Ms Saleh (Jenine) and Drs Robinson, Kugler, Illingworth, Patel, and Saleh (Khaled) are from the Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
Ms Saleh (Jenine) and Drs Robinson, Kugler, Illingworth, Patel, and Saleh (Khaled) have no relevant financial relationships to disclose.
Correspondence should be addressed to: Khaled J. Saleh, BSc, MD, MSc, FRCS(C), MHCM, Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North 1st St, Springfield, IL 62702 (email@example.com).
Technological advances in health care have resulted in enthusiasm and apprehension. The general public sees social media as efficient and accessible, but health care has been slow to embrace this advance in communication.1 Social media are forms of electronic communication through which users create and engage in online communities to share ideas, personal messages, and other information. As the number of individuals using social media platforms continues to grow, its potential to affect health care and orthopedics continues to expand.
This article highlights the rise in popularity of social media, its current applications in health care, and the benefits and weaknesses of social media within health care. We will focus on social media in orthopedic surgery as it pertains to physician–patient relationships and ways of improving patient care.
Demographics of Social Media Use
A recent report showed that between June 2009 and June 2010, the amount of time that people spent on social networking sites increased by 43% and continued to become the single greatest time-consuming Internet activity.2 Of all Internet users in the United States, 74% visited social networking sites, and each user spent an average of 6.5 hours on social media sites per week.3 Facebook has grown to >500 million active users and has become one of the largest sites for social networking among all age groups.4,5 Twitter has >175 million users, with >180 million visitors each month and an average of 95 million tweets per day.6,7 YouTube has grown to >2 billion views per day, with >24 hours of new video uploaded to the site every minute.8 Approximately 200 million Facebook users and 37% of all Twitter users use a mobile device to access their sites, and YouTube mobile gets approximately 100 million views per day.4,7,8
As Americans spend an increasing amount of time on the Internet, they are looking to it as a means of finding health care information.9 In the United States, an explosion of Internet use for health information has occurred, from 25% in 2000 to approximately 61% currently.10 Moreover, 61% of adults use the Internet as a means of finding health care information, 61% look online for health information regularly, and 80% search for health topics online at least once in their lifetime.10
Current Social Media Use in Health Care
Social media are becoming present in many areas of health care. PatientsLikeMe is a platform that incorporates patient education with online peer-to-peer communication, using information sharing about conditions, symptoms, and treatments to link patients together.11,12 Thacker et al13 revealed that of 1323 PatientsLikeMe users, approximately 50% found the site helpful for understanding the side effects of their treatments, and 42% agreed that the site helped them engage with peers who had undergone similar treatments.
Hospitals across the country are turning to social media as a means of distributing their message, educating their patients, and marketing their services. Barry14 identified the primary social media uses for 1800 hospitals using social media: supplying information to a general audience (97%), providing content about the entire organization (93%), announcing news and events (91%), furthering public relations (89%), and promoting health (90%). Hospital systems such as the Mayo Clinic, Henry Ford Health System, Innovis, and Scripps Health use blogs—or interactive, informal communication Web-based pages, linked with Facebook, Twitter, and YouTube—to expand their reach to patients.15 For example, the Mayo Clinic Center for Social Media fosters connections between patients and health care providers while building support, allowing patients to share stories through the blog at Sharing. MayoClinic.org.
Social Media in Orthopedics
Orthopedic surgeons, organizations, hospitals, and practices have begun to use social media to reach out to their intended audiences. Orthopedic organizations such as the American Association of Orthopedic Surgeons have been using social media to reach out to their members, advertise upcoming events, and participate in patient education. The variety of results from a July 2011 search of the term “orthopedic” on Twitter illustrates the global effect that social media has had on the entire orthopedics industry. The first page yields 20 results: 6 from orthopedic groups, 3 from orthopedic organizations, 2 from orthopedic journals, 5 from individual orthopedic surgeons, 2 from orthopedic research organizations, and 2 from orthopedic industries.
Similar results on Facebook and YouTube indicate a growing trend in the orthopedics field as a whole. On YouTube, a July 2011 search of “arthritis” resulted in 45,700 videos, “orthopedic surgeon” resulted in 4360 videos, and “total joint replacement” resulted in 1,090 videos.
Along with the expanding availability of orthopedic information among social media sites accessible to the general public, networking sites aimed directly at orthopedic surgeons have also become widely available. Web sites such as OrthoMind.com and VuMedi.com aim to bring orthopedic surgeons together over the Internet and provide discussion forums, video postings, and webinars to enhance education and promote discussion. Both of these sites aim to better educate surgeons and thereby improve patient care.
