Social Media in Practice

Social Media in Practice

Issue: April 2021
Source: Healio Interviews
Disclosures: Bloomgarden, Gunter, Juarez and Pessah-Pollack report no relevant financial disclosures.
April 21, 2021
11 min read
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Endocrinologists turn to social media to connect with public, colleagues during pandemic

Issue: April 2021
Source: Healio Interviews
Disclosures: Bloomgarden, Gunter, Juarez and Pessah-Pollack report no relevant financial disclosures.
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About 60% of U.S. adults belong to at least one social networking site, and 90% of physicians are engaged on social media, according to a committee opinion from the American College of Obstetricians and Gynecologists published in 2019.

It is not just acceptable for providers to use social media today, but perhaps advisable as the proliferation of health misinformation makes it difficult for the public to discern what information is true and what is fake.

Misinformation has always been an issue in health care, according to Jennifer Gunter, MD, an OB-GYN and pain medicine physician in San Francisco with more than 300,000 followers on Twitter. However, she noted, the internet and social media have allowed misinformation to become easier to find and more pronounced.

Concerned about health misinformation online, Jyothi Mamidi Juarez, MD, started Your Endo Doctors accounts on Facebook and Instagram to provide reliable information to patients on the platforms they use.

Photo courtesy Jyothi Mamidi Juarez. Printed with permission.

“There’s definitely been medical conspiracy theories around forever,” Gunter told Endocrine Today.

The cancellation of in-person medical conferences has also made social media an important tool for networking. With the pandemic preventing in-person conferences, Facebook and Twitter allowed health care professionals from around the globe to stay in touch.

“A big part of it was collaborating with other physicians — physicians I wouldn’t normally meet who, unless we see each other at specific meetings, we don’t really interact with each other,” Jyothi Mamidi Juarez, MD, endocrinologist and owner of Partners in Endocrinology in Webster, Texas, told Endocrine Today.

Juarez created groups on Facebook and Instagram for connecting.

“The Facebook group created a big community so we can share cases,” she said. “It has been nice to get good input from a wide variety of people who trained at different places.”

Eve Bloomgarden

Social media is also quickly becoming an essential tool for many to promote research and support the work of others.

“Social media is constantly evolving,” endocrine surgeon Julie Ann Sosa, MD, MA, FACS, MAMSE, FSSO, professor and chair of the department of surgery at University of California, San Francisco, told Endocrine Today. “If you’re not going to participate professionally, I’m not sure that’s contemporary, because social media can augment, or amplify, a professional voice.”

The constantly shifting social media environment has led health care professionals to use these platforms in a wide variety of ways. From engaging with the public through Instagram to networking through Twitter journal clubs, the use of social media continues to evolve.

“Even over the past year, it is skyrocketing more than I would ever have thought,” said Rachel Pessah-Pollack, MD, FACE, clinical associate professor in the division of endocrinology at NYU Langone Health and an Endocrine Today Editorial Board member. “It’s going to continue to be the way we communicate.”

Combating the ‘infodemic’

Jennifer Gunter

During the early days of the COVID-19 pandemic in March 2020, a group of parent-physicians in the greater Chicago area became concerned about what they were seeing in their local area. Packed events full of people without masks, long lines of unmasked travelers at O’Hare International Airport and more sparked the founding of the Illinois Medical Professionals Action Collaborative Team (IMPACT), an organization focused on disseminating and amplifying evidence-based science around public health issues using social media as a tool to spread accurate information.

According to Eve Bloomgarden, MD, assistant professor of medicine in the division of endocrinology at Northwestern University Feinberg School of Medicine and one of IMPACT’s founders, the group has had three main goals: transmit accurate information on COVID-19 to the community, communicate health-based information to state and national government officials, and fight the “infodemic,” a term Bloomgarden uses to describe health misinformation online.

“To date we’ve written more than 35 op-eds, we’ve been in Forbes, USA Today, the Chicago Tribune, Time magazine, and the Washington Post,” Bloomgarden said. “We have a weekly segment on the local news answering questions about the pandemic and now about vaccines. We are active on social media, amplifying good sources of information. We are only successful because there are many of us. None of us could do this alone.” Bloomgarden did not have a large social media presence before COVID-19, but health misinformation is nothing new for her. She said information about her specialty focus, thyroid, includes a lot of poor information on different treatment pathways. However, the misinformation she dealt with previously paled in comparison to what she has seen in 2020.

