1 Chiropractor B.Sc. M.Chiro. ICCSP, Enhance Healthcare, Canberra, Australia
The growth of social media has long been on the radar of health professionals, their industries and their regulators. The initial response by many was one of fear and ignorance. Although the popularity of social media is rapidly rising, its adoption by health professionals does not appear to be increasing at the same rate. Additionally, the way that people seek knowledge has changed. In this paper I discuss not only this changing landscape with its pitfalls and opportunities but also give recommendations on how those in healthcare can engage in this new landscape effectively.
La croissance des médias sociaux est apparue depuis longtemps sur les radars des professionnels, de l’industrie et des autorités de la santé. Initialement, la réponse de nombreux acteurs a été marquée par une forme de crainte et d’ignorance. Si bien que le développement rapide de la popularité des médias sociaux n’a de loin pas accéléré leur adoption par les professionnels de la santé. En parallèle, on se doit de constater un changement dans les stratégies des personnes pour accéder aux connaissances. Dans cette article, je présente non seulement cette évolution avec ses écueils et ses opportunités, mais je donne aussi quelques recommandations pour les soignants qui souhaitent interagir dans ce nouvel environnement de manière efficace.
The phrase “Social media” is defined by Merriam Webster to be: “forms of electronic communication (such as websites for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content (such as videos)”.
This includes platforms such as blogs, Twitter, Facebook, Pinterest and Instagram among others. The popularity of social media is remarkable. As of August 2017 there are billions of people connected to and influenced by social media.
The growth of social media has long been on the radar for health professionals, their industries and their regulators. The initial response by many was one of fear and ignorance.
Regulators and industries were well aware of the risks associated with social media and began to devise guidelines. In the meantime everyone stuck their heads in the sand and hoped it would go away. Since then, there has been the introduction of industry specific social media guidelines throughout the world.
I have noted that although the popularity of social media is rapidly rising, its adoption by health professionals is not increasing at the same rate. Additionally, the way that people seek knowledge has changed. These days people no longer go through their encyclopaedia collection for the answers to their questions nor do they go to libraries. They look for the information from their smartphones either online or via social media. Information retrieval is cut-throat, it is quick and fast. From this information, people are making their healthcare choices.  Many of us have either a direct or indirect relationship with the public, the influence of which may be diminishing if we don’t become aware of this changing world. It is important that our communication practices adapt to reflect this.
It is often questionable whether health professionals should have a strong and active presence on the internet.
Before we go head first into this new world it is important to consider not only the pitfalls but also new exciting opportunities available for health professionals. In this report I hope to enlighten you, yet, leave these decisions to yourselves.
Social media offers health care organisations and practitioners many benefits. In this section we’ll look at a few of the great opportunities made available through social media.
1. Share updates
- If word of mouth is an effective tool for spreading the word about your skills, practice or brand, social media is the next level. Rather than posting up quality articles and health messages on a news board with a limited audience, we are now able to share those articles with the public and for the public to then share on those articles. The distribution potential is almost unlimited. There is incredible opportunity for health professionals to use social media to get health messages out. Due to this distribution potential it is of my opinion that all health practitioners should not only simply be on social media, but that they have a responsibility to get involved sharing quality and accurate information. 
- Quality health messages need to be distributed amongst the public to promote improved health through as many mediums as is required to make change. Some smaller healthcare organisations utilise social media and their websites to share information with consumers in ways such as sharing general information about flu shots and tips to avoid a cold. 
- The sharing of knowledge is also helpful between health professionals. Many clinicians who attend conferences these days will “live Tweet” on Twitter. That is, they share slides and quotes from the conference they are attending in real time. As we are not able to attend every conference, Twitter can be an excellent tool to view the highlights of a seminar. For example, The Rugby Science Network is run by World Rugby, has outstanding speakers and was on 12th September 2017 at the University of Bath, England. If you missed it you can catch up on the highlights. Search for #RSNLive17. The speeches from RSNLive16 and RSNLive17 speeches are also available on youtube afterwards. Use Symplur.com to find other live conferences.
Other forms of sharing information that can be useful through social media include:
- Providing relevant media to your clinics followers either on the latest health news or currently relevant health issues. 
- Providing updates on services offered.
- Changes to practice schedules. Let people know that your location may be closed or limited hours due to events
such as public holidays, family events or a practitioner is currently away due to illness.
