Social Media Use and Community-Based Cardiovascular Health-care Professionals: Perception versus Reality.

Social media use has dramatically increased in the past two decades. This growth has been seen in the health-care field as well. Social media is being used for a variety of activities including networking, education, public health, and marketing. Health-care professionals in cardiology participate in social media to varying degrees and in different ways. Current studies have focused primarily on physicians who have an established presence on social media. To learn more about the social media habits of community-based cardiology providers, we queried attendants at a cardiovascular conference held by our health-care system. The purpose of this article is to: Highlight the social media habits of a range of community-based cardiology providers and distinguish between producing and consuming social media. There is a predominance of social media content consumers compared to producersOutline important considerations when assessing the risks and benefits of social media use and the perceived concerns of cardiology health-care professionalsEmphasize the need to incorporate guidelines for social media use into institutional policies and provide training on social media use to the health-care community. Copyright:

INTRODUCTION

In the last two decades, social media use has increased exponentially in all segments of society, including in the field of health care.[12] Social media is a broad term encompassing web-based platforms such as blogs (Blogger, Wordpress), microblogs (Twitter), social networking sites (Facebook, Reddit), podcasts (The Curbsiders), professional networking sites (LinkedIn, Doximity), and media sharing sites (YouTube, Instagram, and Snapchat). Health-care systems, medical societies, and health-care professionals have taken to social media for a range of activities including networking, education, public health, and branding.[1]

During this time, patients have also increasingly turned to the Internet and social media sites for health-related questions. Not surprisingly, the topic responsible for the most activity in Google search history is coronavirus (COVID-19).[34] Even before this pandemic though, health searches were very common. A quick Google search of “How many Google searches are health related?” reveals that 5%, or 1 in 20 searches, are health-related queries. Most patients have searched online for information about their symptoms well before seeing their cardiologist.

In the United States, over 60% of adults search online for health information and almost 40% turn to social media. Younger people (school aged children to those in their mid-thirties) are the demographic most comfortable accessing social media for health information.[2] The recently founded Association for Healthcare Social Media, the first social media nonprofit organization created by health-care professionals, recognizes the potential implications of social media on the patient-professional relationship and health communication. Its self-described mission is to play a key role in developing best practices for social media use in health care and to advocate for the recognition of social media as an important public health tool in the fight against medical misinformation.[5]

SOCIAL MEDIA TRENDS

Social media – everybody seems to be doing it. Current studies, however, focus primarily on physicians who are very active on social media. This means they produce original content, participate in online group discussions, or curate information by sharing useful links.[67] There is little data regarding whether these activities reflect the social media habits of clinicians in the field of cardiovascular medicine.

We queried a group of community-based providers attending a cardiovascular conference organized by our health-care system in the United States. There was approximately an equal proportion of nurses and advance practice providers in attendance as cardiologists. The conference focused primarily on traditional practice topics but also included a social media segment with talks such as Social Media: How to Start, Best Practices for Social Media Use, Social Media for Career Development, and The Legal Landscape Medicine and Social Media.

At the conclusion of the conference, an online survey was distributed to all participants with questions on basic demographics and social media use [Table 1]. Respondents were also able to leave comments. The activity was approved by our institutional review board. Of the 125 conference attendees, 67 participants completed the survey.

