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What’s Important: How Social Media Can Foster Connectedness

2021; Wolters Kluwer; Volume: 103; Issue: 12 Linguagem: Inglês

10.2106/jbjs.20.01738

1535-1386

Lisa G. M. Friedman, Mariano E. Menendez,

Health Literacy and Information Accessibility

The genesis of this article is reflective of the times we live in. The two of us exchanged messages on Twitter, learned that we had common interests and goals, and decided to work together to explore how social media is shaping interactions within the orthopaedic community, which can ultimately impact the way surgeons care for patients. Perhaps now more than ever, social media platforms are essential for surgeons to network, educate one another about different ways to approach problems, learn about policies and practice structures around the world, and participate in conversations that help propel the field forward. However, social media is not without its risks, including concerns over patient confidentiality, the credibility of presented educational information, and the professionalism of those who choose to engage in online conversations. We interviewed physicians who are part of the #OrthoTwitter community to get their insights on social media utilization, and their thoughts are included below. Promoting and Sharing Research There is some evidence to suggest that increased social media presence of a research article is associated with greater dissemination and impact1-3. However, it remains unclear as to whether the higher impact is a cause or the result of the increased social media presence. Nevertheless, social media plays an important role in promoting and sharing research ideas. Dr. Grant E. Garrigues (@Grant_Garrigues), associate professor at Rush University and cochair of the American Shoulder and Elbow Surgeons Technology Committee, is a prolific researcher who utilizes Twitter to share his investigative work and engage with other researchers. He emphasized that social media allows researchers' and physicians' voices to be heard. "In this information age, if you toil away on a research project and it's simply filed away in a dusty library never to be read again, then you haven't helped any patients or physicians…Social media allows you to highlight impactful research and help realize the goal of improving patient care." Fostering More Inclusive Conversations For others, social media plays an important role in forming social connections and networking in a global orthopaedic community. This is all the more important as the COVID-19 pandemic limits travel and the ability to interact in person. Dr. Nancy Yen Shipley (@_NancyMD), a partner at Multnomah Orthopedic Clinic in Portland, Oregon, commented that Twitter can promote interactions that are often difficult in real-life settings by leveling the playing field. "A resident can be involved in a discussion with a world-renowned surgeon, and hierarchies are gone." Indeed, one of the biggest advantages of social media is its ability to democratize opportunities for learning by making educational content available to more people and for more diverse opinions to be heard as discussions occur between those from different countries and backgrounds. As noted by another surgeon we spoke to, who frequently posts educational information, "[The] intended audience is other surgeons, residents, and international surgeons who don't necessarily have access to our societies and journals. I…[also] learn a lot from the comments I receive." A note of caution from this physician: when posting information from a patient case, they get specific consent to share imaging that is separate from the surgical consent. They suggest staying as vague as possible when describing patient characteristics that do not impact the educational value while also avoiding or changing data that could potentially identify the patient. This includes waiting to post so that the date of surgery cannot be used to ascertain the patient's identity. They also try to restrict education to basic concepts as complex cases can often be identifiable. "I keep it strictly educational—there should be no posts going 'look at this gnarly injury' for the [sake of obtaining] 'likes'." This last point is very important and one that can be challenging to regulate. While social media can play an important educational role, its lack of nuance and context can lend itself to extorting the patient in order to gain "likes" and "follows," a violation of ethics in the patient-physician relationship. Varying Approaches to Engagement There is no single right way for orthopaedic surgeons to integrate social media into their practice. For many, social media pages serve a purely professional purpose. Dr. Yen Shipley has opted for a more holistic approach to social media that encompasses both professional and personal life. "I used to think that the different parts of my life had to be compartmentalized…but what I put out on social media encapsulates who I am as a person [who] holds many roles—surgeon, mother, wife, podcaster, and beyond." Such an approach, however, requires discretion. She added, "As surgeons, we are often used to casual OR banter but need to keep in mind that this is not always appropriate in all settings, including online public forums. Anything I post publicly, my barometer is whether or not I would want my 85-year-old patient to see it and still respect me as a surgeon." Still others prefer an anonymous account, allowing one to post more freely about controversial topics and eliminating any stress about a reader being potentially offended by a well-intended comment. Dr. Dustin Schuett (@djschuett), an orthopaedic surgeon at the Naval Medical Center in San Diego, California, maintains both an anonymous account and a professional account. He sees multiple benefits from social media, including connecting with and making friends with peers, gaining