Cover Story – January 2012
Tex Med. 2012;108(1):14-21.
By Crystal Conde
After reading a USA Today report in late October on the worst outbreak of measles in the United States in 15 years, Jason Terk, MD, felt compelled to speak up about children contracting vaccine-preventable diseases because their parents didn't have them immunized. The Keller pediatrician wanted to give his personal perspective while reaching the public quickly and effectively. He could think of no better forum for spreading the word than the Texas Medical Association's new blog, MeAndMyDoctor.
"The traditional communication media clearly fail to reach a significant portion of the public, so we have to use what works," said Dr. Terk, chair of the TMA Council on Science and Public Health.
Indeed, the media took notice when TMA shared Dr. Terk's blog post on Twitter. KRLD radio and CBS Channel 11 in Dallas/Fort Worth both ran stories about physicians turning away unvaccinated patients to protect their more vulnerable patients, complete with a commentary from Dr. Terk. He told them that because some of the children in his office are too young to be fully vaccinated or have weakened immune systems, he has a responsibility to keep them safe and to prevent exposing them to unvaccinated children.
Like so many physicians, Dr. Terk realizes he can't answer every question and address every concern patients or their parents have during a 15-minute office visit. Parents may want more information about the new health system reform law, or elderly patients may desire to know how the potential cut in Medicare physician payments could affect them. Unfortunately, physicians don't have time during appointments to explain health policy issues and to share gripping stories about the effects of health system reform on their practices and patients.
But it's these stories that resonate best with patients. That's why TMA created www.meandmydoctor.com, where physicians and patients can interact, and is soliciting blog articles and videos from physicians. (See "Calling All Medbloggers.")
"We physicians have to get used to telling our stories as a way of ensuring that the right things happen for our patients. The general public often doesn't place the appropriate amount of weight on those things we in the sciences value, which are good data interpreted in good studies published in reputable scholarly journals," Dr. Terk said.
He says patients are prone to make important health care choices based on their personal life experiences and anecdotes. Physicians have to share stories with patients that "support the evidence-based recommendations we make."
A blog that fosters patient-physician online interaction like MeAndMyDoctor has many benefits, Dr. Terk says.
"Properly managed communication such as the new TMA blog can not only reach patients in the virtual places we have not existed before, but can also serve to shape public opinion on important issues that affect public health policy," he said.
TMA's Media Relations staff sees every comment on blog posts and can delete any inappropriate content. TMA Director of Media and Public Relations Pam Udall is the gatekeeper of guest submissions. To discuss an item you'd like to post, contact Ms. Udall by telephone at (800) 880-1300, ext. 1382, or (512) 370-1382, or by email.
Steve Levine, vice president of TMA's Division of Communications, says MeAndMyDoctor gives physicians the opportunity to be part of a powerful coalition that neither Washington nor Austin can ignore.
"As loud as physicians may 'shout,' they can never make as much political noise as the collective voice of their patients. The power of social media blogs is that they foster conversation among people who would likely never see, hear, or speak with one another. That cyber-dialogue among groups of physicians and groups of patients expands the patient-physician relationship beyond the exam room," he said.
While Dr. Terk isn't yet entirely comfortable with social media, he acknowledges that to communicate with patients effectively, he must learn to use it properly.
"It's important to have a professional presence separate from your personal one in the social media world and to only allow access to the professional one to your patients," he said.
The Making of the Blog
From May 5 to July 31, 2008, TMA conducted a pilot project in Wichita Falls titled "Me and My Doctor: We Know Best" to educate community members about the health care system and to get them more involved in seeking solutions to problems. TMA tested campaign names with Texans, and the one that received the highest marks was "Me and My Doctor: We Know Best." TMA purposely used a grammatically incorrect title because it puts patients first.
TMA held a news conference and town hall meeting and spearheaded other grassroots efforts in Wichita Falls. During the town hall meeting, about 100 physicians, local legislators, patients, and employers spent two hours discussing what they liked and disliked about the health care system, as well as what they hoped to see in the future. Among the positive results of the pilot project were that residents had a more favorable view of physicians and an increased awareness that doctors were doing the most to fix the broken health care system.