Table 1

Survey Demographics and Questions with Responses

Gender
Male-36%	Female-64%
Age
18-24 years old-0%	45-54 years old-15%
25-34 years old-16%	55-64 years old-30%
35-44 years old-28%	65+years old-11%
Occupation
Cardiologist-42%	Surgeon-3%
CRNP/PA-24%	Industry-1%
RN-18%	Other-7%
Fellow/Resident-5%
If you use social media, how would you describe your use?
Consume Content-42%	Produce Content-9%*
Consume and Produce Content-25%	Neither Consume/Produce Content-24%
*Of respondents identifying as producers, 2/3 (or 6% of total respondents) rated their social media competence as very good or excellent
If you use social media, which platform (s) do you prefer for professional use?
Facebook-30%	Podcasts-18%
Twitter-30%	Instagram-13%
YouTube-25%	SnapChat-6%
LinkedIn-21%	Blogs-1%
If you use social media, which platform (s) do you prefer for personal use?
Facebook-57%	Podcasts-9%
Instagram-40%	Twitter-9%
YouTube-13%	LinkedIn-4%
SnapChat-10%
Do your patients contact you through social media for medical advice?
No-97%
Do you respond to patients on social media?
No-97%
What makes you most hesitant to use social media in the professional setting?
Liability concerns-46%	Do not know how to use it well-11%
Lack of time-21%	Concerns regarding negative feedback (“trolling”)-6%
Do not want to-16%
If your health system/practice offered training/course in social media, would you enroll?
Yes-49%
I use social media primarily to_____________.
Learn about new developments-58%	Advance my career-6%
Because everyone is doing it-24%	Communicate with patients-2%
Communicate with colleagues-10%
How would you rate your level of competence in social media?
Excellent-9%	Fair-25%
Very Good-15%	Poor-14%
Good-37%

The results of our survey highlight important themes about social media use among community-based cardiology health-care professionals.

CONSUMERS AND PRODUCERS

Cardiovascular health-care professionals increasingly use social media for activities such as education, networking, public health initiatives, and career advancement.[1] However, “increased social media use” is often assumed to mean that health-care professionals are producing or actively curating social media content. Available data estimate that at best 10% of health-care professionals use social media in this way, and the overwhelming majority (90%) are social media consumers who use social media mostly to obtain relevant information related to their field.[8] This is consistent with our experience wherein only 9% of respondents viewed themselves as producers of social media content. Twitter statistics about the general population reveal similar trends. Many consume or access social media, but fewer produce content. Of the 1.3 billion Twitter accounts created worldwide, 44% have never sent a single tweet.[9] In the United States, 10% of Twitter users are responsible for 80% of tweets produced.[9]

WHY TWITTER?

Twitter has emerged as a leading social media platform in health care and medicine. Major journals, professional societies, and experts in their fields have taken to the “Twitterverse” to disseminate health information rapidly on a global scale.[610] Studies have tried to correlate the impact factor of journals and/or citations of published papers with Twitter statistics. They suggest publications with a high number of tweets/retweets within the first 3 days of release have more citations.[1112] New indices, such as alternative metrics (“altmetrics”) have emerged to measure the web-based impact of traditional citations.[12] Twitter use is also thought to have the potential to increase journal readership.[1]

Although the social media landscape is more than just Twitter, it has become a dominant mode of communication for immediate release of new research, networking, physician education (i.e., Tweetorials and Twitter-based journals clubs), and public health information.[1013] Our survey respondents preferred Twitter as a social media platform for professional use with approximately 30% of respondents citing it as their preferred platform. Only 9% of respondents preferred Twitter for personal use.

Certain features unique to Twitter make it appealing for professional use. It networks by ideas rather than known contacts, no permission is needed to follow or gain access to a user's profile, information is rapidly disseminated, and its brief, character limited messages are easily digestible on smartphones. These features allow for broad, rapid exposure to a potential global audience. The immediacy and reach of Twitter are perhaps most evident with the current global coronavirus pandemic. Health-care professionals are using Twitter to learn about developments in real time and to educate the public and others in the medical field about their experience treating patients.[1415]

CONCERNS

Despite the potential benefits of social media use, there are many concerns. Health-care providers are generally hesitant to communicate individually with patients on social media due to professional liability.[101617] The vast majority of our survey respondents did not have patients who contacted them through social media and only 3% said they would respond to patients through social media. Nearly half of our respondents cited liability concerns as the primary hesitation when deciding whether to use social media professionally. Social media posts often include images, stories, or other patient-related details. Even if protected health information is omitted, identification of the patient may still be possible, and this can result in legal consequences for the posting health-care professional.[18]

In the United States, even social media provider-patient contact outside the professional setting can result in liability and violations of the Health Insurance Portability and Accountability Act (HIPAA). Despite the lack of case law and legal precedent in this area, a number of cases have been litigated against healthcare providers in the U. S.[1016] To add to the complexity and potential legal ramifications, privacy laws vary from region to region. State and local laws also apply to patient health-care information and HIPAA does not necessarily override local regulations.[1920]

Regulations vary worldwide. In the European Union, interpretation is more limited and the General Data Protection Regulation does not recognize data that has been rendered anonymous as personal.[21] The lack of consistent legal standards is one of the challenges of social media use and social media users should familiarize themselves with the data governance regulations within their own institutions and places of practice.