“I’ve never seen anything like what’s going on with COVID-19,” Bloomgarden said. “And I’ve never seen it so widespread. Part of that is because messaging has been very disrupted. The entire response to the pandemic has been a patchwork of good and bad plans that had no coordination to them. There’s a lot of distrust. ... It was the perfect breeding ground.”

Gunter said several factors allow misinformation to spread widely on the internet. One way is on websites that appear to have informational health articles, but whose purpose is to promote a false medical conspiracy or sell a product.

Conspiracy theories and medical misinformation also find their way onto social media, where ideas can quickly proliferate and be viewed by thousands of users because of sharing, retweeting and bots designed to intentionally spread misleading ideas.

Health misinformation online may have been magnified by COVID-19, but it is not new. A 2018 article published in JAMA Network discussed the vulnerabilities of medical science on social media. The authors cited the rapid decrease in the cost of publishing, consumers selecting only what information they want to hear, and the ability for misinformation to appear as accurate online.

“With a traditional library, you have a librarian to curate things for you, and with the internet, there’s nobody curating quality,” Gunter said.

Misinformation can also stem from legitimate medical research on social media. Sosa said she has seen visual abstracts posted by researchers that tell a different story than what is published in the full study.

“If you have a visual abstract, and you put it on Twitter, your own Altmetric score is going to rise, and almost instantly, you’re going to increase the impact of your science,” Sosa said. “What’s irresponsible is taking your manuscript and making a visual abstract that does not represent your results.”

Connecting with patients virtually

A big part of IMPACT’s mission is to provide accurate and useful health information to a wide range of people. The organization has been able to do that through its social media channels.

Last fall, in response to statements from then White House coronavirus adviser Scott Atlas, MD, about the lack of efficacy of masks, the inability of children to transmit COVID-19 and herd immunity as the best response to COVID-19, IMPACT drafted a long statement that argued against Atlas’ claims and included links backing up the organization’s information. Partners helped get IMPACT’s message across by sharing the statement on their social media accounts.

Juarez also saw a need to get accurate health information out on social media. She started Your Endo Doctors accounts on Facebook and Instagram to provide general tips on endocrinology issues and conditions.

Juarez said endocrinologists have been more open in recent years to responding to the infodemic. With patients gravitating to social media to search for health advice, Juarez said, it was important to provide accurate information on platforms patients used.

“We felt like something else needed to be done to back us up,” Juarez said about the accounts. “Several of us who are active on Instagram, who feel more emboldened to make our voices heard, feel like we have a backup [and] support each other online.”

Physicians understand the importance of promoting strong medical information on social media, but ethical concerns remain. Pessah-Pollack noted some of her patients follow her on social media and, at times, she has gotten direct messages from patients on Twitter. Instead of having a discussion over social media, Pessah-Pollack directs any patients who contact her to call her office instead.

Julie Ann Sosa

“I just find [social media] is not really the medium I would want to give patient advice through,” Pessah-Pollack said. “I’m very aware of HIPAA and privacy rules. It’s too wide of audience for me to be doing that.”

A new way to network

Social media has also changed the way providers interact with each other. Five years ago, Juarez was looking for a better way to network with professionals in her field. She decided to start a private Facebook group for endocrinologists.

“There really was no other way to keep in touch at that time,” Juarez said of networking before social media. “Most of us would have that ‘phone a friend’ group of colleagues who we trained with and, if we had a concern or a clinical question, we would text them or call each other. But other than that, nothing unless we went to a conference.”

The endocrinologist group is a private page where endocrinologists can discuss their research, ask questions about treatments, or find a solution to a practice issue.

Since the group launched, it has ballooned to more than 2,500 members. Its success encouraged Juarez to start a separate group for those working in private practice. There are more than 6,000 members in that group today.

Both the endocrinologist and private practice groups are not searchable on Facebook, meaning physicians must be invited to the group by a colleague.

“It is mostly word of mouth,” Juarez said. “Again, we are a small community, so we’ve heard about each other through other colleagues and it’s a good place to have social interaction without having met each other, especially now, without conferences.”

Rachel Pessah-Pollack

With the absence of conferences now stretching into a second year, social media continues to be a valuable tool for physicians looking to stay in touch with their colleagues. For Pessah-Pollack, the Endo Journal Club has taken on extra importance over the past year. @EndoJournalClub is a Twitter account that hosts occasional virtual events where an endocrinologist will present a recent journal article and discuss it, complete with Q&A sessions, polls and conversation with other users.

Pessah-Pollack got involved as a guest specialist early on and later began serving as a co-host.

“It’s definitely a different format that you have to get used to,” Pessah-Pollack said of moderating. “After you do that type of moderating, it is not that it ends right there, it has a wide reach. The day after, tweets were getting liked, tweets were getting shared, tweets were getting commented on. I thought that was incredible.”

