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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Six Smart Doctors to Follow on Social Media

Six Smart Doctors to Follow on Social Media | Social Media and Healthcare |

Several years ago I wrote a white paper called The Social Physician. Back then, it was relatively easy to keep track of the socially engaged doctors because there were so few. Today all that has changed as more and more physicians flock to Twitter, Facebook, YouTube, Pinterest, blogs, and beyond. Here are six doctors I follow in social media, all of them practicing and all worthy of your attention. I focused on practicing doctors because they choose to engage on top of all their clinical responsibilities. For them, social media is an important way to stay connected with patients, peers, and the world outside their office.


Dr. Wendy Sue Swanson
Twitter: @SeattleMamaDoc

Known to her legion of fans (of which I am one) as SeattleMamaDoc, Dr. Swanson is one of the most eloquent medical writers in the social sphere. A pediatrician, she is an avid blogger for Seattle Children’s Hospital where she covers everything from swimming safety to measles outbreaks. Her recent post on the hiring of Jenny McCarthy on The View is indicative of her passion and willingness to take a stand on important, even controversial, issues. She also uses video effectively to educate, such as teaching parents about bike helmets. Dr. Swanson is pretty amazing.


Dr. Zubin Damania
Twitter:  @zdoggmd

Known by his alter ego ZDoggMD, this Las Vegas-based internist and hospitalist is a wannabe rapper/comedian/reality show star in scrubs. He is funny, sometimes hilarious, as he sings about everything from insurance paperwork to prostate cancer. My favorite video is one in which he gets his psychiatrist mother ZMommMD to “lay down the smack” on his internist father ZDaddMD. Seriously, though, I think that ZDogg makes medicine more accessible and relevant to the public and that’s a good thing.


Dr. Nina Shapiro
Twitter: @drninashapiro

Parenting young children is hard enough, and when they start with the constant coughing, noses that ooze, and ear maladies it’s time for a visit to Dr. Nina Shapiro’s website. While the Internet is never a replacement for a visit to the doctor, as director of pediatric otolaryngology at UCLA, Dr. Shapiro blogs, tweets, and updates Facebook with practical, trustworthy content for parents struggling with snot, boogers, and beyond. One of my favorite posts was Am I a Mean Mom? which challenges parents to let their kids experience the world – even if hurts a little – instead of constantly shielding them from it. Most recently, Dr. Shapiro joined the vaccine conversation with an op-ed in the L.A Times called With fewer vaccinations, is your child’s school safe? Can you tell I follow strong, smart women?


Dr. Mike Sevilla

This early adopter has gone from being Dr. Anonymous to being…Dr. Mike Sevilla. In between he used Family Medicine Rocks as his home base, where he tirelessly advocated for his specialty – and primary care in general. Recently, he took a break from social media to regroup (many of us were sad), but came back stronger than ever (which made us happy). Dr. Sevilla uses every form of social media: blog, podcasts, YouTube, Facebook, Twitter, Vine, Instagram – name it, he’ll try it. Wherever he is, he’s one to follow for his honest, funny, human musings about family medicine and life in general.


Dr. James Salwitz

He is a recent addition to my list based on a poignant piece he wrote for KevinMD. It is a story of his angst about a patient who died a terrible cancer-stricken death after enduring a tragic life of untold abuse from her husband. The patient’s children wouldn’t let her go even though an earlier departure would have been – in a sad twist – more humane. “There was no happy ending. I failed to appease their pain during Ellen’s life, so she died terribly,” wrote Dr. Salwitz. I read more of his posts on KevinMD and discovered what a compassionate and steadfast advocate for patients he is. Dr. Salwitz seems to be everything you would want in an oncologist (and I’ve met some who were everything you wouldn’t want).


Dr. Leslie Saxon
Twitter: @DrLeslieSaxon

Dr. Saxon is a health tech rock star on a coast full of them, yet most are male. She is both chief of cardiovascular medicine at USC Keck School of Medicine and executive director of USC’s Center for Body Computing. Known as the Digital Heart Doc, she is a pioneer in the evolving world of wireless and digital health. Her research using a smartphone-based ECG recorder for inexpensive, continuous heart rate monitoring helped the AliveCor device gain FDA clearance, one of the first mobile applications to do so. Dr. Saxon’s social media posts are generally on major news outlets like CNN – Leading the Charge in Wireless Health was fabulous. She tweets, too, so if you’re interested in where digital is going, she is one to follow.


Bunny Ellerin (Twitter: @BunnyEllerin) is Senior Vice President at Intouch Solutions, a privately held marketing agency specializing in digital and mobile solutions for the pharmaceutical and health care industries. She is also co-founder and president of NYC Health Business Leaders, a cross-sector network of senior executives that showcases NYC’s position as a thriving center of health, medical and life sciences innovation.

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Social Media Guidelines Force Physician Identity Crisis

Social Media Guidelines Force Physician Identity Crisis | Social Media and Healthcare |

Newswise — From the small-town doctor to the Freud—Ferenczi debate over sharing personal anecdotes, controversy over physicians’ professional identity is nothing new. The question of physician conduct on social media is simply a new context for an old debate, but ethics and psychiatry experts at Johns Hopkins say current guidelines are misframing the issue of physician professionalism online, missing the opportunity to shed new light on the evergreen issue of physicians’ role in society.


In a JAMA Viewpoint opinion published August 14, the experts say that current guidelines, including the recentlyreleased by American College of Physicians and Federation of State Medical Boards, are asking the wrong question about medical professionalism online; it’s not a question of whether content is professional or personal, but whether it is appropriate of a physician in public.

“Resolving the online identity crisis requires recognizing that social media exist in primarily public or potentially public spaces, not exclusively professional or exclusively personal ones,” write authors Matthew DeCamp, MD, PhD, Thomas Koenig, MD, and Margaret Chisolm, MD.


The authors assert that it is “operationally impossible” and therefore “nonsensical” to separate personal and professional identities, as many guidelines suggest. They will underscore their point by participating in a live Twitter chat scheduled for 2:00 PM on Friday, August 16, with the hashtag #IDcrisis, hosted by the Johns Hopkins Berman Institute of Bioethics(@bermaninstitute).


“Professional identity is a component of personal identity, much as a person can identify both as a colleague and parent in different contexts,” says Chisolm, a professor in the department of Psychiatry and Behavioral Sciences.

“The internet is a reimagined small-town square for the digital age, where a comment made casually to a friend can suddenly spread like wildfire,” says DeCamp, a practicing general internist at Hopkins and faculty member at the Berman Institute. “Social media presents an opportunity for physicians to connect with their community, and they can maintain an appropriate professional identity while doing so by keeping in mind they are speaking in a public forum. So rather than something completely novel, social media is simply a new forum for professional conduct in public, which physicians negotiate all the time,” DeCamp says.


The authors warn that attempts to adhere to existing guidelines and “depersonalize” their identity online may backfire, reducing trust of physicians who are attempting to hide something, and increasing patient stress in response to a physician perceived to be impersonal and unsympathetic.


About the Johns Hopkins Berman Institute of Bioethics

One of the largest bioethics centers in the world, the Johns Hopkins Berman Institute of Bioethics is the home for collaborative scholarship and teaching on the ethics of clinical practice, public health and biomedical science at Johns Hopkins University. Since 1995, the Institute has worked with governmental agencies, nongovernmental organizations and private sector organizations to address and resolve ethical issues. Institute faculty members represent such disciplines as medicine, nursing, law, philosophy, public health and the social sciences. More information is available at

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The Impact of Social Media on Medical Professionalism: A Systematic Qualitative Review of Challenges and Opportunities

The Impact of Social Media on Medical Professionalism: A Systematic Qualitative Review of Challenges and Opportunities | Social Media and Healthcare |
Professionalism is the basis of medicine’s contract with society [1]

In 2002, the European Federation of Internal Medicine, the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), and the American Board of Internal Medicine (ABIM) felt it necessary to renew the sense of professionalism due to changing market forces. The result of these efforts was a new physicians’ charter, which claimed to apply to physicians throughout the world.


Ten years later, the rising influence of social media in our private and professional lives is a new force that affects our understanding of medical professionalism. Social media, as a part of the Web 2.0, include blogs, wikis, podcasts, and social networking platforms such as Twitter, LinkedIn, YouTube, and Facebook, to name just a few. In contrast to websites where people are limited to the passive viewing of content, Web 2.0 tools are people-based knowledge sharing, learning, social interaction, and collective intelligence tools that support knowledge collaboration, exchange, sharing, and creation [2]. Thompson et al reported in 2008 that 45% of medical trainees, 64% of medical students, and 13% of medical residents had Facebook accounts [3].

The asymmetry of disclosure in the doctor-patient relationship was emphasized long before social media [4]. Today, social media allow patients to gather increasingly more information about their doctors’ private and professional life. Excessive self-disclosure from the side of the physician is generally regarded as a boundary violation in the patient-physician treatment relationship [5]. Disclosure of this kind of personal information on a social networking site is usually not aimed at patients, but patients might nevertheless access this information [6].


Persistence, searchability, replicability, and invisible audiences are unique characteristics of Facebook and other social media platforms [7], which form—based on the ease of searching and storing digital information—a “permanent” digital fingerprint and online reputation. Once information is online, it is extremely difficult to remove it (if at all) and it can quickly spread beyond one’s control. A moment of rashness could have unintended and irreversible consequences in the future such as suspension from medical school, loss of employment as a physician, and loss of trust in the medical profession [8]. It could concern future or current employment candidacy, or current employment and training conditions. There are already cases of students, trainees, or medical staff being dismissed because of their “unprofessional” online image [9,10].


However, the reduction of power imbalances between patients and doctors has been shown to improve patient confidence in starting, stopping, or making changes to treatment regimens [11]. Social media may also help to distribute precise health information to a larger group of individuals than ever before. But is online available medical information reliable? Who provides the medical information on blogs, YouTube, Twitter, and Facebook? In 2008, there were 1434 medical-related blogs; however, only 279 were actually written by medical professionals [12]. As advertising and business interests strongly influence the order of search engine listings [13], it might be advisable for the medical and dental professions to proactively refer patients to high-quality sources of medical online information [14,15].


Universities and medical organizations, especially in the United States (such as the American Medical Association, AMA) and United Kingdom, have started to develop guidelines and policies for health care professionals concerning proper social media use. In order to foster awareness, courses on handling social media associated with medical professionalism have been implemented in the professional curricula [16]. The recently published position paper on online medical professionalism by the American College of Physicians and the Federation of State Medical Boards provides the latest recommendations on strategies for physician-physician communication that aims at preserving confidentiality while best profiting from the new technologies of social media [17].

The importance of social media is also indicated by the increasing number of scientific publications that deal with them in the medical context. While our search (see Methods) found a total of 1471 publications focusing on social media on PubMed in December 2011, by the end of December 2012 there were 2330 hits.


To our knowledge, there is no systematic literature review that analyses the full spectrum of (1) social media–related challenges to medical professionalism and (2) social media–related opportunities to either undermine or improve medical professionalism. The aim of this systematic qualitative review is to present this spectrum.

Literature Search and Eligibility Criteria

In December 2011, we searched PubMed with the following terms: “social media” OR “social networking” OR “digital age” OR “blogging” [Majr] OR “facebook” OR “twitter” OR “tweet” OR “youtube” OR “Web 2.0”. The search was restricted to English or German language papers. Publications before 2002 were excluded because all major social media platforms were founded after 2002: MySpace was founded in 2003 [18], Facebook in 2004 [19], and Twitter in 2006 [20]. We included publications focusing on the use of social media by health professionals, challenges imposed on health professionals by social media use, and ethical considerations concerning the relationship between patients and health professionals in the Internet era. We excluded publications focusing on eHealth/telemedicine, addiction, and other psychiatric issues related to social media, and advertising or marketing. See Figure 1.

[view this figure]Figure 1. Flowchart illustrating identified references.

Extraction and Categorization of Social Media–Related Opportunities and Challenges for Medical Professionalism

Our aim was to develop a qualitative framework of narrow and broad categories of social media–related opportunities and challenges for medical professionalism that best accommodated the opportunities and challenges mentioned in the included publications.


