Social Media and Healthcare
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Social Media and Healthcare
Articles and Discussions on the intersection of Social Media and Healthcare.
Relevant to Healthcare Practitioners, Pharma', Insurance, Clinicians, Labs, Health IT Vendors, Health Marketeers, Health Policy Makers, Hospital Administrators.
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HIPAA and Your Nursing Practice | NursingCE

HIPAA and Your Nursing Practice | NursingCE | Social Media and Healthcare |

Angela worked as a nurse in an urgent care clinic where her 16-year-old daughter was treated for a urinary tract infection. Concerned, Angela looked up the urine culture results in her daughter’s chart and less than a week later was fired for Health Insurance and Portability and Accountability Act (HIPAA) violation.

Jennifer, a charge nurse on MedSurg, recognized the name of her best friend in ED while scrolling through ED holding patients, and opened the chart. She says her friend did not mind if she looked at her medical information, but she was fired nonetheless by her hospital.


HIPAA law was created in 1996 to protect and keep individuals' protected health information (PHI) confidential.

What is PHI? PHI stands for Protected Health Information and under US law, PHI is information that can be linked to an individual. It includes unique personally identifiable health information as well as billing information.

A breach of HIPAA is when PHI is acquired or disclosed in a manner not permitted by HIPAA. Such use of PHI constitutes a risk to the individual in terms of reputation, or financial harm.

PHI can include anything from a diagnosis to a list of allergies.

It is a Crime

Not only is breaching patient information unethical, it is against the law. A former University of Pittsburgh Medical Center Patient Information Coordinator was fired and prosecuted by the federal government for accessing Protected Health Information (PHI) that was not legitimately needed for her job and without authorization.

It is most serious when done with malicious intent as in the case of a former receptionist at a dental office who sold PHI to criminals who used the PHI to incur huge debts to the patients.

In addition to criminal charges, nurses can be subject to discipline from the BON and risk their licensure.

Social Media Celebrity Katie Duke

Social media celebrity Katie Duke, a nurse and former star of the reality TV show New York Med, was fired from New York Presbyterian Hospital for tweeting a picture of an empty ED room after a trauma patient was treated. The room was empty of people and the picture showed what a room looks like after a code, with no breach of information.

Even so, it was considered insensitive by the hospital because she mentioned a train accident.

Most Common Violations

Despite ample training on HIPAA, violations occur. Common examples include:

  • Faxing errors, such as accidentally faxing the surgery schedule to the wrong department.
  • Sending sensitive information via unsecured email.
  • Giving a patient discharge instructions intended for another patient.
  • Leaving medical records left in non-secure areas. Patient charts must be kept away from the public’s view.
  • Unauthorized employees accessing patient files.
  • Texting patient information. There are encrypted programs but both parties must have it on their device. Follow your facility’s policy and never accept orders via text.

Protect Yourself

Never post patient photos on social media, even in a closed or private group. Even a photo that is posted briefly and quickly taken down is discoverable. A nursing assistant is currently facing a jail sentence for posting embarrassing photos of nursing home clients on Snapchat.

Do not access patient information from your home computer. Resist the temptation to share patient information with family and friends.

Make sure you understand your facility’s policy- ask your employer for the rules surrounding HIPAA in your facility.

If you accidentally violate HIPAA, report it immediately following internal reporting requirements.

If unsure, do not open a patient’s chart. It is very easy to track who has been in a patient’s electronic chart and it is never OK. Many facilities use programs to run reports of every user in a patient’s chart, and can verify those with a legitimate work reason.

Be careful on social media! Every post is discoverable, even after it is deleted.

Protect Your Patients

Know your facility’s policy of releasing health information. Typically patients are given a code that they can share with anyone of their choosing, and the nurse can then release certain information.

The National Council on State Boards of Nursing (NCSBN) cautions that we must safeguard any patient information disclosed to us. As nurses we have an ethical and moral responsibility to maintain patient confidentiality.

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Helping Patients Navigate Pricing Transparency with Digital Marketing

Helping Patients Navigate Pricing Transparency with Digital Marketing | Social Media and Healthcare |

New regulations around hospital service pricing may offer increased transparency, but could also confuse patients. Fortunately, hospitals can use digital marketing tools to give patients a better sense of what they’ll actually pay.

For a long time, patients in the United States have demanded increased transparency when it comes to what they’ll pay for a hospital visit. Recently, the Trump administration has responded with new rules that aim to stimulate competition amongst hospitals and provide greater options for patients.

The new regulation, entitled the “Inpatient Prospective Payment System Rule,” requires hospitals to post list prices for their services on the internet in a machine-readable format. Though hospitals must already make their pricing available in some form, the rule places new emphasis upon price transparency for consumers, going so far as to base Medicare reimbursements upon the quantity and quality of pricing information available.

On its face, transparent hospitals pricing seems like a good thing for consumers, allowing them to comparison-shop for services as they would in any other industry. However, medical providers rightfully have concerns about whether this information will actually help patients make informed decisions. Thanks to digital marketing, however, hospitals have tools at their disposal to educate patients about what their cost burdens will really be.

New Pricing Guidelines Could Be Confusing to Patients

Many doctors worry that the new price transparency regulations will confuse patients instead of helping them make decisions. After all, the vast majority of patients won’t pay the chargemaster price for a service; instead, they’ll pay the portion not covered by their insurance plan, which can vary widely depending on the plan provider and terms. Patients who can only see the chargemaster price may come away with the wrong information about which provider will be best for them.

It would be much more useful to instead provide patients with estimates of out-of-pocket (OOP) costs based on historical data and payer information. As of now, only 29% of healthcare providers intend to post additional pricing information beyond the requirements. However, as hospitals realize the benefits of providing context for the chargemaster numbers, more will almost certainly follow.

Communicating the True Price of Care with Digital Marketing

For hospitals looking to gain a competitive advantage with helpful pricing information, the question becomes how to propagate this information so patients will see it. However your hospital decides to disseminate pricing information, digital marketing can be a valuable tool in communicating messages about pricing to the right audiences.

First, we recommend that hospitals create a dedicated microsite or portal for service pricing information. The site should be simple and easy to navigate, with clear explanations about the meanings of different pricing structures.

The ability to price-compare hospitals will also lead to an influx of search queries about pricing. Take advantage of this by buying search ads for pricing-specific keywords – preferably “long tail” keywords that are relevant to your geographic area, service lines, or to a specific procedures you perform. For example, a keyword like “arthroscopic knee surgery cost in Calabasas” is much more likely to match up with patient queries than “ knee surgery cost.”

Social media ads also offer an opportunity to not only communicate pricing information, but also to educate patients on how they should be considering these important medical decisions. For instance, hospitals could create Facebook ads that lead to a landing page or microsite about deciphering service prices. It could distinguish between chargemaster and out-of-pocket costs and include a tool that would allow patients to estimate the true cost of a given procedure.

The new regulations for pricing transparency, though difficult for hospitals to navigate, can also present an opportunity to become a trusted resource for patients. With the right digital marketing tools, hospitals can get out in front of misinformation and give patients insight into how to make smart healthcare choices.

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Boost Your Social Media Results

Boost Your Social Media Results | Social Media and Healthcare |

Whether you have been on social media for years, or are just getting started, chances are you’d like to increase your effectiveness. By “effectiveness” I mean, get more likes or followers, expand your visibility, increase interaction, and of course attract new patients. We’ve seen great results for all of these objectives with social media advertising and promotions, such as placing ads or sponsored posts on Facebook and Instagram.

Let’s look at a step-by-step process of creating and launching successful social media ads for your practice.

First – Define Your Objective 
What is it you want your ad to achieve for your practice? Consider this list of potential objectives:

  • Grow likes or followers
  • Expand visibility
  • Increase interaction
  • Attract new patients
  • Generate goodwill

You might be thinking that the whole point of being on social media is to get new patients, so why include any other objectives? There are several reasons why. The most important reason is that you need social proof in order to convert patient leads. Social proof means a healthy number of likes, reviews, and interaction. In other words, your page (and your practice) won’t have much credibility if you have 13 likes, outdated content, and the sound of crickets on your business page.

In the case of a page with only 13 likes and no recent or zero activity, a Facebook ad that helps to generate likes is a great place to start. Another option is to use the organic method of word of mouth to grow your page likes and followers. For example, inviting patients to like your Facebook page or follow you on Instagram while they are in your office. For this to be effective, it will require that you have a system in place. Often this is a team member who likes social media and is happy to consistently engage in a brief conversation with patients while they are in your office.

A natural, organic time to invite patients to join you on social media or share their thoughts in an online review is anytime a patient compliments your team or practice. You can thank the patient sincerely for the feedback and then ask them if they are active online. Give them the option of posting their thoughts on your Facebook page, Google listing, or review platform of their choice.

Back to social media ads … Social media ad objectives other than “new patients”, are sometimes a means to an end… with the end being to attract new patients. It’s important to note that the most successful practices on social media see the tool as a great way to grow relationships and generate goodwill in the community—which can also lead to new patients over time.

Second – Craft Your Ad 
Your objective will help determine your ad content. For example, an ad to generate likes can be created through Facebook’s ad platform option, “Promote your Page”. If however, your objective is to expand your visibility, you could choose to “Boost your Post”, which would expand your post visibility to your desired city or zip codes and extend the shelf life of your post. In other words, sponsoring a post or creating an ad from a post allows that post to appear in the newsfeed for your desired number of campaign days, based on your budget.

Ideally, you will use Facebook’s ad platform to place your ads. It gives you much greater targeting options than the Boost Post button/option directly on your page. To access Facebook’s ad platform, visit and click the “Create an ad” option.

You may prefer to use Facebook’s Ads Manager app to place your ads. You can download the Facebook Ads Manager app from the app store on your device. If you spend more time on your mobile device or simply find apps more userfriendly, you will enjoy the convenience of this option. The app is available for iPhone and Android.

Facebook provides numerous tutorials and references to help you place ads yourself. If you want someone to hold your hand, look over your shoulder, or handle it entirely, there are agencies that understand the nuances of dentistry to help with that as well. For those of you who plan to do it yourself, you’ll also want to consider the following:

  • What you want your ad to say – text may or may not be limited depending on the type of ad you are running
  • What you want your ad to look like – be aware that Facebook has limitations on the type of image/visuals you may use
  • When you want your ad to run – choose the number of days and a budget for your campaign

Third – Determine Your Budget 
There are infinite campaign and budget options. You can experiment for as little as $5.00 for a Boost Post campaign that may run several days. I suggest you keep your budget minimal the first few times you run your ads. This will allow you to familiarize yourself with the ad process and ensure you’re representing your practice well. A conservative budget that will still get results is as little as, for example, $5 per day for five days.

If you check the option for your campaign to “run continuously”, be sure to set a reminder for yourself of when you want the campaign to end. One doctor called me frantically asking how to stop his ad that had been running for a few months because he’d forgotten about it!

Also, you want to make sure your ad doesn’t overdo impressions. In other words, make sure your ad isn’t served to your audience too many times. If people see your ad over and over again, they may get annoyed and click to inform Facebook that they don’t want to see your ads—ever. This is considered negative feedback and may result in higher ad prices.

Facebook has recently added a relevance score to ads. This is a grade for your ads with 10 out 10 being excellent and one out of 10 being poor. The relevance score and other ad metrics can be found in your Facebook Ads Manager Campaigns section. The relevance score, in addition to reach, spend, cost per engagement, etc. are updated constantly. Much of this information is also provided within the Facebook Ads Manager app dashboard.

Facebook continues to add resources and make improvements to make ad placement more convenient and user friendly. For example, if your ads or boosts are appropriate for Instagram, you can opt to share your promotion on Instagram as well. This can help showcase a specific post or suggest others follow your account. Both Facebook and Instagram allow you to target users based on a variety of demographics.

Finally – Track Your Ad Results 
There are several ways to track your ad’s effectiveness. Depending on your objectives, Facebook ad campaign reports can provide results. Regarding leads and new patients, you can use a unique phone number to track and record calls, have a special questionnaire to interview patients, or create specific options on your online intake forms. I recommend the online intake forms. In an example where a new patient was referred by a friend, they are still be able to check off that they’ve also seen you on Facebook or Instagram if you have those options as checklist items on your forms. If you don’t have these options on your intake forms, you will never know for sure if your social media marketing is working or not.

These ads have taken many dentists’ mediocre Facebook pages and turned them into visibility machines. Gone are the days when social media advisers used to say, “You should never sell on social media.” In fact, you can be very direct and include calls to action with these ad options—depending on your objectives. Now that the secret is out, you may want to jump on board with social media advertising. Like all pay per click ads, as demand grows, chances are campaign prices will grow too. I encourage you to implement at least one ad campaign per month to get started. Keep me posted on your progress!

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How To Create Engaging Posts on Your Dental Practice's Social Media Pages 

How To Create Engaging Posts on Your Dental Practice's Social Media Pages  | Social Media and Healthcare |

Ever since attending the Art of Treatment Planning seminar in Seattle this past August, I’ve made it my resolution to use my new camera more often. While taking a modified full series with frontal retracted, occlusal and buccal images is a great way to start discussing comprehensive dentistry with your new patients, you can start small as well.

Posting photos to an office Instagram account or Facebook page is also a really good way to engage with your patients and the community and show the kind of work you do on a daily basis. I’m finding that it’s more important to be regular and consistent than to make one post a year with a large case that you recently completed.

With all the dental social media accounts that have thousands of followers, fancy equipment and software, sometimes its easy to get into a mindset that the things we do on a daily basis won’t be “cool” or impressive to our patients. But I’m finding that those routine things we do can be a great conversation starter, while also boosting your office’s online presence.

One feature I love on my Nikon D7500 is that it can sync via Bluetooth straight to my phone or iPad through the SnapBridge app. This means that I can take a simple photo before and after the procedure, and within minutes make a spiffy post to our office’s social media accounts via the Instagram or Facebook apps, or discuss with a patient on an iPad in the operatory. No need to take the card out, go find the card reader, download the pictures to the computer and then try to edit the photos in a special program before posting, or trying to get it to a computer in the consult room where you can discuss with the patient and have to move them there.

Now, this won’t take the place of a proper consult or a “tour of the mouth” for comprehensive exams, but this can definitely streamline the process and make regular posting more convenient.

If you plan on posting photos publically, make sure you have a photographic consent form signed by the patient, either on the day of the procedure or one on file from a new patient intake packet. Even though most of the photos I post don’t show or reveal any patient identifying features, it’s good to cover your bases.

If you have a Nikon D7500 or other camera with the SnapBridge technology, all you need to do is download the SnapBridge App to your phone or tablet. You can pair the camera and device together and then be able to see, select and download only the photos you want from your camera on your portable device. If you want to just show the patient while they are in the chair, you can stop right there.

If you want to create a post on one of your accounts, the photos will be right there in your library and can be uploaded like any other photo post. If you are planning on sharing a before-and-after photo, I’d recommend downloading the Layout app as well. The app integrates with Instagram and allows you to show the two images in a single picture. Within the Instagram app, there will be a Layout button, and it will take you through the process of orienting your photos relative to one another, and allowing you to do some minor rotations, cropping and zooming.

Once your collage is done, you can post it straight to your office Instagram account (with witty caption and hashtags, of course). The collage will also be saved in your device’s photo library so you can post it to your Facebook account, just like uploading a single photo. I hope this encourages you to use a camera more and get connected with your community by showing the great work we do on a daily basis.

Dr. Imahn Moin, DDS.