Benefits in Health Care and Orthopedics
The use of social media and the Internet for health care purposes provides several benefits for patients and providers that can ultimately help to improve overall health care and costs to patients. Social media can be used as a means of increasing patients’ knowledge of their own health concerns, allowing them to take more initiative in their own health care. Furthermore, social media and the Internet provide patients with increasingly abundant opportunities to communicate with people who have or have had similar health experiences. Studies have shown that when discussing sensitive health topics among breast cancer survivors, several benefits exist in online social networking.16,17 These benefits include reduced feelings of isolation and uncertainty and increased patient education before and after their visit.16,17
Social media can facilitate, enhance, and improve physician–patient communication by allowing physicians and organizations to become more accessible and approachable.18 Patients report that access to online health information makes them feel empowered because they have the knowledge to ask their physicians well-informed questions.18
Given time-restricted consultations, patients perceive the Internet to be particularly useful for confirming and expanding on information. Patients see the Internet as an additional resource to support existing and valued relationships with their physicians.19 Therefore, physicians should not feel challenged or threatened when patients bring health information from the Internet to a consultation; rather, they should see it as an attempt on the part of the patient to work with the physician and respond positively.
Studies suggest that patients still consider medical professionals to be the most important source of health information, and that the information gathered online may complement rather than oppose information delivered by medical professionals.20–22
Patients can benefit from social media sites throughout the examination, treatment, and rehabilitation process. For example, patients with severe osteoarthritis of the hip can use social media sites to learn how osteoarthritis of the hip is treated, learn about other patients’ experiences with their treatments, and learn about who might benefit from common treatments, such as a total hip replacement. They can use social media sites to prepare for the orthopedic surgery visit by learning what questions and examinations to expect. Once patients make the decision to have a total hip replacement, they can use social media sites for push notifications (notifications that appear as pop-ups on Internet-based devices) to remind them of important topics, such as preoperative tests, home planning, and requirements. Following a successful operation and hospital stay, patients can use social media sites to keep up-to-date on where they should be for rehabilitation progress and to remind them of important postoperative safety precautions. Patients can join group pages and share their experiences with others, as well as provide feedback and offer personal experiences to physicians. Health care processes facilitated and supported by social media can create increased trust between physicians and their patients.
Weaknesses in Health Care and Orthopedics
Opponents of online social communities for patients argue that some patients may not understand the limitations of the Internet.23,24 Some worry that because standards of care have not been established for health information on social media Web sites, patients may be vulnerable to false information provided for them online.23,24
Patients need to fully understand that any advice provided on social media sites is limited by the fact that it is not based on their individual medical history. At this point, guidelines that explain to what extent physicians can provide care online and what they are liable for have not been established or implemented. In the United States, physicians are licensed by individual states. However, on social media sites such as AmericanWell.com, which provides video conferencing between physicians in the continental United States and patients in Hawaii, health information is available for anyone regardless of their location.23
However, if a physician were to make a misdiagnosis online, he or she would not be held liable for what happened to the patient. A growing number of experts believe that a national, or even global, regulatory structure is needed to incorporate health care into social media.23 They believe that the regulations should address concerns such as online provider licensing and liability issues.23
Health care providers also face limitations and barriers if they want to share patient health stories using social media. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 ensures patient confidentiality, stating that physicians can use patient data without their consent only for 3 purposes: “treatment, payment, or health care operations.”24 Therefore, HIPAA requires physicians to obtain patient consent before displaying information anywhere, including public and restricted networks.24
The British Medical Association recently released guidelines for physicians and medical students regarding social media use.25 Physicians and medical students are to protect patient confidentiality equally on the Internet as on other media, adopt conservative privacy settings on social media platforms, and declare any financial or commercial interests in health care, pharmaceutical, or biomedical companies when posting material online.25 These regulations protect the ethical standards of patient confidentiality and should allow physicians and patients to feel comfortable with how social media platforms are used for sharing health information.
The extent to which social media has been, and will continue to be, integrated into health care and the orthopedic industry will likely be a patient-guided decision. As we begin to see a transformation in health care as a whole, it is likely that the concept of the educated, proactive patient will expand due to social media platforms. Patients who want to understand the decisions being made in their treatment will continue to turn to social media sources for health care information, requiring us to embrace the use of social media as a platform of communication and education among patients and physicians. The use of social media may help promote patient happiness, safety, and overall well-being, which are ultimately the top priorities of the health care industry.
- Eckler P, Worsowicz G, Downey K. Improving physician-patient communication. In: Parker JC, Thorson E, eds. Health Communication in the New Media Landscape. New York, NY: Springer; 2008:283–302.
- The Nielsen Company. What Americans do online: social media and games dominate activity. http://blog.nielsen.com/nielsenwire/online_mobile/what-americans-do-%20on-line-social-media-and-games-dominate-activity/. Accessed August 20, 2011.