To operationalize “medical professionalism”, we referred to the 10 commitments/professional responsibilities presented in the physicians’ charter, “Medical professionalism in the new millennium” published by the ABIM Foundation, the ACP-ASIM Foundation, and the European Federation of Internal Medicine. To our knowledge, the physicians’ charter is the most widely accepted and most often cited framework for medical professionalism. It has been endorsed by over 90 professional societies worldwide. Since its publication in 2002 in several journals, it has been cited more than 900 times (as assessed by Scopus). The 10 commitments are (1) professional competence, (2) honesty with patients, (3) patient confidentiality, (4) maintaining appropriate relations with patients, (5) improving quality of care, (6) improving access to care, (7) a just distribution of finite resources, (8) scientific knowledge, (9) maintaining trust by managing conflicts of interest, and (10) professional responsibilities.


We employed the 10 commitments of medical professionalism as our matrix to guide the identification of text passages that mention social media–related opportunities or challenges for medical professionalism. Mentions of such opportunities and challenges in different papers were compared. Broad and narrow categories were developed for similar mentions of opportunities and challenges. According to our matrix, these broad and narrow categories were grouped under the 10 commitments.


To ensure the validity of coding as well as intercoder reliability, we employed the following procedure: 3 authors (FG, VW, DS) identified and initially categorized opportunities and challenges (based on the above described extraction matrix) independently in a subsample of 5 publications. The authors discussed whether paragraphs mentioned opportunities and challenges and how they should be categorized. The remaining 103 publications were grouped in three clusters of 60, 23, and 20 publications. One author (FG) with an MD degree then extracted and categorized social media-related opportunities and challenges from this first cluster of publications. The result was a first version of the spectrum of social media-related opportunities and challenges grouped under the 10 commitments. The second and third clusters of references were then used to check theoretical saturation of the spectrum. Theoretical saturation means that no new categories can be generated [21]. Once theoretical saturation was reached for broad categories, the other authors (DS, VW), with professional backgrounds in bioethics, clinical psychiatry, internal medicine, philosophy, and health services research, checked the extraction and categorization of opportunities and challenges in a random sample of 25 publications. Coding problems were resolved by frequent meetings and discussions between all authors.


From 1471 initial hits in PubMed, we finally included 108 in this review. The 108 references consist of 46 original research studies and 62 commentaries, editorials, and opinion papers. The majority are from the United States (79 publications), followed by 15 from the United Kingdom. Other papers come from Canada (5 publications), Ireland (3 publications), Australia (2 publications), and Germany, Peru, France, and New Zealand (1 publication each). The sample consists of one article published in 2006, three in 2008, 13 in 2009, 21 in 2010, and 70 articles in 2011.


We identified 23 broad and 12 further-specified narrow categories for social media–related opportunities (n=10) and challenges (n=13) for medical professionalism, grouped under the 10 commitments of the physicians’ charter.

For example, for the first commitment “professional competence”, we identified four broad categories for opportunities (A-D) and one broad category for a challenge (E): (A) Employing social media as a tool for improved information sharing, (B) Increasing the involvement by doctors in under-served areas, (C) Committing to life-long learning supported by the use of social media, (D) Mentoring student’s reasonable engagement in social media, and (E) Ensuring evidence-based Continuing Medical Education in the environment of social media. Some of these broad categories are specialized into more narrow categories. For example, the broad category (A) Employing Social Media as a tool for improved information sharing was specified into five narrow categories: (A1) Fast and boundless dissemination of news and experience, (A2) Collaboration on challenging cases, (A3) Improving access to and benefits of conferences and news exchange, (A4) Sharing information on physician-only social media sites, and (A5) Accessing news/information from professional organizations. One of many original text passages extracted from the narrow category (A1) is “With Internet-based tools, physicians are no longer limited by geography, specialty, and time zone in their attempts to connect, engage, and learn from each other” [22]. For technical reasons and for didactic purposes, we restrict our presentation to one exemplary text passage for each of the 33 narrow categories (see Multimedia Appendix 1 for these findings; [4,9,14,22-41]).

Principal Findings

This systematic qualitative review presents the full spectrum of social media–related opportunities and challenges for medical professionalism as they are currently discussed in original research studies, commentaries, editorials, or opinion papers published in scientific journals listed in PubMed. Thereby it builds a unique source of knowledge that can inform further research and policy development in the intersection of social media and medical professionalism.

The need for policies on the use of social media by medical professionals, trainees, and students has already been addressed by some universities [42] and also by institutions such as the AMA [43]. The AMA policy “Medical professionalism in the digital age”, which was adopted in November 2010, presents general recommendations. It encourages the medical practitioner to “weigh a number of considerations” when it comes to social media. The gist of the policy is to preserve patient privacy and confidentiality in all environments, to avoid excessive self-disclosure by using adequate privacy settings, being aware that they are not absolute, and routinely monitoring one’s online presence. It stresses the necessity of maintaining appropriate patient/physician boundaries, and in doing so to consider the separation of professional and personal online content. The policy tries to raise awareness of the professional’s responsibility to bring posted unprofessional content to the attention of the individual in question or to inform appropriate authorities, as those failures may affect the medical professional’s reputation among patients and colleagues and may undermine public trust. Even though the above-mentioned issues (which almost all describe challenges) are important, the AMA policy neither illustrates a more differentiated view of social media-related challenges, nor does it acknowledge social media-related opportunities and the need to address them appropriately. Such opportunities include, for instance, improvement in sharing information, access to care, and quality of care, etc [43] (see Multimedia Appendix 1).


The University of Florida, for example, recognizes the relevance of social media as a current form of communication. However, it also focuses on challenges and distinguishes “strictly forbidden” from “strongly discouraged” online interactions, which could be the basis for disciplinary actions. Violating patient confidentiality, reporting private academic information, and neglecting official work commitments when interacting online are strictly forbidden actions. Strongly discouraged actions include use of vulgar language, implying disrespect for any individual due to age, race, gender, etc, presentation of alcohol misuse, substance abuse, sexual promiscuity, and posting unflattering material on another individual’s website. The policy tries to raise awareness that a mature, responsible, and professional attitude should also be displayed when interacting online privately and to think twice before posting any material because online privacy measures might be unreliable [44].


Although it is a laudable first step that both the AMA policy and the University of Florida policy explicitly address some social media–related challenges for medical professionalism, in their current version they address neither the full spectrum of challenges nor any of the social media–related opportunities (see Multimedia Appendix 1). In general, social media–related challenges are more frequently discussed in the reviewed publications than social media–related opportunities. But as the relevance of social media might further increase, there is an ongoing demand for a critical and constructive discussion about, and guidelines/recommendations on, how to best possibly address the multifaceted spectrum of challenges and opportunities.


Particularly among medical students and young professionals on the one hand and educators and practicing physicians on the other, there may be a different attitude towards the use of social media. Prensky introduced the distinction of digital natives and digital immigrants that is often referred to in today’s debate on online medical professionalism [23,45]. Current trainees and medical students born after 1980 are considered as digital natives, as they grew up in a world where using technology (eg, computers, the Internet, text messaging, blogging, and SMS text messaging) was already integrated within their education, patterns of establishing/maintaining relationships, and means of self-expression. Older faculty who completed their training before 1980 are considered digital immigrants because a good number of them experience a challenge to continually adopt to the particularities of the digital age with which their students are likely more familiar [23]. However, a sharp distinction between digital natives and digital immigrants might blur in the near future, and further distinctions across digital natives might occur. We have, for example, anecdotal evidence that some current medical students do not understand how to use email for personal communication due to unfamiliarity; instead they try to use it as if it were Facebook or Twitter.


In addition, professionalism is acquired over time and is best learned within the practice community and specifically through observation of role models [46]. However, mentoring and observation of role models as a vital component of developing professionalism might face difficulties in the digital age, with different generations of physicians practicing in parallel [23]. This particular situation further favors policies that capture the broad spectrum of challenges and opportunities for medical professionalism with respect to social media.


There are some limitations to our review: we screened only contributions published (in different types of publications) in scientific journals listed in PubMed. Only German and English publications were considered. Only publications after 2002 were included, due to the fact that all major social media platforms were founded after the year 2002 [18-20]. While our search revealed 1471 references listed in PubMed for the years 2002-2011, another 982 references are listed in PubMed in 2012 that could not be included in this review. Because our review already included more than 100 references published in journals from various subspecialties and because we reached theoretical saturation for our broad categories of opportunities and challenges, we felt justified in limiting our review to the described literature search.

Because the findings of our review are purely descriptive and we did not provide additional normative analysis to each of the identified challenges and opportunities, we refrain from concluding on how these challenges and opportunities should be best addressed in medical practice. However, the recently published position paper by the American College of Physicians and the Federation of State Medical Board presents several distinguished implications of online activities for patients, physicians, and the medical profession and provides recommendations on how to avoid potential pitfalls while best using social media technologies [17]. Also, other in-depth analyses result in specific suggestions on how to deal with social media-related challenges and opportunities [16,47]. However, none of the above mentioned policy and recommendation papers refer to a systematicially and transparently derived account of challenges and opportunities.


The integration of traditional core values of medicine (privacy, confidentiality, one-on-one interactions, and formal conduct) and the culture of social media (which tends to value sharing and openness, connection, transparency, and informality) present opportunities as well as challenges for medical professionalism [24]. As a profession that is entitled to self-regulation, health care professionals should proactively approach these challenges and make use of the opportunities. There should be room for fostering interprofessional and intergenerational dialogue (eg, digital natives/digital immigrants). There is a further demand for research and policy development to integrate the broad spectrum of social media’s opportunities and challenges into the current existing frameworks for medical professionalism. This review builds a unique source of information that can inform further research and policy development in this regard.

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Getting Started Guide: Social Media for Primary Health Centers

Getting Started Guide: Social Media for Primary Health Centers | Social Media and Healthcare |

Social media platforms have given organisations and individuals the opportunity to communicate, engage with others and build on-line communities in a way they have never been able to before. Social media is here to stay and its use and reach is growing exponentially.

This Guide identifies how social media can be used by the primary health care community to communicate, build networks, collaborate with others and access research and primary health care information. It also defines the major social media platforms available and their uses.



The primary health care community is able to consume, share, comment on and debate content with existing and potential stakeholders using social media and the benefits are best described as the five C’s of social media.


  1. Connect - Connect with others in your community, often in real time.

  2. Communicate - Through social media platforms, primary health care professionals and researchers can communicate with an online community and share health promotion messages and information.

  3. Collaborate – Social media allows for the establishment of a network or online community of global stakeholders and to share ideas, collaborate and develop alliances.

  4. Consume – By joining a social media community, the primary health care community has access to that community’s latest research information.

  5. Converse – Unlike traditional media which is a one-way channel of communication, social media allows for two-way conversations and knowledge exchange between members of a social group.




Social networking - A social networking service is a platform to build social networks or social relations among people who share interests, activities, backgrounds or real-life connections.  ( eg: Facebook


Social bookmarking - Social bookmarking sites allow users to store, tag, organise, share and search for bookmarks or links to resources online. (Social Media: A guide for researchers, Research Information Network)


Blog - A blog is an information site published on the internet that presents a mix of opinion, news and other types of content. eg: Croakey – the Crikey health blog


Microblogging - Microblogging is a broadcast medium in the form of blogging.  A microblog differs from a traditional blog in that its content is typically smaller and allow users to exchange small elements of content such as short sentences, individual images or video links.( eg: Twitter


Wiki – A wiki is a collaborative website whose content can be edited by anyone who has access to it.  They can be used as a source for obtaining information and knowledge and also as a method of virtual collaboration. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education. Eg A-Z of social media




Social media can be used by the public, patients and health professionals to communicate about health issues with the aim of potentially improving health outcomes.  Social media is a powerful tool which offers collaboration between users and is a social interaction mechanism for individuals.  Although there are several benefits to the use of social media in the primary health care context, the information exchanged needs to be monitored for quality and reliability and the users’ confidentiality and privacy need to be maintained.


The main uses of social media for health communication focus on increasing interaction with others and facilitating, sharing and obtaining health messages. A new dimension of health care: a systematic review of the uses, benefits and limitations of social media for health communication.


The most commonly used platforms and a great place to get started include those listed below.


 Twitter is an online social networking and microblogging service that enables its users to send and read text-based messages of just 140 characters, known as tweets. (  Tweets can be linked to websites, photographs and videos.  Primary health care organisations and professionals can use Twitter and develop an online community by following others on Twitter with whom who they want to engage and follow.


 Facebook is a social networking platform that allows users to create a profile, share information, upload photos and videos and send messages. Users invite friends, family and colleagues to become their Facebook friends and thereby share information on their Facebook profile. 


 LinkedIn is a professional networking platform where members establish a profile, connect with colleagues and other professionals and gain access to information about jobs, research grants, opportunities for collaboration, news and updates.