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How social media can lead to a HIPAA violation

How social media can lead to a HIPAA violation | Social Media and Healthcare |

Dr. Derm is a well-known specialist in the use of biologic agents for psoriasis. He has many happy patients. One of them described in detail on her social media site her course of treatment and the great results she had seen. Dr. Derm sees this as a great chance to promote himself and uses these accolades on his own social media sites and website. He assumed that he did not need her permission. The patient finds out about this and sues Dr. Derm for a HIPAA violation and demands $500,000.


Dr. Derm is beyond upset. He reaches out to his attorney to ask how something placed on the public domain by a patient, then used by him can be a violation of health care privacy? 

When can a physician disclose protected health care information?

What is clear is that a covered entity, such as a physician’s practice or health system can disclose protected health information (PHI) in a couple of different scenarios:

1) The patient provides his/her formal written authorization, and/or
2) there is a statutory exception to requiring formal written authorization.

An appropriate compliant HIPAA authorization has a number of requisite details. The requirements include a description of who is authorized to make the disclosure and receive the PHI, a specific and meaningful description of the PHI, a description of the purpose of the disclosure, an expiration date or event, signature of the individual authorizing the use or disclosure of her/ his own PHI and the date, information concerning the individual’s right to revoke the authorization, and information about the ability or inability to condition treatment, payment, enrollment or eligibility for benefits on the authorization.

Conversely, there are situations when a physician does not need a patient’s written authorization for every disclosure. These invariably are where there is a statutory basis for the exception.

For example, the broadest exceptions are known as Treatment and Payment Operations. Within those categories, a dermatologist does not need a patient’s authorization to disclose PHI to get paid or to send information to another treating doctor to take care of a patient. These exceptions are clearly spelled out in the HIPAA statute.

Thus, if a patient has described her healthcare journey with Dr. Derm on his or her Facebook page, can he say thanks? Or can Dr. Derm even “correct the record” if the posting is incorrect?

The reality is that unless Dr. Derm has the patient’s authorization, the answer is no.

In fact, physicians are forbidden from even acknowledging that person was a patient. It can be argued that it is absurd that a patient might publish every detail about his or her care and, yet, Dr. Derm must remain silent — even if the record is full of inaccuracies.

It’s doubly absurd because Dr. Derm may not be disclosing any more than the patient already disclosed on his or her own. But, the regulations on this are clear.

A recent Connecticut case highlights this issue:

In 2015 a patient contacted a local TV station stating a medical practice turned her away because she had a service animal. The reporter called the practice for its side of the story. The physician’s office, in defending themselves, disclosed PHI.

A subsequent Office of Civil Rights investigation found that the doctor’s discussion with the reporter demonstrated a reckless disregard for the patient’s privacy rights, and that the disclosure occurred after the doctor was instructed by the practice’s own privacy officer to either not respond to the media or to respond with no comment.

Additionally, the Office of Civil Rights’ investigation revealed that the medical practice failed to take any disciplinary action against the doctor or to take any corrective action following the impermissible disclosure to the media, the statement notes.

The medical practice was found liable and forced to pay $125,000 for this violation.

There are now documented million dollar fines to hospitals for similar violations.

What appeared to be a simple benign action by Dr. Derm may in fact be a HIPAA violation.

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5 medical online marketing ideas to outpace the competition

5 medical online marketing ideas to outpace the competition | Social Media and Healthcare |

Online marketing might have a lower entry cost than traditional marketing, but because of this it’s also competitive. Facebook ad spending alone has increased 62 percent year-on-year as of 2018, according to Econsultancy.

With more people buying ads and investing in online marketing, you’ll need every edge you can get to outpace the competition. Here are five steps to help you gain the lead on your competitors and get the most out of your online medical marketing efforts.

1. Enhance your web presence

A strong web presence is key to any online medical marketing strategy. Make sure your web presence is up to par by claiming your practice listings on any local business and healthcare directories. If your site is already listed, audit them to ensure accuracy.

You also want to ensure you’re using high-quality photos on your listings. Provide an even better experience by offering one-click booking for appointments.

Check out: 3 most common online directory listing mistakes

2. Build an optimized website

It’s not enough that you have a website in today’s marketing climate. You need to have an optimized site. This means several things:

  • Your site needs to be mobile-first. Mobile users account for more than 48 percent of all online traffic, according to Statista. Mobile-first sites display properly on mobile devices, while older, unoptimized sites can display incorrectly. This can result in visitors missing important information or leaving your site entirely.
  • Your site must be optimized for search engines. A site that’s easy for users to navigate is important, but your site won’t be discovered if it isn’t optimized for search engines. Make sure your website is up to date and follows current search engine optimization (SEO) best practices. Otherwise, it can lose out to better optimized competing pages.
  • An optimized site should convert visitors into patients. When filling out your pages and designing your site, think about whether it will lead visitors through the marketing funnel and turn them into patients. A site that doesn’t convert prospects isn’t worth the investment and upkeep. Be sure to feature patient testimonials and important information about your services and credentials so visitors can book appointments with confidence.

Related: 5 pages your medical website needs

3. Offer online appointment scheduling

Plain and simple, you should be offering online appointment scheduling. It’s convenient for patients, and it can act as a selling point for those torn between two practices. If that’s not enough, nearly half of the people we surveyed in 2016 said they want online appointment scheduling to be offered by the practice they choose.

4. Drive online patient reviews

Online reviews and testimonials can do wonders for your practice. According to BrightLocal, 91 percent of 18 to 34-year-olds trust online reviews as much as personal recommendations.

To help build your online reputation, ask your patients to review your practice, and share their experiences online. Automating feedback collection will take the burden off your staff, and allow you to quickly review feedback.

Search engines also use reviews to determine rankings, so having a strong online reputation is paramount to success.

5. Publish great content

Writing quality content and sharing it on your site and social media sites can help your practice in many ways.

  • According to Google, 75 percent of people who find useful information in a search are more likely to visit the physical location of the company afterward. Great content on your site can translate into more patients coming to your practice.
  • Regularly publishing high-quality content can establish you as a thought leader. This can lead to guest posting opportunities, speaking engagements, and, in general, position your practice as a place is prestige.
  • Sharing content on social media gives you the opportunity to engage with current and future patients. This can help with retention, boost the possibility of word of mouth, and put your practice in the minds of future patients.
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How to reduce SEO ranking fluctuations 

How to reduce SEO ranking fluctuations  | Social Media and Healthcare |

Your Google rankings are climbing higher and higher, then bam! You’re knocked down. So, what happened?


Ranking fluctuations are the movement of websites’ positions in search engine results pages (SERPs). At the beginning of your search engine optimization (SEO) campaign, ranking fluctuation is normal and natural, especially on the bottom half of the first page. But if your website is appearing on the top half of the first page, that does not mean it is going to stay there for a long time. 

Fluctuations occur less frequently on the top half of the first page because those websites have already proven themselves to search engines, including Google, as credible results. So, regardless of the placement of your healthcare website on SERPs, the fluctuation is normal, and you cannot avoid it. 

Why do rankings fluctuate?

For SEO experts who track their website’s search engine ranking on a daily basis, it is not surprising to see the ranking move from position one to seven. The SERPs fluctuate depending on visitors’ search criteria and intent. Some days, you will notice the ranking sticking to the same position and moving on others. 

In order to protect your website rankings, we will first look into the factors that cause shifts in search engine results:

1. Search engine algorithm updates: This is one of the most frequent causes of fluctuations in website positions. It may be a new algorithm, upgrade of an older algorithm, or refresh of an existing algorithm. Any change in the search engine’s algorithm can cause rankings to fluctuate for a few weeks after the rollout. Although less disruptive now than they used to be, extreme ranking fluctuations may still occur when Google makes a significant algorithm update. While fluctuations are an essential part of Google’s algorithm, this does not always mean you have to be taken by surprise each time the algorithm updates.

2. Search engine penalties: There are many possible reasons for search engine penalties, both on-page and off-page. For instance, you may be penalized because of low-quality content, user-generated spam, irrelevant content, spammy links, or using any black hat SEO methods.

3. Technical issues: Any changes in the website, including redirects, redesigns or HTTP/HTTPS migrations, may cause crawl problems. You may also notice a dip in the rankings if you incorporate complicated code that slows down your website speed. This happens because the crawlers lack accessibility to your website. In addition, some of the web hosting services may not give you a good uptime. A website that is down most of the time may send a signal to search engines that it is not a credible site.

4. Inbound links: Hyperlinking strategies can cause significant ranking fluctuations. If you are trying to implement outreach strategies to point to specific pages, the unexpected flood of links can cause a rise in ranking. The absence of links pointing to your medical practice website can cause a drop as well. However, if lost links are resulting in a ranking drop, the fall will usually be moderate.

5. Competitors: Competition in the healthcare SEO arena is intense, and no matter how current your strategies are, your competitors can still outdo you. The best thing you can do is to focus on implementing effective SEO strategies. By doing this, your overall ranking will stay up even though you might lose positions for some of your web pages. 

How to react to ranking fluctuations

Above all else, do not panic. It is important to learn why there has been a sudden drop in the rankings. You should investigate the amount of fluctuation and explore reasons that could have caused a drop in positions. It may just be a temporary change and after a few days your web page rankings will rebound.

It’s also a good idea to check your competitors’ web page rankings using the Google keyword position checker. If your competitors also have a position drop, then you have no reason to panic. However, if your competitors are running fast, that could be a reason why your rankings fell. 

Fortunately, you can take proactive and preventive measures to minimize ranking changes. It is important to implement the appropriate SEO tactics and be consistent and patient while those changes take effect. Although the problem of ranking fluctuations will still occur, you can consider implementing the following strategies to minimize the impact:

1. Use internal linking to help leverage keyword targeting. Avoid using rich anchor text.

2. Keep an eye on your website speed. If your website is loading slowly, the visitor might exit and click another result. This will signal to search engines that your website is not valuable. 

3. Counterbalance a decline in rankings by building links. However, search engines will catch if your website is building links at an abnormal rate. This may set off red flags and ultimately result in ranking drops.

4. Refresh content on your website. Updating content on a page that is already ranking well is a good idea. You want to ensure that your content is refreshed once a year at a minimum. You will find that having updated content will help improve your rankings. When content gets stale or no longer relevant, you will start to see a large bounce rate or a drop in your rankings. Although content updates are only one part of an overall SEO strategy, they are key to maintaining those high rankings. Sometimes, all it takes is a little bit of updating to rank above your competitors. 

Is ranking fluctuation a serious problem?

If you notice rankings are falling abruptly within a very short time, there is likely to be a severe problem. For instance, if you ranked in the top three but the website has suddenly dropped 20 or 50 pages, you should immediately investigate. Google might have caught something devious and devalued your links within days.

So, the next time your website’s rankings fluctuate, do not panic—and do not let these changes spook you. Focus on your content marketing and technical SEO strategies. Review and revise your plan for ways to keep improving your web page rankings over the long term.

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The complicated relationship between social media and depression

The complicated relationship between social media and depression | Social Media and Healthcare |

Over the past decade, social media platforms like Facebook and Twitter have become a central part of everyday life. Despite their massive popularity, however, controversy abounds regarding their impact on mental health and wellbeing. A new research study by the University of Amsterdam (UvA) has now found a correlation between the passive use of social media and depression symptoms like loneliness and fatigue. The findings were recently published in the Journal of Experimental Psychology: General.

Tracking wellbeing with an app

For many of us it is a daily habit. Whenever we have a moment to spare, we find ourselves reaching for our smartphones and aimlessly scrolling through social media feeds reading updates or looking at pictures. This behaviour, called passive social media use (PSMU), is often used to relieve boredom and can swallow up large chunks of personal time. While seemingly innocent, PSMU isn't without controversy – experimental research shows that it can decrease affective wellbeing, a sense of belonging and life satisfaction.

To investigate the link between social media use and depression symptoms, an international research team led by the UvA recruited 125 students and measured their wellbeing and passive social media use seven times daily for 14 days. A special app on their phones prompted participants at fixed times to complete a 12-item depression questionnaire. Their responses were analysed with a novel statistical technique, which was developed/implemented by researchers affiliated with the UvA's Psychosystems Group (Dr. Laura Bringmann and Dr. Sacha Epskamp). The analysis focused on three timeframes – short-term (within the same two hours), medium-term (prediction from one prompt to next) and longer-term (across the entire 14 days).

Negative feelings and social media

Although the results showed that engaging in PSMU did not predict depression symptoms, they did reveal a noticeable relation between negative wellbeing and increased social media use. "Feelings of fatigue and loneliness at a given prompt predicted PSMU at the next prompt, indicating that certain depression symptoms might lead individuals to scroll through social media feeds," says George Aalbers, a UvA Research Master's graduate in Psychology and lead author of the study. "We also found that passive social media use at a given prompt co-occurred with a loss of interest, concentration problems, fatigue and loneliness at the same prompt. However, we don't know whether PSMU causes these symptoms or vice versa. This is a topic for future research."

Most importantly, Aalbers adds, the study shows that the link between social media and psychological well-being is more complicated than 'social media make people depressed." "Instead, specific social media behaviour seems associated with specific depression symptoms, and more research is required to find out how these social media use and mental health influence each other."

The researchers believe the next important step is to replicate the findings in a clinical setting. "Our study used a student sample, in which average levels of depression symptoms, loneliness and stress were fairly low. As previous research suggests that social media's adverse effects could be stronger in depressed than in non-depressed individuals, a clinical sample might show a more pronounced link between PSMU and depression symptoms."

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11 Great Ideas To Help Market Your Doctors Office To New Patients

11 Great Ideas To Help Market Your Doctors Office To New Patients | Social Media and Healthcare |

Reaching out to new patients, or even being able to retain your current ones, can sometimes seem like a struggle.  Worrying that you won’t be able to attract new patients, or waking up in cold sweat that one day your schedule will be bare, is a constant concern for doctors and physicians. However, it needn’t be.

To help you to promote your business, here are 11 great ideas to help market your medical practice:

1.  Have A Professional Website Built

The internet is your shop window to the world, and to be able to compete in the digital age; you need to have a comprehensive online presence.  The most effective way to do this is to have a professional website that offers information about your services, as well as easy to find contact details, patient testimonials, and a blog page to help build SEO for your medical practice.


2.  Be A Part Of Your Community

As a provider of health care services, it is vital that you are seen as helping your community where possible.  Being active in your city could be as simple as sponsoring an annual event, or something on a grander scale, like organizing a charity ball or fundraiser.  You could also have a mobile booth that can be set up at health fairs, community gatherings or even sporting events to tell the community about your doctor’s office.


3.  Make A Donation

Following on from the above, a great way to get your name out there is to donate something for free.  This could be a coupon for free treatment or a promotional discount. Donating a free service to a local charity will not only attract new customers, but it also helps to promote you as a leading benefactor in your neighborhood.


4.  Understand your Patients

To market your business successfully, you need to know exactly who you are marketing it to. Understanding what makes your potential new patients tick is key to engaging with them. Build up a profile of your typical patient, including how much they are willing to spend, how they pay and how often they return, to see what kind of patient is attracted to the services you offer.  You can then undertake some basic research that will help you find the best ways to reach them. For example, affluent older patients might be best reached using upscale magazines, while younger patients could be more accessible using social media like Facebook or Twitter.


5.   Hold An Open Day

You may have potential new patients in your neighborhood that have heard of you but don’t know much about the services you offer.  You could hold an open day or reception and invite the public, colleagues and other healthcare providers that provide referrals to your event.  Have your most experienced medical staff on hand to discuss the treatments available at your office, and answer any questions about them.


