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Medical News & Perspectives
July 31, 2019

Getting Social: Physicians Can Counteract Misinformation With an Online Presence

JAMA. 2019;322(7):598-600. doi:10.1001/jama.2019.10779

Austin Chiang, MD, a Harvard-trained gastroenterologist at Jefferson Health/Thomas Jefferson University Hospitals in Philadelphia, was recently appointed the institution’s first chief medical social media officer.

Karen Bucher/American Medical Association

The 33-year-old Chiang, president of a new nonprofit called the Association for Healthcare Social Media (AHSM), is trying to encourage physicians and other health care professionals at Jefferson and across the country to establish an online presence beyond sharing vacation photos with friends on Facebook.

Physicians need to recognize that patients are getting much of their information about health care via social media, often from unreliable sources trying to sell questionable products, notes Chiang, who is board-certified in internal medicine and obesity medicine. Instead of scoffing at Instagram and Twitter, he says, physicians should regard the social media platforms as tools with which to inform patients and connect with colleagues.

Following his own advice, Chiang, social media chair of the Association of Bariatric Endoscopy, has more than 23 000 followers on Instagram and nearly 6000 on Twitter @AustinChiangMD as well as his own YouTube channel.

Chiang spoke with JAMA about why physicians and other health care professionals need to take advantage of social media and how best to do that. The following is an edited version of that conversation.

JAMA:Why did Jefferson Health create the position of chief medical social media officer and was that done with you in mind?

Dr Chiang:I had a conversation with our CEO, Dr Steve Klasko, who is known for his innovative spirit. I think it's become more important for us to have an online presence as clinicians so that we are directly connecting with the communities we're serving.

JAMA:What are your responsibilities in that role?

Dr Chiang:I'm basically the clinical liaison to the media relations team here. Traditionally, a lot of the social media efforts have been handled by communications, PR [public relations], and marketing experts. When we're discussing health, I think it’s helpful to have a clinical perspective, so my role is to help the clinicians here at Jefferson get engaged online and serve as expert voices in their specialties.

JAMA:You've described yourself as a social media and YouTube junkie. Do you remember how old you were when you discovered these platforms?

Dr Chiang:I grew up in this social media generation. When Facebook launched at the first several colleges, that was my freshman year, and I was quick to jump on it. But even before that, some of the other platforms, whether Myspace or Friendster or some of the blogging websites like Xanga, were all part of my youth.

My own personal professional use dates back about 6 years ago. I had spent a couple weeks at ABC News, wanting to learn how the general public receives their medical information through the media and how journal publications are vetted by networks like ABC before making their way onto the evening news. They were hosting a weekly Twitter chat on specific health topics, and that's how I saw that social media could be used productively in health. That's when I made a conscious effort to start live-tweeting at medical conferences to build a social media presence for my division when I was training.

JAMA:Why did you create the VerifyHealthcare hashtag on Instagram and Twitter?

Dr Chiang:It's important to point out that the influencer culture was largely born out of Instagram. There were a lot of fashion and fitness influencers, and we really have seen a huge surge in health professionals getting onto Instagram over the past year or 2. It's a very visual platform, and there have been instances where several of us have noticed specific individuals who've misrepresented themselves. There were students who were saying that they were physicians, and there were other professionals who weren't physicians or weren't nurses but saying that they were.

The VerifyHealthcare campaign highlighted the fact that there were these individuals who were misrepresenting themselves and their credentials. We wanted to encourage everyone to disclose their training and credentials and encourage followers to double- and triple-check who they were trusting online. That really took off.

JAMA:Some of the medical misinformation on social media comes from physicians who tweet or blog about therapies that aren't evidence-based, at least not yet. Does that concern you, and how can you counteract that?

Dr Chiang:Just because someone is a physician or just because someone is board-certified doesn't mean that they're disseminating accurate information. Colleagues have to check each other online, and a lot of that is happening on Twitter. But there are also ways that we could improve how we cite medical literature and raise awareness of patients and the general public on how to assess and appraise the sources of information.

JAMA:The VerifyHealthcare hashtag led to the creation of the AHSM. Describe the organization and what you hope to accomplish as its president.