 YouTube allows people to share and watch videos. It provides a forum for people to connect, inform, and inspire others across the globe and acts as a distribution platform for original content creators and advertisers.


 Pinterest is a pinboard-style photo-sharing website that allows users to create and share theme-based image collections such as research posters or events.



A guide to using Twitter in university research, teaching, and impact activities. LSE Public Policy Group, 2011, Amy Mollett, Danielle Moran and Patrick Dunleavy 
This guide available for download as a PDF answers how Twitter, which limits users to 140 characters per tweet can have relevance to universities and academia.


Ethical issues in using social media for health and health care research Institute for Social Change, University of Manchester, 2013, Rebecca McKee 
The ethical issues of using social media to disseminate health research information.


Social Media: A guide for researchers,Research Information Network 2011, 
Social media for research and academic purposes and how media can help researchers find, use and disseminate information.


The Sociological Life: Social media for academia: some things I have learnt, 2013, Deborah Lupton 
A personal experiment of what can be achieved through social media.



Innovative Social Media Health World 
Illustrative examples of how others are using social media to engage in health research, health policy and clinical practice
Richard Smith: 10 tips on using and enjoying social media, BMJ Publishing Group 2013.
10 tips on using social media from a workshop developed for students


A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication
Moorhead SA, Hazlett DE, Harrison L, Carroll JK, Irwin A, Hoving C
J Med Internet Res. 2013 Apr 23;15(4):e85.
How to prepare for and establish a social media presence
This article explores the importance of establishing a digital presence for healthcare professionals and how to go about it.


Social networks, social media and social diseases
This article offers a description of several current uses of social media in health care and also describes how our understanding of social networks and media could be harnessed for treating socially shaped diseases.


20 Stunning Social Media Statistics, Jeffbullas’s Blog, 2013 
An article and infographic on global use of social media


eGovernment Resource Centre – State Government of Victoria 
The Victorian eGovernment Resource Centre with articles and resources about how to develop a social media strategy, plans and social media marketing in general.


Bit Rebels - 5 Effective Social Media Strategies 
An article and infographic on how to be successful with social media


Social Business, IBM 
A study of how to and why an organisation should become a social business


Related resources on the PHC RIS website


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Overcoming Social Media's Challenges for Medical and Pharma Product Makers

Overcoming Social Media's Challenges for Medical and Pharma Product Makers | Social Media and Healthcare |

The primary challenges with adopting social media for makers of prescription products are operational. Though much is made of the absence of an explicit Food and Drug Administration guidance on social media, we know the answer to most of the questions about the regulatory requirements for social media activity. 

Making claims about a product’s benefits requires providing appropriate risk information to ensure that the claim is balanced regardless of where the claim is made – be it on Twitter, YouTube, a television commercial, or a print ad. Using the brand name requires the use of the generic name with no intervening matter, regardless of how long the brand name or generic names are or how space-limited the context. There certainly are issues that FDA guidance could address, but no further FDA guidance is likely to change these and other basic parameters.


The operational issues, however, present a different set of obstacles to marketers of prescription products. Those issues can be addressed, and makers of prescription products can engage in social media compliantly and effectively, but first they have to understand the challenges.


What are the unique challenges of social media? Three lead the list:

1. Adverse event reporting

2. Responsiveness

3. FDA filing requirements


One of the five questions from the 2009 FDA hearings on social media was about adverse event reporting and how sponsors should address any Adverse Events (AEs) they come across in social media. While waiting for the FDA to deliver guidance on this issue, industry has already adopted a position. It reports adverse events that meet FDA’s definition of a reportable event, and it does so regardless of the medium where those events are uncovered. Social media is being treated as just another medium and companies have adapted their AE reporting processes to accept social media incidents. Vendors who engage in social media listening and other activities are regularly trained on a company’s AE reporting requirements. 


This has proven far less apocalyptic than some feared. The incidence of AEs in social media has been far greater than a few well-known analyses predicted, but companies actively engaged in social media have not been overwhelmed. No company has yet withdrawn a social media initiative because of an excessive volume of AE reports.


The second and the third issues are closely connected. Expectations in social media are not set primarily by the makers of prescription products. The expectations for how any company, regardless of industry, will engage socially are being set by Comcast, Delta, General Motors, American Express, and other highly social enterprises. A consumer who mentions a delayed flight on their Twitter feed has become accustomed to receiving a response from the airline in minutes, and consumers expect the same from companies that make pharmaceuticals and other prescription products.


That level of responsiveness can be difficult and the idea of generating a custom response to a social media post can seem daunting. Just getting the response through the medical-legal-regulatory promotional materials review process can take several days (or weeks), and when a product is discussed the response has to be sent to the FDA before use. 


Marketers already know how to deal with these challenges in their non-social media activity. Many of those interactions are scripted with a variety of appropriate responses approved and submitted to the FDA well in advance. By thinking through the most likely scenarios, developing the appropriate possible responses, and establishing a decision procedure for choosing among the options, marketers will be able to provide the same level of responsiveness as other, less regulated industries.


Understanding the challenges of social media enables marketers to overcome them and provide information to people in the channels they prefer. As social media’s importance continues to grow, makers of prescription products need to adopt these same channels and do so compliantly. Otherwise, they face the far greater risk of becoming irrelevant to people’s health discussion.

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Social Media and the Empowering of Opponents of Medical Technologies: The Case of Anti-Vaccinationism

Social Media and the Empowering of Opponents of Medical Technologies: The Case of Anti-Vaccinationism | Social Media and Healthcare |

Social media has been defined as “a group of Internet-based applications that…allow the creation and exchange of user generated content” [1]. These platforms range from social networking sites such as Facebook, to content sharing sites such as YouTube and Picasa, and even to interactive virtual worlds such as Second Life and World of Warcraft. Rapidly increasing in popularity and influence, social media presents a double-edged sword for proponents of medical technologies. On one hand, social media has transformed how companies communicate with potential consumers of medical pharmaceuticals and technologies.


Both consumers and producers have a range of novel communication channels available to them that can rapidly match consumer interests and needs with available products and services. Social media platforms provide companies with new communication channels, relatively inexpensive and targeted advertising opportunities, and a consumer-mediated information stream that could potentially improve consumers’ trust in information and brand loyalty to companies through information shared online. Social media has also given consumers communications tools that enable them to rapidly seek health information, share medical advice, directly manage health conditions, and benefit from, and contribute to, a community discourse by rating, ranking, and describing experiences with medical products. These applications have been developed partly in response to a shift in how consumers see their role in managing their health in an increasingly complex and patient-oriented medical system [2-4].


However, along with these opportunities for empowering both health consumers and producers alike comes potential peril [5]. Social media activities have raised alarms in the medical research community over companies having more effective tools to directly market health products to consumers—an activity regulated in most jurisdictions outside the United States [6,7]. The direct marketing of pharmaceuticals, procedures, devices, and medical tests to consumers is thought to lead to overconsumption or inappropriate consumption of medical technologies [8,9]. Conversely, social media also presents new opportunities for opposition to medical technologies, most notably for those that raise the ire or concern of some citizens, such as religious opposition to stem cell or novel fertility technologies. Social media provides a new platform for these individuals to organize, communicate, and undermine industry messages. It allows these individuals to circumvent traditional communication mechanisms and therefore does not require their messages to be either acceptable or relevant to mainstream broadcasters. It thus permits a minority of motivated individuals to potentially control the discourse and, at times, contribute to the spread of misinformation, damaging an otherwise useful interaction between proponents and consumers. An example of where this disruptive new media has been particularly problematic, and which offers cautionary messages to advocates of other technologies, is in the field of immunization. We have been studying this phenomenon and provide a summary of our experiences and lessons for advocates of new and existing technologies.

Social Media and the Anti-Vaccination Movement

Anti-vaccinationism has existed since the introduction of the first vaccine. Individuals who have alternate belief systems have mobilized, typically geographically, to communicate their concerns. This has led to sporadic vaccine rejection movements. More recently, the claim that the MMR (measles-mumps-rubella) vaccine or thimerosal containing vaccines are associated with autism continues to persist despite numerous studies refuting the link [10]. This rumor, largely initiated by a since-withdrawn paper in the Lancet, has resulted in vaccine rejection and contributed to over 26,000 cases of measles in Europe in 2011 [11,12].


What is social media’s role in all of this? Traditionally, geographic proximity was necessary for mobilizing anti-vaccination forces. However, social media has circumvented this potential barrier, allowing individuals from disparate regions who likely would not have otherwise communicated to come into contact. In this process, individuals who had otherwise had their viewpoints rejected and been marginalized can be emboldened and can feel empowered. Social media also provides these individuals with new dynamic mechanisms to communicate their viewpoints. We observed this in several ways while studying vaccine concerns. We first observed the congregation of anti-vaccination viewpoints on YouTube [13]. Individuals utilized YouTube to upload videos that highlighted vaccine concerns and commented on each other’s videos in a quasi social-network manner. Our observation was reinforced by the fact that anti-vaccination videos had more views and higher ratings than pro-vaccine videos. We observed similar vaccine concerns on the social media site MySpace when studying postings related to the HPV vaccine [14]. Examining these blogs revealed geographical clustering of anxiety—with Texas’ attempt to make the HPV vaccine mandatory leading to a plethora of anti-HPV vaccine blogs in that state. Our assessment of the blogging sentiments also revealed potential future challenges in having boys accept the vaccine given that boys’ blogs were determined to be more negative. We even observed organized anti-vaccine behavior when we surveyed health communications in the virtual world Second Life [15] (see Figure 1 for a screen capture showing the Vaccine 911 auditorium; Vaccine 911 is a vaccine critical organization that presents weekly lectures on immunization in Second Life).


As can be surmised, these pernicious activities can pose a real threat to mainstream messaging. If vaccination, one of the most important mechanisms for reducing mortality and morbidity where all established sources of information support the practice, can be undermined by social media activities, more novel technologies are at real risk of being similarly undermined [16]. Other examples of where traditional health messages have been undermined using social media include the promotion of anorexia and the spread of misinformation pertaining to rheumatoid arthritis [17,18].


[view this figure]Figure 1. Screen capture from the Second Life Site of the Vaccine 911 auditorium: The Iowa Wellness and Spinal Tuning Center (SLurl 163,122,28; Image taken Dec 15, 2008).



What strategies should advocates of medical technologies employ to combat the social mobilization of opposition to their products derived from marginalized opinions, hearsay, and inaccurate representation of the science involved? Here are a few recommendations stemming from our observations.

Social Media Monitoring

This is now an established part of marketing strategies. Numerous services are available to track online comments and social media activity about a new product and also to analyze sentiment, providing businesses with an opportunity to interact with customers, and to potentially intervene and prevent viral marketing campaigns by responding rapidly to customer concerns [19]. This is a necessary first step for any pre-emption efforts. Moving beyond social media monitoring, advocates of medical technologies may also want to consider monitoring search behavior related to their products. In health, search term surveillance has shown promise in identifying behavior patterns and anticipating disease outbreaks [20].

Be Where the Conversation Is

The US Centers for Disease Control and Prevention has made it part of their outreach mandate to master the various social media platforms so that, as much as possible, they can deliver scientifically accurate and appropriate content at the point when a consumer is seeking information, either via a Google keyword search, blogging on Facebook, watching videos on YouTube, or scanning related news items [21].

Interacting Through Social Media

This is a delicate task that needs to be approached with caution. When exploring social media contact, proponents of medical products may encounter a lot of negative sentiment. However, responding to the sentiments may simply provide a platform and greater audience for the more extreme viewpoints. Proponents of medical products need to recognize that opposition to their products will lie along a spectrum. There will be those who are ideologically opposed, and no effort to persuade them will be successful and will likely only intensify their opposition. We observed this when studying anti-vaccination attitudes and found that individuals often frequent social media sites to hear like-minded viewpoints and are not interested in hearing alternate viewpoints [13]. While vaccination may be a somewhat extreme example given the intensity of rhetoric that characterizes the discussions, nanotechnology, stem cells, and reproductive technologies could also create similar opposition. Proponents of medical technologies need to recognize that their target is the ambivalent individual. An individual who has no strongly held opinion and is susceptible to influence by a persuasive argument or an argument that resonates with a strong pre-existing belief system they hold (for example religious/political views). This leads to our fourth recommendation.

