The Twitter diagnosis: A doctor’s dilemma

Several miles into a long run last week, I started to feel a pang of pain with which I had grown familiar. I knew I would need to stop to “shake it out,” then slow my pace substantially until I could regain my stride and run through it. Because I’d had the same pang around the same mile for the past two weeks, I started thinking that I should talk to my family doctor about it. My first thought wasn’t to call her office – it was early on a Saturday morning, after all – it was to tweet it.

In addition to my personal Twitter account, I am one of the administrators for TAFP’s account and I know several of our family physician members who follow our feed. My tweet (from my personal account) would have gone like this: “Need advice: Sharp pain in the outside of my left knee near my kneecap around mile 7. Is this serious? Should I wear a brace?” With the remaining 15 characters, I would have tagged a few physician friends, none of whom is my personal family doctor.

As I kept plodding through the miles, I decided it would be unprofessional for me to use TAFP members — even those I consider to be friends — to give me a free diagnosis. However, I wondered if it would even be possible or ethical for a physician to give a diagnosis in 140 characters.

The way people communicate is obviously changing. Thanks to smart phones, we’re always plugged in checking e-mail, texts, and social media apps like Twitter and Facebook. More people post more information about themselves online, and connect with others by reading a digest of friends’ activities rather than calling, visiting, or (gasp) sending a letter.

Doctors are no exception. A growing faction of physicians supports expanding the use of social media to hash out ideas and drive reform for our health care system, market their practices, and share health information with medical students and patients. Some of these tweets are traceable through their hashtags, including #FMrevolution and #hcsm.

As explored on a recent blog post from KevinMD.com, the author writes that the application of social media to health care is “a strong candidate for bottom-up change.”

“It’s at least worth considering that, appropriately utilized, social media could do something for the doctor-patient relationship akin to what Facebook and Twitter is doing for family, friends, and business relations all over the world. … Many physicians and medical students that I know have not yet begun to wade into the Twitter waters or explore blogging. These tools must be engaged with before they are applied. I think there’s reason to believe that the very act of engagement will stimulate ideas for implementation. If big changes in health care are going to be bottom-up, and these social media tools are truly useful, then simple exposure to physicians on the ground may likely instigate much progress.”

 To satisfy my original question, I sent a tweet that tagged a few active tweeting doctors. In their experience, had they come across any barriers working with social media? Did they think these applications could only be used for social purposes, or could they be expanded for clinical purposes as well?

Respondents said that they had come across barriers, the biggest being concern for patient privacy that limits what a doctor can actually say. There are also personal-professional boundaries. However, they resoundingly supported social media being used for more than just making friends.

They said that patients seem more prepared to incorporate some social media into their medical care than doctors, and that physicians must overcome larger mental and perceived barriers for adoption. One said he faces the task of convincing skeptics that social media can be used for professional purposes, particularly when on the job. If he checks medical apps or blogs on his phone, “it’s viewed as disinterest or assumed that I am texting friends.”

There are obvious differences between having a living, breathing patient on your exam table for a 15-minute office visit and reading a string of patient-written micro-posts. Particularly for primary care, which often calls for a multi-organ-system diagnosis, Twitter consults could oversimplify a patient’s care and take the doctor out of the driver’s seat. That may be why one responder said that patients could benefit from Twitter consults with some specialists.

As a benefit, Twitter provides access to a wide database of information-sharing and knowledge that, in one source’s opinion, can be beneficial to educating medical students. To me, this is the whole point. Twitter can either mean throwing information out into a larger audience to gauge response (as I did for this post), or it can mean tagging a specific person to have a semi-private conversation (as long as both agree in its use).

In the end, I scheduled a visit to my family physician and had a conversation much longer than a 140-character tweet. She inquired about things I hadn’t considered, and I walked away with a wealth of helpful advice to keep my knees in good shape for the race and in the years to come. We can talk Twitter on my next visit.

[Special thanks to @DrJonathan, @mdstudent31, and @danamlewis for contributing to this post. To all — please comment and let me know what you think. How are you using social media in your personal and professional life?]

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One Response to “The Twitter diagnosis: A doctor’s dilemma”

  • Lloyd Van Winkle:

    There are so many steps on the path to law that a good bill can be sunk by any of a number of parliamentary moves so that even a bill sponsor can be secretly letting their own bill die just so they can say to a “supporter” that they introduced the bill but “sadly” it failed. I wonder what a more transparent system would be like?

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