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OP-ED
Year : 2011  |  Volume : 1  |  Issue : 2  |  Page : 47-49

"To post or not to post" - that is the question


Editor in Chief, Journal of Laryngology and Voice,

Date of Web Publication19-Sep-2011

Correspondence Address:
Rakesh Datta
ENT surgeon, Commanding Officer, UNIFIL Hospital, Naqoura-Lebanon

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DOI: 10.4103/2230-9748.85061

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How to cite this article:
Datta R. "To post or not to post" - that is the question. J Laryngol Voice 2011;1:47-9

How to cite this URL:
Datta R. "To post or not to post" - that is the question. J Laryngol Voice [serial online] 2011 [cited 2014 Jul 29];1:47-9. Available from: http://www.laryngologyandvoice.org/text.asp?2011/1/2/47/85061

"36-year-male, school teacher developed sudden hoarseness following shouting in a class. Fiberoptic exam (can be seen in video below) shows the left vocal cord to be hemorrhagic. pls comment on further role of treatment. Any role of oral steroids?"

A not-so-young laryngologist posted the above on a popular ENT forum in Facebook. Reflexly, I replied asking for some more information about the case. And lo and behold, by the next day not only were there further clarifications about the patient including a voice sample, but also a plethora of advises, experiences, references to published literature on the post. In the ensuing few days, the participants in the group read regular clinical updates and expert opinion which was being posted and many actually participated in the "virtual management of the case" till the "virtual patient" had improved 3 weeks later. The participants ranged from senior and respected colleagues to fresh residents into ENT, and busy private practitioners to peers working in academic institutions. With more than 800 professionals registered in the group, this was turning out to be one interesting brainstorming session. Continuing medical education had suddenly acquired a new meaning.

If the above scenario sounds familiar, it is not surprising! Social Media is making inroads in all spheres of life - so should health care professionals be any different? There is a fair chance that the reader of this article has already been the part of a social networking website such as Facebook, Twitter, LinkedIn, Google Plus, and so on. Also I would not be wrong in presuming that more people would be reading this article over the internet and not in a printed form in their hands, taken off the library shelf. Maybe many of them actually landed on this article through one of the social networks themselves! The number of active users on Facebook as per their statistics webpage is more than 750 million - that's more than a staggering double of the entire population of the United States today and a more than 10% of humankind !! And with more than 9 out of 10 college students in the world having their presence in social cyber space already, this tool of information exchange is only bound to grow exponentially. [1]



The question which comes to the mind however is the impact of social networks on the health care professional. The matter is complex and requires experts to deliberate on these issues. What is needed is an assessment of how these tools are impacting our professional lives today.

The ENT cyber space too has silently grown and evolution of social media has enabled blogs and common interest groups to take firm foothold. One of the popular Indian Otolaryngology blog has over 1400 subscribers. Many Facebook groups boast of having more than 800 members. The reach of the social media has expanded with Twitter enabling even the ubiquitous mobile phone to be used as a microblogging tool by simply using a SMS. Not only is the reach of these newer media impressive, but also the content and interactivity extremely dynamic.

Typically, cases are posted with detailed findings. The person who "cyber-presents" the case is available to clarify further questions that may arise. The presence of experts in the field adds to the quality of discussion and many a time differences in opinion are evident. Since no-one is actually conducting the interaction, the course of discussion can be very varied. The beauty lies in the problem-based learning approach and the active involvement of the participants. It is like sharing your experience and gaining from others simultaneously.

Though this concept of knowledge sharing may not be entirely new, social media enables to conduct such a discussion on 24 x 7 basis, with no physical requirement of being together. The power of reaching out to many experts in the field without being direct and personal also makes this a unique tool. These discussions also enable more people to take part since there is no time constraint and it is easy for the busy practitioner to participate during his/her relatively free time. Moreover, a certain hierarchy which exists in the offline world is mitigated in social networks. All other persons are contacts/friends and this removes a mental barrier to participate - all are on the same stage. Also since the posts are not directed at someone, more reserved colleagues may find it easier to participate. The amount of wisdom and frankness that comes out on these forums is sometimes more than a typical CME/conference. The range of topics on discussion is impressive- from steps of performing surgery to therapeutic dilemmas, from wax removal preferences to intra-operative nerve monitoring, from choosing a career to choosing an endoscope - you have it all.