Recognizing the Power of Social Media

While some of the more radical viewpoints on social media may seem bizarre, dismissing the overall sentiments on social media would be a mistake. Public figures may champion these viewpoints (Jenny McCarthy on vaccines and Prince Charles on nanotechnology) giving the viewpoints’ credibility among more moderate participants. Further, heavy-handed tactics by proponents of new technology may backfire because of the ability to create opposition through social media. Finally, and perhaps most importantly, there may be a basis of truth to the concerns voiced on social media sites. Proponents of medical products would be well served to listen to this discourse, ignore the extreme contributors, and prepare to address the concerns of the more moderate contributors. Companies that respectfully acknowledge these concerns and respond with clear actions, demonstrating that these concerns are being listened to, will build trust in their products. In contrast, companies ignoring the media and its messages will do so at their own peril.

Social media has been described as a game changer and proponents of medical products will have to develop mechanisms to understand and manage its influence. In many ways, social media has been beneficial, serving to improve the interaction between proponents of products and the public, in addition to providing members of the public an opportunity to provide valid criticism. However, the risk of discourse being hijacked by an extreme minority can be destructive to the relationship between producer and consumer. Ours are but a few of the suggestions to guide proponents of medical technologies as they navigate this new media and its impact.

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How is Digital & Social Media changing Medical Journal Publishing?

How is Digital & Social Media changing Medical Journal Publishing? | Social Media and Healthcare |

Last night, when I was searching online for an article published in the Journal of American Medical Association (JAMA), a message popped up on my screen, asking if I would like to install an app called “The JAMA Network Reader“ in my Google Chrome browser. Out of curiosity, I downloaded the app and set up an online account. I was immediately impressed by the app: it has incorporated content from 10 JAMA journals, highlighting “Online First” articles and including links to all articles in current issues.  The intuitive web-based digital platform is easy to navigate with a clean and modern design. Other helpful features include “Offline Library” and “Bookmarks.” Like Amazon’s Kindle, the app even allows you to adjust font size instantly.  I was surprised the well-designed app was developed by a medical journal publisher.

The design of JAMA Reader is sleek and intuitive

The content of medical journals (data and science-heavy) and their primary readers (physicians) did not traditionally fit into the digital media world–we would never expect articles in the New England Journal of Medicine to be written in the same way as Buzzfeed viral stories. However, in the last couple of years, there have been some gradual but major changes driven by digital technologies and social media in the medical journal publishing industry.

Besides JAMA, several other medical journal publishers have taken the advantage of digital technologies and social media to leverage user experience and content sharing. For example, NEJM has established a comprehensive online presence, from Facebook pageFacebook appTwitter handleemail alerts tomobile apps. And the uptake has been high. The NEJM Photo Challenge Facebook app has more than 8,900 active monthly users. NEJM’s Facebook page has more than 430,000 subscribers and its Twitter handle has more than 129,000 followers.

In addition to efforts in digital and social media, the open access movement has gained momentum in medical journal publishing as well. PLOS, a peer-reviewed, open access medical journal online publishing platform challenges the traditional process of science data publishing, attracting much attention from the research community. Now the non-profit organization has seven journals and five blogs, accumulating more than 53 million page views, 12 million article downloads and 145,000 cross citations.  Other organizations have also announced plans to join the movement–the Infectious Diseases Society of America announced this year that it will launch Open Forum Infectious Diseases, another open access online journal in the first quarter of 2014.

Open access movement is changing the landscape of medical journal publishing.

As the health care landscape continues to evolve, these changes are inevitable for the medical journal publishing industry.

Physicians, the biggest clientele of medical journals are rapidly adopting digital, social media and mobile. According to a Google/Manhattan Research published last year, when making clinical decisions, U.S. physicians spend twice as much time using online resources compared to print. 87 percent surveyed physicians use a smartphone or a tablet in their practice. The increasing demand for digital and mobile-friendly content requires medical journal publishers to build robust online platforms and create more engaging content.

The culture of medical research is also shifting as big data, open access movement and social media lowered the threshold to enter the medical research conversations. Collaboration among different industries and business functions are reshaping medical research and drug development, which forces publishers to adapt to the new reality by embracing emerging communication channels, facilitating a quicker and streamlined publishing process and expanding data/content access to a larger audience.

Together, these efforts are changing how medical research information are being distributed and received: data will be more accessible and sharable; jargon-filled journal articles will be easier to understand and more fun to read; more people from outside of medicine will participate in and contribute to conversations around medical research. The bottom line is that these changes can lead to higher efficiency in knowledge sharing and innovation, something the medical research community has been searching for a long time.

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More Hospitals' focusing on the Wrong Agenda for Social Media

More Hospitals' focusing on the Wrong Agenda for Social Media | Social Media and Healthcare |

Picture this: Mary has been sitting in a hospital bed all morning struggling to cope with her recent medical diagnosis. Looking for a way to interact with other residents in her situation, she clicks on the hospital’s Facebook page. All she sees on the group’s newsfeed, however, is a history of interactions between employees and hospital achievements.

There is no mention of the group yoga session set to occur at noon. There are no subgroups where patients can connect with one another. Instead, the only thing that the patient sees is a string of comments on the recent employee of the month, and a group vote asking what to order for lunch on Friday.

According to a recent study, customer interaction in the healthcare sector is suffering on social media. Hospitals are increasingly focusing on promoting internal dialogue through social media at the expense of patients’ interests. In fact, the report indicated that only one quarter of all posts observed in the study were patient-focused. This is extremely detrimental to the growth of organic user generated content. 

“We find that if a hospital devotes its postings towards client-specific communications, then active social media management can still lead to incremental user-generated content, which is a function of the number of clients,” the study says. “However, most hospitals do not do this. Instead, more of their postings are devoted to either generic observations or to employee-related issues and achievements. Such content appears to inspire primarily the employees at the organization to respond, rather than clients.”

In the healthcare industry, patient outreach is a crucial method of preventing those who are sick from feeling like customers in line.  Right now, however, only 18 percent of hospitals actively manage their Facebook accounts.

In a setting such as a hospital, customer interests have to come first. As it was proven in a 2012 Global Consumers Survey, one in five customers switched providers in 2012 based on a negative customer service experience. Focusing on employee interests or organizational gains via social media does nothing to help those who are actually in need.

 Likewise, prospective patients will look at social media pages as a means of gauging the level of care they are to receive. In fact, 90 percent of adults between the ages of 18-24 claim that they would trust medical information from peers across a social media network. Further, 41 percent of people claim that social media would play a role in choosing a healthcare provider.

Failing to cater to this demographic could be detrimental to a hospital’s marketing strategy. By keeping the conversation focused on patients, however, this could be avoided. At the end of the day, nobody likes to hear an organization talk about itself excessively.

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Can A Hashtag Change Healthcare? The Impact of Healthcare Tweet Chats

Can A Hashtag Change Healthcare? The Impact of Healthcare Tweet Chats | Social Media and Healthcare |

The first time I read this quote from Dana Lewis, moderator of #hcsm the premier tweet chat on healthcare, I was gripped by the notion of how Twitter and in particular tweet chats could influence the way we practise healthcare.

Social media is a radical shift in the way we communicate. The healthcare conversation is no longer a one-way narrative but is evolving into a global, participatory discussion. One of the most powerful ways I see this happening is in the modality of the tweet chat. The role Twitter plays in breaking down patient/provider barriers, disseminating and expanding the reach of healthcare information, widening social networks and co-creating a collaborative model of shared health information is one of the most exciting developments in social media.

What Is A Tweet Chat?

For those who may be unfamiliar with the phenomenon of a tweet chat – it is a pre-arranged chat that happens on Twitter through the use of updates called tweets. It includes a predefined #hashtag which links the tweets together in a virtual conversation. Most tweet chats follow a common format of a moderator who introduces pre-arranged topics relevant to the chat and keeps the conversation on track. The chats usually last one hour and a transcript of tweets is available after the chat has ended.

Symplur is doing an impressive job of compiling all of the healthcare hashtags and providing chat transcripts in The Healthcare Hashtag Project. The goal of the project is to make the use of healthcare social media and Twitter more accessible for the healthcare community as a whole (a full list and a tweet chat calendar of meeting times can be found on the Symplur website).

What Is The Impact Of Tweet Chats On Healthcare?

As a relatively new technological innovation, the use of Twitter as a modality for health communication is only now beginning to be explored with particular emphasis on the role Twitter may play in contributing to health based conversations directed at individual, community, and societal levels.

Many times, people’s choices in terms of Personal Health Practices (PHP) are context dependent and socially constructed. Healthcare tweet chats have tremendous potential to motivate participants and encourage change. Much of this change comes from peer-to-peer support which has been shown to be highly effective in motivating change. Many participants share conversational and informational knowledge that they believe is valuable both to themselves and others.

Tweet from participant in the #BCCEU (Breast Cancer Social Media Europe) tweet chat

Studies show that individuals enrolled in meaningful social networks have protective properties in terms of overall health and wellbeing. Healthcare tweet chats provide participants with a sense of community and valuable opportunities for meaningful exchange and positive interactions.

The impact of digital technology in healthcare is leading to changing expectations by health consumers who, along with a desire to share information and connect with others, increasingly want to interact and engage with their healthcare providers. Twitter has also facilitated the emergence of  the “patient opinion leader” an individual who is seen as an expert in chronic conditions such as cancer.  Gunther Eysenbach refers to this group as “Apomediaries” – individuals that assist in the process of information searching but do not act as a gatekeeper.

So, what’s in it for healthcare practitioners?

Dr Bryan Vartabedian (@Doctor_V) of Baylor College notes of social media ”the greatest value of this medium is the breakdown of barriers that have traditionally come between doctor and patient.” It is encouraging to see the increasing participation by doctors in many healthcare tweet chats, reaching out and sharing information, but also listening too.

Twitter offers opportunities for healthcare to reach out to patients in new and valuable ways.

These [social media] tools help us reach so many more people; we can bring shared interactions into our practice and that is powerful … This isn’t an addition to your job. This is part of your job.  This is a conversation, and that is what we are trained to do … This is where our patients are these days and this is where we need to reach them. We can engage learners, patients and peers, and we are not limited by geography or time – Farris Timimi, M.D., medical director for the Mayo Clinic Center for Social  Media.

Another striking feature is Twitter’s crowd-sourcing capacity which allows health consumers, researchers and practitioners tap into a global source of advice, support and information. Twitter also provides a unique opportunity to learn from patients’ direct experience shared during these chats.

If healthcare innovators and providers wish to remain relevant and connected to digitally enabled patients, they need to go where the conversations are – more and more those conversations are happening on Twitter and the evolving dynamic of the tweet chat is the best place to find them.


Eysenbach, G. (2008). Medicine 2.0: Social networking, collaboration, participation, apomediation, and openness. Journal of Medical Internet Research10(3), e22. doi:10.2196/jmir.1030

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Digital Profile Management tips for the Modern Doctor

Digital Profile Management tips for the Modern Doctor | Social Media and Healthcare |

A patient complained about a doctor on Facebook and generated a lot of online traffic. The story was reported in the newspapers. The Medical Board started an investigation. Pending the outcome the doctor relocated to another city. This left the local community without a doctor as no replacement could be found.

Reputation management should be part of a professional risk management strategy.

A year later the doctor’s name was cleared by the board. But the damage was done. And for many years the article kept showing up in Google search results in relation to the doctor as well as her old practice.

The good news is that I made this scenario up. The bad news: reputation damage can happen to all of us. Pro-active online reputation management should be part of a healthy risk mitigation strategy.

Here are some simple (ethical) tricks I have used to manage my online reputation and improve my Google rankings. You can do it too, it’s easy. It is applicable to your personal brand (your name) as well as your organisation.

1. Always respond to customer needs and expectations

Prevention is better than cure. Our managers act on complaints immediately, as negative comments have the potential to spiral rapidly out of control, especially online. Here is an example of how not to handle a social media crisis.

Our quality assurance committee starts its meetings with a ‘good, bad and ugly’ review of the past month. The group looks at any problems or feedback received, including e.g. Facebook comments. We’re not perfect by any means, but this approach allows our organisation to improve patient services on an ongoing basis.

2. Create, promote, and update your own online content

Develop a professional website but don’t stop there! Start a Blog. Create social media profiles on LinkedIn, Twitter and Google+, and update your profiles regularly. This will improve search engine rankings so your own content will show up first. Use to find out which social networks are available.

3. Interconnect your online profiles

This will further improve rankings. Splash pages like help to connect your profiles in one place.

4. Encourage constructive criticism and respond timely to feedback

Engage when people post comments. Respond preferably on the same day. Look at feedback as free business advice. Thank the reviewer and explain your point of view. We have learned from the comments on our website and practice Facebook page.