6.  Use Email Marketing

Most doctors offices ask for an email as part of their data-capture procedure.  Using a regular, but not intrusive email marketing campaign you can keep them up to date with new procedures, special offers, and promotional events via email.


7.  Introduce A Referral Program

Finding a good doctor is vital to anyone looking for effective, reliable and affordable healthcare.  If you offer your existing patients an excellent service, they become a walking, talking advertisement for your office.  If they look amazing thanks to the surgery you have performed or feel brand new thanks to your medical care; you can guarantee they will be happy to recommend you.


8. Become An Expert In Your Field

Everyone uses the internet for research these days, and often turn to Google before making initial inquiries in person.  Blogs are a great way to offer information about your own expertise (you are reading one now, after all), and you can show your prowess by writing informative, engaging pieces about your specialism.  You could go even further and submit articles to online and prints publications, talk at seminars or offer your own V-log YouTube channel.


9.  Offer A Customer Survey

Sometimes a patient will walk out of your office full of praise, but maybe wishing that a part of their visit had gone differently.  Offering a customer survey gives patients the opportunity to voice their opinions on paper, which many people find easier to do. Please take note of their suggestions, and act on them where possible.  When you do make changes, be sure to tell your patients about them using your email marketing campaign.


10. Build Your Brand

Finally, you can be the best doctor in the world, but if the service you offer is inconsistent and uninspiring, your patients will quickly be enticed by a doctor with better bedside manners!  You and your team should prioritize customer service at all times, from the first inquiry to the last aftercare appointment. Be professional, of course, but also be helpful, courteous and personable.  Let them get to know you, and become their trusted medical provider.


11. Tell The World Your Story

The way to market your doctor’s office is to give it a voice and a personality all of its own.  Unless you offer a service that is unique, you will always face competition of some kind.

By offering a personal service, with a strong brand ethos behind it, your patients will return to your time and time again.  Be transparent, never promise more than you can deliver, and take the time to listen to your patients’ needs.

Getting to know your patients, as well as providing consistently high levels of customer service and clinical excellence, will build trust and quickly transform your practice from just another doctor to a trusted professional.

A satisfied patient will always be your most effective and believable marketing resource, and if you continue to deliver, they will always be your greatest asset too.


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Social Media Needs Transparent Privacy Policies for Healthcare Data

Social Media Needs Transparent Privacy Policies for Healthcare Data | Social Media and Healthcare |

Two healthcare leaders are calling for greater transparency and stronger laws that outline the data collection practices of social media platforms.

In Applied Clinical Informatics, Carolyn Petersen, Mayo Clinic Global Business Solutions Senior Editor, and Christoph Mehmann, MD, Professor for Biomedical Informatics and Pediatrics at Vanderbilt University outlined the privacy issues highlighted by the Facebook data scandal and the potential impact on social media in healthcare.

The Facebook scandal is the ultimate example of privacy practices gone wrong. The company is still facing legal action by the Federal Trade Commission and has been fined by other governments for several data breaches and scraping the data of 2.2 billion users in violation of a 2011 user privacy decree.

“The recent revelations about Facebook’s handling of user information have confirmed suspicions that an industry offering its services for free to users most likely has already turned its user base into the marketed product or is about to do so,” the authors wrote.

“More importantly, such revelations leave individuals who use social media feeling betrayed, bereft, violated, and concerned about how to safely and appropriately use social media to support health-related goals and build community,” they added.

The trouble is that the digital health movement touted social media as a collaboration between patients, caregivers, and other health stakeholders, the authors explained.

The platforms connect individuals to health information, along with an anonymous space for people to explore health concerns without stigma, they explained. Social media also helps patients and their families crowdfund medical treatments and the like.

However, despite these benefits, the “platforms frequently fail to take into account the unique needs of this population, which can create special challenges and additional work for healthcare practitioners and may require focused efforts to overcome real and potential privacy abuses,” the authors wrote.

Social media use is wrapped around trust, the authors explained. That trust extends from an understanding the internet service provider won’t view shared data, to trust that the platform will abide by its terms of use.

Facebook worsened its position in terms of privacy when it covertly sought deals with healthcare organizations to share patient data. The authors explained that while that data could help provide insight to caregivers, the creation of enhanced patient profiles presents an opportunity for illegal data sharing.

But the authors noted that even without Facebook, social media platforms will remain. As a result, lawmakers and industry stakeholders must get ahead of the situation by mandating full transparency and incentivizing the development of user-friendly platforms.

These companies must provide comprehensive user education while establishing user-friendly business models and policies, the authors added. The proposed law would ensure these platforms clearly state data collection, use, and sharing policies, which will promote accountability for social media companies.

“A comprehensive privacy protection system for the United States would include a ‘Right to be Forgotten,’ as well as regulation and oversight of data collection, analysis, and sharing practices,” the authors wrote. “Social media companies that use security practices to shield themselves from the exposure of their privacy-violating practices, are vigorously fighting these initiatives.”

“With the passage of legislation prohibiting deceptive practices and the establishment of patient/consumer education campaigns … patients will be in a position to use social media for their benefit, rather than primarily for the gain of profit-focused platforms,” they added.

In the US, especially in healthcare, there’s been a massive push for consumer privacy rights. In November, AMIA called for a federal alignment of health data privacy policies, including making consumer-centricity a prerequisite condition.

Just this month, AHIMA and AMIA called on Capitol Hill members to upgrade HIPAA to support a patient’s right to access their own data. Meanwhile, The Center for Democracy & Technology proposed a bill centered around a consumer’s right to understanding where their data is located and reasonable data access.

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Navigating Social Media Issues in Medical Practice: An Expert Interview

Navigating Social Media Issues in Medical Practice: An Expert Interview | Social Media and Healthcare |

According to a recent PEW report, 70% of Americans use social media, up from only 5% in 2005.1 A separate report indicated that an increasing number of American employees across the board in a range of industries are using social media while in the workplace, with the top 2 reasons being taking a mental break and connecting with friends and family while at work.2 In fact, several studies have suggested that restrictions against use of social media at work may adversely influence the hiring process by deterring would-be employees from accepting employment.3

Issues that affect employees in all industries are compounded by a unique set of additional concerns that affect employees of medical practices. To shed light on the issues related to social media in medical practices, MPR spoke to Michael J Sacopulos, JD, CEO of Medical Risk Institute (MRI), a firm that provides "proactive counsel" to the healthcare community to identify where liability risks originate and to reduce or remove those risks. He is also General Counsel to Medical Justice Services. Mr Sacopulos is the coauthor of Tweets, Likes, and Liabilities: Online and Electronic Risks to the Healthcare Professional (Greenbranch Publishing: 2018).

How did you come to write your book?

I began to consider some of the complexities of practicing medicine in the digital age and the number of risks that accompany social media and the Internet. I am a lawyer whose career began doing medical malpractice defense work. This was clearly not my niche and I didn't enjoy it. I decided to keep physicians out of trouble rather than defending them once they got into trouble. The basis of my career is to look at where trouble potentially originates and help physicians come up with plans to avoid it. My coauthor, Susan Gay, had written an earlier book about online reviews and ratings of medical professionals. Our book was a natural outgrowth of her previous work and my current interests.

Who is your primary target audience?

I represent individual physicians or physician practices, and my book was designed to help these physicians or their office managers address digital challenges. Although many of the same issues apply to larger health systems, those typically have in-house counsel and compliance officers, while smaller practices have the same obligations but do not have the resources or infrastructure of larger health systems.

Are there guidelines for physicians regarding their use of social media?

The Federation of State Medical Boards has issued Model Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice,4 which contains the "industry standards" for cyber security, online behavior, and patient privacy. I advise all of my clients and the medical practices I work with to familiarize themselves with these guidelines.

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What are the parameters of an employee's use of social media?

There are 2 aspects of using social media as an employee of a medical practice. One is during work hours and the other is on one's own time. A practice's social media policies can't be too restrictive, but on the other hand, social media posts must respect patients and do no harm to the practice.

Obviously, there are concerns about distractibility and whether an employee's attention is diverted by posting on Facebook or some other forum during work hours. This concern is across the board in all industries, not only medical.

But there are additional concerns that specifically apply to medical practices.

For example, it is legal to criticize one's superior in a personal Facebook post. I know one case in which someone contacted her friend, a dental assistant, on a personal Facebook page to find out if her employer does dental implants. “Oh, he tries,” the dental assistant responded. While that may not be illegal, it's definitely disrespectful. I'm sure the dentist did not want that type of comment out there.

On the other hand, there are aspects of work that would be completely inappropriate to post, even on a personal Facebook page.

What types of posts would be inappropriate for medical practice employees to post on their own social media sites?

Any practice-related matter concerning a patient would be a violation of HIPAA and inappropriate to post, even without mentioning the patient's name. For example, there was a case with a nurse at a hospital who was in the ER when a police officer was shot and brought in, together with the alleged shooter, both being treated for gunshot wounds. The officer ended up dying from his injuries. The nurse went home and posted, “I had to take care of a cop killer today. Hope he burns in hell.” This was considered by her employer to be a violation of privacy and she was fired. I could see how some people would not see this as a breach of privacy because no names were used, but the facility had a firm policy in place that any post about a patient situation was grounds for dismissal.

What is the role of "policy" in these issues?

The role of “policy” is very important. There was a case of a female patient at a medical center who was given a diagnosis of an STD. Her ex-boyfriend worked at the facility, copied her records, and posted them with a derogatory heading about her. He was fired because the facility was able to determine that he had accessed the record in an unauthorized way, as he was not involved in her care. The patient sued the facility, but the facility was shielded from liability because they had a specific policy in place prohibiting employees not involved with a given patient's care to access that patient's records. There were also mechanisms in place to detect when that happened, and the facility took immediate action to dismiss the employee. It was ruled that although the employee had violated HIPAA, the facility was not held responsible.

You mentioned unauthorized access. Beyond use of social media to disseminate patient information, what concerns are there and how might those be addressed?

It is essential for practices to monitor their electronic records to make sure unauthorized individuals are not accessing them. There have been many accounts of hospital employees looking at the medical records of celebrities – for example, when one of the Kardashians had a baby, many people unrelated to her care looked at her electronic records and all were fired.

The issue is not confined to celebrities. I remember a case that took place in a tiny rural town in which everyone knew everyone else. A group of teenagers used some type of synthetic drug at a party. Ten partygoers ended up in the hospital and 1 of them died. There were at least 30 hospital employees who accessed those records. My guess is they were not malicious, only concerned for their friends and neighbors. But they were all fired because of this.

What other privacy concerns might be unique to medical practices?

Posting photographs of the practice can lead to some serious violations if a patient chart or any information with a patient's name accidentally is caught in the picture. It can also be problematic if a patient is inadvertently photographed. In a recent case, an employee in a plastic surgeon's office took a picture of a fellow employee who had a new hairstyle. What she didn't realize was that there was a patient standing nearby who ended up being in the picture. The picture was subsequently posted on the employee's personal Facebook. The patient somehow became aware of it and was none too happy that people had found out that she was going to a plastic surgeon.

Do you have any other advice for physicians?

None of these issues are terrible, intractable problems. They arise because practitioners are not aware of the shifting and rapidly expanding social media landscape. If you follow the guidelines and pay attention to potential issues that might arise, then with relatively little expense and effort, you can avoid a lot of these problems and benefit from the upsides of the digital age without the downsides.

It is also important to recognize that these issues do not only concern compliance but also patient safety. There are patients who are afraid to seek medical or mental health help because they are afraid their data or privacy will be compromised. People's confidence in the integrity of your staff and strength of your cyber systems are an important part of building trust and enabling you to practice medicine.

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10 Ways to Thank Donors With Social Media

10 Ways to Thank Donors With Social Media | Social Media and Healthcare |

Nonprofits often have a hard time acquiring and retaining longtime donors. It's not uncommon to lose as many donors as gained or to lose as much money in donations as gained, making the entire effort seem like running on a treadmill: a lot of effort but no forward movement.

Donors make a decision to stay loyal to your organization and to give again based on three things:

  • They must receive a timely and meaningful acknowledgment of their gift. In practical terms, the acknowledgment should be immediate and consist of more than just a receipt.
  • They must have an opportunity to assist a particular project rather than the “general operating” bucket.
  • They must understand the impact of their gift and what it helped to accomplish.

It's important to provide all three of these things to your donors every single time they make a donation—even when you are not asking for money. Your donors want and need to hear from your organization frequently, and social media is a perfect way for you to stay atop their minds while acknowledging their generosity and support.


Social media isn't a replacement for personal techniques like thanking donors face-to-face or through phone callshandwritten thank you notes, and appreciation events. However, it is worthwhile to start thinking about the different ways you can use online communities like Facebook and Twitter to further cement relationships with donors and to showcase the great work that you do every single day.


There at least 10 low-cost and simple ways to use social media to thank donors and supporters.


1. Share helpful resources

The best long-term strategy to thank donors and encourage them to remain a part of your nonprofit community is to share consistently practical, useful, and valuable information. You can find this information by thoroughly understanding your donors and what makes them tick. What interests them? What resonates? What sparks an action? What falls flat?


By connecting your donors to other resources that they may find valuable, sharing helpful information, and providing useful tips and content, you show them that you are listening and that you understand them. In return, they may engage with you on social media and share your posts with their networks. 

The American Red Cross is a good example of an organization that shares helpful, relevant tips on its Facebook page and blog.

2. Answer donors’ FAQs on Facebook

Think about the most frequently asked questions that you receive from donors. Craft a short response to each question, add a great visual, and you’ve got a useful and informative Facebook post.


For extra credit, put donors' names in the post and tag them or their company to build the relationship further—with their permission of course.


The NonProfit Times provides some good examples of frequent questions that donors ask, and ColoradoGives sets a good example of a useful FAQ page.


3. Showcase your donors

On social media, you have a split second and limited characters to capture a users’ attention. In any social media post targeted to donors, start with “Because of you” or “Thanks to your generosity.”


Showcasing the generosity and passion of your donors will help you stand out in a cluttered news feed and encourage donors to share the post with their networks.


Project AWARE and Sport Diver Magazine choose a monthly #DebrisHero and feature their story and photo on their social media accounts. These people may be donors, volunteers, or legislators who have demonstrated a commitment to keeping the oceans clean.


4. Retweet and repost your donors’ content

Make a Twitter list of your donors, corporate sponsors, funders, and major supporters. Also, set up Google alerts for this same list of people and their companies.


This way you can easily monitor their tweets, blog posts, and news stories and share their content on your social media channels. By showing that you are paying attention and acknowledging their other achievements—beyond just donating to your organization—you will build even better relationships with these donors. You’ll also learn more about them, which always an effective fundraising strategy. 


5. Make thank you videos using Facebook Live and Instagram

Facebook Live and Instagram are mobile apps that allow you to take videos and share them from any mobile device. Using just your smartphone, you and your staff or your volunteers can make a short and sweet thank you video for donations as they come in.


6. Provide exclusive access

Offer your donors exclusive access to your top officials through a live Google Hangout or webcast on Facebook. Experiment with live streaming apps like Periscope or Meerkat and provide a live, behind-the-scenes look at an event or program.


The Gates Foundation, for example, uses live Facebook Q&As to give their supporters access to Bill Gates and to promote their work and mission.


7. Demonstrate impact

Showing your impact is by far the most important way you can use social media to thank donors. Tell them where their money went and thank them for helping to make the world a better place by sharing regular, meaningful updates on your clients, your work, and your impact.


Boston Children’s Hospital frequently shares impactful posts on their Facebook page, often showcasing the story of a patient who was helped by the hospital.