Another advantage of the social media may lie in their ability to connect and network between professionals. Social networks provide this opportunity at practically no cost with reach beyond geographical boundaries. Common causes and problems are identified and a positive relationship develops amongst like-minded people which may tend to get carried over in the real world. Online communities so developed can play a positive role in serving common interests and compete with traditional professional bodies of the physical world. Even disseminating of information about various conferences, updates and training events can be done in an efficient and cost effective way using social media.

However, is there something at the back of our minds before hitting the 'post' button? Does the simplicity and convenience social media offer betray some underlying fine print we should be worried about? Definitely there are certain areas of concern in the usage of these tools.

The main consequence we professionals must be prepared to deal when using social media is of medical ethics. In the example at the beginning of the article, I wonder what would be the ethical considerations in case such a hypothetical situation was to occur. Does the patient know of his illness being discussed in an online forum? Does the doctor get biased in his approach to treatment based on discussions? What if the "online advice from a friend" proves detrimental? What is the neutrality and reliability of information being provided over the network? Many such questions however do not have a simple answer today and require due thought and consideration. We may face a situation where discussion about a patient online may be constituted as breach of trust and lead to possible litigation.

The most commonly quoted Achilles heel of social media is its susceptibility to breach of individual privacy. Is the privacy of a patient being compromised in certain situations (example by posting photographs and videos)? Even discussing a health problem of an individual in a public forum may lead to an inadvertent divulgence of information with consequences to both the patient and doctor. Sometimes there are gross privacy issues and the lack of regulations should not be an excuse to post sensitive patient identification details online. What we choose to tell and show to others needs to be strictly controlled using privacy settings.

This loss of privacy also has the potential to play spoilsport even between peers and effect professional relationships. The hydra headed nature of social networks makes them a common platform where personal and professional lives get mixed up. It must be remembered that social networking tools have developed basically as entertainment and personal tools. Professional rivalry may easily spill onto the virtual world in this mix up and we need to be very sure of what we post with utmost respect for others.

This loss of privacy takes on another meaning when the doctor-patient relationship / friendship scenario is being played out on these media. Should you interact with patients using these media? How much should they know about you and your personal lives? Or vice versa? The issue of social networking sites in these relationships can be complex and has been dealt with in an thought-provoking write-up recently interestingly titled "Facebook friend request from a patient?"[2] Also since there does not seem to be any practical way to separate patients from peers online, what you choose to divulge may not necessarily be limited to either group. Admittedly there exists no code of online conduct to serve as guidance and we can only use our own judgment as of now.

The question of quality of information being generated on social media websites is also debatable at times. Though social media have enabled professional discussions of good standard, it does not replace peer reviewed professional scientific work. This needs to be borne in mind when reading and writing posts on these media. The views expressed are purely personal and at times the remedies suggested anecdotal and lack scientific scrutiny. The lack of reliability and accountability makes this information dangerous to the reader looking for a quick answer or a shotgun solution to a case he/she is faced with. To add to this there may be an undeclared element of conflict of interest in the information being presented. The availability of this medium to all, including members patronized by industry, may make social networking behave like advertising at times. After all, many marketing campaigns for consumer goods are already run on social media with dedicated budgets. The potential for this form of proxy marketing is there and true information can be mixed with promotional language with ease.

So finally - "to post or not to post" is a question which raises more questions than an answer. Despite its many lacunae, we need to embrace this online call. At the same time it is important to remember the pitfalls of the new world order. The issues of practicing medicine in the age of social networking are far from addressed as institutions grope to develop suitable policies. [3] There is a need to evolve some "Best Practices" or guidelines for surviving in this online jungle. So to my online "friends" - well let us use this media energetically but responsibly, and embrace ethics and accountability as we embark on this exciting online journey of our professional lives.

 
   References Top

1.Smith SD, Salaway G, Caruso JB; Research ECfA. The ECAR study of undergraduate students and information technology, 2009: ECAR, Educause Center for Applied Research; 2009.  Back to cited text no. 1
    
2.Devi S. Facebook friend request from a patient? Lancet 2011;377:1141-2.  Back to cited text no. 2
[PUBMED]    
3.Kind T, Genrich G, Sodhi A, Chretien KC. Social media policies at US medical schools. Med Educ Online 2010;15.  Back to cited text no. 3
    




 

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