can be a disaster. "Companies who rush to publish information without carefully considering the legal consequences, inadequately monitor their social media channels, or fail to correct or rectify misinformation published are sure to experience a rude awakening at some point. They’ll face either the FDA or private plaintiffs in court with causes of action tied back to sloppy social media information management."

Twitter Screenshot/Creative Commons

Networking Within the Medical Community

One interesting footnote, aside from the marketing benefits is the networking opportunities for physicians to share information with each other. Sites like Sermo and Ozmosis are specifically geared toward physicians. Feature-strict membership requirements, these sites are springing up so that doctors can freely communicate with each other. Twitter also appears to be a popular way of sharing information, while clinics and hospitals are using Facebook as a recruitment tool to attract new talent.

Social networking isn't exactly a technology one can choose to opt-out of, that's why it's best at this point to embrace it, while taking the proper precautions. As Gardner says, "We’re undergoing a paradigm shift, and I don’t see it relenting. Social media is not a fad. It’s a new way to communicate. It’s a breakthrough to the Internet in the same way the telephone revolutionized communications by improving on the telegraph. One way communication is great, but two-way is genius."