8. Make yourself accessible

Donor churn often can be a result of poor customer service.


The cure can be as easy as responding to questions and comments whenever they come in. Do not shy away from debates and conversations on your social media channels. Chime in where appropriate or direct people offline to further address their concerns.


Create a transparent online culture where donors and other members of your online community can ask questions and voice opinions. Whatever you do, do not delete comments or questions unless they are obscene or spam.


9. Run a gratitude campaign

Girls Inc. stages a “30 Days of Gratitude” campaign to thank their donors, using a multichannel approach involving social media.


The Wellbody Alliance takes to its blog and social media channels twice per week in November to express gratitude for their donors, employees, volunteers, and partners. Through visuals and graphics, Wellbody tells the story of one or more people they feature. 


10. Connect donors to each other

Start an exclusive Facebook or LinkedIn group for your donors. Creating a group like this for donors who also fundraise on your behalf is especially gratifying since they can then share best practices, ideas, and give feedback on each other’s campaigns. Donors are people too, and they have careers and professional interests of their own. Helping them advance and build their networks is a fantastic way to give thanks.

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7 Easy Tips to Make Your Own Medical Practice Website

7 Easy Tips to Make Your Own Medical Practice Website | Social Media and Healthcare |

Finding new patients for your practice can be difficult. One way you can get new patients is to create a medical practice website. Through your website you can reach out to new patients and keep your other patients updated with any news about their health and your practice. Here are seven easy tips to make your own medical practice website. 

1. Originality

You want your website to reflect your medical practice. Figure out what makes your office unique and interesting. Be sure to put in only original content, as you do not want to plagiarize on your website because that will cause people to distrust you. You also want to welcome new patients in to your office with your website. New patients will look for a website that is open and welcoming to them. They will want pertinent information on the front page and easy accessibility throughout the website.

2. Domain name

You will need to pick out a domain name. You want to choose something that is easy for your patients to remember and works with your practice. You can use the name of your or the name of the founding doctors. Either way, you should choose wisely as this will be the first thing that people associate with you.

3. Images and graphs

You want your website to be eye-catching and using images and graphs will help your reader take notice of your webpage. Choose an image that is eye catching and pertinent to your practice. You want people to stop and look at your website so catch them with an image or graph first. If you run a pediatrics office you might want a picture of your staff dressed in silly costumes to show they want to serve you with a smile. Pictures of your offices and buildings will draw people’s eye and show them where they will be going.

4. Blog

You should publish a daily, or three times a week, blog with relevant information for your patients. It could be a blog about vitamins to help prevent colds or a blog telling them about a new prescription drug. Make sure you only include original content and use keywords to draw your people to your website. SEO’s, search engine optimizers, pick up on repeated words throughout a blog or website. The more keywords you have the higher your site will rank in a search. Do not put too many in but make sure you have at least three or four per blog, and four or five per page.

5. Layout

The style and format of your website will say a lot to potential customers about your office. If your layout is sloppy they might skip over your site to go and find another one they can maneuver through more easily. You can look up the best free website builder to proceed with your layout and design needs.

6. Site map

Never underestimate the power of a site map. If someone is looking for something specific in your website and cannot find it they will then look for a site map. If you do not have a site map on your web page they will leave and not come back. If  someone cannot find the information pertinent to them on your website they will look for it elsewhere. A site map offers a different way to search for things beyond a search button. Anything to draw new people into your site is a good thing.

7. Social media

Be sure to let your website be known on all of your social media pages. Provide a permanent link at the top of the page or wherever new patients accessing your social media will see it. You are your own best advertiser and you want to keep on top of promoting your webpage. The more you promote it, the more people will see it and maybe share it with their friends. You want your website to spread around the internet to draw in as many potential new patients as possible.

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“Please Don’t Tell My Family!”: Helping Patients Face Lung Cancer Stigma

“Please Don’t Tell My Family!”: Helping Patients Face Lung Cancer Stigma | Social Media and Healthcare |

Narjust Duma, MD, is the chief hematology/medical oncology fellow at Mayo Clinic in Rochester, MN. Her clinical and research interests include thoracic oncology, women with lung cancer, and the stigma surrounding the disease. Follow her on Twitter @NarjustDuma.  

“Please don't tell my family,” Mary* immediately asked me after I disclosed the results of her lymph node biopsy and diagnosis of metastatic non-small cell lung cancer. At the time, I was a first-year oncology fellow. Initially, I thought it was a routine reaction (an example of my lack of experience). I respected her wishes and only disclosed to her family that she had metastatic cancer. I thought, it’s her right to decide how much they know. Hours later, when I presented the case to my attending physician, she was surprised about the patient’s request but honored it as I had done it earlier.

Mary was a 43-year-old woman, never smoker, active runner, wife, and mother. One week later, I saw her in the clinic for the first time; she came to the visit alone. I asked, “How is the family?” She stated, “They are better not knowing.” Over the following weeks we talked on the phone frequently as she was experiencing side effects from her treatment, and little by little our relationship grew.

We approached the first set of scans, and her disease was progressing; she was once again alone during the visit. After we shared the bad news and mourned for 15 minutes, I asked again about her family. In tears, she shared, "I do not want them to know I have lung cancer. I do not want our neighbors to know. I can't deal with their judgment."

I was stunned. She was afraid of the stigma associated with lung cancer.

She benefited from second-line therapy for 6 months. We discussed many times her fear of disclosing her diagnosis to her family; we incorporated psychology care and palliative medicine to our team. Her family now knew that her cancer started in “the chest” but the words “lung cancer” were never said. She shared with us stories of members of her church and school who were diagnosed with lung cancer, judged and forgotten by the community.

We started treatment with platinum doublets. She progressively became weaker, scans only showed progression, and after a few months and some immunotherapy, I saw her condition deteriorate and she lost weight. Her family started coming to the oncology visits. Every time before our visits she would give me a piece of paper on which she’d written, “Please don’t tell my family.” Those words continue to follow me to this day.

On a Thursday night, I received a call from Mary’s oldest son that she was in the ER due to confusion; she had a fever and progressing brain metastases. I thought to myself, “Her diagnosis will be disclosed now." Little did I know that Mary had planned for this ahead of time, enlisting her sister—her best friend—as her ally. Her sister rushed to the ER and asked physicians to avoid using the words "lung cancer." While in the hospital, Mary and I met a few times; we cried, laughed, and hugged. We knew she was reaching the end of her journey. She transferred to hospice care and died peacefully at home a few weeks later.

During her journey, I developed a strong relationship with her family, especially her sister. During the funeral, she told me that only Mary’s closest family (her husband and children) knew about her diagnosis of lung cancer.

One day while opening mail, I got a copy of Mary’s obituary. It described her as a "loving wife, mother, and sister” who “died of breast cancer,” and it explained that the family had donated to a breast cancer-related charity. Almost immediately I started crying; my dear patient had to spend her last days carrying a lie because of the stigma associated with this disease. That moment, and Mary herself, ultimately changed my career path. In the past few years, many patients have shared the stigma they encounter when disclosing their diagnosis of lung cancer.

Social media has helped connect patients with lung cancer. Groups like the EGFResisters and foundations like Breath of Hope provide patients a safe place and an accepting community.

Lung cancer is the number 1 cancer killer in the United States and represents 14% of all cancers in the country. Advances in treatment have improved the survival of patients with lung cancer, but we still have a lot of work to do, especially in how this cancer is seen in the community. Stigma surrounds the disease and judgment is experienced frequently.  It’s time to change the face of lung cancer!

*Name and details changed for privacy.

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The Use of Social Media for Clinical Trials Patient Recruitment

The Use of Social Media for Clinical Trials Patient Recruitment | Social Media and Healthcare |

Katja Reuter writing for Dermatology Times notes the popularity of social media has created a new opportunity for the research community to recruit study participants.

Recent data indicate that nearly 70 percent of U.S. adults use some social media1. Coinciding with the surge of social media adoption, study teams increasingly report the use of social media to enhance recruitment in clinical research with promising but mixed results. Recruitment of study participants is a significant problem, particularly in clinical trials. It remains a critical roadblock to successful clinical and translational research4,5.

In this issue of Dermatology Times, Katz and colleagues describe the results of a targeted advertising strategy on social media and search engines for 150 days. The goal was to recruit patients with moderate to severe atopic dermatitis in a randomized, double-blind, placebo-controlled, phase three trial and to evaluate the efficacy and safety of tralokinumab monotherapy. Read Ms. Reuter’s article for the interesting details.

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A Dentists Guide to Getting Started With Social Media

Despite the popularity of social media, many dentists have yet to get in on the social networking craze that has become an integral part of the average consumer's daily life. If you haven’t built up your business’s online social network, you're missing out on a major opportunity to increase your online presence and gain the benefits that are part and parcel of participating in social media.

Even if you don’t have your social media presence set up yet, you probably understand the importance of social media. More than ​2.27 billion people are on Facebook alone. It’s been estimated that ​79% of 30-49 year olds have Facebook accounts.


Your potential customers are using social media.

I know I personally have been influenced by social media and have actually made purchases from brands I was introduced to on social media.

Indeed, social media is one of the most relevant modern phenomena in the world of advertising and marketing.

Social media provides businesses with a highly personal outlet they can take advantage of when sharing their products and services. Social media integration positions you as a relevant, in-touch business that truly connects with its customers.

Luckily, it’s pretty easy to get started with your dental practice on social media.

First, I’ll tell you the social networks you ​should consider using; then we’ll get into what you should and should not do as a dentist on social media.

2. Social Networks Your Practice Should Consider Using


Now more than ever, “Likes,” “Favorites,” and “Shares” are essential to any marketing campaign. Not only can you get potential customers from social media, but Google and other search engines factor in the size and engagement of your business’s social media network. All things being equal, a dentist that is active on social media will rank higher in search results than one that does not engage on social networks.

Some of the most commonly used social media applications include Facebook, Twitter, LinkedIn, Pinterest, and Instagram. Each of these platforms has a distinct tone, allowing you to reach a broad and diverse audience if you cover all your bases.

1. Facebook

Everyone knows about Facebook, and just about everyone has an account. Facebook is a useful tool for people trying to stay in touch, but it’s also a valuable tool for your dental practice to use for advertising.

You can easily create a corporate Facebook page through which you can advertise coupons, sales, product promotions, and services, as well as events for product releases or big company celebrations. Furthermore, you can develop customer loyalty via image shares and other compelling content that people like or share from their own Facebook profiles. This way, users of your products or services advertise for you, bringing you both revenue and attention in an indirect way that is more convincing to potential customers than would be an advertisement that came directly from you.

Creating a Facebook page for your small business allows you to establish a more open forum of communication with your patients. It provides a more casual environment and encourages dialogue and engagement. If a patient “Likes” your page, your posts will show up in their news feed, and the more views, the better. As I work primarily with dentists, I've seen the power of Facebook, and its ability to humanize your office and staff.

2. Twitter

Twitter is different from Facebook in that users don’t typically develop highly personal accounts; Twitter is more about sharing information. Users share up to 280-character “tweets” (used to be 140) that can take the form of opinions, updates, hyperlinks, replies to other users, etc. Dentists ​can usually get the most from Twitter by sharing pictures of new products or services, releasing coupon information, or updating followers on office events and promotions.

Twitter is a useful platform because it’s built for extremely frequent updating, which means you can run extensive advertising and marketing campaigns without being obnoxious – a continually updated Twitter feed is something people want to see, so tweet as much as you like!

Twitter is an excellent way to get information out fast. Although the number of characters that you can tweet is limited to 140, you can craft a tweet and include a short link that will drive traffic to your ​website — the more impressions, the better.

Go ahead and set up a Twitter account for your business if you haven’t already.

Twitter is an excellent way to get information out fast.

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3. Instagram

Instagram is unique in that users share snapshots rather than text. Sharing pictures might not seem to have any business value at first blush, but in actuality, images of products or services can be an extremely effective way to get patients to visit your office for a checkup or other dental needs.

Visual information appeals to a different segment of the market than that which would be pleased with purely textual advertisements, so many dentists have started making extensive use of Instagram to appeal to this different area. Millennial's, in particular, are active on Instagram — according to eMarketer research, by 2019, two-thirds of all millennial smartphone users will be on IG.

Taking advantage of this increasingly popular social network is a surefire way to get more exposure, which means more business. You can also include one link in your bio, which might be a link to your business website’s homepage, or to a promotional landing page for whatever special you currently have on offer — dentists often share an image representing a product or service, and then indicate in the photo caption that you can purchase the item through the “link in bio.”

What are you waiting for? Go ahead and set up your business Instagram account for your dental practice today.

4. Pinterest

Like Instagram, Pinterest is also great for both sharing photos of products and linking those photos to your website. While Instagram displays photos in a type of news-feed, Pinterest displays posts in a gallery format.

Read Now:  11 Proven Ways to Market Your Dental Practice in a Small Town

Pinterest can be a great place to showcase your services.

You can also post articles and links in Pinterest’s gallery format for your dental office. You can share tips and links to useful information on your website, such as blog posts.

I haven't seen much (actually any) in the way of dentists using Pinterest to actually gain new patients, but that doesn't mean it isn't happening. That said, I'd focus on Facebook, Twitter, and Instagram before Pinterest.

But, test it out! Don't just take my word for it. Test anything you do when it comes to marketing.

Set up your business’s Pinterest account here.

5. LinkedIn

LinkedIn provides a way for you as a dentist to expand your contact base, gain new customers, and build brand loyalty and credibility. For example, you can post articles or start discussions with other experts in your industry.

LinkedIn provides you with another way to start a dialogue and builds your reputation as a subject matter expert (SME). LinkedIn has recently started allowing users to blog on their sites. It makes sense as a form of SEO for dentists or any other profession where your reputation is paramount. LinkedIn is also important for branding, marketing, and even hiring.

In addition to setting up a LinkedIn account yourself as an individual professional in your industry, you can also set up a LinkedIn dental office page. Get started with LinkedIn for small business today.

6. Google+

Contrary to previous reports, Google+ is not disappearing.

​Actually, as I update this on 12/31/18, Google + is disappearing! ​It is shutting down in April 2019. ​ That said, Google My Business now allows for business owners to make posts on their Google Local page, and have that show up in branded search results. For more information on how to create a post in Google My Business, read the Google help guide.

Sure, it has evolved and changed over the years, but it still has an active and large community! Not only does a Google-branded social media presence increase your business’s search engine traffic, but it also functions similar to a review website such as Yelp, letting customers leave and read reviews. It also integrates with Google Search and Maps, allowing searchers quickly contact and navigate to your dental office using their smartphone.

Your business’s social Google account additionally links to your YouTube account, which can be another form of advertising for your business. You can also host “Hangouts” with your followers — a Google Hangout can be a place to host a fun, casual promotion such as a drawing for a free iPad, or you can use it a more formal “webinar” type event.

On all of these applications, there is a way for customers to “Favorite” or “Like” your posts. They can share posts with their contacts, comment on them, send you a direct message, and all the while provide more impressions the more a post gets shared. You can also include links to your business website, which boosts your overall online presence as well.

One thing that’s a little confusing about it is that the name of Google’s business arm seems always to be changing. You can currently manage your business’s Google+ account under Google My Business (i.e., your business’s Google+ page is now managed through your Google My Business dashboard).

Though often overlooked, Google’s social network is among the most powerful ways for your dental practice to extend its reach and become a local leader in your area. Even if you don’t use Google+ often, you need to claim your business’s Google My Business listing so you can start managing your online reviews and contact information.