Based on the success of the pilot project, TMA launched an ambitious outreach campaign in 2009 that featured town hall meetings, referred to as "TMA House Calls," in more than 15 urban and rural settings throughout Texas. TMA and a county medical society leader cohosted each meeting. The forums allowed physicians and patients to voice their opinions on health system reform. The meetings also let physicians demonstrate to their patients that they're listening to what they want from national health care reforms and are working with Congress to achieve them.
TMA learned Americans continue to trust their physicians highly. They listen not only to their doctors' medical advice but also to their ideas about all things related to health care. They are looking for trusted leaders in today's confusing health care debates, and physicians are the most likely candidates to provide that leadership.
TMA gathered data from House Calls on what attendees valued about the health care system and what they wanted to change. The positive feedback generated by House Calls and the connection it facilitated among physicians and patients inspired TMA to create an online space where the conversation can continue.
MeAndMyDoctor takes the town hall meeting format to the next level via social media. It allows physicians to talk about the medical profession in a way that patients can relate to. The blog also extends TMA's Trusted Leader Initiative, a project to inform physicians and the public of issues and concerns related to public health, patient quality, and medical education through the use of social media.
Karen Batory, vice president of the TMA Division of Public Health and Medical Education, hopes the new blog allows physicians to share their expertise and perspective to influence policymakers and community leaders.
"We want physicians and their patients to tell stories about the value of what physicians do to support the health of the public. Considering the dramatic funding cuts for public health and medical education this legislative session, coupled with a struggling economy, we felt the time was right to take advantage of social media to communicate the impact of diminished funding on patients and local health care systems," Ms. Batory said.
A "Platform to the World"
Bryan Vartabedian, MD, a pediatric gastroenterologist in The Woodlands, stepped into blogging with "the selfish intention of selling books." It was 2006, and his book Colic Solved was on the shelves. He used Parenting Solved, his blog at the time, to promote it.
The next year he posted what he thought was a modest entry about Nestle acquiring Gerber. The story generated a lot of traffic to the blog, and the next thing he knew, a European financial newsfeed picked it up.
"I realized then that my blog was actually a platform to the world," Dr. Vartabedian said. "I thought it was a gimmick but learned it was actually a powerful way to convey information across the globe."
He continued blogging on Parenting Solved about parenting and child health until 2009, when he transitioned to Facebook and set up a new blog called 33 Charts. With 33 Charts, Dr. Vartabedian focuses on the convergence of social media and medicine. He delves into the potential for technology and communication tools to redefine the role of the physician, concerns physicians face in the digital era, how social media can change the dialogue between physicians and patients, and more.
Social media represents opportunities for physicians to become individual publishers, creating and conveying information in real time, Dr. Vartabedian says. While he has seen more of his physician colleagues accept and adopt social media, he says the medical community has yet to fully leverage the capability of tools like Facebook and Twitter.
Dr. Vartabedian has studied the adoption and use of social media by physicians as a means to share medical information with other physicians. He is one of seven coauthors who presented the results of a survey on the subject at the Medicine 2.0 Congress at Stanford University last September. The survey examined physicians' adoption of the most commonly used information and communication technology to share their medical knowledge with other physicians, compared the number of users who claim that they "will never use" these technologies with the number of "current users," and looked at differences between oncologists and primary care physicians.
The email survey collected data in March 2011 from 186 oncologists and 299 primary care physicians in the United States. Paid for by the Medical Education Group at Pfizer Inc., the study gathered 491 responses.
Results show restricted online communities (51.5 percent among all physicians), texting (39.5 percent among all physicians), and cell phone applications (35.6 percent among all physicians) are the most commonly adopted information and communication technologies. Restricted online communities include SERMO, an online physician community where practicing physicians collaborate on cases and exchange observations, and Medscape Physician Connect, a discussion board where physicians can engage their peers.
Data show the Twitter adoption rate among physicians is lowest at 6.7 percent. The study's authors concluded physician adoption of social media varies, with primary care physicians being more open to new technologies. Oncologists were more likely to adopt technologies used for communicating factual information instead of social networking. Adoption by physicians of health care information technology systems that incorporate technologies such as email, restricted online communities, cell phone apps, iTunes, and wikis may be more widespread.
TMA has data on social media adoption among physicians. The TMA May 2010 Communication Survey of Texas Physicians showed a significant difference in the use of some social media tools by age. (See "Selected Differences in Personal Social Media Use by Physician Age.")