- Practice transport updates such as weather warnings or roadworks which may affect the ability to attend your location. 
2. Communicating during a crisis
Sharing news regarding outbreaks or health hazards is an effective way for larger healthcare organisations to provide accurate and timely information to the public.
- The Centre for Disease control and Prevention (CDC) is a great example of a quality global health organisation encouraging leaders in healthcare to use social media. According to the CDC’s Millennial Health Leader’s Summit, social media can be used in the following ways:
- Educating communities not being adequately reached
- Offering useful content where consumers are
- Facilitating real time conversation
- Improving credibility and thought leadership. 
A great example of social media usage by the CDC was during the Zika crisis of 2016. One of the main issues with Zika was that although it is not a new virus, not many health providers were familiar with it and hence the public were left in the dark.
The CDC designed and successfully implemented a social media plan for Zika which achieved the following:
- Building awareness and transmission prevention knowledge amongst frontline healthcare practitioners. Information was provided such as detail on its symptoms, transmission, localisation, and prevention techniques. This was made available in various forms to both clinicians and the public. Twitter chats were held with experts. Some chats were directed at clinicians and some were directed at the public.
- Crisis communication updates were shared regularly via the CDC website, Twitter and Facebook.
- Minimising the spread of misinformation related to its treatment, risk zones and prevention while maintaining awareness whilst the disease was still active.
Overall this campaign was hugely successful and improved the health outcomes of many. This was an outstanding example of how social media is effective at sharing information and can be used by health organisations. 
3. Professional Networking
Social media can be an excellent tool to network with other like-minded clinicians. If you see a conversation online, you have the ability to join in and contribute.
- Think of social media as a conversation at a friendly bar. Engage if you feel comfortable. Note of caution: tone is not perceived very well in the written format. Sometimes it’s preferable to have a conversation in private rather than being restricted to the 140 character limits of Twitter, or 280 characters since their recent update.
- Some health professionals either work in small teams or have limited access to other professionals. Social media can help to link like-minded professionals, regardless of the distance between them, to share ideas and professional advice. Private messaging a specialist colleague on the other side of the world for a second opinion on a case is possible thanks to social media and can be invaluable. There are professional and personal benefits. Your networking may lead to new jobs and opportunities previously unavailable.
- Social media also gives you the opportunity to discover other health organisations or professionals whom you may learn from. Many academics also have their Twitter handle on their papers for discussion after the matter. Get chatting. Very rarely will quality professionals not respond.
The social aspect of social media means that any messages shared can be widely distributed, for better or worse. Social media could result in the greatest praise or by far be the worst public humiliation you could experience. There are people who have had their whole life or career ruined by social media.
At this point of the article I invite you to investigate your local social media regulations for professional and legal reasons. It is outside the scope of this article to cover best practice guidelines for all scenarios. If no regulation code exists for your profession or for a certain topic please use caution and common sense. Many of the guidelines reflect basic courtesy and respect.
Another consideration is the quality of the information that you share. Be sure to share the content of high quality journals. Many high quality journals have a high impact factor. Be careful sharing papers from journals that do not have an impact factor or a rigorous peer reviewed editorial process. Before you share a post online, don’t think twice, but thrice.
Note: Care with confidential information
As discussed above, the protection of confidential information is a responsibility given to health professionals and that duty extends to social media. Many are aware of this fact and may declassify personal details to share information online however one must be careful of breaches.
In 2011, a Rhode Island physician was fired for posting patient data to her personal Facebook profile. The actual patient’s name was not mentioned however the information posted provided enough detail for others to guess who the patient was.  Always err on the side of caution.
Devastating breaches of confidential information into the public may include your own! I would highly recommend amplifying your privacy settings for your personal accounts. It is advisable to have multiple layers of privacy and group contacts ranging from long term friends, to acquaintances and people whom you’re friends with so as not to offend them. Rants or personal comments on your private accounts or in the most private of online forums or groups can and sometimes will be used against you.
Top tips for effective and efficient social media usage engagement
- First of all, decide whom your target audience is. Are they patients? The public? Fellow clinicians? What age are they primarily? The language you speak, your tone and the complexity of your words should be reflective of your target audience. I recommend you consider multiple social media platforms if you plan to engage with different target audiences whether one is in layman phraseology or one is in a different language, e. g. “Excellent thoughtful work by Dr. Boris Gojanovic with both @ drsportsante and @ drsportsante_f to appeal to both french and english speaking audiences.”