Note that while all of these networks are free to use, you can pay to advertise on them as well, getting even more exposure for your posts. Paid social media advertising might not be economically feasible to do year-round, but you might want to consider a short-term promotional campaign on Instagram, Facebook, etc., to advertise a business location opening, limited-time sale, or other promotion.

​3. Common Social Media Mistakes Dentists Make

​Now that you know which social platforms your dental practice needs to be on, it’s time to start posting. But wait — you don’t want to post just anything! Before I get into the best ways to capitalize on your business’s social media accounts, let’s first take a look at five social media mistakes you don’t want to be making.

​1. Not Using It

​Don’t be so intimidated about getting started with social media that you don’t use it. That can be an extremely costly mistake. You may not see the benefits immediately, or maybe even not within the first year, but eventually, if you use social media properly, you will reap the rewards. I recommend at the least getting a Facebook Business, a LinkedIn Company Page, and a Google+ Business page. By not using social media, you are screaming loud and clear to all your potential patients that technology isn’t important to you, and that you are behind the times.

​2. Inconsistent Posting

​So you set up your profiles and pages, and you maybe even added a background cover photo. You posted once or twice, and that was it. Months go by and you don’t post. A year goes by, still no posts. Imagine a potential customer coming to your Facebook page that hasn’t been updated since November 2015. It would be similar to looking into a storefront window and the lights being off, and nobody in the store. Same message. So, be consistent! You can use a tool like Hootsuite, which will allow you to post to all your social media platforms at once. It even allows you to schedule your posts for the future as well.

​3. Too Edgy/Opinionated

​Social media is not the place for a dentist to express political opinions or to post on edgy or controversial topics. You don’t want to alienate your customers or potential patients. One wrong tweet could cause thousands of dollars in damage. Think before you post. How many potential patients would you alienate if you posted something political (see below example) that offends half of your patients or potential patients?

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Confidentiality – Seeking Patient Referrals via Social Media 

Confidentiality – Seeking Patient Referrals via Social Media  | Social Media and Healthcare |

Suppose that a mental health practitioner is active on a popular social media site or other communication sites/networks involving colleagues (other licensed mental health practitioners) and others who are not licensed health care practitioners. Suppose further that a participating psychotherapist posts a request for a referral recommendation from another practitioner, and in doing so reveals enough information about the person or patient to be referred that the identity of that person or patient may be unintentionally revealed or that suspicions may be raised among family, friends, or others. Or, suppose that a psychotherapist posts on a popular social media site his or her desire to obtain a consultation with another mental health practitioner and in doing so, describes the patient or patient’s issues with an abundance of detail? These scenarios assume that the name of the patient is not disclosed.

I create these scenarios because a reader expressed concerns that he/she was seeing an increased number of requests for referrals to psychotherapists on a social media site that gave an abundance of detail about the patient and the patient’s issues. I was rather surprised that the examples cited from a well-known and widely used social media site were quite so detailed about the patient to be referred. Moreover, I was surprised to learn that a licensed mental health professional would solicit such referrals from other practitioners on a site that was also accessed by the general public – that is, by those who were not licensed mental health or medical professionals. My first thought was that there must be better ways to obtain one or more referrals to other practitioners for a particular patient and a particular set of issues than to post something on a site such as, but limited to, Facebook.

Practitioners must always be aware of the duty of confidentiality and must be certain that they are not revealing enough information about a particular patient such that the identity of the patient might be accidentally (or negligently) revealed to others, including family or friends. Merely because a name is not mentioned does not assure that a breach of confidentiality will not occur. It is possible that the patient may become aware of the information posted and might be upset or concerned with the detail given. If a therapist was to obtain a carefully crafted signed authorization from a patient that authorized a detailed request for referrals on a publicly accessed site, then the disclosures made would not constitute a breach of confidentiality. But I would think that patients who are seeking a referral to another practitioner or to a “specialist” of some kind would not react well if asked – “do you mind if I look for a referral for you on the social media site I frequent with many of my colleagues and with members of the general public?”

Suppose a practitioner wants to disregard the above and nevertheless seek a referral to another practitioner by posting something on a social media site. The practitioner should first ponder whether the facts to be revealed are really relevant to obtaining names of other licensees that would make for appropriate referrals. Does it really matter that the client is in his forties, or that the client is a recently divorced dentist whose spouse just left him for the grocery store butcher? Is there another way to seek an appropriate referral without giving unnecessary detail? Of course, if there is appropriate masking that does not change the clinical significance of the information being revealed, masking some or most of the details would be wise. But I nevertheless ask – are the details really necessary? Perhaps it is better to leave the details for the client to explore with the subsequent practitioner.

If the social media group were limited to licensed psychotherapists, for example, and if referrals were sought, it would be less risky to disclose details about the person and the issues involved. Generally (each state’s laws will vary in some degree or in fine nuance), one of the most important exceptions to confidentiality is where a disclosure of confidential information is made to another licensed health care provider for the purpose of diagnosis or treatment of the patient. The disclosures made to other licensed health care professionals would seemingly be for the purpose of obtaining treatment for the patient and would seem to be included within this broad exception to confidentiality (where a signed authorization to disclose is not required). Nevertheless, it is my impression that there are better ways for referring practitioners to make appropriate referrals. There is an expectation in the various mental health professions, either express or implied, that practitioners are knowledgeable about culturally and clinically appropriate referral resources.

I have previously encountered this issue in situations where a practitioner makes a presentation (at a workshop or seminar) to other professionals about the treatment of a particular patient – without using a name, but with an abundance of non-masked detail about the patient. In such situations, another attendee may express some ethical concerns at the degree of detail provided, or may even have a reasonable suspicion of who is being described. I have also encountered this issue when someone writes a paper or a book that similarly gives details about a patient previously treated. What if the patient discovers that the paper or book was written about him/her without prior authorization or consent? Will the fact that a name was not disclosed protect the writer? Did the therapist/writer exploit the patient’s information for his or her own economic gain, and if so, does the patient have reasonable grounds to pursue legal action or to file a complaint?


Are you aware of any law, regulation, or ethical code provision in your state of licensure and in your profession that clearly defines what is expected when one practitioner refers a patient to one or more other practitioners? Why do so many therapists talk about the need to make three referrals? What liability, if any, does a therapist have for negligently making a referral? Is there a duty, or should there be a duty, for the referring therapist to either check with the licensing board or suggest that the patient  check with the board in order to see if the practitioner to whom the patient is referred has been the subject of disciplinary action? Is the referring therapist ever under a duty to check with the former patient to see if the referral was acted upon by the patient or that treatment is continuing? Rather than referring to a named practitioner, is it appropriate to refer the patient to a professional association’s or other referral service? These are but some of the many questions that may arise when the practitioner is faced with the need or desire to make a referral to one or more other practitioners.

One of the times that mental health practitioners will need to make a referral is when they discover that the patient they are treating requires the expertise or specialized competence of another practitioner. Not all therapists and counselors are competent to treat all patients and all disorders – so practitioners must be sure that they make a referral when their competency is challenged. Some provisions of ethical standards delineate the circumstances when the need for a referral arises (such as, but not limited to, as described immediately above or when a conflict arises), and other provisions may in a broad or general way provide some guidance regarding the ethical obligation(s) when making a referral.

One ethical standard says that when making a referral, the practitioner should take appropriate steps to facilitate an orderly transfer of responsibility. Another ethical standard, when warning against the abandonment of patients, says that if a therapist is unwilling or unable to continue to provide professional services, the therapist will assist the patient in making clinically appropriate arrangements for continuation of treatment. Another standard says that when practitioners refer clients to other practitioners, they insure that appropriate clinical and administrative processes are completed and that open communication is maintained with both clients and practitioners. These standards seem to this writer to be vague and subject to various interpretations – which could affect enforceability. Of course, not all ethical standards are intended for enforcement – some may be intended as mere suggestions or as guidelines, even aspirations.

None of the standards mentioned above define the particular actions that must be taken in a particular case or situation, nor, I argue, should they. What are the appropriate steps? What constitutes clinically appropriate arrangements? What are appropriate clinical and administrative processes? Unless there is a law or regulation that is applicable, the action(s) that must or should be taken in each situation is left to the sound clinical judgment of the practitioner. Thus, when answering the questions asked above, and many others (as I may do in future articles), the answers necessarily depend upon the particular facts and circumstances involved, including the interpretations of applicable ethical standards, guidelines, laws, or regulations.

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Building Relationships With Patients on Social Media –

Building Relationships With Patients on Social Media – | Social Media and Healthcare |

In this age people are more aware of their rights and are looking for doctors who have more than papers. That’s making the internet the first stop people make when searching for a healthcare provider. People are no longer only after the services. They are mindful of who and where they spend their hard-earned dollars. If the PR efforts are anything to go by, organizations across the board are finding that they have to do more on their end to build relationships. 

The role of social media in healthcare

Getting new clients is a byproduct of using social media. However, the primary focus of healthcare providers ought to be fostering relationships and sharing their expertise. Educating the masses about even the simplest of practices could be something to strive for. It paints the brand in a caring light. There is already negative press about how expensive hospitals are and the image that they are only out to make a profit. To be set apart entities would benefit from stepping away from the stereotype and be helpful. 

Building communities is also another way healthcare providers can use social media to be a catalyst of progressive change. People visit hospitals for various reasons, and rallying a community of like people is another way to remind people they are not alone. They can find support in each other, with the hospital acting as the platform in which the community gets built. Anyone can do the same; a mediation Toronto studio can provide similar services for those diagnosed with illnesses where mediation is a recommended form of therapy. 

Bringing the human back in healthcare

There are forums where patients share horror stories about the cold treatment they received. Daniel Coleman explores in his book the role of emotional intelligence in healthcare as more people move away from traditional doctors to seek holistic healers. While their facility is required to take steps to transform and become more mindful of people’s emotions in the midst of their ailments, something similar should take place online. 

The aim is not to make people emotive to reach out, but rather to demonstrate how you care. Messaging should therefore not be overtly profit driven but rather to provide the narrative in which a person stands to benefit through partnership. If they find your social media channels helpful, then in their time of need they will almost certainly reach out.

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Why Marketing is Also Important in Medical Field

Why Marketing is Also Important in Medical Field | Social Media and Healthcare |

We can all agree to the fact that that social media has quickly transitioned from a well-used buzzword to becoming the state of the internet. As a matter of fact, there are over 3,1 billion social media users across the globe. An ecosystem that has facilitated the majority of our communications, and thus, the majority of our people. From students and executives to lawyers and physicians. They are all available online, consuming each others content, making it no surprise that $51,3 billion USD has been spent on social media advertising by companies from all industries in 2017. Including the medical field. But isn’t the medical field too much of a traditional and bureaucratic industry for it to be using flamboyant 21st-century marketing strategies? Not really. Here are 3 key reasons as to why the medical field should be prioritizing digital marketing approaches.

The majority of people you want to target are available on social media.

It’s true! The majority of your customers will be available online browsing the web trying to find physicians to treat them. Yet you’re considering not spending advertising dollars on digital marketing? Social media marketing is truly underpriced attention, allowing you to reach tens of thousands of a specific demographic, for under $100. Tell me where else you can find that return on investment? Your customer’s attention is online, and so should yours.

Your candidates are looking for similar jobs, online.

According to TopResume, 73 percent of companies today have used social media to successfully recruit and hire candidates. And that is of course because 45% of job seekers search for jobs daily on their mobile devices, online. It is therefore crucial for physicians and other stakeholders in the medical field to constantly create and share new and insightful narratives about themselves and the work they are doing. Educate your future candidates and customer about where you are located, how they can get in touch with you and what services you provide. Maybe even introducing FAQs (Frequently Asked Questions) or launching a podcast where you answer a medical related question. And by continually sharing relevant information and content with your community, it will primarily establish credibility, both online and in person.

In an online world, offline communication is still attractive.

We can sometimes get stuck in our new, old ways believing that the only way to find and attract new customers or talent is by spending marketing dollars on digital media. Forgetting that a handshake or a short conversation is a lot more memorable and impactful than a Facebook ad. Especially in the medical field where customers want to see and trust the people behind a certain medical service. Make sure to attend annual conferences and network with your people. Business cards might sound old-fashioned but still, work like a charm. Even holding monthly free seminars to a group of physicians or potential clients is still incredibly impactful, allowing you to develop that personal relationship with your targeted audience than an ad would never do.

We live in such a fast-paced society where things are constantly moving and changing, forcing you to change with it, or becoming part of the past. Changes are everywhere, making it a priority for healthcare companies to make use of dynamic physician practice marketing approaches. The world is constantly adapting & evolving, and so should your strategies. Adapt, adopt and rethink your strategies.

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Examining the Evolution of the Patient-Physician Relationship

Examining the Evolution of the Patient-Physician Relationship | Social Media and Healthcare |

The internet has brought a new challenge into the evolving parameters of the patient-physician relationship: patients have begun equipping themselves with knowledge gleaned from websites, social media, and direct-to-consumer testing to diagnose their own ailments.

An article published in JAMA outlined the obstacles and solutions for physicians who must adapt to the era of increasing patient autonomy.

“Today, some patients arrive at the physician's office having thoroughly researched their symptoms and identified possible diagnoses,” wrote Steven Joffe, MD, MPH, of the Department of Medical ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “It will bring new challenges for physicians who must manage the downstream consequences of tests and screens they did not order.”




Patient autonomy has increased steadily for more than half a century. New models of care lean toward emphasizing patient choice, and shared decision making has been the go-to model since the 1980s.

Direct-to-consumer tests and do-it-yourself kits are the new norm in healthcare. For example, using the US Food and Drug Administration (FDA)-approved 23andMe®, consumers can check their risk for a variety of diseases without setting foot in their physician's office. Do-it-yourself electrocardiograms can be conducted using a $99 device and a patient's smartphone.

“But while patients can research their symptoms and order many laboratory and genetic tests online, they will continue to depend on their physicians for advice, procedural expertise, and access to restricted medical services,” Dr Joffe wrote.



Dr Joffe and the study's co-investigator, Madison K. Kilbride, PhD, also of the Perelman School of Medicine, outlined the 3 main responsibilities of physicians in this new age of patient autonomy. First, physicians must advise and consult patients as they provide thoughts or claims about their diagnoses; second, physicians should continue to provide diagnostic procedures that patients can't access by other means; and finally, physicians must serve as a legitimate source of medical information to clear up any misconceptions and point the patient in the right direction.

“By appreciating how the Internet, social media, and other factors are transforming medical relationships,” the researchers wrote, “physicians will be better able to meet their patients' health care needs in the age of enhanced patient autonomy.”


Kilbride MK, Joffe S. The new age of patient autonomy. JAMA. 2013;320(19):1973-1974.

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How devices are letting people take control of their own healthcare

How devices are letting people take control of their own healthcare | Social Media and Healthcare |

It's 6am in the yoga room when my Apple Watch beeps three times. It's not helping the mediative mood but I have to look. I've been wearing the watch for two weeks and I'm tracking everything I can about my body. Right now my heart rate is 68 beats per minute. The readout tells me I've stood for a minute each hour for 10 consecutive hours. Through the My Fitness Pal app, I've logged exactly what I've eaten today and learned a glass of Bonsoy is nearly as calorific as a banana. Where my doctor's advice and own self-interest failed to get me doing my 30 minutes of exercise a day, the watch has succeeded.

