Healthy Exchange


What am I doing?

You\’re blogging, dummy.

No, I mean what am I, as a doctor, doing writing in this blog?  Why do I do a podcast?  Why do I do Twitter and Facebook?

Because you are pathetic and can\’t find real friends, and real things to do.

I know that!  No, I am looking deeper as to what the role of social media is in medicine.  I\’ve been asked by numerous people recently about my opinion on this issue.  Aside from proving that the end of civilization is at hand, it has provoked me to think a little deeper about the deeper meaning of what I am doing.  I\’ve been blogging for nearly 4 years (Blog-o-versary is May 21), and yet the question is: what is the point?  What is the overall purpose of medicine\’s presence in the social media universe?

Whoa.  That\’s deep stuff.  I\’ll keep quiet while you talk.


In my musings on the subject of social media, I am moved to an even more basic question: what is the purpose of healthcare?  The measure of the contribution of social media gives to healthcare will be based on its alignment with the purpose of healthcare.  Yes, there is an aspect of blogging, Facebook, and Twitter that is personal, but one of the main reasons I get the attention I do is the fact that I am a doctor.  I speak from the doctor\’s perspective, expose the thought process (albeit a little demented) of a doctor, and try to influence the overall discussion about the delivery of healthcare in America.

So what is the purpose of healthcare?  The answer is in the word \”healthcare\”: giving care to patients.  The patients get care that doctors, nurses, and others give.  The patient and the caregivers are costars in the drama, the absence of either making the discussion irrelevant.  Patients don\’t just have needs, they want those needs met.  Being a doctor is pretty much meaningless without patients (it does let you impress people at parties with your fancy Latin and Greek words, though).  The interface of caregiver and those needing that care is what medicine is.  The effectiveness of  the exchange between the two (or more) people will be the measure of the care.

Social media, then, should also be measured by this exchange.  Does it influence the exchange between patients and medical professionals?  Does it help patients get better care?  Does it help doctors be better doctors?  Does it improve the relationship between doctors and nurses?

It does as long as they don\’t read your blog.

Hey, I thought you said you would keep quiet!

I couldn\’t resist.


The answer to those last questions is this: sometimes.  Sometimes it improves care and sometimes it makes it worse.  Just like there are healthy exchanges in the hospital or medical office, there are healthy and unhealthy interactions using social media.  There are a number of areas in which that exchange can succeed or fail.

  1. Is the information good or bad?  Is it biased by desire for financial gain or personal crusade?  Both doctors and patients can become sources of information, and the quality of that information is highly variable.  The problem is that if a person trusts bad information, it is not just their knowledge that is harmed, they can be physically harmed.
  2. Is the content constructive or destructive?  Some doctors blast patients, and some patients blast doctors.  While the Internet is an open venue for venting frustration, there are some who cross the line and undermine or even betray trust.
  3. Is the virtual interaction appropriate?  As the House Call Doctor, I get asked a lot of specific questions that are beyond what I should be doing.  I don\’t want to undermine the relationship a person has with their doctor, I want to enhance it by informing the patient.  Social media can do either.
  4. Are risks being taken?  A big danger of interactions on the Internet is that they are recorded for posterity.  Patient privacy can be breached, and medical mistakes can be recorded.  Bob Coffield, an attorney in West Virginia who is especially interested in social media, has speculated that Twitter is akin to the elevator in the hospital.  Others can listen in and get wrong ideas or draw wrong conclusions.  This may be a bigger risk than we realize.

Obviously, I think social media is worth it (since I am deeply involved in it).  The benefits clearly outweigh the risks, but the risks should be seriously considered and minimized as much as possible.  Here are the benefits I see from social media:

  1. I have a voice – I have the ability to express myself where previously I had little say.  The biggest benefit of SM is the empowerment of those who had no voice in the past.  Instead of just hearing the medical lobbyists, academic physicians, or medical media\’s perspectives, people have the ability to hear from real doctors, nurses, and patients about what it\’s like in their shoes.  This is especially powerful when contrasted to the political grandstanding in Washington.
  2. It humanizes medicine – I am just a guy who is a doctor.  The black box of our medical knowledge is gone, with the access everyone has to copious amounts of medical information.  So now we can let down that air of mystery and relate to people as people.  I am compelled by the humanity of the relationship between doctors, nurses, and patients, and think that truly embracing and understanding it will be a big step forward in care.
  3. I have made friends – I am interacting with people from all over the world, and I really like a lot of them.  I would never have had this opportunity without social media.
  4. Opportunities – I was hired by Macmillan for my podcast because of my blog.  I have gotten a chance to express my opinions on NPR, in the NY Times, New England Journal of Medicine, and in many other venues.  I greatly appreciate the opportunities it has given me.
  5. I have fun – I\’ve discovered my ability to write and have had a chance to express my sense of humor.  I\’ve learned about things I would never have known from other bloggers, and have truly enjoyed interaction with my readers.

In the balance, social media has the same risks as medicine in the office.  The negative is that it is recorded and transmitted over the world.  The positive is that it gives the opportunity to give and take with people from all over the world.  It\’s a medium, and so is neither good nor bad in and of itself.  The content of that medium is what makes it helpful or harmful.  All in all, I think the potential benefit is much bigger than the risk.

So do you think llamas are helpful or harmful?


13 thoughts on “Healthy Exchange”

  1. Healthymagination

    Thanks for sharing your thoughts on the role of social media in health care, Dr. Rob. There are many benefits and risks to participating in social media as a physician. Social media cannot replace the in-person visit, but it can increase trust between doctors and patients. At Healthymagination (, we are committed to building stronger relationships between doctors and patients. We think Facebook, Twitter, and blogging can help provide more open channels of communication.

  2. I think it's great that people have come out and shared their experiences. You are one of the best blogs, because you welcome the lay person, as well as other professionals to join you in a back and forth, give and take exchange.

    I feel that it's great for patients to see that doctors are just people; they're human. They have families, feelings, bad days, illnesses of their own. Each side gets to think about the others' perspective.

    It also aids you to hear (read) the patients' stories, and learn what they have gone through. You may learn just as much from them, and alter the way you handle certain situations. Social media in these instances seems a win, win.

  3. Oh dear Dr Rob-My mother used to tell me it was ok to talk to myself as long as I didn't start answering myself–that was grounds for the funny farm. I think you've done both here. LOL. (Sorry-I couldn't resist!) I do enjoy your blog though. NOt only is it informative, sometimes its funny or silly too–great stuff & I hope you keep it up!

  4. I enjoy your e-mails, but wondered if you could expound on this a bit more? I am curious about crossing any lines, on either a moral or legal basis online, and thought that since you brought this up you could share an example (or two) to help us maintain a type of internet etiquette. I realize we all have our First Amendment rights, but the line above about “trust” made me wonder how you would view that type of scenario (you wrote about it, so you, obviously, thought about this at least a bit). I wouldn't want to stand on my rights and betray a trust, so you have intrigued me.

  5. I am not going to specifically point the finger at a given blogger, but there are medical bloggers who:
    1. Are not careful with confidentiality in discussing things they say. They refer to patients they have seen – “interesting cases” and don't do much to change the facts.
    2. Say nasty things about patients and other healthcare professionals. We do see people who do some pretty stupid things, but to parade them for all others to see and then mock them is far over the line. I have seen this from both doctors and nurses.

    We formed the healthcare blogger code of ethics ( in response to such (and other) abuses of position. We wanted to encourage a community where the exchange between people would be constructive, not a mud-slinging match that some have made it.

  6. Great post
    I agree, being embroiled in social media and being open to the amazing potential for education is fantastic.
    I have been collecting consented images for the last 15 years and have now been afforded the opportunity to contextualize fictional cases for educational benefit.
    In many cases the literary 'now' may be misconstrued as 'real-time now' when in fact images, locations, sex and age have all been altered to suit a particular learning objective.
    I am a visual learner and I find the opportunities afforded by the sharing of 'doctored' information invaluable in the medical education process…far better than non-interactive, non-compelling books
    I also like llamas very much

  7. quote: In many cases the literary 'now' may be misconstrued as 'real-time now' when in fact images, locations, sex and age have all been altered to suit a particular learning objective.
    I am a visual learner and I find the opportunities afforded by the sharing of 'doctored' information invaluable in the medical education process…far better than non-interactive, non-compelling books [end quote]:

    On one level this makes sense……….to say the information is more important than the informant….but on another level it causes an incongruity within that very information when it's not provable, or possibly unethical. But I guess it beats meeting in a dark, parking garage with people titled “Deep Throat”! <G>

  8. I am not comparing the value of the information with the value of the informant.
    I believe it is unethical if the informant provides images and information in 'real-time' context without fictionalization or educational justification.
    I post consented images with fictionalization of the real events, time, place, person to protect patient privacy. It is the context in which these images or writing are used that provides educational information from the informant.
    Images are from various institutions around the globe and are used to demonstrate an educational approach to patient management. In effect these 'interesting cases' are therefore 'hypothetical scenarios'. They are not 'news' articles, and are not intended to be. The literary contextualization adds a sense of realism to enhance iterative learning – but I do not believe that the fact they are not “provable” makes these posts “unethical”

  9. That makes sense. Thank you for explaining. Sometimes it's hard to get to the truth online, so I try to ask more questions in an effort to make sure I see the whole picture the poster is portraying. I am trying to find time to read the link posted yesterday and find myself wondering if there is a website that covers a type of patient's vocality towards trends (and improvement) in medicine, in a timeline fashion. I tend to think that patient's speaking out has changed medicine for the better, but the internet adds a whole new monkey wrench to the pile of information.

  10. I appreciate your integrity on the issue of patients. I have often read doctor's comments online and wondered why on earth someone would rag on about their patients in that manner. Of course, we do take liberties with doctors to. I read an article last week from a doctor who seemed like an enigma to his peers because he announced at a dinner party that he actually enjoyed his job. If job dissatisfaction is that high…….you find yourself wondering why they don't go into research where the public is safe from them! <G> I believe Edwin Leap wrote something similar last week about his personal frustrations with being a good physician, and his verdict that it's overall worth it. I, also, read if a doctor doesn't like a patient the patient probably won't receive good care. And, I understand, doctors won't stand it and move on quickly when they sense a type of incompatibility.

    It's a real dilemma out there as patients decry doctors with attitudes, and doctors rally against persnickety patients (the patients do have some leverage because they are often sick and awnry). Insurers portrayed as villains, but the foundation of this mess was often a small minority of doctors who abused the system (and, ultimately abused some patients).

    With patients outnumbering doctors I imagine the internet is filled with patient horror stories (with a daughter with cancer I had to get offline for several months because for every encouraging post there was a nightmare post that would send my mind reeling)…… I often wonder about where to draw the line. I would, also, imagine doctors have a right to vent about patients to. As I read your piece last week I was wondering if that patient who was upset with you would recognize himself in your piece, but you had spoke with him face-to-face so it shouldn't come as a surprise. I know I posted last week on a different board about a nameless doctor I love, and our bit of a rocky road to get to this place (our reactions to the adversity actually made the relationship better. It was handled well). I wrote to him and said that the next time he feels insecure to just go and read the thread (it was a thread on malpractice). This is why I questioned you for more specifics because sometimes posting is fearful, therapeutic, risky, and sometimes useless. No easy answers!

  11. How right you are. I did change enough of the patient encounter from last week that it should not be evident who it was (although my nurse sure knows). It really was a mix of multiple encounters. I am very careful to do that.

    I am another who enjoys being a doctor, but there are definitely things about it that I don't like.

    Doctors are under a different set of rules than patients, as privacy laws forbid us from saying a lot. Patients could be held for libel if they say a doctor's name, but short of that they can say whatever they want.

  12. Alice Robertson

    quote: Doctors are under a different set of rules than patients, as privacy laws forbid us from saying a lot. Patients could be held for libel if they say a doctor's name, but short of that they can say whatever they want. [end quote]

    But, again, a doctor is at a disadvantage…because if there is even an iota of truth in something a patient would post publicly with a doctor's name attached the doctor would walk a fine line if they sued a patient for libel. A public record of a deposition or trial could be more condemning than an online post venting (and I think the court usually asks that a “cease and desist” order be issued first to show goodwill)? I only share this as an FYI, in a questioning manner, to help patients understand just what is allowable on a legal basis. Sometimes our need to rant publicly crosses the civil law line, and it's not the open-season on doctors people think it is.

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