Thursday, January 27, 2011

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.


  1. Hello Marya,

    I can see we might be in the midst of a series of posts on 'social media and medicine'! I might have to do one myself!

    I'm not sure that what makes a doctor have a twitter profile is belief in communication or now. I know that is a simplification of your point. Lots of people from different disciplines are not using social media- does that mean that they don't believe in the power of communication? I don't think so. With regards to doctors, many of the my good friends who are tremendous communicators as doctors are not on twitter? Why? They just don't see the point. I've been here 2 years and I'm still figuring out the point myself. I'm happy to share what I have learned with anyone who is interested but I'm not about to start chastising those who are not interested.
    Yes, I have picked Twitter as an example here but I could have as easily chose any other service.
    You believe in an evidence-based approach to medicine. What would an evidence-based approach to social media in medicine look like? In a way we are the 'researchers' (early adopters). I can't really blame others for not wanting to come aboard whilst we are still figuring out the basics.
    Thanks for stimulating my thoughts! It's one of the reasons that I hang around here:)

  2. Anne Marie, thank you for your comment. Of course I am not implying that all physicians who are not on twitter are not interested in communication. I think what I am trying to say is that communication outside the profession has not traditionally been stressed as an important value. And while many docs are doing great talking to their patients, we really need a louder presence in the unfiltered media in order to preserve the credibility of the profession. The public needs docs to participate first-hand in discussions of evidence, rather than relying on the (often inaccurate) translations in the media. Also, I do think that coming down into the crowd off the traditional pedestal would be a positive development for medicine, increasing transparency of the field.
    Thank you for challenging me on my thesis, as I am, as usual, still developing this thought. Looking forward to reading more of your ideas on the subject.

  3. Thank you. That has helped me to understand your emerging thesis :)

    I'm not sure that I even believe that "preserving the credibility of the profession". I believe in healthcare, not doctors, and in improving the health of populations (that doesn't really require doctors either!). Year after year in the UK doctors score very highly as being a trusted profession. I believe that when answering a survey on that topic most people are thinking of their own personal experience of doctors, not of doctors in general.
    The public need good, easy-to-understand sources of evidence. I hope that in the future we might have a proliferation of freely available decision aids. I'd love if NHS Choices Behind the Headline service was where everyone went first to check when they heard about a dubious new scientific report in the media. And I'd be delighted if more people accessed the already free resources available in the UK (NHS Choices, Map of Medicine, and Clinical Knowlege Summaries). I'm a part-time GP in a practice of 5000 patients. We have to think about what is good use of our time. If I could do a good job of curating content wouldn't that be more sensible than actually creating content myself. Obviously there are local issues where it would make sense for us to get together with colleagues to collaborate.
    I'm not sure about coming down of pedestals. Again, I don't think that is the reason that doctors are not blogging or tweeting. Researchers, nurses, teachers are not blogging and tweeting en masse either.

  4. And just to follow-up: Perhaps I see doctors mainly as practitioners not as scientists. How is social media useful to practitioners? As a reflective space? How appropriate is a public space for this?

    On the other hand I agree that scientists and researchers do have a responsibility to share. Having access to other audiences is key. Last night I blogged about my colleague's research bringing that to a wider audience. This generated responses that will not be seen in any 'letter to the editor'. And as a medical educator the contacts I have made are immensely useful.

    So I think that rather than flatly saying 'doctors should engage with social media' we can think about how social media might fit with any of the given roles that a doctor might have.

    Thanks again,

  5. Anne Marie, I really appreciate your nuanced explanation. I think the types of communication you have pointed out are key. But perhaps doctors, as practitioners, have the responsibility to communicate information that can lead to better public health? I guess I am advocating some kind of advocacy communication, if not strict science or evidence. Applied evidence, so to speak. But really you are largely correct, I think, about how SoMe fits with each of the roles.

  6. This is something that I can definitely agree with you on! I'd love to see doctors becoming advocates and public health champions in the communities they work in. I don't want to see us just preaching about healthier lifestyles. We should be speaking out for our communities on the wider determinants on health.