- The Nielsen Company. Social networks/blogs now account for one in every four and a half minutes online. http://blog.nielsen.com/nielsenwire/online_mobile/social-media-accounts-for-22-percent-of-time-online/. Accessed August 20, 2011.
- Facebook. Factsheet. http://www.facebook.com/press/info.php?statistics. Accessed July 15, 2011.
- Smith J. Fastest growing demographic on Facebook: women over 55. http://www.inside-facebook.com/2009/02/02/fastest-growing-demographic-on-facebook-women-over-55/. Accessed July 15, 2011.
- Twitter. About. http://twitter.com/about. Accessed July 15, 2011.
- Huffpost Tech. Twitter user statistics revealed. http://www.huffingtonpost.com/2010/04/14/twitter-user-statistics-r_n_537992.html. Accessed July 15, 2011.
- You Tube. YouTube statistics. http://www.youtube.com/t/press_statistics. Accessed July 15, 2011.
- Fox S, Jones S. The social life of health information. Pew Internet & American Life Project Website. http://www.pewinternet.org/~/media//Files/Reports/2009/PIP_Health_2009.pdf. Accessed August 2, 2011.
- Frost JH, Massagli MP. Social uses of personal health information within PatientsLikeMe, an online patient community: what can happen when patients have access to one another’s data. J Med Internet Res. 2008; 10(3):e15. doi:10.2196/jmir.1053 [CrossRef]
- Swan M. Emerging patient-driven healthcare models: an examination of health social networks, consumer personalized medicine and quantified self-tracking [published online ahead of print February 5, 2009]. Int J Environ Res Public Health. 2009; 6(2): 492–525. doi:10.3390/ijerph6020492 [CrossRef]
- Wicks P, Massagli M, Frost J, et al. Sharing health data for better outcomes on PatientsLikeMe. J Med Internet Res. 2010; 12(2): e19. doi:10.2196/jmir.1549 [CrossRef]
- Thacker SI, Nowacki AS, Mehta NB, Edwards AR. How U.S. hospitals use social media. Ann Intern Med. 2011; 154(10):707–708.
- Barry F. Social media 101 for healthcare development organizations. AHP J. 2010; Fall: 30–34.
- Eytan T, Benabio J, Golla V, Parikh R, Stein S. Social media and the health system. Perm J. 2011; 15(1):71–74.
- Høybye MT, Johansen C, Tjørnhøj-Thomsen T. Online interaction. Effects of storytelling in an internet breast cancer support group. Psycho-Oncology. 2005; 14(3):211–220. doi:10.1002/pon.837 [CrossRef]
- Barak A, Boniel-Nissim M, Suler J. Fostering empowerment in online support groups. Comput Human Behav. 2008; 24(5):1867–1883. doi:10.1016/j.chb.2008.02.004 [CrossRef]
- Stevenson FA, Kerr C, Murray E, Nazareth I. Information from the Internet and the physician-patient relationship: the patient perspective: a qualitative study. BMC Family Pract. 2007; 8:47. doi:10.1186/1471-2296-8-47 [CrossRef]
- Culver JD, Gerr F, Frumkin H. Medical information on the Internet: A study of an electronic bulletin board. J Gen Intern Med. 1997; 12(8):466–470. doi:10.1046/j.1525-1497.1997.00084.x [CrossRef]
- Norum J, Grev A, Moen MA, Balteskard L, Holthe K. Information and communication technology (ICT) in oncology. Patients’ and relatives’ experiences and suggestions [published online ahead of print March 27, 2003]. Support Care Cancer. 2003; 11(5):286–93.
- Henwood F, Wyatt S, Hart A, Smith J. Ignorance is bliss sometimes: constraints on the emergence of the ‘informed patient’ in the changing landscapes of health information. Sociol Health Illn. 2003; 25(6):589–607. doi:10.1111/1467-9566.00360 [CrossRef]
- Ahmad F, Hudak PL, Bercovitz K, Hollenberg E, Levinson W. Are physicians ready for patients with Internet-based health information?J Med Internet Res. 2006; 8(3):e22. doi:10.2196/jmir.8.3.e22 [CrossRef]
- Hawn C. Take two aspirin and tweet me in the morning: how Twitter, Facebook, and other social media are reshaping healthcare. Health Aff. 2009; 28(2):361–368. doi:10.1377/hlthaff.28.2.361 [CrossRef]
- US Department of Health and Human Services. Information privacy. http://www.hhs.gov/ocr/privacy/. Accessed August 2, 2011.
- British Medical Association. Using social media: practical and ethical guidance for doctors and medical students. http://www.bma.org.uk/images/socialmediaguidancemay2011_tcm41-206859.pdf. Accessed September 1, 2011.