- Find content that appeals to you and you believe would appeal to your target audience. This could be RSS feeds, links to sports medicine journals or even the news. Put yourself in the shoes of your audience and post articles and Tweet titles that you would click on.
- To get started pick one platform and do it well. Don’t spread yourself too thin early and lose the fun of it all. Keep active but remember, sometimes less is more. 
- Develop a simple routine that you can complete daily, every other day or as often as you’re comfortable. Remember that the more time you invest in relationships with more people, the more you’ll get out of social media. 
- Although there are more advanced ways to use social media which may help to make your engagement for time efficient however if you can’t commit to at least a couple of hours over the course of a week then social media probably isn’t for you. 
Don’t forget the SOCIAL in social media
- Following one another on social media isn’t enough to build a strong relationship. Foster the relationship with the contacts you want to engage with. Interact regularly, share great, helpful tips and content (not always your own). Even jokes often go down well. If you support others by promoting and sharing their content over time, before you know it some may reciprocate and help you out when you need it. 
- Use social media to create relationships and take advantage of opportunities to meet social connections in real life. Meeting in real life is much more powerful than a Tweet or exchanging comments on a Facebook group post, even though those are great places to start conversations. 
- Don’t just broadcast messages and have an account full of links to articles. Get people involved. Include others in your Tweets who may benefit from that tweet to get the social aspect more exciting. Get the attention of your friends or relevant colleagues when you find relevant or interesting articles. It’s very thoughtful and it makes social media a lot more exciting. Sharing is caring!
- It’s critical that you respond when someone makes contact, Tweets or mentions you, reply. Thank people for resharing your Tweets or following you and so long as a user isn’t violently in opposition to your beliefs, following back is a nice touch. People are more likely to unfollow you and become disinterested if you’re more concerned in improving your followers to following ratio beyond 1:1 and refuse to follow back.  “E.g. Great video on prescribing running shoes by Kevin Maggs @runningreform. https://vimeo.com/126720173. Wow! Check it out @glasgowosteo @aquesousco @sportmednews.”
- Frequently contribute to your social media. You don’t need to be on 24/7 but presence is important otherwise people will assume your accounts are unused and refuse to follow you. 
Take advantage of Twitter Chats and online public forums
- Twitter chats are chats which are either one-offs or take place at a set time on a weekly or monthly basis and are typically moderated by topic experts or rotating guest hosts. They are conversations on set topics. #physiotalk is an example of a friendly regularly run chat on primarily musculoskeletal issues. A hashtag (#) is used to identify messages on a specific topic.
- To follow the conversation, log into Twitter and type the chat’s hashtag in the search bar. To get involved, simply tweet your thoughts from your own account. Don’t forget to include the chat’s hashtag to enable others to find your tweet, e. g. “The sports’ concussion tool you discussed from @Bjsm_bmj is mentioned here: http://bjsm.bmj.com/content/51/11/851 #(insert hashtag here)”.
- The website Symplur tracks popular healthcare-related hashtags and also includes a weekly schedule of healthcare tweet chats, including a list of upcoming one-time and irregularly scheduled Tweet chats. That said, if you’re running an event and want to generate interest, register it with Symplur. You just need to choose a hashtag to identify the conversation.
- A few tips: The hashtag should be short to minimise characters and be memorable and dated. e. g. #ZurichKnee17.
- Take care with acronyms! First search to make sure the hashtag you desire hasn’t been used already, especially for a topic you don’t want to be associated with.
- From Symplur you’ll be able to log your hashtag and record details for the conference or twitter chat for a set time period including total views, number of shares, those involved in the chat and top interactors. You are able to share those stats easily with your followers.
- Don’t be scared of making mistakes – so long as you follow your industry’s guidelines and are polite. 
- Commit to it and develop a habit. Little and often is the key and it will take time to build relationships – don’t expect instant results, seek out opportunities to help others first. 
- Tend to your social media garden regularly, respond to comments, comment on others’ posts/tweets and re sharing/retweeting the content of others. 
- Have fun! There are incredible opportunities out there for those willing to give up a small amount of time to network with like minded colleagues online.