Dr. Vartabedian hopes future surveys will show greater adoption of social media by his colleagues.
Social Media Fosters Patient Connections
Dan McCoy, MD, a Dallas dermatologist and secretary of the TMA Board of Trustees, aims to change the way patients get health information with his blog, DocDano.com. He has a video studio and a three-person team that helps him develop effective ways to deliver information patients want to know "as opposed to what physicians think they want to know."
For example, when patients with colon cancer search online for information on their disease, they'll find a plethora of articles about treatment. What if they want to know how to swim with a colostomy or want to hear testimonials from patients who survived colon cancer? Social media provides effective ways of answering such questions.
Dr. McCoy says social media promotes storytelling and can help physicians and patients connect with one another. He includes video to deliver information on his blog.
"So much of communication is visual, and video helps with retention of information and is more compelling and captivating," he said.
Social media improved Dr. McCoy's interaction and relationship with his patients.
"Patients appreciate the fact that I'm trying, and I think my presence on my blog and Twitter adds a modern flair to my communication experience with patients. It shows patients that I'm willing to do what's necessary to communicate with them," he said.
Twitter complements Dr. McCoy's social media presence as a medblogger, a term for a physician who blogs.
"I use Twitter to advertise what I've posted on my blog and as a news source to see what's going on in health care," he said.
Marta Katalenas, MD, a Round Rock pediatrician, uses Twitter to help communicate with her patients. She has more than 180 followers and tweets frequently about a variety of topics, from healthy lunches for kids to allergies to information about her practice.
"Twitter allows me to send communications to my patients in a fast way. For example, if the practice changes office hours, hires new providers, or has to close due to inclement weather, I can notify patients quickly with Twitter," she said.
In addition to sharing information about her practice, Dr. Katalenas uses Twitter "to present valuable information to patients about controversial issues and medical news in a format they understand and use all the time."
She says patients have responded enthusiastically to her use of Twitter.
"They love it. They are proud our office participates in the latest communication technology has to offer," she said.
Dr. Vartabedian encourages physicians to use social media to communicate with patients but warns the permanent record of their posts can be a double-edged sword. He says concern over maintaining online professionalism is blossoming in the medical field.
"Medical students and residents need to understand what they post is a reflection on them and could affect their reputations. They also need to be educated on the limits of social media in regard to patient privacy," Dr. Vartabedian said. He says more medical schools are adding tracks on social media to their curriculum.
Dr. Vartabedian recommends students "keep in mind that everything they do and say in social media becomes part of a timeline people can track. That's how people will judge them. They should never discuss patients, never give medical advice, avoid discussions about employers, and never post anything anonymously."
A Massachusetts pediatrician known in the cyber-world as "Flea" learned about the limitations of online anonymity the hard way. A plaintiff's lawyer unmasked his identity during a 2007 medical liability trial.
Robert P. Lindeman, MD, had been posting to his blog unsavory comments about the plaintiffs, their attorney, and the jury in a wrongful death lawsuit. Upon cross-examination, opposing counsel shocked the courtroom by pointedly asking Dr. Lindeman if he was "Flea." Under oath, the pediatrician admitted to his pseudonym and settled the case for a substantial sum the following day.
"Flea was edgy, and his disparaging comments cost him his medical liability trial," Dr. Vartabedian said.
A "Moral Obligation"
Dr. McCoy applauds TMA for launching a blog where physicians and patients can discuss the health care system.
"TMA lends credibility to social media. When a stakeholder entity like TMA offers a platform that allows patients and physicians alike to share information on health care policy, you know you can trust it," he said.
Dr. Katalenas agrees.
"Patients these days are presented with a lot of information; some is good, but some is unreliable. The problem is that patients don't have any way of telling the difference. But they usually trust their physician, the professional who knows them and has a reputation of looking after their best interests," she said.
Drs. Katalenas and Vartabedian believe physicians have a moral obligation to participate in online dialogue, let their voices be heard, and defend modern medicine.
"Too much erroneous, biased information is passed around for us, the professionals, to remain silent," Dr. Katalenas said.
Dr. Vartabedian says physicians will have to participate in social media platforms ultimately, as "the online world increasingly becomes part of the real world."