5. Don’t argue online (and offline)

Set an example. Be a leader. I know this is not always easy, but an angry response is as bad as no response. Be aware that many clients are watching. Avoid deleting comments as this will usually not help your case.

6. Monitor the web

Google yourself and your organisation at least weekly. Set up Google alerts for your own name and other brands or topics you would like to follow. Free services like,, and can be helpful. There are lots of other tools to watch your web presence.

7. Correct and improve information on external sites

Most sites will update your details at no cost. Some sites like HealthEngine or HealthOptions Australia may have added your name and address but will only allow you to update details or improve your listing after paying a subscription fee.

If you feel a review about you or your organisation is incorrect or unfair ask the owner of the website to make amendments. If that’s not an option request to write a comment on the feedback. Google will only remove reviews if they contain unlawful content, are spam, off-topic or if there is a conflict of interest.

Google offers useful tips about how to respond to reviews.

8. Improve positive content, push down negative content

There are many reputation management services on the web. They improve rankings and make it harder for negative content to show up high in search results. is an excellent free reputation management tool to improve your personal search results. You need to have a social media profile and a website before you start.

9. Be ready to engage with traditional media

Have an official spokes person. Consider media training. I like to give journalists a written summary of the main message our organisation wants to bring across.

10. Know the rules

The Guidelines for advertising of regulated health services explain the advertising limitations under the ‘Health Practitioner Regulation National Law Act 2009’. The Good Medical Practice Code of Conduct of the Australian Medical Board includes principles about how to respond to complaints. If in doubt, ask your medical defence organisation.

Most social media networks, including Facebook have rules. This article is a great illustration: Kicked off Facebook? Here’s what happened. If you want to know how not to use social media – and stay out of trouble – have a look at the AMA social media guidelines.

Reputation management will take time and ongoing commitment. We’re improving our strategies all the time – learning from our mistakes. Let us know how you go! Tips are always welcome!

The information contained on this site is intended to support, not replace, discussion with your doctor or healthcare professionals. The contents of this post are the opinions of the author(s) and do not necessarily represent the views of the Panaceum Group. Blog content is copyrighted. Please read our disclaimer. Thanks for your visit!

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10 tips for Medical Device Companies using Social Media

10 tips for Medical Device Companies using Social Media | Social Media and Healthcare |

Doctors and patients are using social media, so it makes sense that medical device companies have a presence too. But jumping into social media should be done with eyes wide open. It requires commitment and diligence…and, doing it without understanding social media’s platform could hurt your brand.

Building relationships with your audiences requires taking a very different approach compared to traditional marketing. Traditional marketing is an outbound marketing initiative—your direct mail, print advertisements, TV ads, cold calls, etc. Social media marketing is an inbound marketing initiative—your website SEO, blogging, social media, etc. Relationship building means engaging with others.

With this in mind, here are 10 steps to better social media for medical device company owners and marketers.

  1. Listen. Before you even choose a name for your Facebook page, listen to the existing conversations of your audiences. Joining social media conversations is similar to approaching a group at a party. Etiquette keeps you from overtaking a conversation—stepping in to bark your opinion—without listening to what’s being said. So, don’t push messages at your audiences on social media platforms. The conversations are already happening. Listen to them.
  2. Create a Social Media Policy. Medical device companies live in a regulatory environment. To avoid a warning letter from the FDA, work with your legal counselor to create a Social Media Policy. According to DuVal & Associates Attorney Mark Gardner, social media is a useful but potentially dangerous medium. Understand the legal issues related to it and put an SOP in place for social media use that covers training for employees, monitoring of social media pages, when to turn comments on or off, and who actually posts and edits your social media messages.
  3. Be Strategic. Your social media strategy should meet a business goal and be integrated with existing marketing strategies. Define clear objectives for social media marketing. Create key messages and plan your content. Web 2.0 is broader than social media platforms. It includes your website, your mobile website, online public relations, online advertising, webinars, etc. Integrate your marketing across platforms.
  4. Optimize. Optimize. Optimize. Many medical device companies have not optimized their websites for being found on search engines. Optimizing your website is an important step in effective social media marketing. But you will also want to optimize your blog and Facebook posts, Tweets, YouTube and LinkedIn content.
  5. Engage with Visitors. According to Facebook, the top reasons people “like” a brand on Facebook is “to get the latest information,” followed closely by “to fully engage as a fan.” Social media is a two-way medium.
  6. Lead and Follow. Whatever social media platform on which you choose to participate, post information of value and pay attention to others on that platform. An example would be Twitter. Follow others—especially Twitter influencers—to hear conversations and lead with your own Tweets. Re-Tweet. Join the conversation.
  7. Be Easily Found. Make it easy for customers, patients, and doctors to engage with your company via social media platforms. If you have a Facebook page, use a Facebook widget on your website. Better yet, have a live stream of your latest Facebook posts with it.
  8. Don’t Wait for FDA. The FDA is not likely to come out with guidelines specific to social media any time soon. According to Gardner, the rules don’t change just because the medium is different. The same rules apply to social media as to all other labeling and advertising.
  9. Be Balanced and Transparent. Don’t make claims that are false or misleading or lack fair balance and remember that failure to present risk information may violate federal regulations. Choose your content wisely. Watch how you use Twitter, which limits your message to 140 characters. Be transparent. Avoid using links to risk information.
  10. Monitor Conversations. From a marketing perspective, you want to continue listening to conversations on social media platforms. But you’ll also want to pay attention to how information you post is re-used as you are responsible for what you post.

**BTW…Both articles are worth a read if you’re with a medical device company and interested in using social media: Thinking of Dipping Your Toes in Social Media? Medtronic is the Example to Follow andExpert Gives Medtronic’s Social Media Effort a Big A+, Patients are More Critical.

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How to cite a Tweet and other social media in a medical journal

How to cite a Tweet and other social media in a medical journal | Social Media and Healthcare |
Social media has blossomed recently as a repository for professionals to share ideas and thoughts. Many healthcare professionals follow journals, key individuals in their fields, and general users for the information they put out.

Often, these sources of information may take precedent over searching for information in the general news. In a way, this curated version of information is becoming very popular. With this in mind, now academics and others are considering how to use this information for research and writing purposes.

How does one cite a tweet, blog, or Youtube?

There has been a fair share of attention given to this. For instance, The Atlantic ran an article on it, and the education technology blog Edudemic has recently released an article as well. TeachBytes also created a great table (as seen below) to help users cite social media in APA and MLA style.

Social Media Citation Table attached

The one thing that this still does not answer and I have not found an answer for is how to cite Chain-Posts. This includes when a post (e.g. Tweet) runs over the word limit and has two or more parts. Do you cite both of then? The other issue, is how to cite a conversation, such as a TweetChat.
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Medicine & Social Media: Worktools for a Relationship in Progress

Medicine & Social Media: Worktools for a Relationship in Progress | Social Media and Healthcare |

As social media usage continues to expand beyond the personal realm, it’s not surprising that doctors are exploring its potential for enhancing their communication with patients. The business world’s increasing reliance on social media has naturally led physicians to consider whether it offers any advantages in improving care or strengthening their financial base. The American College of Physicians (ACP), the second-largest physicians’ group in the U.S., has given thought to the potential risks and benefits attached to doctors’ use of social media, and they have recently released a position paper detailing their recommendations.

Proceed with Caution

The press release summarizing this position paper strikes a cautionary note, and raises interesting new issues that many physicians and patients probably never previously contemplated: The ACP urges physicians to keep personal and professional profiles separate, and to avoid “liking” or friending patients. Communication with patients by text message regarding medical topics is likewise discouraged, except in cases in which the physician knows the patient well and has previously secured permission for this means of contact. Even email, while perhaps more secure than text message, must be used with great caution when communicating with patients.

The concerns voiced by ACP center on confidentiality and the risk of substituting online contact for in-person consultation. While the association recognizes the clear benefit of increasing physicians’ accessibility, it suggests that digital communication between doctor and patient be restricted to situations in which the online conversation is going to be followed up by an in-person office visit.

Not Yet the Norm

It’s worth noting that, while clearly expressing reservations, the ACP did not broadcast a blanket rejection of the idea of doctors and patients connecting via social media. The shape of internet conversation continues to evolve, and it’s obvious that in the near future, some form of social media contact between doctors and patients will become the norm. Given that fact, it’s important to have a look at the types of tools that are currently available to physicians.


Hootsuite has become one of the staple social media tools in one’s arsenal for B2B and B2C organizations alike — and healthcare is no different. More healthcare institutions, hospitals, group practices, and solo practitioners are utilizing Hootsuite for brand and patient engagement. One hospital utilized Hootsuite to “live tweet” during a surgical procedure to help educate their patients. A medical school in the Caribbean is using Hootsuite to aid in their recruitment efforts. Group practices are using the tool to manage their content, streamline their profiles and monitor social communications. And solo practitioners have found that Hootsuite makes it easy to monitor their brand and engage with potential patients on any of the major social media networks.


One of the more general tools for contact management is Nimble, a web-based relationship management solution that unifies the four C’s (“contacts, calendar, communications and collaborations”) in one simple platform. Nimble merges activity from Twitter, LinkedIn, and Facebook with an office’s business contacts, so that it’s possible to keep track of all the conversations currently being generated by the people important to your business or practice. In this way, customer relationships are easy to nurture and advance, and there is no need to jump back and forth between social media websites. The utility of this customer relationship management (CRM) tool is obvious, and PC Magazine had good reason for awarding it “Editors Choice” status. It is not specifically tailored for the medical provider, however, and would not be helpful in communicating personal information to a patient. For direct patient engagement, PostwireHealth may be a more appropriate tool.

Postwire Health

A more specialized — and more private — channel through which doctors and patients can communicate online is Postwire Health. Post Wire Health characterizes itself as a HIPAA-compliant “Patient Engagement Tool,” and it works in conjunction with office visits. The medical practitioner videotapes the office interaction with the patient, and then shares the video (together with other supplementary information) with the patient through the patient’s personal online portal. This enables the patient to revisit and review the interaction as many times as they wish, so that there is no danger of forgetting any part of the provider’s advice. When this type of communication is used by a practitioner who gives specific exercises or discharge instructions, it empowers the patient by giving them the chance to listen over and over again. This functionality is extended into the area of clinical counseling, so that patients can listen at home to their therapy consultation and have the chance to remember everything the therapist said.

Medical Marketing or Patient Engagement?

When evaluating which type of social media channel to reach out through, it’s important not to lose track of your reasons for using social media in the first place. If you’re involved in medical marketing, your social media use will center on branding and accessibility. For example, a physician could use Nimble to manage various posts and public conversations on medically valid health tips, and to present ways that their medical practice provides outstanding service.

This kind of content can be shared from one patient to the next, through their personal networks, and can be a friendly (but still professional) way for a medical practitioner to engage in marketing. Individual patient treatment discussions are a very different kind of social media engagement, since confidentiality laws require these conversations to be private, restricted to one doctor and one patient. A doctor can be in touch with a patient via email, or can make use of a secure, encrypted platform such as Postwire Health. This type of online conversation will not give rise to a flurry of sharing, but will enhance the individual patient’s experience and may attract new patients via word of mouth. Healthcare providers’ professional use of social media is still in its early days, and patients’ expectations of their doctors’ online accessibility will continue to evolve in coming seasons.

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The Power of Social Media in Medicine: Using Facebook to Save Lives

The Power of Social Media in Medicine:  Using Facebook to Save Lives | Social Media and Healthcare |

Recently, there has been a great deal in the press surrounding organ transplantation.  Sara Murnhagan, the courageous little girl with end stage cystic fibrosis, captured the nation’s attention as she waited for a life saving lung transplant.  The organ transplantation and procurement system in the US today is not without flaws.  Organs are at a premium and finding the best way to allocate them to matched patients who need them the most is a daunting task.


Today, nearly 120,000 people (men, women and children) are actively waiting for organ transplantations and are listed on the UNOS.  However, only 29,000 organ transplants were performed in 2012.  Obviously the demand far exceeds the supply for suitable organs for patients who need transplantation for survival.  Paradoxically, 90% of Americans say that they support organ donation but only 20% have taken the necessary steps to be a donor.  The rate of registered donors has remained static over the last twenty years while the numbers of those waiting for transplantation has increased 20 fold over the same time period.


Researchers are actively engaged in clinical investigations designed to identify better ways to recruit potential organ donors.  In order to improve the availability of organs for those in need we must find a better way to successfully register potential donors and allocate organs.  In particular, certain groups such as minorities and children are poorly represented as registered donors.


