December 6, 2011

What will it take to get physicians using social media in healthcare?


Editor’s Note: Mark Ryan, M.D., is a member of the External Advisory Board for the Mayo Clinic Center for Social Media.

Medical education is based on the foundation of science.  Undergraduate premedical majors are required to take a number of science courses in order to be considered qualified applicants for medical school.  Once in medical school, students are exposed through all four years to scientific research: we are taught about seminal basic science experiments that helped establish the biochemical mechanisms, and were are taught about the process of clinical research and how the scientific method has helped develop current medical treatments.

At the same time, as we are steeped in the tradition of science, we do not always do a good job of following the scientific method.  One of the greatest examples is the continued practice of providing antibiotic prescriptions for viral illnesses, despite the clear knowledge that antibiotics will not affect how quickly patients improve.  Even though we are trained to approach questions from the scientific perspective, human nature can impact how reliably we follow evidence-based, scientifically-grounded recommendations.  Often time, the rationales given include either the fact that one might be uncertain about the nature of the illness being treated and/or the claim that patients expect antibiotics and that it is easier (and more customer-friendly) to just give patients what they expect as opposed to standing by the evidence.

The truth is that medical practice is a combination of science and human nature.  Hopefully we lean towards the evidence more often than not, but you cannot deny the human part of the process.  Add in the fact that many physicians are employers, small business owners, and breadwinners, and the balance can become more complicted.  As a result, many of the decisions we make are based on considerations from both sides of the issue.

I believe that this will also be true of efforts that attempt to engage physicians in communicating via social media.  To date, efforts to encourage physicians to engage in social media because it is interesting, fun, etc do not seem to have much traction.  I propose that it will require showing that social media has measurable benefits to patient care (scientific argument) and that it improves practice efficiency and/or practice income (human nature argument) in order to increase physician engagement.

  • If research programs that are well-designed, double-blinded studies investigate whether various approaches to social media engagement improve patient outcomes of some sort (disease-oriented outcomes like blood pressure or diabetes control, patient-oriented outcomes such as a global measurement of wellness) and show a beneficial result, then we will have scientifically-based evidence showing that social media can improve healthcare.  This will appeal to our self-perception as scientists.
  • At the same time, if it can be demonstrated that using social media improves how medical practices work (fewer calls back, more new patients, more satisfied patients, etc) and if they can increase the efficiency of medical practices (thus reducing costs), then we will have information that impacts the human nature side of the decision: physicians will have more profitable practices, or will be able to hire more staff, or will be able to offer additional services to their patients.  This appeals to the business/professional side of a physician's worldview.

Needless to say, these two goals are not mutually exclusive.  Often times, interventions that improve medical outcomes also improve practice efficiency...and could become more important as medicine moves towards paying for quality of care as opposed to intensity or quantity of care.  But I think it will take arguments that satisfy our scientific training as well as business needs that will increase physicians' involvement in social media.

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