Dr Chiang:This is a nascent organization, founded by 15 of us who are very active, especially on Instagram. It's mainly a board of physicians, although we have since incorporated an advisory council of other professionals, including nurse practitioners and a psychotherapist. It's an opportunity for everyone who wants to get involved early to take on leadership roles—not just physicians, but also trainees as well, so med students are welcome.

We created this because we noticed that there were clearly a lot of questions about how to go about using social media in an effective way to reach greater audiences while also being responsible about what we're putting out there.

There have been organizations focused on health communications professionals but not for clinicians using social media. If we're going to encourage health professionals to get online, we should have a central resource. We should also have best practices, which we are trying to define through this organization.

In having an organized effort like this that's nonprofit, that's multispecialty, that's all-inclusive, we can partner with other academic institutions, medical societies, and industry to make sure that we are doing things as responsibly as possible and to boost the value of social media. Currently, we are all incentivized to contribute to traditional forms of academic productivity, like journal publications, but we really should also be rewarded for our contributions to health journalism and social media because this is a lot of where patients are getting their medical knowledge these days.

JAMA:Do you think all physicians should have some sort of social media presence, and, if so, why?

Dr Chiang:Yes, but with an understanding of the caveats and the pitfalls and the commitment it takes to maintain a consistent presence. An inactive social media presence might not look as great as having no presence at all. I think that there are various benefits for physicians in addition to education and putting our voice out there. It's also a way to build a practice, to recruit patients for clinical trials, to dispel any sort of misconceptions about a field.

Also, every major journal and major society is present on social media, and getting those updates in real time is very helpful. I personally don't wait to flip to the table of contents when a journal shows up in my mailbox. If something is disseminated on social media, I get those alerts right away. Having a digital presence and shaping that ourselves is important because our patients will be going on Google and looking us up. Otherwise, our narrative would be written by other people. We have to go about doing this in an effective way so that we can actually reach [broader] audiences and not just our friends.

JAMA:What do you tell physicians who say they have no time for social media?

Dr Chiang:A lot of us already are using social media personally. For me, rather than spending that time aimlessly scrolling, I felt that it could be put to more productive use. It's helped in my learning, in networking with other colleagues, in research opportunities. There would not have been any other way for a group of multispecialty physicians spread across the country to come together in a very short amount of time and form a nonprofit organization.

JAMA:For newbies who want to stick their toe into the waters of medical social media, what platform should they try first and why?

Dr Chiang:I would recommend starting with Twitter because that's where most academic discussion is happening and where you are probably more readily reaching your colleagues and able to communicate with them and develop those networks. Also, it's where most journals and societies have a social media presence.

That said, it also depends on your field. There are certain fields out there that have been very used to being visual with their presentations, like dermatology and plastic surgery; they've been using Instagram for much longer. Instagram and other platforms, like YouTube, may be more general public and patient facing.

JAMA:What are some of the more common mistakes physicians make on social media?

Dr Chiang:I think the number 1 concern that I am asked about is patient confidentiality and potential violations of HIPAA [Health Insurance Portability and Accountability Act]. It's not as simple as posting a patient's photo or posting their name or other obvious identifiers. It can also come with describing a certain procedure or describing a case, something that, if I were a patient's family member and came across on a social media post, could easily identify someone. I am also very careful about mentioning whether I'm tired or sick or how I feel a certain day because I think that may be misconstrued.

Virtual contact and communication on social media are sometimes thought to be in isolation and only online, but these are real connections that we're making and real networks. Any interaction should still be respectful and treated as though it was a real-life, in-person conversation.

JAMA:Have you encountered backlash from physicians who don't see the value of medical social media, other than as a marketing tool?

Dr Chiang:I've definitely seen backlash in terms of folks who are supervising trainees and concerned about the liability of their trainees using social media. But I will say that my early involvement in social media, in my field specifically, has led to so many opportunities, including the opportunity of this role at Jefferson. Every institution should have a similar position, so we need more clinicians involved.

If our goal is to impact our patient outcomes and public health, we need to really meet the patients where they're getting their information. And with Instagram and the influencer phenomenon, there are a lot of gray areas that we're trying to better define. Our patients are seeing a lot of sponsored content, and they're seeing products being promoted by medical professionals. These patients are going to show up in our clinics, and there may be real clinical impact when it comes to how we practice medicine.

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