Our society today is more connected than ever.  Social media outlets including Twitter, Facebook, and YouTube are easily accessible and widely utilized.  In particular, Facebook is one of the most commonly visited websites in the world–second only to google.  Facebook is often the first stop for those who begin their exploration of the world of social media.  Facebook has become a great place to connect and to share ideas and news.  In addition, Facebook has been a place to inform others of an important cause or event.


Researchers at Johns Hopkins reported on a demonstrated effect of Facebook on organ donor registration rates.  In the report, the rate of increase was nearly 21-fold in one day–this was a day in May 2012 when Facebook allowed users to make their organ donor status public on the site (and also provided easy links to DMV sites so that users could make their status official).  On the first day that the new service was available on Facebook there were over 13,000 new DMV organ donor registrations–as compared to an average day where there are only 600 new registrations in a day.  This enormous bump in organ donor registration demonstrates the power of social media to move people towards action in ways that can benefit others.  Social media outlets such as Facebook are not only a great place to share pictures and reconnect with friends–they can be a new way to effect social change.


In medicine, we have only begun to scratch the surface of the full potential of social media.  It is imperative that physicians begin to interact virtually and engage fully in social media in order to effect change.  As we have seen with the New York Stock Exchange, social media outlet such as twitter can move markets (reference the largest 3 minute drop in the Dow in history when the AP twitter account was hacked).  WE must ALL work together to realize the untapped potential of social media in medicine–it can save lives–improve health–and even provide a large number of new registered organ donors.

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Five Reasons Why Physicians Should Be in Social Media

Five Reasons Why Physicians Should Be in Social Media | Social Media and Healthcare |

In November, 2011 the AMA published a report on Professionalism in the use of Social Media.  A brief summary of the paper  was published in June, 2010.  The issues addressed by the AMA are reasonable and practical in my view.  There have been some excellent pieces written about the ‘ethical’ issues seen by others about physicians being on social media as well as reasons that physicians themselves give for not wanting to participate. The issue has also generated some excellent thought-provoking discussion in the Digital Health Linkedin group.    As an active participant is social media, I realize its value to patients, caregivers and providers. There have been many other articles and posts about physicians and social media.  I just thought it was time for me to put my perspective out there. I would like to touch on five reasons I believe that physicians should embrace social media.

1.    It’s where the patients are.  Social media is becoming part of the healthcare landscape.  Probably the largest growing sector is online health communities.  I feel that physicians can gain a keener insight into patient concerns (many of which might be very eye opening) by getting involved in social media.  Physicians in social media have been found to be more highly rated by patients so much so that engaging in social media has been recommended to improve online physician reputations.  What is interesting is that while older people (baby boomers) are OK with engaging social media to obtain information, they are far less likely to share personal health information than young people, according to a PwC Health Internet Research Survey.  “More than 80% of individuals ages18–24 would be likely to share health information through social media, while nearly 90% of individuals would engage in health activities or trust information found via social media. Less than half (45%) of individuals ages 45–64 would be likely to share via social media, while 56% would be likely to engage.  I believe this might change if physicians are in social media even in ways conforming to accepted guidelines.  It might add legitimacy, knowledge, and more trust in the space.

2.    It’s where hospitals and healthcare systems are.  The PwC survey also stated that more than 1200 hospitals participate in over 4200 social networking sites.  It would behoove physicians and other providers to know what information is being supplied by their own hospitals or organizations.  In this regard, they can perhaps partner with the institution and both gain some knowledge about what their patients are reading online as well as perhaps provide more targeted information (most hospitals use content provided by others) by offering collaboration.

3.    It makes for engaging and useful interactions with vendors and colleagues.  As physicians are busier than ever, they have less time to interact with Pharma and device companies (who have less and less access to providers) as well as colleagues.  Social media lends itself to interactions which occur in more relaxed and customized settings.  While online health communities can be a source of marketing research, they can serve as points of educational interactions with both patients and providers. Companies such as WCGLiquid Grids, and others are using sophisticated analytics to translate conversations into useful data for providers and others. One must certainly differentiate between open and closed social media sites.  Open sites are ways in which physicians can either observe or interact (paying attention to the guidance cited above) with patients.  Closed platforms provide a more targeted audience for vendors and serve as a forum for more relaxed (HIPAA compliant) conversations among physicians.

4.     It’s social. Providing a humanistic side of oneself to the public as a physician is therapeutic to both the writer and reader.  Being social is not the digital equivalent of running into a patient at the supermarket, soccer game or restaurant and having him show you a skin lesion for examination or describe a symptom. One might ‘lurk’ or merely observe what is being discussed.  Patients are more candid with each other  (or even providers which aren’t necessarily their own) in social media than they are in real life.  Observing these discussions provides perspectives which might have been previously unknown or discounted. When I was in practice I found that it expanded my horizons.  It opened my experiences to previously compartmentalized areas of the healthcare ecosystem, incorporating new ideas, beliefs, and sentiments which became integrated with my daily practice.

5.   It’s not mandated.  So much of a physician’s practice is either directed towards satisfying regulatory mandates or indirectly related to them. Digital interactions with patients and colleagues might therefore be viewed as welcomed respite. It can be disease specifically related (as in online patient communities such as HealthTap, Wego Health, Treatment Diaries, or others) or not, perhaps via Linkedin groups representing multiple facets of healthcare. I have found interactions via Tweet chats with patient advocates and providers alike in a number of areas to be satisfying by contributing basic knowledge about navigation of the healthcare system which is both the most difficult patient problem these days and a potential contributor to morbidity and mortality. It is enlightening to realize how much a physician takes for granted how little it takes to contribute in a significant way to people’s knowledge. Participation in social media is on a person’s individual time schedule and therefore is neither stressful nor imperative.  It creates virtual friendships, respect, and collaboration.  Try it, you might like it.

–David Lee Scher, MD is Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in helping digital health technology companies, their partners and clients. As a former cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he is uniquely qualified to address both clinical and operational concerns of clients. Scher was Chair of Happtique’s Blue Ribbon Panel which established standards for certification of medical apps in the categories of safety, operability, privacy, and content. He is a well-respected expert in mobile and other digital health technologies and lectures worldwide on technology and its impact on patients and healthcare systems.

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The doctor will like you now: social media meets health care

The doctor will like you now: social media meets health care | Social Media and Healthcare |

In an era when we spend much of our lives online, does social media help or hurt our health care decisions?


If you gave Elle DeLacy a choice between her neurologist and her online stroke support group, it’d be an easy choice: the support group.


“I suffered a stroke and two concussions and now seizures — all leading up to great losses in my life,” says the Las Vegas woman, a member of the Facebook group Post Concussion Syndrome Awareness. “I joined this online group for help and support with my post-traumatic concussion syndrome. What great support and insight I receive from the group. They have helped me so much through the good and the bad. Really quite better than my own neurologist.”


Indeed, we all use the Internet to share pics, shop for stuff and keep up with the news. But how about diagnosing a medical condition or simply finding a sympathetic ear about your achin’ joints?


Don’t smirk. There never seems to be TMI on the Internet — particularly when it comes to our health. In an age when we divulge an increasing amount of our private lives on the public sphere of the web, people are increasingly seeking — and sharing — health information. Consider: According to a 2012 PricewaterhouseCoopers survey, 30 percent of consumers use social media to discuss health matters. And, according to the Pew Internet and American Life Project’s Health Online 2013 report, 59 percent of adults said they have looked online for health information in the past year. And 35 percent of adults have specifically tried to figure out what medical condition they or someone else might have.


It’s a relatively new phenomenon that piques a range of responses in the medical professional community. Some doctors embrace social media, others regard it with caution, and still others take a dim view of jumping online to research health-related concerns. But one thing’s for sure: “Like” it or not, the trend is as persistent as that long-lingering invite to play Farmville.


First, undo harm


Many physicians find themselves deploying social media as a Band-Aid after the fact, using services such as Facebook and Twitter to correct bad information.


“It’s tremendously helpful when we want to clear up misinformation online and promote healthy lifestyles,” says Kevin Pho, founder of, a site for medical news. A practicing physician in New Hampshire, Pho himself has become something of a national pundit on health care issues, and is also author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. “One of social media’s greatest strengths is to really increase that transparency between doctors and patients,” he says.


Transparency is great — as long as the information is trustworthy. Other doctors encourage users of social media to be cautious when seeking health advice online from their virtual circles of friends or from medical websites. Misinformation — often shared with the best of intentions — abounds.


“I think that the web, including Facebook, is a great place to find information,” Dr. Joseph Adashek of Desert Perinatal Associates writes in an email. “However, I think that patients think that just because it is written down that it must be indisputable fact. ... That said, I also love the fact that I can tell a patient a certain diagnosis that she may have, and she can go and read about it and then ask me questions and learn about it.”


“Patients need to know which are the sites with professionally approved clinical content. They also need to know that just because someone writes about or discusses a medical topic online, it does not mean that they are a doctor or their advice is appropriate for every patient,” adds Mike Coyne, CEO of QuantiaMD, an online physician community.


There’s a lot of material for would-be self-diagnosers to weed through. “Not all of it is reputable,” agrees Pho. (Thankfully, according to the Pew study, 53 percent of those who sought health information online talk to a clinician about what they’ve uncovered, presenting the opportunity to fix the bad advice they’ve received from “Dr. Google.”)


That said, let’s not discount the positive impact social media services have on public health. For instance, social media can actually help track — and thus prevent — the spread of disease. Data shared online at Google Flu Trends is available to anyone with a web browser. Being aware of outbreak areas can provide incentive to use protective measures like hand-washing. Plus, Google’s stats on the incidence of influenza-like illnesses come out two weeks sooner than those provided by the Centers for Disease Control. That early warning can be a huge help in dealing with a possible pandemic.


Should you ‘friend’ your doctor?


Patients and consumers must navigate a tricky terrain online, avoiding scams, bad information and possible quacks. Meanwhile, in the world of social media, physicians face a dilemma that is more subtle but no less challenging. In the examining room, the doctor-patient relationship is private, even sacrosanct, and also highly regulated. But what about on Facebook? Can a doctor also be a patient’s “friend”? Drawing those lines is an ongoing challenge for local doctors.

“I end up very close with many of my patients, so I have become Facebook friends with some of them,” Dr. Adashek writes. “Typically, my patients are of very similar demographics as me and we have a lot in common, and I have become true friends with some of my patients.”


Adashek’s open-arms attitude might be the exception. According to a 2011 QuantiaMD study, one-third of physicians said a patient had tried to “friend” them on Facebook — and three-quarters of them declined. Those who accepted got more friendship than they bargained for, and were left in an awkward position when patients messaged them with questions. To help navigate these murky waters, the American Medical Association has issued guidelines urging physicians to maintain appropriate boundaries with their patients and encouraging them to separate their personal and professional online personas.


Vegas cosmetic surgeon Michael Edwards follows the AMA’s advice. He has a Facebook page and a Twitter account just for his practice. Content is very specific. He focuses on educating patients about “aspects of health and plastic surgery I believe are important and timely,” he says. “I don’t correspond with patients there other than general comments or (saying) thanks.”

Meanwhile, Adashek sees close ties with patients as enhancing his care rather than complicating it.


“Both my wife and I have met some great friends through my practice. I do not really draw a line in the sand with my patients. I try and treat them like they were my sister and I give advice to them as though they were my family member. I don’t just give option A with the risks/benefits and option B with the risks/benefits — and then tell the patient to make a decision. I give my advice to them.”


Local internist Dr. Traci Grossman uses social media to weigh in on health-related topics, like the state of medicine or changes in health insurance. She’s careful to limit her comments to “general advice when a conversation about a certain medical topic is going completely sideways.”


Comprehensive Cancer Centers of Nevada might be one of the valley’s most avid users of social media, with Facebook, Twitter, Google+, YouTube and Pinterest in their toolbox — not to mention profiles on and entries in Wikipedia. But the goal is scrupulously sharing news with an audience they’ve grown organically. “We use it to communicate to our followers new happenings at CCCN, such as new physicians joining our practice, new research trials, awards or accolades our physicians have earned, cancer awareness days and other general health advice,” Director of Marketing and Public Relations Lisa Santwer writes in an email. “I think social media plays a positive role in health care as long as no patient information is exchanged and no medical advice is given.” (Still other doctors ask: Facewhat? CCCN oncologist Dr. Nicholas Vogelzang writes: “No social media, never have done it, probably never will. I’m busy enough!”)