Dr. McCoy adds that physicians need to realize more of their patients are getting news via social media because it's live, interactive, and mobile.
"It's important for physicians to realize they don't have a choice because patients want information delivered via blogs, Twitter, Facebook, and other social media channels," Dr. McCoy said. "The take-home message for physicians is that social media can improve their practice and bottom line by attracting more patients."
Crystal Conde can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email.
Calling All Medbloggers
TMA's new blog, www.meandmydoctor.com, is a forum for physicians and patients to join candid, open discussions about today's pressing health care issues. The purpose of the blog is to help patients and their peers better navigate health care in a time of change brought about by health system reform.
Subscribe to receive blog news and updates on the MeAndMyDoctor home page by entering your email address. Submit articles, videos, and photos to appear on the blog by email. You can also participate by posting comments to blog articles; sharing articles and videos with friends, families, and colleagues; tweeting about blog articles; and submitting guest posts.
When contributing to the blog, keep video and written submissions short and simple with a conversational tone. Remember: You're talking to patients, not creating a white paper. Keep content professional but easy to understand. Limit video and written submissions to one topic at a time to keep them focused.
TMA is fostering patient participation via Facebook, Twitter, and other social media outlets, and is reaching out to patient advocacy groups such as AARP and the Healthy Futures Alliance.
Already have your own blog? Let TMA promote your posts. Submit your blog's web address to Steve Levine, vice president of TMA's Division of Communication.
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Electronic Communications and the Law
Email, blogs, Twitter, and social networking websites are pervasive and offer physicians a way to more rapidly communicate with patients. But physicians must be cautious when doing so. State and federal laws govern the privacy and confidentiality of patients' protected health information.
Confidentiality is a concern when physicians and patients correspond via email, as well. Physicians need to be aware of state and federal laws and regulations on physician-patient communications.
State law prohibits physicians from disclosing communication with patients unless the patients authorize it.
The federal Health Insurance Portability and Accountability Act (HIPAA) privacy rule requires physicians to disclose patient information when a patient requests it or when the U.S. Department of Health and Human Services secretary seeks access to information to determine if a physician is complying with the rule. The rule prohibits physicians from selling, transferring, or using protected health information for commercial advantage, personal gain, or malicious harm. Those who commit this HIPAA violation face a $250,000 fine and 10 years imprisonment.
The Texas Medical Board (TMB) has rules governing the retention and handling of patient medical records, including electronic records. TMB spokesperson Leigh Hopper says the board doesn't monitor doctors' use of social media but may investigate complaints alleging "false advertising, violations of telemedicine rules, or patient confidentiality violations involving social media somehow." TMB can cite physicians for unprofessional or dishonorable conduct if they violate patient confidentiality.
"Possible penalties could include fines, a requirement to pass the Medical Jurisprudence Examination, on up to more severe penalties depending on the nature of the violation," Ms. Hopper said.
TMA's Task Force on Patient Medical Information and Privacy and Physician Use of Information Technology developed guidelines in 2001.
Security guidelines say physicians should use a system that:
- Requires authentication of users (patients, physicians, and staff) and verification of their access privilege before they can access any identifiable personal or health information;
- Encrypts all identifiable personal or health information; and
- Has an audit trail to track time, date, content, and senders' and recipients' identification for all communications.
Electronic communication guidelines urge physicians to:
- Avoid anger, sarcasm, harsh criticism, and libelous references to third parties in messages.
- Establish turnaround time for messages to ensure quick responses.
- Tell patients who besides the physician processes messages during usual business hours and vacations or illnesses; the level of security of the communication system used; and that the message will be included as part of the medical record, at the physician's discretion.
- Establish types of transactions (prescription refills, appointments) and sensitivity of subject matter (HIV, mental health) permitted via email.
- Instruct patients to put the category of transaction (prescription, appointment, medical advice, billing) in the subject line of the message for filtering.
- Ask patients to put their name and patient identification number in the body of the message.
- Configure an automatic reply to acknowledge receiving messages.
- Print all messages, with replies and confirmation of receipt, and put them in the patient's chart.
- Ask patients to use an auto reply feature to acknowledge reading the message.
- Develop archival and retrieval mechanisms.
TMA's principles are similar to those of the American Medical Association.
January 2012 Texas Medicine Contents
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