For any health-care professional using social media, legal considerations include protecting patient information/privacy, professional social media interactions, appropriate posting of images, and not providing individual medical advice through social media. These may be obvious considerations to health-care professionals already established on social media but may not be readily apparent to those just starting.

In addition to the nebulous medical-legal landscape, most cardiovascular health-care providers did not grow up in the age of the Internet and have limited experience using social media professionally. Studies have previously documented that social media proficiency decreases with increasing age.[22]

Five of the most popular social media platforms – Facebook, Twitter, LinkedIn, Instagram, and Snapchat – were launched or founded after 2003.[23] These five platforms, worth over $650 billion dollars and used by approximately one-fifth of humanity daily, have been in existence <20 years – approximately the amount of time required to become an interventional cardiologist.[23] Moreover, communication models that have been taught to health-care professionals for decades and are deeply entrenched in medical teaching, often require face-to-face interactions. These are not easily transferrable to the online environment and can result in ambiguous ethical dilemmas for health-care professionals when navigating online interactions.[24]

IMPROVING SOCIAL MEDIA LITERACY

Despite these concerns, social media is here to stay. By all indications, its use by medical professionals continues to rise.[1] Therefore, institutional social media policies and/or training in social media have become increasingly important. None of our survey respondents had training available on appropriate social media use at their workplace, but 49% reported that they would take advantage of training if offered. Fortunately, many professional medical societies now have position papers or published guidelines that can serve as a starting point to understand best social media practices and that address issues such as patient confidentiality, patient-provider boundaries, and appropriate documentation of e-communications.[25]

It is more common to find sessions at professional meetings that either highlight potential pitfalls of social media use or advocate for more social media engagement and content production by health-care professionals. What is far less frequent is training in the granular details of content production/posting/curation and education of institutional social media policies, if they exist at all. In addition to educating health-care providers about institutional social media policies, education of staff beyond those directly providing care (i.e., medical assistants, transporters, schedulers, etc.) is just as crucial.

WHY USE SOCIAL MEDIA?

Despite increased social media use in medicine, perhaps the most important question for cardiovascular health-care professionals often goes unasked. Why are you using social media and what are you hoping to achieve? Perhaps, the goal is simply to consume social media without posting content or engaging in discussions with other professionals. In our survey, this was sufficient for a significant number of respondents. Nearly half (42%) of our respondents said that they use social media to consume content only and 58% said that they primarily use social media to learn about new developments in their field. If the goals are simply this, limited social media proficiency may be adequate.

However, limited engagement becomes increasingly difficult as more patients turn to social media for health-care information and because social media has other potential uses for community-based cardiology providers. Other commonly cited goals for social media use include networking, mentoring, self-promotion, public health education, career advancement, and providing evidence-based information to combat medical misinformation.[12] Compared to consuming social media only, these goals require more engagement, more time, and more discipline to avoid the potential pitfalls of social media use.

CONCLUSION

Social media has become pervasive in all facets of life, including the medical domain. Compared to the hierarchy of medicine, social media is informal and unregulated. This allows for communication among the public, patients, and health-care professionals in a way not previously possible, but it also allows for misinformation. Conventionally, the flow of medical information has been asymmetric with health-care professionals, especially cardiologists, controlling the conversation. No longer are they the only or even the predominant information source for the patient.

Patients will continue to access social media for answers to health-care questions. For a technology that greatly impacts patient-provider communication, too few health-care systems and medical practices provide basic training on social media use to its workforce. Regardless, a certain level of social media literacy is a must in the modern age. Those who are digitally literate are better positioned to frame the narrative. It is precisely for this reason that a portion of our conference was dedicated to the topic of social media use. The traditional patient-provider dialogue has changed, and social media is now a part of it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.