There is a rapidly developing form of social media that physicians seem to embrace: online physician communities such as QuantiaMD. Think a Facebook for doctors where they can keep up on medical developments, share insights with other doctors and comment on the healthcare topics of the day. Perhaps most importantly, physicians also use these sites to consult with others in their field on issues they’re dealing with in their practices — and it’s helping patients. Coyne of QuantiaMD is proud of his website’s success stories when sharing information saves patients time, money and discomfort. In one scenario, Coyne says, after watching a QuantiaMD presentation about a patient with a partial small bowel obstruction related to taking an ACE inhibitor (a hypertension and high blood pressure drug), a member physician realized she had a patient with similar troubles. She successfully adjusted her patient’s treatment. “The doctors saved her patient from having to undergo some painful testing,” Coyne says. That’s definitely something we can all “like.”

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Who’s using social media to network on health care topics? The young and healthy.

Who’s using social media to network on health care topics? The young and healthy. | Social Media and Healthcare |

More than half of respondents in a survey last year said they would trust health information posted on social media by a hospital’s account. Doctors were the most trusted posters, with 61 percent of respondents saying they would trust their social-media advice, followed by nurses at 56 percent.


Only 37 percent said they’d trust information from a drug company via social media. 


The most likely to share their own health information are what health care industry experts call “the young invincibles,” people ages 18-24 in good health. Nearly 90 percent of them say they’d engage in health activities or trust information found via social media.


Less than half – 45 percent – of individuals ages 45–64 would be likely to share.


One-third of consumers surveyed said they would be comfortable having their social media conversations monitored if that data could help them identify ways to improve their health or better coordinate care.


More than 75 percent of consumers surveyed would expect health care companies to respond within a day or less to appointment requests via social media, while nearly half would expect a response within a few hours. 


Of those who said they were likely or very likely to share about a health care experience afterward, 44 percent said they’d share their positive reviews of hospitals; 40 percent said they’d share negative reviews.


The margin widens when the question is about a specific doctor, nurse or other provider: 42 percent said they’d share praise, and 35 percent said they’d share criticism.


This data is from a PricewaterhouseCooper survey of 1,060 

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Why Social Media Matters in Your Medical Practice

Why Social Media Matters in Your Medical Practice | Social Media and Healthcare |
Quite simply stated, social media matters to your practice because it allows you to connect with more patients. And when you connect with more people in your community, you are giving yourself and your clinic the opportunity to serve more people.
Begin by determining who you want to reach, who is your ideal patient, and then jump into social media with both feet.

Who do you want to connect with?


According to a study that ended in 2012, 71 percent of women and 62 percent of men use social media on four main platforms. Here’s a brief overview of each of them.

1. Facebook: Facebook has 67 percent of all Internet users liking and posting to each others’ walls and is most popular with 18- to 49-year-olds. Looking for patients 50 to 64 years of age? About 50 percent use Facebook, as do about 33 percent of the 65-and-older crowd. Those are a lot of demographics to consider. Because Facebook is the most popular platform that reaches the largest demographic of people, I advise clients to use Facebook, plus another platform or two that they enjoy participating in. One of the keys to connecting with your ideal patients on Facebook is to use your personal page. Business pages no longer scroll in users’ news feeds as they did previously; they only scroll in the pages feed, which appears as a small button on the lower left column. Never noticed it? Exactly… neither have your patients. Primarily, only paid ads appear in the main feed on Facebook. 

Using your personal page with your name gives you more freedom to connect as you can see what your friends are posting and comment on their posts and pictures as well.

2. Twitter: Twitter has roughly 16 percent of Internet uses hooked. Twitter has the highest number of under 17-year-old users and the lowest number of over-65 users, with the rest of the statistics closely mimicking Facebook.

3. Instagram: Instagram is growing in popularity, especially with businesses, and has roped in 13 percent of Internet users. Of those users 24 percent are under 18, about 65 percent are 18 to 35.

4. Pinterest: Pinterest is phenomenally popular with women, and even more specifically moms. Pinterest carries 15 percent of Internet users. Interestingly enough, 30 percent of users have a household income of over 100k. Pinterest also boasts the highest number of referrals to websites of the pins that are posted.


What do you post?

Let's revisit your ideal patient. Are you looking for "good patients" who deliberately seek health information? Then health information is what you post!

Post a good, healthy (no pun intended) mix of personal photos and statements, links to blog posts on your practice website, events, local information, office funnies (no patient pictures without releases), testimonials, compliments, national health/medicine-related news stories, patient resources, and announcements. Mix it up and keep it natural.


When do you post?

The best times to connect and be seen are around 8:30 a.m., the lunch hours of 11 a.m. to -1 p.m., and then 5 p.m. or after. Post according to the time zone where you’re located.

Who should post?

Ideally, you. However I understand that adding another responsibility to a physician’s plate can be daunting. So there are two good options if spending time on social media is not your cup of tea.

1. Autopost Services: Hootsuite, Sprout Social, Buffer, and Tweetdeck round out the top four autopost services. Each one has posting programs that cost between zero and $40 per month per user. The nice thing about the auto posters is that you can set your post in advance and then only log in to your social media sites to respond and comment on others’ posts. The downside is that your post will have a tag on it, such as "powered by Hootsuite," which will give savvy users the indication that you are not present and set things up in advance.

2. Customized spreadsheet: I think this is the best option I have created a system for clients where the upcoming week’s scheduled posts are determined in advance, plugged into a spreadsheet, and then posted either by the physician on the account or delegated to another trusted source on staff in the clinic.

Social media is a very simple, and essentially free, way to connect with your ideal patients and serve more patients. For next week’s post I will drill down further and share a simple acronym that will help you to keep your posts on track.

- See more at:

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Social Media: One Size Doesn't Fit All

Social Media: One Size Doesn't Fit All | Social Media and Healthcare |

By Bryan Vartabedian, MD

When we think about the boundaries of communication technology and social media, we tend to put students, residents, and faculty into the same bucket. Policies for one are the policies for the others. But these are all very different people with respect to their ability to understand and handle their public presence.

The latitude given a publicly seasoned attending should be different than that of third-year medical student. For example, I encourage students to avoid online discussion about the hospitals they are rotating in. This is because:

  • They don’t yet know what represents the normal workings of a hospital. There are things that seem strange or unjust to a trained eye but happen for a good reason. Perhaps more important, the viewing public doesn’t understand what students don’t know.
  • Students are sorting out what represents the thoughts and ideas for their close personal network versus those for global publication. They’re learning which conversations belong where.
  • They’re figuring out their public presence.

Students come to medicine with a relatively self-focused view of their networked world, and don’t yet understand how they fit into the broader networked world. As they mature professionally, they recognize that they are part of a broader community, which brings accountability. This progression has real importance when we expose ourselves to the great wide open.

The way we handle ourselves must be driven by the context of where we are. Discussions, guidelines, and educational programs need to be designed around the specific differences that exist at various levels of experience and clinical maturity. Not all policies fit these different levels.

While the principles of privacy and professionalism in the public space shouldn’t differ at any level, the way we approach and discuss those principles necessarily must.

–Bryan Vartabedian, MD, writes monthly for Wing of Zock about the intersection of health care, medical education, and social media. He is a pediatrician at Baylor College of Medicine in Houston, Texas, and blogs at 33 charts.

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The Facebook Effect - Boosts Organ Donor Registration in a Single Day

The Facebook Effect - Boosts Organ Donor Registration in a Single Day | Social Media and Healthcare |
Johns Hopkins researchers see 21-fold increase in a single day

A social media push boosted the number of people who registered themselves as organ donors 21-fold in a single day, Johns Hopkins researchers found, suggesting social media might be an effective tool to address the stubborn organ shortage in the United States.

The gains were made in May 2012 when the social-networking giant Facebook created a way for users to share their organ donor status with friends and provided easy links to make their status official on state department of motor vehicle websites. The findings are being published in theAmerican Journal of Transplantation.

“The short-term response was incredibly dramatic, unlike anything we had ever seen before in campaigns to increase the organ donation rate. And at the end of two weeks, the number of new organ donors was still climbing at twice the normal rate,” says study leader Andrew M. Cameron, M.D., Ph.D., an associate professor of surgery at the Johns Hopkins University School of Medicine. “If we can harness that excitement in the long term, then we can really start to move the needle on the big picture. The need for donor organs vastly outpaces the available supply and this could be a way to change that equation.”

Over the last 20 years, despite many efforts, the number of donors has remained relatively static, while the number of people waiting for transplants has increased 10-fold. There are more than 118,000 people currently on waiting lists in the United States for kidneys, livers and other organs and thousands of these patients will die before they receive transplants. It’s estimated that between 5,000 and 10,000 people die every year whose organs would be suitable for transplant, but because they had not consented to be donors, their organs go unused. In the United States, organs may not be removed from a deceased donor without permission from either the individual prior to death or the family at the time of a relative’s death. It is believed that over time, roughly 100 million Americans have registered to donate.

By looking at data from Facebook and online motor vehicle registration websites, the researchers found that on May 1, 2012, the day the initiative began, 57,451 Facebook users updated their profiles to share their organ donor status. There were 13,012 new online donor registrations on the first day, representing a 21.2-fold increase over the average daily registration rate of 616 nationwide. Registrations varied by state, with the first-day effect in Michigan rising nearly seven-fold and with nearly 109 times as many online registrations in Georgia as on a typical day. Cameron says it was heartening to see that the states of New York and Texas, where organ donation rates are among the lowest, had some of the biggest bumps on that first day.

While the number of online registrations dropped over the following 12 days, Cameron says it was still twice the normal rate at the end of that study period. “The half-life of a movement online is often just hours,” he says. “This had a very powerful, lasting effect. But we need to find a way to keep the conversation going.”

While the number of declared organ donors increased, it could be decades before researchers determine whether those people ultimately donate their organs.

The Facebook organ donor project came about after Cameron, a transplant surgeon, and his Harvard University classmate — and current Facebook chief operating officer — Sheryl Sandberg began talking about the organ shortage at their 20th college reunion in 2011. Through many conversations, the idea of having a place in the Facebook timeline for users to share organ donor status was born.

Going forward, Cameron says the key to continuing the push for more organ donors is figuring out a way to bring back some of the lost attention of those early days of the campaign and to find a way to get it to again go viral. Cameron says he has spoken to Facebook officials who are discussing relaunching it on its mobile platform, changing its prominence on the Web version or even offering incentives, such as coupons, for people who declare they are organ donors.

Cameron says that in recent years social media has shown it is not only a place for sharing what you ate for lunch or posting cute pictures of your kids. It can be an agent of social change, such as its use during the Arab Spring, after natural disasters such as the recent Oklahoma tornado, and in get-out-the-vote efforts before the recent election, he says.

“This was the first effort like this designed to mobilize people for a public health cause,” he says. “Now we want to build on that. Studying the response to the organ donor effort is the next step in the process of using social media for social good.”

Other Johns Hopkins researchers who contributed to this research include Allan B. Massie, Ph.D.; Robert A. Montgomery, M.D., D.Phil.; and Dorry L. Segev, M.D., Ph.D.

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How hospitals are hustling as health content creators

How hospitals are hustling as health content creators | Social Media and Healthcare |

Today’s health care consumers – baby boomers in particular – are hungry for reliable health content, and more than ever they are using the web to educate themselves. The Pew Research Center reports that nearly 80 percent of internet users go online for answers to health questions.

Perhaps more surprising is the rising role social media plays in consumer health education. According toPwC’sHealth Research Institute (HRI), 42 percent of consumers have used social media to access health-related consumer reviews (e.g., specific treatment therapies or physician reviews), and 20 percent have joined a health forum or community. Younger consumers in particular tend to trust social media as a credible source of information – 90 percent of individuals age 18 to 24 would engage in health activities or trust health information found via social media.

Consumers also are demanding tools to help them take charge of their own health care decisions. Currently, more than 40,000 health-related apps are marketed to consumers – covering everything from diet counters to smartphone-enabled blood-pressure monitors and glucometers.

This change in consumer behavior represents a huge opportunity for fast-moving hospitals to become content creators and provide an alternative to Google search, Everyday Health, and any of the thousands of health-centered sites and apps available today. Let’s take a look at which hospitals are moving fast, launching marketing news portals, community sites, videos and mobile apps to satisfy their customers’ appetite for health content.

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Social Media & Technology Access Could Lower Barriers to Clinical Trial Acceptance

Social Media & Technology Access Could Lower Barriers to Clinical Trial Acceptance | Social Media and Healthcare |

“Research is to see what everybody else has seen, and to think what nobody else has thought.”Nobel Laureate Albert Szent-Gyorgyi no doubt would be impressed with the modern pace of medical research, but possibly concerned that we need to think about clinical trials in ways nobody else has.