I now have data about how much I weigh, what I eat, how well I sleep, how much I've walk and how hard my heart is working. If I am prepared to share some of this information with my insurance company I could get a discount on my life cover. But what I am doing is just the start when it comes to monitoring my wellbeing. Already, there's a wristband that scans whatever you put into your shopping basket to find out whether it's a good match for your genetic make-up, an app that alerts your doctor when you haven't taken your antipsychotic medication and a box in your bedroom that can sense your heart beat in the living room.

Across the world, healthcare is undergoing a fundamental transformation. As we all live longer, health systems are increasingly dealing with chronic conditions as opposed to the old model of acute care lasting days or weeks. And the promotion and management of healthy lifestyles, to combat the rise of lifestyle diseases, is becoming an increasingly important part of the health mix.

Globally, nearly 28 million wearable devices were sold in the second quarter of 2018. SEE CAPTION INFO

In supporting and propelling that general shift, there has been an explosion in devices, apps and technology designed to record or modify everything from what we eat to how we breathe.

Tech giants such as Google are rumoured to be working on AI-assisted wellness coaches that push you towards healthier menu options where you're dining, or customise workouts and meal plans for you. Apple is making huge investments in both consumer and clinician-level health and wellness technology. These are not sci-fi dreams. These are available or in development now. We have never before had access to this level of information about our health. And we have never before shared this information so widely. We're still figuring out what it means for the way we live, how the medical profession treats us, how public health is managed and how we are insured. How much information is too much?


Globally, nearly 28 million wearable devices were sold in the second quarter of 2018 – a 5.5 per cent increase on the previous year – according to the International Data Corporation. That's $US4.8 billion ($6.7 billion) worth – an 8.3 per cent rise. The IQVIA Institute of Health Data Sciences says there are more than 310,000 health apps now available. The business of keeping well is booming. In October, the Global Wellness Institute reported that the wellness industry, covering everything from spas to apps, was worth $US4.2 trillion in 2017 – a growth of 12.8 per cent over two years which, it says, now represents more than 5 per cent of global output.

Instant genetic information

Diabetes is an area of intense activity in health tech. Between 1980 and 2014 the global population of diabetics nearly tripled to 422 million. For those with type 2 diabetes – the form of the disease that affects 90 per cent of diabetics – which a change of diet can fix the problem. If people can change their food buying behaviour it makes sticking to a healthful diet easier. That's where entrepreneurs like Professor Chris Toumazou come in.

Not long before I met him, Professor Toumazou wanted a chocolate. "I'm not going to not have a chocolate," he says. So at the shop counter, he waved his wristband over his two preferred options: a Snickers and a Mars bar.It flashed green on the Snickers. Based on his DNA, it had determined the bar to be the healthier option. (He has the hypertension gene, not the obesity one).

The wristband and analysis are developments from the Imperial College biomedical engineering professor's company, DnaNudge. The London-based company has developed palm-sized micro-labs which do on-the-spot DNA analysis for key risk factors – including diabetes and hypertension. It also looks for genetic markers that reveal how well substances including carbohydrates, proteins, saturated fat, caffeine and sodium are metabolised. The data is encrypted and uploaded to the user's app and wristband. They then scan or photograph foods to find out if an item is healthy for them.


The object is to help people gradually change how they shop by being able to quickly tell which food options are best for them. For example, someone with a poor ability to break down fat will be guided away from foods high in fats.

In October, the company announced a year-long trial of the technology with a group of 1000 pre-diabetic customers of British supermarket chain Waitrose who will try to reduce their risk of developing the disease. Toumazou hopes to be rolling the technology out commercially in key global markets, including Australia, by the end of 2019.

There are a number of startups using DNA to direct eating behaviour but large companies are also getting in on the act. Nestle in Japan has a Wellness Ambassador programme. Subscribers to the programme upload pictures of their meals onto photo-sharing app Line, the food image is then analysed for its nutritional content. Users can also submit their DNA to a third party for analysis. On the basis of all this data, Nestle makes tailored diet and recipe recommendations. It also proposes particular supplements or kale and fruit smoothies for use in the Nestle Dolce Gusto machine.

DnaNudge says that when the technology is fully commercialised, the company will have booths in every supermarket where a shopper could swab their cheek and pick up a wristband complete with their genetic information 15 minutes later. The micro-lab cartridge with the DNA sample would be destroyed immediately afterwards. Toumazou is intent on making the technology affordable; he says the hardware will retail for tens of dollars and there will be a small subscription fee for the app – which could branch into monitoring inactivity levels, offering meal plans and building social networks of people with similar conditions.


Toumazou says decades of healthy eating advice has failed to stem a global obesity epidemic. Something needs to disrupt that tide. "It's got to be very simple so people make small changes, without really affecting their behaviour too much in the short term," he says.

Chronic condition management

By taking a long-term approach, Australian tech start-up Perx is hoping to crack chronic condition management. According to the Australian Institute of Health and Welfare, half of the Australian adult population has one of eight chronic conditions – arthritis, asthma, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes and mental health conditions – and 39 per cent of potentially preventable hospitalisations were due to these eight conditions.

Through a cluttered bookshop on Bourke Street, Surry Hills, in Sydney, and up a winding staircase, old high school friends Scott Taylor and Hugo Rourke have set up an office for Perx, an app that encourages people to stick to clinical treatments through gamification. The young co-founders are bright-eyed, wearing matching branded T-shirts, Apple Watches and physiques that suggest participation in amateur rowing or rugby union teams. They sit in their sparse, small meeting room, a blank white board against one wall.

Users of Perx have to upload evidence that they have taken their medication, a photo perhaps. They are then sent a simple game to play which offers the possibility of winning a prize such as movie tickets or a donation to their favourite charity.

Imagine a contact lens that continuously monitors diabetics' blood glucose levels from their tear drops and transmits the data to an app.  Google

The start-up is partnering with the NSW Health Sydney service, Diabetes NSW and ACT and Novartis, among others, which pay a licence fee for the technology; for the end user, the app is free. Data from the users is encrypted and aggreggated and general reports are sent to the participating organisations about the level of the groups' adherence. They have several thousand users.

Perx began as a side project when Taylor was working in private banking and Rourke was a consultant across a number of consumer industries. Both men had family members struggling to manage different chronic conditions and they realised how few behavioural economics tactics were being used in the health sector. Two years after they started, the team now numbers seven (who are hard at work in a small room adjoining the meeting room) and a further three people are about to join the company.

"It's pretty rapid growth given that this time last year it was three guys in a room in Bondi," says Taylor. "We're super excited about it."

There is plenty of room to grow since 230,000 hospitalisations a year in Australia are because people fail to take their medications as prescribed. In Europe the problem is the cause of 190,000 avoidable deaths.

Dr Harry Nespolon, president of the Royal College of Australian General Practitioners, says the role of the GP will evolve, and become more central.  RACGP

"Healthcare has traditionally suffered from top-down direction, not treating the patient as a person who can manage their own care," says Rourke. "If we can empower people, health will be in a better place."

The invisible doctor

At the Consumer Electronics Show conference in Las Vegas, run by the Consumer Technology Association, wellness and health technology formed a large part of this year's new products. There were lots of cutting-edge devices making huge claims: E-vone smart shoes can detect a fall and call an emergency contact; a magnetic attachment for Motorola phones, which can measure respiratory rate, blood pressure, body temperature and blood oxygen levels; a Somnox robot pillow which glows and contracts as the user cuddles it in bed, all the while detecting carbon dioxide, sound and movement.

But in terms of the leading edge, few companies scrape it so closely as Emerald Innovations. It isn't in the business of wearables, but "invisibles".

Emerald Innovations, a Boston start-up led by MIT professor and Macarthur "genius" prize winner Professor Dina Katabi, has already put hundreds of its Wi-Fi-like boxes in homes in the United States. The Emerald is able to detect a user's posture, gait, heart beat and breathing without ever touching them. Without even being in the same room. Katabi says the technology could herald a new era of independence for people with serious conditions or older people, and could transform the way we conduct clinical trials, with pharmaceutical companies able to take continuous readings from trial participants to assess a drug's efficacy. In a TED talk, Katabi said the device has even been deployed in homes of people with depression and anxiety.

"Every single move that we make – even when we take a breath, or the pulsing of our blood – changes the electromagnetic waves around you," Katabi tells AFR Weekend. "Our idea is to have a sensitive device that can detect changes in electromagnetic waves, and use the advances in machine learning to interpret those changes so we can refer the physiological signal to the end user."

The end user may be a clinician monitoring a patient's condition remotely, an adult child concerned about an elderly parent or a drug company conducting a clinical trial.

Trials in the US for people with Parkinson's have been able to detect when a patient's medication has started to wear off by assessing their movement, and has helped doctors adjust doses accordingly. The traditional alternative has been sporadic visits to doctors who assess movement visually within a consultation.

Katabi says that the device use is based on the consent of the person monitored, that they can determine who gets what data. However, she says, just like you don't have to inform your house guests if you have a baby monitor or security camera, she expects that the user would not have to notify any guests that an Emerald box was in use, despite the fact that it could monitor their vital signs too (though their information won't be stored).

Perx co-founders Scott Taylor (left) and Hugo Rourke (right). Perx is hoping to crack chronic condition management. Kate Geraghty

"Getting information on anyone is getting information that they may consider private," she says. "But at the same time, you compare it to the alternative. For an older person who lives alone, what are their options? Putting a camera in the home would be way more invasive of privacy – as would asking a carer to live with them. It's really about trying to find the right trade-off to deliver something that can provide a lot of gain, while managing the privacy issue in the proper way."

Public health implications

A study published in the Digital Medicine journal, which analysed studies and trials of the efficacy of mobile health apps for things such as managing weight or mental health, found evidence that while some worked, overall the quality of the studies were too poor to reach any conclusions.

Professor Tim Shaw of the Digital Health Co-operative Research Council, which launched this year with $55 million worth of federal government funding, agrees.

"It's a bit like where pharmacy was in the 1800s. It was totally unregulated. You could buy a drug for just about any condition and it was largely financially driven. At the moment, people are building apps for $3, just as I'm sure you could buy a pill for leprosy for $3 back in the 1800s, and there's not a lot of evidence as to how that actually impacts on health," he says. "That's changing."

The US Food and Drug Administration has just cleared two Apple Watch medical apps – one that can take an electrocardiogram by the user touching a button on the series 4, and another that can detect signs of atrial fibrillation and warn the wearer. In Britain, the National Health Service has its own apps library, which recommends apps for everything from managing panic attacks to blood clots, and indicates which of these are undergoing NHS testing. Here in Australia, the CSIRO and Therapeutic Goods Administration are looking into how to regulate the emerging medical devices industry.

"As apps become part of how we deliver care – because we are heading towards prescribing apps – we will have a smaller number of evidence-based apps and devices that have impact," Shaw says.

The Digital Health CRC is investigating how all these data sets being created by personal apps and devices, and in clinical environments, can be utilised to improve individual and public health. The infrastructure supporting this is lacking, says Shaw. "It's like we have well and truly made it to Mars, but we dragged the rocket to the launch pad with a horse and cart," he says. "We have these fundamental failures in the underpinnings about how data is connected together."

This data, when combined with augmented intelligence, could shift the way the healthcare system works. Shaw says that at present, for instance, Sydney's Royal North Shore Hospital can predict that on the weekend it might have five people show up with a broken leg, four with influenza and 53 heart attacks. "What we can't predict is who those 53 people are that will have those heart attacks and reach out to them two months before and stop it happening. This is the really interesting piece that AI can contribute to; our predictive ability to make decisions on people's trajectories."

The US Food and Drug Administration has just cleared two Apple Watch medical apps – one that can take an electrocardiogram by the user touching a button on the series 4, and another that can detect signs of atrial fibrillation and warn the wearer.  Bloomberg

It might be, Shaw says, that a patient on a trajectory to a heart attack on the basis of data such as their heart rate, activity levels and other information might pop up on a doctor's computer. The doctor might then call in their patient to prescribe lifestyle changes and potentially medication that could prevent a catastrophic event.

Meanwhile, for healthy people and those with chronic conditions alike, having access to personal and continuous data about their health and wellbeing will see them more empowered in their relationships with clinicians.

"You're almost getting the emergence of expert consumers that understand their own data best, and can start to work much more collaboratively with the clinician in terms of what matters to them," he says.

New roles may be created within medicine, says Shaw. People can manage their lifestyle and chronic conditions largely on their own, when supported by technology. The remote monitoring of these things could mean the creation of a something like a virtual coach, who may co-ordinate different aspects of an individual's health and wellbeing and call in consultants or doctors when needed.

Dr Harry Nespolon, president of the Royal College of Australian General Practitioners, says the role of the GP will evolve, and become more central. The GP could monitor a thousand patients at once as they upload their data about sugar levels, heart rate and the like, but only need to call in a few for consultations. The lower-value consultations will start to disappear; managed by patients themselves, nurses or even pharmacists.

"It's exciting," he says. "It will help patients understand what they're doing better – whether they do anything about that is going to be their choice."

Privacy and data

The implications of this personal health data go beyond healthcare. It could change the way some industries do business.

For a few years now, MLC has been offering discounts on life insurance premiums for policy holders who agree to share their steps data with the insurer. In return for demonstrating that they are walking at least 37,500 steps a week for 30 weeks out of 40, the policy holders get a 5 per cent annual discount on their premium; if they don't meet the target, the premium rises the following year. Just under 5000 people are enrolled in the programme. The data from their Fitbits, Apple Watches or other activity trackers is sent to a third party, encrypted and then the step count alone is passed on to MLC for verification. For the insurer, it's a way to not only make their customers healthier – and therefore lower risk – but also to build a closer relationship with them.

For a few years now, MLC has been offering discounts on life insurance premiums for policy holders who agree to share their steps data with the insurer. 

Last year, MLC's head of retail, Sean McCormack, broke his sternum in a car accident on the way to Tullamarine Airport in Melbourne. He went from averaging about 15,000 steps a day, to nothing. In the future, McCormack would like the insurance company to notice such a change and make contact. They could say: 'Hey Sean, we've noticed you're really inactive. Something seems to have happened. Is everything all right? Is there anything we can do to help you?'" And then signpost things such as recovery tools or programmes. "This positive customer engagement I think is the real opportunity for us in the future," he says.

Technologies such as the in-development contact lens that monitors blood glucose levels or heart-rate monitors are also of interest. It could change the way companies underwrite customers, able to show that while an individual has a chronic condition, it is well managed and therefore a lower risk. "It's really, really exciting," he says.

For Dr Lisa Carver, a sociologist at the Queens University in Canada, the scenario put forward by MLC sounds terrifying.

Dr Carver has raised concerns that the multiple sets of health and wellness data that stream into the ether from our devices, phones, apps, watches could be used to create a wellness score report – much like the financial credit reports held on every individual. And just like credit reports, they would be compiled without the participation or notification of individuals, she says, and potentially used to restrict access to various services, such as health insurance (in countries where insurers can charge or refuse policies to individuals who present high risk), or even medical procedures in public health systems.

"These programmes can become gatekeepers," she says. "Just like credit reports, they may be full of errors." Carver paints a hypothetical picture of a wine enthusiast, who spends time researching fine wine, enjoying a moderate amount but not drinking beyond limits. Perhaps this person's data is skewed because they're wearing their heart rate monitor wrong, or they break their leg and are rendered sedentary. And say that person also ended up requiring a liver transplant in a public health system. "What concerns me is if your app, browser and credit card history linked to wine is added to health data, all of these factors combined could end up with you being told you don't get a liver transplant because you're labelled by your 'health report' data profile as an alcoholic.

