In a growing social media world population, one cannot ignore the technological invasion of the medical world. From the discovery of penicillin to electronic medical records and the digital health revolution, real medical revolutions are not too many.

However, social media is disrupting the medical ecosystem and how we practice medicine. Information to the public is moving from a “push system,” where the teacher or the publisher decides what information to diffuse, into a “pull system,” where all the information is publicly available, and people are free to extract whatever catches their curiosity.

Therefore, it becomes extremely difficult to control the quality of information posted. Anyone, knowledgeable or not, can post, comment or publish on every medical topic.

That is why we believe that the education of “future patient generations” is needed to critically judge which source to trust and how to select reliable information. This difficult task of orienting the public in searching for reliable and relevant information has been treated in a previous article published by the senior author as it was recommended to doctors to orient their patients in their medical research, hence embracing the fact that people constantly look up their symptoms and diagnoses.

In this article, we outline and briefly present some aspects of medical social media that affect patients and physicians in their online medical experience.

Rating physicians

Studies show that 80 percent of patients look up their doctor online in search of their ratings. Today, this step is considered a decisive phase in choosing providers, leading to new business ventures like reputation management firms.

However, rating a physician is not as simple as rating a pizza parlor. Despite the common knowledge that mostly unsatisfied or unhappy patients rate their doctor, multiple factors affect the scorings that are mainly separate from the direct interaction with the physician or the quality of care. These factors should be considered, such as booking appointments, cleanliness of the office, office staff attitude, waiting time in the office. This can be especially unfair to employed physicians (increasing in numbers in the U.S.), who have little to say regarding office operations and workflow outside their direct face-to-face interaction with patients.

Also, in a world where everyone “looks up” everyone, there are two types of physician rating websites: institutional and independent. A major discordance exists between how physicians and patients look at these websites. While doctors tend to agree with health system sites but see that online comments increase their job stress, patients tend to trust independent websites for rating health professionals.

Patient support groups

This social media aspect is particularly interesting to patients with rare symptoms and diseases. These support groups help them realize they are not alone. They can share experiences and understand what to expect from the evolution of the disease or other people’s experiences with the side effects of treatment.

Regarding patients fighting long-term illnesses or rare diseases, these online groups have proven to redress knowledge deficits, improve self-management by learning behaviors from others, build a community of like individuals, and cathartic release. This is encouraged by dissociative anonymity and invisibility as a facilitator for expression.

These patients, avid for emotional support, spend limited time engaged with their medical professionals compared to the time they spend trying to get by every day to manage their conditions. The support groups don’t replace a doctor’s visit but may help improve patients’ every day and have a supportive psychological effect on them.

Physician-only communities

There was a time when “social networking” meant attending a cocktail party and handling business cards. A survey of 4,000 conducted by QuantiaMD found that over 90 percent of physicians use some form of social media for personal use, and over 65 percent use it for professional use. Physicians use communities like Sermo, QuantiaMD, Doximity, and Medpedia to enhance their professional networks, connect with peers, share cases, discuss practice management, and make referrals. These websites differ in whether they are open to the public or limited to medical professionals. Some even use the NPI database to verify providers; others also provide CME credits.

Social media facilitates closed physician groups within the same specialty and provides a safe platform to discuss practice issues, patient cases, supply shortages, and billing issues. These online discussions and exchanges help keep physicians up to date, ultimately improving patient care. During the pandemic, with no in-person conferences, the closed groups were of great value to many physicians who were not comfortable attending general online meetings or conferences.

Blogs and digital grand rounds

Blogs are designed to be personal pages where people post articles, some highly specialized in a specific pathology, a medical specialty, or even a cause. Some blogs have become very popular and are followed by physicians worldwide. This widespread information has been an eye opener on many changes in health care, which results in impelling changes within the medical profession.

The comprehensive accessibility of medical information through blogs has many benefits to the community, like the deprofessionalization of physicians, to some degree, leading to a better understanding of medical issues, enhancing doctor-patient communication, and humanizing physicians as they explore ways to express themselves in open, informal ways.

On the other hand, medical bloggers use these platforms to assert their reputation and affirm trust in their expertise. Tumblr, WordPress, and Blogger are examples of these platforms. The intersection between digital media and health care, a phenomenon called Health 2.0 by Hughes, Joshi, and Wareham led to a new way of conducting grand rounds in hospitals. Among other tools like forums and podcasts, these timeless digitalized grand rounds gained popularity and value among health professionals who can now exchange ideas with experienced peers and contribute widely to medical research.

However, there is growing concern about the ethical use of social media.

That is why the American Medical Association (AMA) has published guidelines for the ethical use of social media, highlighting the need to respect HIPAA rules while posting online. Medical bloggers should also avoid discussing legal cases, which can be easily discovered online.

Knowledge aggregation

Nonmedical websites like Wikipedia are usually the “go-to websites” for patients, medical students, and even physicians before digging into peer-reviewed data. As it regularly ranks high in Google searches, Wikipedia is the most visited resource for health information for the public, patients, students, and even practitioners.

In an article by Denise Smith, published in Nature journal, the authors stipulated that the number of errors found in Wikipedia was comparable to Encyclopedia Britannica. Behind this page is a diverse community of altruistic editors who believe that accurate information should be available and accessible to everyone and everywhere. Today, Wikipedia is the 7th most frequently accessed website in the U.S. According to the article “Situating Wikipedia as a health information resource in various contexts: a scoping review,” Wikipedia was as accurate as the NIH website. It surpassed WebMD, another prominent health-related site.

However, there is some wariness to using Wikipedia. Other studies have shown contradictory results regarding whether Wikipedia suits medical students. Keeping this information in mind, physicians are recommended to visit Wikipedia occasionally to be aware of the information to which patients and medical students are exposed.

Peer-reviewed literature

Peer-reviewed medical literature is now on social media. PubMed and high-impact-factor journals followed the online trend and embraced social media to increase their reach with a broad range of potential benefits to key stakeholders. These have hired specialized social media editors (SMEs) to manage content, mainly interactions and postings, and publish post-publication feedback. Among the responsibilities of the SME, we highlight the role of vulgarizing medical vocabulary to be understandable to everyone outside the medical community, making this online medical literature a reliable source of information for patients.

Finally, social media has effectively conveyed health-related issues, especially during the fast-changing policies like Ebola and COVID-19 health crises.

In conclusion, social media is here to stay. In 2019, the FSMB published guidelines on the appropriate use of social media in medical practice. Highly engaged patients are a reality that physicians need to embrace and guide as much as possible. Both physicians and patients should be aware of the right and relevant sources of information. As Erik Qualman said: “We don’t have a choice on whether we do social media; the question is how well we do it.”

Homer Moutran is an otolaryngologist. Caline El-Khoury is a clinical project manager. Danielle Wilson is a medical student.