Only 3% of people with cancer enroll in a Phase I trial, but 72% of all Americans say they would gladly volunteer on the advice of their doctor. Social media and internet tools have tremendous potential for increasing volunteer enrollment in clinical trials, but many barriers still exist. The factors keeping potential trial volunteers away have been consistent over the years: unease with trial settings, randomization and placebos; lack of understanding or discomfort with the research process; fear of drug side effects and trial protocol rules/requirements; as well as lack of awareness, a perception that trials aren’t appropriate for serious disease, and hesitation among physicians to make recommendations.

While internet access to clinical trials, online patient groups, and social media tools can’t do much about side effects, randomized protocols and research processes, they can raise awareness, change perceptions by patients and doctors, and maybe even make favorable changes to trial settings and protocols.

A number of new online tools introduced this year make it easier for patients to enroll in clinical trials, and may help boost awareness of these studies. The National Institutes of Health website,, lists about 145,000 trials—albeit it’s not the easiest list to use to find your disease. So, to sift through all this data, patient advocate sites have developed ways to match patients with trials, and physicians with clinical researchers. These sites include the Michael J. Fox Foundation-sponsored Fox Trial Finder, a Parkinson’s disease site for patients, and Virginia Commonwealth University’s MD Alert Notification System, which pings physicians at the university’s cancer center about patients who might be eligible for trials.

But how well do these tools work? For most, it’s too early to tell. But one site,, created by UC San Francisco surgeon Laura Esserman, tested the acceptanceof the site and found that more than half of the patients surveyed at cancer clinics were eligible for a trial, and 42% reported enrolling in a trial. Another study suggested that as more of these tools expand beyond pilot stage, and patients themselves start directing their doctor’s attention to these clinical trial tools, we may see a shrinkage in the critical gap between patients needed and people volunteering.

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Doctors who skip social media risk alienating patients

Doctors who skip social media risk alienating patients | Social Media and Healthcare |

Physicians who forgo social media in their practices run the risk of falling behind patients’ growing demands for digital communication and allowing negative reviews to define their reputations, says a new research paper by HP Social Media Solutions, a digital consulting firm.

The report, released June 27, details why hospitals, health systems and physicians should have social media presences as more patients use technology to discuss and manage their health care. It says doctors who don’t use social media are more likely to be unaware of negative reviews posted by dissatisfied patients. Having no social presence online makes it difficult for doctors to respond to such reviews.

Doctors can use social media to counteract wrong medical information posted online by providing correct information for patients or guiding them to other websites, the report said.

Social media experts said physicians don’t need to spend a lot of time online to meet patients’ increasing digital demands. But they do need at least a minimal presence to enhance their practices and protect themselves from unfair criticism. Building positive reputations online can offset negative comments, and having a social media presence allows physicians to respond to patients’ comments in a timely manner.

“They should have a social media plan,” said Frances Dare, managing director of connected health services for the consulting firm Accenture. “If they don’t do social media, social media will do them.”

At the minimum, physicians should monitor their digital footprints to see what patients are saying about them, Dare said. Some patients post negative reviews on various doctor rating sites.

Beyond that watchful eye, physicians should consider having a practice website with a blog. Opening a Twitter account to post updates about their practices and general health reminders is a good idea, too, Dare said.

In addition to a practice website, doctors might consider creating a LinkedIn profile, said Leslie Hobbs, director of public relations at, an online reputation management company. Doctors should create Twitter and Facebook accounts in their own names to prevent anyone else from claiming to be them. They also should get on health care industry profile sites such as, Hobbs said.

“Purchase website domain names for yourself and your practice,” Hobbs said in an email. “There are many low-cost or no-cost templates for creating a nice website, but you can also hire a designer. Populate your site with what you’d want to know as a prospective patient. Where did you go to medical school? What awards have you won? What do you specialize in? What’s your philosophy of care? Where are you located? What insurance do you take?”

Increased access wanted

Nearly a quarter of patients reported in a 2012 survey by consulting firm PwC that they are using social media to manage their health care, said John Edwards, PwC’s director of health care strategy and health care business intelligence. PwC surveyed more than 1,000 consumers and 124 health care executives.

Edwards said many patients are interested in making appointments online, receiving appointment reminders through texts and interacting with physician practices through secure emailing options.

"DID YOU KNOW: 25% of Americans use social media to manage their health care."

Patients in the survey said they used social media to talk about their health care with others. Twenty-four percent said they posted about their medical experiences, and 27% said they posted reviews about medications, treatments, doctors or health insurers.

Edwards said physicians should ask their patients what kind of social media communications would be most helpful.

“Ask them what they want,” he said. “Asking patients about this is a step toward demonstrating how you want to be relevant to patients.”

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Are Your Patients Engaging with Your Brand? (why you needed to be on this yesterday)

Facebook, much like Google, is constantly evolving, staying ahead of the spammers, the scammers, the cheaters, and the haters. The relentless evolution has purpose – to better the brand experience for Fans, and to make money. These are essentially the same philosophies that drive every business, including healthcare and medical business. With that said, some new News Feed changes should be accounted for, and a fresh look at your healthcare marketing on Facebook needs to be addressed. Let Quaintise walk you though it.


The two new concepts that Facebook has released to update it’s News Feed include Story Bumping and Last Actor. shares with us what these exactly mean:


  • Story Bumping – This shows older stories that the user might have missed the last time they perused their News Feed.  In other words, the stories are new to the user, although possibly older than the current time they’re viewed. Facebook saw:
    • a 5 percent increase on interaction with stories from Friends
    • an 8 percent increase in interaction on stories from Pages
    • an overall increase in stories read from 57 percent to 70 percent
  • Last Actor – This involves real time “signaling,” where Facebook tracks the last 50 interactions a user has done within the social network on a rolling basis, and uses that to rank which stories to show in a feed.


What I want you to notice is the “overall increase in stories read from 57 percent to 70 percent.” This is a big jump, and could mean big things for your social media healthcare marketing campaign.


Do Your Patients See Your Posts?

According to Facebook itself, 16 percent of your Fans will actually see your Page posts. That is a remarkably low number, and yet in 2011 that number was as low as three to 7.5 percent.


Thankfully, Facebook seems to be taking steps to improving that 16 percent, but you, the healthcare marketer, physician or specialist must give Facebook a reason to increase that 16 percent for you specifically. How do you make that happen? Let Quaintise show you:


1. Post Photos –

Don’t just post a photo, post a photo with an engaging description and call to action. Photo posts get 39% more interaction on Facebook then any other form of post. More importantly, photo posts get 84% more click-throughsthan traditional link posts. As a physician on Facebook, look to The Cleveland Clinic or Family Practice Specialists for examples on what these photo posts look like, and how they can improve engagement with your Fans. Ultimately, improved engagement means that 16 percent will increase dramatically.


Of course, this is subject to each specific physician Facebook Page. For example, Quaintise client Family Practice Specialist’s Facebook Page receives the greatest amount of engagement through links to the website, while Arizona OBGYN Affiliates receives the greatest amount of engagement from photo posts.


2. Short and Sweet –

There is a practical reason why Twitter initially took off like it did, and why it’s continuing to grow in leaps and bounds – short posts. On Twitter, you’re limited to 140 characters, which is not necessarily a bad thing according to new stats showing that shorter posts actually generate more engagement – 23 percent more to be exact.


3. Perfect Timing –

Every social media marketing agency in the healthcare industry is going to tell you the perfect day of the week and time of the day to post on Facebook when, in fact, it all depends on your target audience. Overall, statistics from Buddy Media show that posts on Thursday and Friday receive higher engagement numbers, but as the social media expert at Quaintise I’ve also seen statistics showing Saturday afternoons and Wednesdays to be the most engaging days and times.


In order to know when the perfect time to post your to reach your patients, you’ll need to analyze your page’s Insights. For example, if we look at Quaintise client Arizona OBGYN Affiliates Facebook Insights, we see that Thursday and Fridays right after lunch is the best time to post. But if we look at Quaintise client Family Practice Specialists, we see that Saturdays right before lunch is the best time to post.


5. Should, Would, Which –

According to Hubspot, there are key words that elicit greater responses than others; should, would and which. By asking a question, you can engage your patients on a different level, literally asking them to engage. Statistics show that question posts get 100% more comments than standard text-based posts. If you’re looking to increase engagement, ultimately increasing that 16 percent number of Fans that see your posts, asking the right question is a great way to accomplish that goal.


The social media experts at Quaintise determine the most effective strategies to increase your physician page engagement and ultimately drive traffic to your website for conversions.

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Hashtag your health: Building a health record with likes, shares and check-ins

Hashtag your health: Building a health record with likes, shares and check-ins | Social Media and Healthcare |

Set your status. Check in with your symptoms. Share photos. Tag parts of the body. Hashtag to join conversations. Personiform‘s Project Medyear combines Twitter and Google Plus with a political campaign-style health record-sharing patient movement. It aspires to be NoMoreClipboard on a Friday night — less official, more social. And Personiform’s kicked off a campaign on Indiegogo to raise $80,000 by Sept. 19 to mobilize field operations and volunteers for the movement its website supports.

The site — the “first-ever consumer health information exchange” — would launch Feb. 14, 2014.(The technology itself is already fully funded.)

The idea for the site stemmed from the growing trend of patients taking to social media for healthcare advice, in part due to physicians’ time crunches. But because the social networks don’t really connect physicians and patients, they miss out on the opportunity to learn about and help their patients. (Not to mention the questionable advice they could be getting.) CareRings (a la Google Plus’ Circles) allow users to choose who they share what information with. And that information can be as wide as general statuses to full-fledged clinical records. If your physician joins, you can even share medical history, data and so on with him there. In theory, clinicians, caregivers, patients and physicians could unite using this tool to develop more holistic (if unofficial) records. (According to the company website, the data is secure.)

According to the site, here are Project Medyear’s everyday uses:

  • Compare health records with a stranger that has the same disease
  • Let your doctor know that symptoms have been flaring up a lot recently
  • Remind your brother to take a parent to the doctor today
  • Invite a new doctor into the family health conversation
  • Gain insight about an upcoming procedure from those who’ve had it before
  • Show your support to a good friend going through a hard time
  • Get your latest medical records and test results all in one place
  • Share the kind of images you don’t want all over Facebook

In theory, this would allow patients to connect with other patients, patients to update doctors and doctors to give quick advice and share test results. Unlike NoMoreClipboard, however, this is pretty unofficial. One shortcoming: In the push for sharing and reclaiming data, the convenience of sending that data to your provider or payer — if they aren’t on the social network — seems to have been forgotten. And unlike state health information exchanges, your health info would have a name and a face, if you choose to share it.

But founder and CEO Panha Chheng claims it’s not convenience at the heart of the movement; it’s empathy. When Chheng was in grade school, he came home from school crying to his father (a smoker) about how smoking cigarettes can kill people. His dad quit cold turkey. He claims that sharing health information compassionately leads to change.

Rather than letting states use healthcare information of individuals anonymously, Project Medyear hopes users will add their name, take ownership of their records and propel the empathy movement forward. Though some healthcare providers, like Cleveland Clinic, have made a push for empathy through their marketing, this remains a unique strategy.

According to the website:

Project Medyear is a people’s movement to share health records, however we want. We believe in the power of sharing to uplift lives, and that our collective empathy can become a powerful force for social change.

“We are focused on what it takes to accomplish real progress in healthcare, and it takes more than the best technology can offer,” Chheng said. “It takes people, empathy, and courage.”

Other Personiform leadership includes Dr. Tamer Fakhouri, a physician at OneMedical, and health and social technology strategist Mark Scrimshire, the head of cloud computing at 3M. Chheng has worked at Deloitte, and was a strategist for iSoftStone when it was brought to IPO.

If those connections don’t convince you, maybe the sweet Regina Holliday (patient advocate and artist) jacket will.

Yet, I can’t help but think doctors won’t be too keen on the idea of spending more time on the computer and interacting with potentially hypochondriacal updates. (No more “if it gets worse I’m going to the doctor.”) Or that, if very few doctors join, Project Medyear will dissolve to a realm of everyone crowdsourcing their medical problems, complete with pictures and status updates–a dump of all of those skitterish people looking up what their coughing might mean on WebMD in the wee hours of the morning. (Help me, I’ve been one of them.) No thank you. Sorry if that doesn’t sound empathetic.

Where is the fine line between sharing and oversharing?

Aren’t there better ways to spread empathy in the healthcare community than a social network? What do you think? Let me know in the comments below.

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