"We're sitting here like it's our birthday. We have all these apps we're opening up and we're just jumping right in there," says Carver. "It's too easy for this technology to just become part of life. They'll be ingrained so completely that it'll be impossible for any government to step in and clean it up, because they'll be so integrated into everything. And that really worries me."

Greg Williams, lead author of the CSIRO's Future of Health report, says he is optimistic about the role of technology in supporting individual health and wellbeing, but many things need to be got right. Ensuring equal access to the technology is critical. On privacy, he says: "The funny thing is that none of us have much privacy at all, really. It's just a matter of how aware of that you are."

And on that note, my Apple Watch has beeped. It's time for me to focus on breathing for one minute. I can relax now.

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What will 2019 bring for pharma and digital health?

What will 2019 bring for pharma and digital health? | Social Media and Healthcare |

We've consulted our crystal ball (okay, actually our team chat) and come up with some predictions for 2019, along with the key trends that stood out to our analysts in 2018. 

Ten trends that stood out in 2018:

  • Health applications of chatbots go from shiny and new to tried and true, and pioneering companies are beginning to figure out how to use them to triage inquiries and smooth the customer experience without falling afoul of legal regulatory boundaries.
  • Health AI has a “Last Mile problem” – Watson shows great promise but foibles recall those of driverless cars. The technology is amazing at validating diagnoses against what an MSK oncologist would say, but continues to suffer from cultural and organization-specific blind spots and data constraints, and with lives at stake, close ain’t gonna cut it.
  • GDPR and its California cousin prompt a rethink of data privacy protections, forcing industry to get its act together, build out data management capabilities and negotiate with patients for the use of their data.
  • Substantial improvements in wearables, with ECG applications showing particular promise and BG meters getting smaller and more sophisticated -- but wellness programs’ worth is increasingly in doubt.
  • Physicians’ rage at EHRs boils over in the U.S., even as their potential to tap big data begins to bear fruit; voice tech shows promise to alleviate some of that suffering, but it’s early days yet for the technology. At least the NHS is throwing out its fax machines
  • Payer and IDN marketing comes into focus for pharma amid continued erosion in physician prescribing autonomy. 
  • Pharmas bring on high-level digital and consumer marketing expertise, with several leading companies appointing Chief Digital Officers for the first time (Lidia Fonseca joining Pfizer from Quest Diagnostics, Karenann Terrell joining GSK from Walmart, and Bertrand Bodson joining Novartis from Sainsbury's Argos). 
  • An Amazon-induced scramble for scale sees the rise of a new type of vertically-integrated healthcare megalith in the U.S., from CVS+Aetna to Cigna+ExpressScripts, UnitedHealth+DaVita, Humana’s hospice push, etc.
  • Social media’s mystery fades as a small set of dominant platforms selling out-of-box solutions (Facebook on the consumer side, LinkedIn, Doximity and Sermo for professionals) emerge.
  • Copay accumulators emerge as the latest weapon in the eternal discounting arms race between pharma and insurers in the U.S. Could this be the end for co-pay cards and coupons? Probably not, but stay tuned!

Nine predictions for 2019:

  • The sun begins to set on the Age of the Pharmaceutical Sales Rep as automation shifts an increasing number of traditional rep responsibilities over to chatbots, on-demand webinars and other forms of non-personal engagement. This won’t happen overnight – physicians in many markets and specialties continue to value the rep relationship – but in 2019, we’ll begin to see field forces taper down earlier in the product cycle as companies ramp up investment in NPP (M3’s partnership with Novartis Oncology on a sample-ordering Amazon Ping button is a prime (rimshot) example of this).  Given the enormous hegemonic power pharma sales orgs have exerted on larger commercial orgs, this will portend broader shifts in pharma commercial culture.
  • Med affairs faces automation, too, as more pharmas tinker with using chatbots – tightly scripted, narrow pathway, clear guardrails – to triage physician and other HCP inquiries. You can already see this phenomenon on Pfizer’s medical affairs site, where Medibot, reminiscent of the Jetsons’ Uniblab, fields physicians’ questions.
  • Pharma’s initial forays into chatbots and AI will be concentrated in apps for healthcare professionals, sidestepping the higher regulatory burden that comes with consumer applications. They’ll be tightly scripted, narrowly focused and clunkily utilitarian. But a few brave pharmas will branch out into consumer-directed efforts – as Novartis has already with its Alia Facebook Messenger chatbot
  • Facebook is 2019’s Outcome Health – pharma just can’t quit it, but the platform is losing its luster, and a chunk of its user base in The West, amid a cascade of damaging revelations about its sketchy handling of customer data and exploitation by malevolent state and extra-state actors around the globe. Add to that the parallel collapse in advertiser confidence and we may see pharmas hedging their bets by placing more of their budget in endemic health platforms.
  • Massive real-time patient data and genetic data sets come into play for clinical trials and patient care. Apple Watch and its competitors are becoming standard issue for insurers and commonplace in clinical trials. Meanwhile, 23andMe and other consumer genetic testing firms are seeing their data sets swell just as their commercial model begins to gel.
  • Digital therapeutics prove to be as risky a bet for pharma as drugs – and pharmas clamor to invest and partner. You might think the failure of the most-hyped of Alcon’s partnerships with Alphabet’s Verily, on a blood glucose-reading contact lens, might dampen the fervor for pharma investment in digital or digitally-augmented treatments. But this will probably be the year of the first prescription videogame (Akili’s ADHD treatment is with FDA), and digital treatments for pain are in the works, too (FDA just greenlighted Pear’s app for opioid addiction).
  • Biosimilars crash the party, and market themselves much like traditional branded biologics do. Launches of brands looking to play in crowded and lucrative categories like RA and oncology will aim to make a splash, and will air TV ads and field substantial sales forces to generate awareness. But the real competition will be wooing payers, and the makers of incumbent biologics will need to sweeten the pot substantially to preserve their market positions, while trumpeting their trusted-brand status to all stakeholders.
  • Political whiplash as Trump actually gets tough with pharma and Brexit causes disruption. It’s one of the biggest wild cards in Washington: Does Trump deal with Congressional Democrats on a plan to Get Pharma? So far, the Trump Administration has talked tough on drug prices but been a pussycat in practice. Democrats will offer Trump an opportunity to play up his Man-of-the-People, anti-establishment cred and join them in soaking Big Bad Pharma. Odds are he’ll take it, particularly as the economic situation and the various investigations darken going into a presidential election cycle, and a Republican Senate may have to play along. Question remains: would bipartisan moves to address pricing tend toward the symbolic (prices in drug ads) or the substantive (say, sanctioning CMS price negotiation with pharmas)? Meanwhile, across the pond, Brexit promises to be highly disruptive to pharmas in 2019, on both sides of the divorce. Hard or soft, “Norway” or No Way, Brexit will cause shortages of therapeutics and force an abrupt realignment of regulatory and administrative structures.
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Possibilities and Pitfalls of Social Media for Translational Medicine

Possibilities and Pitfalls of Social Media for Translational Medicine | Social Media and Healthcare |

We live in an age where the sharing of scientific findings and ideas is no longer confined to people with access to academic libraries or scientific journals. Social media have permitted for knowledge and ideas to be shared with an unprecedented speed and magnitude. This has made it possible for research findings to have a greater impact and to be rapidly implemented in society. However, the spread of unfiltered, unreferenced, and non-peer-reviewed articles through social media comes with dangers as well. In this perspective article, we aim to address both the possibilities and pitfalls of social media for translational medicine. We describe how social media can be used for patient engagement, publicity, transparency, sharing of knowledge, and implementing findings in society. Moreover, we warn about the potential pitfalls of social media, which can cause research to be misinterpreted and false beliefs to be spread. We conclude by giving advice on how social media can be harnessed to combat the pitfalls and provide a new avenue for community engagement in translational medicine.

Keywords: translational medicine, translational research, social media, research dissemination, patient engagement, science communication


The emergence of social media has changed the way we communicate and allows for knowledge and ideas to be shared with an unprecedented speed and magnitude. Similarly, an exponentially increasing amount of research about social media is being published (Figure (Figure1).1). Social media come in a variety of forms, including collaborative projects such as Wikipedia, (micro)blogs like Twitter, content communities like YouTube, social networking sites like Facebook, and gaming communities like Second Life (1). These platforms are accessible to all and provide forums where people can freely share thoughts, opinions, and knowledge without—in general—any form of censorship or fact-checking.


Number of publications found on PubMed with the search term “social media,” as shown by publication year.

Several groups have addressed how social media are used by the research and medical communities. Medical researchers have shown doubt about professional use of social media, describing it to be incompatible with research (2). Social media are mostly used for personal and less for professional purposes (34). Yet, on the level of society, social media have great potential. There are many examples of its use for public health and prevention purposes (56). Additionally, the rapid dissemination of research findings and the spreading of knowledge to society has increased public interest and involvement in research. Consequently, patients increasingly can and want to be part of developing solutions for their illness (37).

The use of social media for purposes of implementation and translation of research is still in its early stages. At the same time, social media are clearly being used by both patients and professionals for personal content and information sharing. Various efforts of using social media for research are also increasing. Thus, it is important to raise awareness and understanding of the possibilities and pitfalls that social media present to the research and medical communities as well as to regulatory bodies, patients, and industries. Therefore, in this study, we aimed to address both the possibilities and potential pitfalls of social media for translational medicine. We aimed to provide a brief and broad overview of this topic that could steer the community to be more mindful when using social media. A comprehensive review of all different aspects relating to social media and translational medicine is beyond the scope of this perspective article.

Possibilities of Social Media for Translational Medicine

Rapid and Easy Dissemination of Research

Social media are widely used all over the world. Facebook, for example, had an average of 1.45 billion daily active users and 2.20 billion monthly active users in March 2018 (8). With this many users, social media provide platforms for researchers and institutes to quickly disseminate their research plans and findings to a greater public. Through online pages of journals, associations, newsgroups, and direct-sharing, it is relatively easy for researchers to reach a broad audience compared to the more “conventional” sharing of knowledge through publishing in scientific journals. Relevant research findings that are interesting to the community may rapidly spread through social media and go viral. This way, social media may be used to rapidly spread and implement public health findings to the general public. An additional benefit is the easier recruitment of traditionally “hard to reach” populations for medical research (911). Furthermore, it increases the chances of research being picked up by peers and stakeholders (4). Faster dissemination of research findings might also prevent other research groups from repeating the same research, decreasing the potential waste of resources. Recently, tools were developed that visualize the magnitude of impact of social media on scientific publications. This is important, as number of tweets within the first 3 days after publication of an article was found to predict which articles would be highly cited on Google Scholar or Scopus (12). The most commonly used tracking tool is Altmetric, which tracks the amount of rumor about an article on nearly all professional and social media outlets (13). For example, an article about the association of fats and carbohydrates with cardiovascular disease published in medical journal The Lancet was at time of writing only cited by 21 articles (14). However, the real “buzz” was generated by 8,313 tweets, 450 Facebook posts and 168 news stories, adding it to the top 5% of the most discussed publications of the year (14).

Critical Review of Existing Articles and Raw Data Sets

In this era of exponentially increasing numbers of publications, using the reviewing power of the scientific community is an opportunity that should not be missed in order to improve overall research quality. As an extension of recent developments toward more transparent peer reviewing, several social platforms that allow open peer review have been developed, encouraging readers to critique existing publications in-depth. In addition, users are stimulated to upload raw data sets as well, including negative results that might otherwise never have been published, thereby counteracting the effect of publication bias (15). However, the scale of impact of open review might be limited to high-profile work that raises concerns, as those are more likely to attract attention (16).

Possibilities for Raising Funds for Research

With its fast dissemination of information and large number of users, social media platforms have the potential to broadly raise awareness for medical research and specific diseases. Social media platforms have been demonstrated to play an important role in reaching potential donors and raising money in crowd funding campaigns (17). In 2014, $115 million was raised from the Ice Bucket Challenge on Facebook for research into new treatment strategies for Amyotrophic Lateral Sclerosis (ALS) (18). In 2016, a 6-year old Dutch boy who was recently diagnosed with a pontine glioma raised € 2.6 million for the Dutch Red Cross by daring people to paint their nails and post a picture on social media (1920). Moreover, a social media-based fundraising contest launched by the University of California San Francisco (UCSF) raised more than $1 million for the UCSF Benioff Children's Hospital, surpassing their initial fundraising goal 10-fold (2122). Thus, with the large audience that can be reached through social media, new opportunities for raising funds arise.

Networking Between Clinicians, Researchers, and Patient Groups

Keeping an up-to-date online presence on social media may prove valuable for clinicians and researchers. Social media create an accessible platform for peer-to-peer discussions and form an increasingly important networking tool. Depending on the platform used, potential target audiences include professionals as well as patient representatives.

Social media outlets also enable patients and patient representatives to efficiently unite into groups. This may be especially beneficial for patients with novel or rare diseases (23). In addition to providing guidance, advice, and support to peers, these platforms may be used to exchange and seek medical information from each other and from medical professionals (24). A unique opportunity for clinicians and/or researchers lies in initiating these groups, which facilitates immediate contact with patient groups. This can provide the researcher with valuable first-hand information and enable patients and their representatives to directly influence research and prioritize projects (25). Similar collaborations on social media between patients, clinicians, and researchers have been shown to contribute to overall scientific knowledge (25).

Big Data Analytics for Prediction Models and Assessing Trends/Outbreaks

Social media outlets have the potential to be used as exponentially growing, observational datasets (2627). A well-known example of big data research performed on online data is the prediction of global influenza outbreaks by analyzing the number of searches of the word “influenza” or symptoms of influenza-like illness on Google (also known as Google Flu Trends, currently discontinued) (28). The same can be done using data social media such as Twitter. For example, based on data from Twitter posts (tweets) researchers were able to detect increases and decreases in influenza prevalence with a 85% accuracy (29). Another example is a study that found that a model that analyzed language expressed on Twitter was better at predicting atherosclerotic heart disease mortality than a model that combined 10 common risk factors such as smoking, diabetes, and hypertension (30). Social media have also been demonstrated to contain information on health-related behaviors, such as smoking (31), sexual risk behavior (32), and sedentary behavior (33). Finally, they could be used to monitor public opinion on important health topics, such as vaccines (34) and opinions on specific projects or studies (35).

Potential Pitfalls of Social Media for Translational Medicine

Lack of Peer Review and Filtering of Quality

The increased speed and magnitude of the spread of scientific findings through social media comes at a price. There is no system for peer review or filtering of social media, which means that any idea can be spread; even if it is fabricated or not supported by evidence. The vast majority of social media users do not have a scientific background and may be ill-equipped to judge the quality of evidence and sources. For example, people might perceive a blog or advertisement stating “proven by science” as just as trustworthy as a research paper in a peer reviewed scientific journal. However, most people will never read the latter; full research articles are simply not as fun and easy to read as readily digestible news items on social media.

Fake News Spreads Fast and Is Difficult to Refute

Fake news often disseminates rapidly through social media. A recent study compared the differential diffusion of ~126,000 verified true and false news stories through Twitter. Worryingly, the study revealed that false stories spread much faster, further and more broadly than did true news stories. True news stories rarely spread to more than 1,000 people, whereas false stories often reached up to a 100 times more people (36). Similarly, false stories spread several times faster (36), proving what Charles Spurgeon's already asserted in 1855 “a lie will go around the world while truth is pulling its boots on” (37). False stories are generally more novel and trendy than true stories, which are often more sober and nuanced, and it is part of human nature to be attracted to novelty (38). Novel information is most valuable to decision-making (39), and surprising content can induce physiological arousal that encourages people to spread information and cause content to go “viral” (40).