Each professional should make their decision for themselves however, in my opinion, so long as you play the game appropriately, the benefits for clinicians and for the public far outweigh the pitfalls. I hope you have enjoyed examples where social media usage was crucial to the success of health programs e. g. CDC with Zika virus as well as noted others where it led to the demise of a clinician. A very high degree of medical professionalism is required before you send your first Tweet or have your first social media engagement.
It is important that healthcare providers are aware of the huge impact of social media and don’t merely shy away from it. It is something that is here to stay and it influences not only the opinions of our patients but also ourselves. It can however be time consuming which is a deterrent for busy professionals. In my opinion it is not just the question of whether health professionals have a place in social media but how are we able to navigate this platform safely, effectively and efficiently.
Nash Anderson has a special interest in sideline care and the SEM community. Nash has created http://www.sportmednews.com, an open access health and sports medicine resource for clinicians and the public. He is a Sports Chiropractor in Canberra, Australia at Enhance Healthcare. He also assists in the management of Social Media for Sports Chiropractic Australia and is associate editor for BMJ’s Open SEM. You can follow him on Twitter (@sportmednews).
If this article has ignited your passion for social media and you’re feeling confident, let’s chat. Follow and contact me either publicly or privately on Twitter at @Sportmednews. Social media is a topic I’m passionate about and I’m happy to share knowledge, answer questions or provide guidance. As an experiment, use the hashtag #SSportMedChat and let’s get a conversation started on Twitter! Type in the username to get people in the conversation.
E. g. “What are other ways to effectively find content for social media? @sportmednews @drsportsante @swisssportsmed #SSportMedChat”
Dr. Nash Anderson
B. Sc. M. Chiro ICCSP
- Rohampton J. Does Social Media Influence Millennials’ Healthcare Decisions? [Internet]. Forbes.com. 2017 [cited 14 August 2017]. Available from: https://www.forbes.com/sites/jimmyrohampton/2017/04/13/does-social-media-influence-millennials-healthcare-decisions/#2048e3727657
Figure 2 by Nash Anderson however statistics from:
- Kallis, P. (2017). Top 15 Most Popular Social Networking Sites and Apps [September 2017]. [online] Dreamgrow.com. Available at: https://www.dreamgrow.com/top-15-most-popular-social-networking-sites/%5BAccessed 8 Sep. 2017].
- The University of Scranton’s Online Resource Center. (2017). Top 5 Ways Social Media is Used by Healthcare Professionals. [online] Available at: http://elearning.scranton.edu/resource/business-leadership/top-5-ways-social-media-is-used-by-healthcare-professionals [Accessed 7 Sep. 2017].
- Ventola, C. L. (2014). Social Media and Health Care Professionals: Benefits, Risks, and Best Practices. Pharmacy and Therapeutics, 39(7), 491–520. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103576/Accessed online: 1/9/2017
- McBride, M. (2012). Ignorance is no defense for violating patient privacy online. [online] Medical Economics. Available at: http://medicale
medicine/modern-medicine-now/ignorance-no-defense-violating-patient-pri?page=full [Accessed 24 Aug. 2017].
- Anderson N, Tillison M. The Ultimate Guide – Social Media in Healthcare and Sports Medicine (With Social Media Legend – Mark Tillison) [Internet]. sportmednews.com. 2015 [cited 1 September 2017]. Available from: http://www.sportmednews.com/blog/the-ultimate-guide-social-media-in-healthcare-and-sports-medicine-with-tillison
- For further information I recommend reading the following paper in the British Journal of Sports Medicine, considering using the online tool Symplur for effective engangement as well as looking into these social media resources from the CDC.
- Ahmed O, Weiler R, Schneiders A, McCrory P, Sullivan S. Top tips for social media use in sports and exercise medicine: doing the right thing in the digital age [Internet]. 2017 [cited 7 September 2017]. Available from: http://bjsm.bmj.com/content/49/14/909
- Symplur. Recommended tool for finding for conferences online and listing your own. https://www.symplur.com/
- CDC Resources
CDC Social Media Tools, Guidelines & Best Practices
- CDC Guide to Writing for Social Media https://www.cdc.gov/
- The Health Communicator’s Social Media Toolkit https://www.cdc.gov/socialmedia/tools/guidelines/socialmediatoolkit.html