Social media has partially filled the conference networking void, but Pessah-Pollack noted one downside is the inability to video chat. @EndoJournalClub is discussing doing a Zoom call to encourage face-to-face interaction between members.

Hospitals, universities and individual departments are also taking advantage of social media to tell their story. Pessah-Pollack helped start a Twitter account for the NYU endocrinology department in October. The account allows the department to share research from its providers, honor those who win awards, promote news from the health system and more.

“It is exciting because if I was applying to fellowship, I would like to see what is going on in a department,” Pessah-Pollack said. “There’s so many things that you want to share. When I published a book chapter, who better to share it with than my colleagues who will see it?”

Researchers are also using private messages on Twitter to stay in touch. Earlier this year, Bloomgarden started a direct message thread on Twitter and invited 33 other endocrinologists to join. The goal was to create an amplifier where researchers and physicians could connect, continue discussions and share research. Bloomgarden said the amplifier was a great boon for promoting posters and presentations that were part of the ENDO annual meeting.

“It levels the playing field, but also gives you this breath of contact for our patients and for our field that we didn’t have before,” Bloomgarden said. “This is a little more direct because Facebook, when you tag someone, maybe somebody sees it, maybe they don’t. Here, it’s more of a text message. It’s easier to follow.”

Defining professionalism on social media

Some physicians may be reluctant to use social media, fearing they may appear unprofessional.

Users should be clear about whether their posts are for an institutional or professional vs. a personal account, which may have different standards for appropriate posts, according to Sosa.

For professional posts, she advises new users to watch before they become active on a platform, to “like” or comment on posts before beginning original threads, to consider having a mentor or colleague review content before posting, and to always follow HIPAA guidelines.

“Every avenue of social media serves different expectations and purposes,” Sosa said. “What someone does on Instagram or Facebook or Twitter may vary based on whether they are sharing their personal or professional lives.”

The recent #MedBikini social media campaign highlights the difference.

In August 2020, the Journal of Vascular Surgery retracted a study published online earlier that year about the prevalence of so-called unprofessional social media posts from young vascular surgeons, particularly women. The male researchers had defined posts with pictures of physicians in Halloween costumes or swimwear, for example, posted to personal accounts on Twitter as unprofessional. The backlash online called “gender bias.”

In an editorial published in World Journal of Surgery, of which she is editor-in-chief, Sosa wrote that the #MedBikini controversy illustrated the extent of gender bias remaining in medicine. She criticized the study’s definition of professionalism for failing to distinguish between personal and professional social media accounts.

Instead of focusing on pictures, Sosa said professionalism on social media should be determined by the information communicated.

“On Twitter, [although you cannot edit tweets] thankfully, you can delete tweets,” she said. “Have a low threshold, think about it before you send it.

“I use Twitter to focus on scientific topics that I’m passionate about, where I do believe there’s right and wrong,” Sosa said. “If I say something controversial in science, I will back it up with evidence, and then people can come to me with their evidence, but I make sure I can support my argument.”

Getting started on social media

Physicians wishing to get started on social media do not need a large following to have an impact. Any providers who see misinformation being shared can help fight against it simply by speaking out.

“If somebody is posting something as a question, then it is an easy dialogue,” Bloomgarden said. “If someone is saying, ‘See, I told you so. Masking doesn’t work and the virus is a hoax,’ then you have to come down kind of strongly. You don’t blame the individual; you blame the idea. You need to be kind, but I feel like I have a responsibility as a physician and as a parent to just call that out.”

Juarez said it is important for providers to emphasize their expertise and credentials when discussing medicine on social media.

“There is a lot of confusion about who should be giving advice on certain topics,” Juarez said. “It’s important to emphasize how highly trained we are. Also, emphasizing that we’re not being negative in our commentary if we’re disagreeing with false medical advice. Give some sense of understanding why someone might be seeking the other type of treatment, but this is what we are recommending based on patient-best interest. If you always present patient best interest and not self-interest, it comes across better.”

Even if they do not want to engage the public, Pessah-Pollack said, physicians should not hesitate to start a professional social media account and get involved with networking.

“Within the NYU [endocrinology] department, I’ve spoken to a lot of people and tried to encourage them to join Twitter because it is a great community,” Pessah-Pollack said. “Obviously, there are a lot of potential negatives that you have to be very much aware of, but within, at least, the #EndoTwitter community and @EndoJournalClub, it does have a lot of opportunities that anybody can start doing today.”