SoMe in medicine: It's about communication, stupid!

My generation of doctors was almost proud of its paternalistic overbearing know-it-all archetype, with the my-way-or-the-highway attitude to patient care. Even today there are inter-specialty fights in medicine that demonstrate these entrenched and seemingly fundamental, albeit willfully exaggerated, differences of opinion and clinical approach. It used to be, and still is to an extent, a badge of honor for an internist to disagree with a surgeon, for a pulmonologist to recommend a course of action diametrically opposed to that suggested by the infectious diseases specialist, and for everyone to disparage neurologists (apologies to my neuro friends). The extent of the discussion with patients as modeled by some of my senior colleagues was to say "You have this, and I am giving you this prescription, and see you in 2 months." And even today, I have observed the best of doctors still respond to a cogent "why?" question from a patient with a "because this is how we do it" answer.

My peers' lack of communication skills is the stuff of urban legends. Yet here we are at what seems like a pivotal moment for so many aspects of medicine -- science, healthcare system, communication technologies -- where effectively communicating outside the profession is a make-or-break proposition. Along these lines, in this BBC documentary Sir Paul Nurse, the head of the Royal Society, examines the societal forces that are coalescing to bring "Science Under Attack." The unifying message that comes out of his inquiry is that other less informed parties with political agendas are co-opting the discussion. Yet there is a distinct lack of the antidote of countervailing communication by scientists in terms that are understandable to the lay public. Nurse's battle cry is that scientists need to do a better job communicating their craft themselves, and not just to each other.

In some ways the prevailing elitism of medicine in the 20th century set the stage for the backlash we are experiencing today. The erosion of trust in the profession, commodification and consequent devaluation of medicine, while multifactorial at their root, could no doubt have been mitigated with better communication. Yet, great communicators rarely choose medicine as the path.

And this brings me to the contentious topic of the role of social media in medicine. For many of the early adopters, the question is no longer "should we", but "how best to." But my sense is, that physicians engaging in social media are still a minority. I am not even sure what proportion of MDs are amenable to communication via e-mail with their patients, though these data may be out there. So, for what seems to me as the majority of MDs who are not sold on e-mail, Twitter, Facebook, blogging or Quora, the value must not be that obvious. This makes me wonder if there are certain unifying characteristics of these docs, one being lack of perceived value of communication outside the profession across all media, including in-person contact.

I am friends with many docs on Twitter and in the blogosphere. The vast majority of them have shown themselves to be patient-centric, knowledgeable and collaborative, the kind of people I would not hesitate to send a loved one to. Yet, this is a skewed sample born out of a selection bias. These are the people who are interested and confident in their ability to communicate outside medicine. These are the people to whom medicine is a humanistic pursuit, where communities of patients and doctors strengthen the discussion of how to transform our system and the patient encounter. My guess is, and this is purely unscientific, that many of those who are skeptical of social media are also skeptical of communication itself, or just do not see the value of it in the equation of providing good patient care within the crushing time constraints of today's healthcare.

So my point is this: before social media tools can be expected to diffuse broadly into the medical community, the value of all communication needs to become clear to physicians in general. At this moment of increasing societal skepticism of science and of usefulness and integrity of the medical profession, against the backdrop of healthcare changes and increasingly unfiltered media noise, willingness and skills to communicate clearly may be as useful to today's doctors as a stethoscope. Once communication becomes the backbone of all medicine, tweets and blog posts are sure to start flowing freely from the fingers of physicians everywhere. And that will be good for the patients, the science and the healthcare system.