Early Career

Lessons learned as a gastroenterologist on social media


 


Each platform has its pros and cons. Twitter is perhaps the most appropriate platform for starters. Easy to use with the least preparation necessary for every post, it also serves as the primary platform for academic discussion among all the popular social media platforms. Over the past few years, hundreds of gastroenterologists have become active on Twitter, which allows for ample networking opportunities and potential collaborations. The space has evolved to house various structured chats and learning opportunities as described by accounts like @MondayNightIBD, @ScopingSundays, #TracingTuesday, and @GIJournal. All major GI journals and societies are also present on Twitter and disseminating the latest information. Now a vestige of the past when text within tweets was not searchable, hashtags were used to curate discussion because searching by hashtag could reveal the latest discussion surrounding a topic and help identify others with a similar interest. Hashtags now remain relevant when crafting tweets, as the strategic inclusion of hashtags can help your content reach those who share an interest. A hashtag ontology was previously published to standardize academic conversation online in gastroenterology. Twitter also boasts features like polls that also help audiences engage.

Twitter has its disadvantages, however. Conversation is often siloed and difficult to reach audiences who don’t already follow you or others associated with you. Tweets disappear quickly in one’s feed and are often not seen by your followers. It lacks the visual appeal of other image- and video-based platforms that tend to attract more members of the general public. (Twitter lags behind these other platforms in monthly users) Other platforms like Facebook, Instagram, YouTube, LinkedIn, and TikTok have other benefits. Facebook may help foster community discussions in groups and business pages are also helpful for practice promotion. Instagram has gained popularity for educational purposes over the past 2 years, given its pairing with imagery and room for a lengthier caption. It has a variety of additional features like the temporary Instagram Stories that last 24 hours (which also allows for polling), question and answer, and livestream options. Other platforms like YouTube and TikTok have greater potential to reach audiences who otherwise would not see your content, with the former having the benefit of being highly searchable and the latter being the social media app with fastest growing popularity.

Having grown up with the Internet-based instant messaging and social media platforms, I have always enjoyed the medium as a way to connect with others. However, productive engagement on these platforms came much later. During a brief stint as part of the ABC News medical unit, I learned how Twitter was used to facilitate weekly chats around a specific topic online. I began exploring my own social media voice, which quickly gave way to live-tweeting medical conferences, hosting and participating Twitter chats myself, and guiding colleagues and professional societies to greater adoption of social media. In an attempt to introduce a divisional social media account during my fellowship, I learned of institutional barriers including antiquated policies that actively dissuaded social media use. I became increasingly involved on committees in our main GI societies after engaging in multiple research projects using social media data looking at how GI journals promote their content online, the associations between social media presence and institutional ranking, social media behavior at medical conferences, and the evolving perspectives of training program leadership regarding social media.

The pitfalls of social media remain a major concern for physicians and employers alike. First and foremost, it is important to review one’s institutional social media policy prior to starting, as individuals are ultimately held to their local policies. Not only can social media activity be a major liability for a health care employer, but also in the general public’s trust in health professionals. Protecting patient privacy and safety are of utmost concern, and physicians must be mindful not to inadvertently reveal patient identity. HIPAA violations are not limited to only naming patients by name or photo; descriptions of procedural cases and posting patient-related images such as radiographs or endoscopic images may reveal patient identity if there are unique details on these images (e.g., a radio-opaque necklace on x-ray or a particular swallowed foreign body).

Another disadvantage of social media is being approached with personal medical questions. I universally decline to answer these inquiries, citing the need to perform a comprehensive review of one’s medical chart and perform an in-person physical exam to fully assess a patient. The distinction between education and advice is subtle, yet important to recognize. Similarly, the need to uphold professionalism online is important. Short messages on social media can be misinterpreted by colleagues and the public. Not only can these interactions be potentially detrimental to one’s career, but it can further erode trust in health care if patients perceive this as fragmentation of the health care system. On platforms that encourage humor and creativity like TikTok, there have also been medical professionals and students publicly criticized and penalized for posting unprofessional content mocking patients.

With the introduction of social media influencers in recent years, some professionals have amassed followings, introducing yet another set of concerns. One is being approached with sponsorship and endorsement offers, as any agreements must be in accordance with institutional policy. As one’s following grows, there may be other concerns of safety both online and in real life. Online concerns include issues with impersonation and use of photos or written content without permission. On the surface this may not seem like a significant concern, but there have been situations where family photos are distributed to intended audiences or one’s likeness is used to endorse a product.

In addition to physical safety, another unintended consequence of social media use is its impact on one’s mental health. As social media tends to be a highlight reel, it is easy to be consumed by comparison with colleagues and their lives on social media, whether it truly reflects one’s actual life or not.

My ability to understand multiple social media platforms and anticipate a growing set of risks and concerns with using social media is what led to my involvement with multiple GI societies and appointment by my institution’s CEO to serve as the first chief medical social media officer. My desire to help other professionals with the journey also led to the formation of the Association for Healthcare Social Media, the first 501(c)(3) nonprofit professional organization devoted to health professionals on social media. There is tremendous opportunity to impact public health through social media, especially with regards to raising awareness about underrepresented conditions and presenting information that is accurate. Many barriers remain to the widespread adoption of social media by health professionals, such as the lack of financial or academic incentives. For now, there is every indication that social media is here to stay, and it will likely continue to play an important role in how we communicate with our patients.

AGA can be found online at @AmerGastroAssn (Facebook, Instagram, and Twitter) and @AGA_Gastro, @AGA_CGH, and @AGA_CMGH (Facebook and Twitter).

Dr. Chiang is assistant professor of medicine, division of gastroenterology & hepatology, director, endoscopic bariatric program, chief medical social media officer, Jefferson Health, Philadelphia, and president, Association for Healthcare Social Media, @austinchiangmd

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