Once a fake story has spread, it becomes increasingly difficult to refute it. This principle is generally known as Brandolini's law, or the “Bullshit Asymmetry Principle”: the amount of energy needed to refute bullshit is an order of magnitude bigger than that needed to produce it (41). Often, the fake news being spread is relatively harmless and primarily amusing. For example, a story by a doctor about a baby boom in Iceland 9 months after a football victory has gone viral, even though it was debunked by statistical analyses (42). Unfortunately, there are also examples of pervasive fake news stories that endanger public health. Perhaps the most famous of these stories is the case of Dr. Wakefield, who wrote an article that suggested a link between the MMR-vaccine and autism (43). The study was soon discovered to be fraudulent, the article was officially retracted, and Dr. Wakefield's UK medical license was retracted (44). It is now 14 years after the retraction of this article, but its fraudulent results continue to refrain people from taking vaccinations (45). A search on Facebook reveals 109 public pages and 94 discussion groups about vaccines with collectively more than a million members and followers, such as @thetruthaboutvaccines (136 k followers) where daily memes are posted to warn people about putative risks of vaccination, including autism. Psychological studies have shown that incorrect memories continue to influence decision making even when you are aware that the memory is false (46), which may explain part of the persistence of these stories. Similarly, most strategies to correct vaccine misinformation are ineffective and could even backfire (47). With fake news being this difficult to refute, it invites the question whether the dangers of the fast and broad dissemination on social media outweigh the advantages.

Misinterpretation of Research

Aside from fake or fraudulent research being spread on social media, there is also the risk of genuine research findings to be misinterpreted. Conclusions of research findings are often simplified and overly extrapolated in the media. A prime example of this happened in 2015, when a study on cancer risk was published (48). The authors concluded that 65% of the variation in cancer risk among different tissues could be explained by the total number of stem cell divisions and thus “bad luck” (i.e., random mutations arising during DNA replication in normal, non-cancerous stem cells). Even though the study did not explore the causes of cancer, major news headlines (mis)interpreted: “most cancers are caused by bad luck–not bad judgement, says study” (49), “most cancers are ‘caused by bad luck–not lifestyle”” (50), and similar titles (51). Six days after publication, an additional press release addressed these erroneous conclusions, but they had already been shared on social media extensively. This exemplifies the damage that can be done when research findings are misinterpreted and spread to the general public.

Dissemination of Pseudoscience Through Social Media

The line between science and pseudoscience is often blurred and it is difficult to determine what is true and false (5253). Sometimes, pseudoscientific information can give false hope to patients with disease. Moreover, while pseudoscientific supplements are often relatively harmless, there are also dangerous advices and practices, which are readily being spread through social media. For example, the use of alternative treatments and supplements without proven efficacy (52) are often promoted through social media. Moreover, multiple procedures for tampering with existing drugs can be obtained via the internet (53). These procedures are illegal and unconfirmed to result in the drug formulation of interest, which in some cases can even lead to (fatal) intoxications (54). This makes the spreading of pseudoscientific findings a potentially harmful situation.

With the increased use of social media, the public is paying closer attention to bloggers and celebrities—regardless of their medical or scientific background—than to experts in their respective fields of interest. For example, Dr. Mercola, an osteopathic physician, has almost 2 million followers on Facebook, a strong online presence and daily emails to subscribers where he pushes “alternative” or “miracle” supplements to the masses. However, in 2016, Dr. Mercola, was ordered to refund customers up to $5.3 million for the false advertisement of his own company's tanning beds that he claimed would reduce chances of getting cancer. This was not his first trouble with regulators: the US Food and Drug Administration (FDA) warned him three times between 2005 and 2011 for violating federal laws for marketing a device he claimed was an alternative to mammograms and for making unproven claims about dietary supplements (55). Dr. Oz is another proponent of pseudoscience and “miracle cures” for an array of conditions. He has 6 million Facebook followers and his own television show. Perhaps most notable is his persistent advertising of “miracle” weight loss supplements that will be effective with little to no exercise. He was criticized by the Senate in 2014 for such unsupported claims for specific supplements and was called to be removed from the faculty at Columbia University, where he worked as a cardiothoracic surgeon. During his testimony, Dr. Oz acknowledged that many supplements he lends support to would not stand up to scientific scrutiny (56) and a recent study confirmed that most of his claims were not supported and, in some instances, contradicted by evidence (57). These instances are just the tip of the iceberg when it comes to examples of pseudoscientific ideas being spread to a large audience.

How to Best Use Social Media

In 2016, politician Michael Gove famously claimed “people have had enough of experts” (58). This assertion was confirmed when the majority of the UK voted to leave the EU against all expert advice. What does this mean for us as a research community, the “experts” on healthcare, and how can we use social media to combat fake news and pseudoscience that could endanger translational medicine and public health?

We believe that we, as a research community, have a responsibility to use social media to spread research findings of public interest and to combat fake news that can be harmful to society. One way to counter the dangerous spread of misinformation is for scientists to critically evaluate the scientific news stories and report inaccuracies in order to correct or refute them. As news media outlets are more likely to report data that are compelling or sensational, it is essential to provide information that is interesting to the general public while at same time maintaining standards for reporting the accuracy of the relayed information (59). Another possibility is for the scientific community to use a rating and online review system similar to travel-review websites such as TripAdvisor, in order to establish consensus about the validity and quality of research and health claims that are circulating on the internet (41). Moreover, several social media groups have been established specifically for refuting false news, such as the Facebook and Twitter group “Refutations to Anti-Vaccine Memes” (@RtAVM), which has 233,871 members that aim to refute fake news stories about anti-vaccine movements by responding with rational arguments and counter-memes that dispel false-beliefs. However, confirmation bias can be strong and it remains to be seen whether people with opposing views will be convinced or even read such pages with opposing views.

Another approach for scientists to reach people with opposing views is to think small and to begin with sharing information within their immediate social network. Many scientists have several hundreds of social media connections, 519 on average, and these personal connections could mean that people trust and value their opinions, especially in their field. It has been suggested that every scientist can be a “nerd of trust” within their network of friends and family, and collectively, we as a scientific community could have the potential to influence the opinion of a large part of society (60).


We live in an exciting age, where social media allow for unrestricted spreading of scientific findings at an extraordinary pace, which brings major advantages for translational medicine, but comes with several potential dangers and pitfalls as well (as summarized in Table Table1).1). We hope that this perspective article helps translational researchers to tackle the challenges and harness the possibilities of social media for the advancement of science.

HEALTH CARE's curator insight, January 14, 3:36 PM
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Can Social Media Have A Positive Impact On Global Healthcare?

Can Social Media Have A Positive Impact On Global Healthcare? | Social Media and Healthcare |

There really isn’t an area where social media hasn’t had an impact. People use social media to share opinions, seek information, and share stories about their experiences. Healthcare hasn’t been excluded from this in any way. In fact, 60% of doctors see social media as an avenue for delivering better healthcare to patients. Of course, that doesn’t mean that there aren’t concerns. For instance, the ways that people choose to use Facebook can lead to negative outcomes.

Still, the impact social media is having and stands to have on global healthcare is a topic worth exploring as there are significant benefits and drawbacks it can cast on both patients and medical practitioners.

Some millennials are ditching doctor visits in favor of social media

While millennials are highly focused on healthy living, 93% of them aren’t scheduling appointments with doctors for preventative healthcare. Instead, they are making use of urgent care when they become ill. For millennials, this approach fits their cost-conscious, convenience-seeking lifestyles. The transparent costs of medical care also appeals to this often cash strapped and uninsured generation as well.


Millennials aren’t just seeking on demand treatment. They’re also seeking on demand healthcare advice and support. Many are finding this through social media. For them, social media is a place to find advice from peers who may be experiencing the same  health related concerns. They also seek out advice on making lifestyle changes and solutions to healthcare problems they may be having.

For example, a millennial concerned about their snoring may seek out blogs, or ask for advice from members of their social media communities. They might seek to alleviate concerns about snoring related health conditions such as sleep apnea, or to read blog posts about the effectiveness of various treatments for snoring.



While social media can be an on demand source of information, there are also concerns. For example, is the information up to date and accurate? Are millennials (or any other generation) qualified to discern good information from bad. Finally, where is the accountability? This is concerning as a study showed that of 20 of the most shared Facebook posts referencing cancer, more than half contained information that had been refuted by healthcare professionals.

Healthcare providers actively use social media as a research tool

Eighty-eight percent of physicians and other healthcare providers use social media and the internet to research medical devices, pharmaceutical information, and biotech data. Just like professionals in other fields, doctors can use social media as a tool to reach out to other specialists. They can explore the social media pages of pharmaceutical companies and device manufacturers. They can even follow the blogs of other practitioners to learn more about their experiences. Also, family caregivers can search online for ways to benefit from the time and effort they dedicate to caring for a loved one.

Social media can also be employed as a research tool in the area of public health. For example, researchers have used social media to track and forecast influenza outbreaks. With so much publicly available information about various diseases and other public health concerns, there is huge potential to use social media as a data mining source. Social media can even be used to track public opinions such as those expressed by anti-vaxxers.

Most importantly, public health agencies and professionals can act on this information. For example, if they are aware of an impending outbreak of an illness, they can plan for supplies and service providers to be available. They can also direct appropriate educational research to counteract the impact of incorrect medical advice and information. Because of the global nature of social media, the application of this information can be used worldwide.

Social media is becoming a marketing and communications tool for providers

Forty-one percent of people have indicated that information they get from social media impacts their healthcare decisions. This includes the choice of hospitals and treatment centers. As a result, physicians, pharmaceutical companies, hospitals, even health insurance providers are using social media for the following:

  • Publishing recent research.
  • Educating healthcare consumers
  • Directing consumers to their websites and landing pages for up-to-date information.
  • Marketing innovative services such as blockchain-based financial solutions to other healthcare companies.
  • Posting case information, photos and outcomes (with permission).
  • Sharing patient reviews and testimonials.
  • Providing customer support and offering healthcare advice.

Of course, all of this engagement must be done while also adhering to privacy regulations, and with a concern for liability. For example, an optometrist may be free to offer general advice on selecting colored contact lenses without much concern. However, if someone contacts them on a public forum describing an eye infection then they may need to thread a bit more carefully.

This leads to another area of opportunity and concern. This is the development of social media relationships between patients and their healthcare providers. On one hand, this provides an avenue that is familiar and comfortable for many people to interact with their doctors. On the other hand, there is a real ethical concern that physicians who have social media relationships with consumers may access private information that is not intended for them. There’s also a concern about patient confidentiality in terms of what other people may be able to access.

While there are concerns about privacy and the spread of untruthful information, social media can be used by those in all areas of the healthcare industry for a variety of purposes. It is a tool for marketing, education, and providing needed services to various communities.

I am a writer and lifestyle entrepreneur. After working in the corporate world for over 5 years, I resigned and took to consulting entrepreneurs and companies, including Fortune 500 companies like LinkedIn and Cisco. 

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Doctors pen 'social prescriptions' aimed at easing depression, loneliness in patients 

Doctors pen 'social prescriptions' aimed at easing depression, loneliness in patients  | Social Media and Healthcare |

When Tammy McEvoy was asked to share her time and crafting talents to engage with other patients at her local health centre, she ended up getting back as much as she gave — maybe more.

McEvoy is one of 15 "health champions" at the Belleville and Quinte West Community Health Centre taking part in an innovative Ontario pilot project in which doctors or other practitioners write out a "social prescription" for patients experiencing depression, anxiety or loneliness that affects their sense of well-being. 

The concept — prescribing a social activity like taking a yoga class, visiting an art gallery or joining a knitting circle — has proven to be an effective tool in the U.K., where research has shown that not only do patients benefit from a mental-health boost, but many also end up with reduced medications and find less need to visit their doctors.

Since the pilot project began in October, McEvoy has taught classes on wreath-making, and cooked an evening meal for an addiction group meeting at the centre's Quinte West site in Trenton. 

The wreath-making classes brought together 16 participants. "The first one I did, I watched magic happen because they all started helping each other," says the 52-year-old self-described empty-nester who's often alone while her husband works long hours.

"I've spent the last six years not working and not being out because of health reasons," says McEvoy, who has a heart condition. "But now I can go there, I'm comfortable there.

"It helps me just as much as it helps them."

Meghan Shanahan Thain, a social worker at the Trenton health centre, says the program is based on a U.K. collaborative practice model called Altogether Better.

"So people come up with their own ideas based on their own talents and skills, but they also have a lens that we don't see in terms of what the community needs and what our clients need," she says of the health champions, who included a singing circle in the social activities on offer.

On one occasion, "we had two people who are widowed who connected to each other and just sang," she says. "A girl from the community showed up with a guitar.

"Music really brings people together, but it also taps into the socially isolated folks as well ... Just having a social connection has a lot of health benefits. Being socially isolated can make us sick in a lot of different ways."

The 18-month pilot project, supported by a $600,000 Ontario Health Ministry grant, is being spearheaded by the Alliance for Healthier Communities, which represents more than 100 primary health-care organizations across the province.

The grant allowed the Alliance to trial social prescribing in 10 of the centres, with a goal of evaluating benefits to patients, says Kate Mulligan, director of policy and communications.

"One example from Thunder Bay that really resonates is there's a long-haul trucker who was experiencing social isolation and he started up a knitting group at the community health centre," she says, adding that it's especially satisfying to see a person in need become a volunteer to help others form social connections.

"They start to recognize their own value and self-worth when they're participating and contributing to the community," Mulligan says. "So you're not just seen as a patient with deficits and problems, but you're a person who has something to offer."

Another of the pilot sites is the Rexdale Community Health Centre in Toronto. A large proportion of patients are recent immigrants or refugees, who are at risk of social isolation that can lead to depression and anxiety, says Dr. Sonali Srivastava, a primary-care physician on staff.

"Really, the research is showing us that social integration is a major part of people's level of happiness and health," she says. "If there's a social component in there that is missing, we need to address it."

That could mean writing a prescription for a patient to join a tai chi class, for example, or to tour a museum or art gallery.

Indeed, the Montreal Museum of Fine Arts (MMFA) and the Royal Ontario Museum (ROM) are two cultural institutions in Canada that have embraced the idea of coupling social activities with health and well-being.

A recent study conducted by the MMFA, McGill University and the Jewish General Hospital found that seniors who participated in drawing and painting workshops reported an improved sense of well-being, health and quality of life.

Starting in January, the ROM will begin providing 5,000 sets of free passes to patients with social prescriptions for a tour of its exhibits for themselves and three companions, working with 20 of its ROMCAN (Community Access Network) partners in the Greater Toronto Area, including the Alliance for Healthier Communities. The program will then be rolled out to the other 80 partners in the network.  

Jennifer Czajkowski, deputy director for engagement at the Toronto museum, says research has shown that museums can be restorative environments for visitors.

"They're with other people, also people are able to see objects that might be from their own heritage, things that help them connect to their own culture or to the cultures of others, other times and places," she says.

"These things can all help to alleviate a sense of loneliness."

Srivastava says social prescribing reflects a change in how the medical community views health and wellness and the role that doctors and allied practitioners can play.

"If I just tell somebody verbally 'I want you to go for a walk for 30 minutes, three times a week,' they're less likely to do it than if I were to write it down on a prescription pad," she says.

"Usually we write down medications, right? But when it's put on a pad of paper and a doctor writes it down and signs it, all of a sudden it means it's serious.

"And I believe the reason why it's important is because we forget that health is not only about physical well-being and mental well-being, it's also about social well-being."

—Follow @SherylUbelacker on Twitter.

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