insights into case management, finding recent journal articles, and developing mentoring relationships. He warned about the risks of social media: "I know several people on Twitter who have had things they said misconstrued or inaccurately interpreted and have gotten in trouble for it at work." He mentioned that those in training may be more susceptible to getting into trouble professionally as they may be excited to share cases and details without fully considering HIPAA patient-confidentiality rules, while there is also a tendency to think that social media is a safe place to vent. Having language misinterpreted at work is not a problem that is unique to social media, but it is certainly exacerbated by rigid character limits and the feeling of personal distance that is created by interacting online. While venting can be important for one's mental well-being, until recently, these conversations have always occurred privately, away from patients and employers. It is important to remember that anyone may be reading posts, and even well-intentioned venting can easily be seen as unprofessional. Dr. Schuett started his anonymous account as part of his work writing satirical content for the website GomerBlog in 2017. While initially he used the account to mostly share jokes and articles, it has transformed into a much more meaningful experience. He stated, "I started having people tag me in posts asking for my opinions and thoughts on cases, as well as tagging me on other threads talking about cases. That developed into getting cases sent to me via DM [direct message] and regular tweets from literally around the world asking my thoughts and advice. I've gotten cases sent to me from every continent except Antarctica so far." Dr. Schuett was selected to be the American Academy of Orthopaedic Surgeons (AAOS) Social Media Ambassador Chair. Since then, he noted, "I've been working on using my Twitter account in my name more to get out there a bit more in a less anonymous manner." While he acknowledged the benefits of anonymity in being able to speak more freely on controversial topics, he noted that anonymity has come with problems with credibility, which is why he has taken to revealing information about his true identity on his anonymous account over time. Yet his point about those in training being in a vulnerable position is a good one. A Canadian orthopaedic surgery resident maintains an anonymous Twitter account (@DInclinic). He stated, "Many of us—especially in medical training have a real fear of retribution/negative contribution from speaking our minds…I've spoken openly about issues I see and experience to other trainees, staff, prospective trainees, and the general public that I would [never] feel comfortable saying as a resident [because] of my anonymity." In this setting, anonymity gives a voice to a population that would otherwise feel powerless, making for a more robust and diverse conversation. However, another potential drawback of anonymity is that can be very difficult to determine whether people are representing themselves accurately. A person could share an opinion on how to manage a particular problem without being vetted as to whether he or she has the requisite level of training to be capable of making such a plan. There is also the potential for a surgeon's account to promote a product or technique without clear disclosure of any conflicts that may be informing its use. Dr. John Shields (@jointdocShields), an associate professor of orthopaedic surgery at Wake Forest Baptist Health in Winston-Salem, North Carolina, enjoys the sense of academic collaboration that is made available by social media. He took the unique step of becoming verified by Twitter. Shields said, "Early in the COVID pandemic there was a lot of misinformation, and so Twitter opened applications to the verification process to physicians to help stop the spread of false information." Becoming verified by Twitter, in which Twitter reviews one's publications, links to one's profile at his or her academic institution, and uses other sources to confirm identity, is one way to establish credibility. Whether anonymous or not, the impersonal nature of internet connections may increase the opportunity for cyberbullying. Simon Fleming (@OrthopodReg) is a trauma and orthopaedic registrar on the Percivall Pott Rotation in London who cocreated the #HammerItOut Campaign, which combats bullying and harassment in medical education. Fleming stated, "Twitter, much like IRL (in real life) reflects many of the same challenges, cultures, attitudes, and biases that exist in health care and orthopaedics." He explained that, while social media has flattened the hierarchy, there is still a power dynamic in place in social media. People who hold a minority view are more likely to stay quiet, while those in the majority view are more likely to be outspoken, which pushes voices and opinions out and can lead to bullying. Fleming, however, is optimistic that this can be improved. "We can all play a part in changing our culture. Not everyone needs to be an outspoken culture-change advocate. But even making an effort to do better, once you know better, will make a difference." An Evolving Conversation Social media is a dynamic tool that was unavailable to prior generations of trainees and surgeons. It has the power to foster academic collaboration and share new ideas among researchers. It democratizes learning, although it can also make it more difficult to determine who the experts are. Attention to professionalism and adherence to HIPAA standards are paramount because the setting is casual and the audience is varied and difficult to define. Regardless of an individual's engagement in social media, this developing technology will continue to reshape the way in which surgeons interact with one another and with the public. For the two of us (@Shoulder2LeanOn and @memenendez1), social media has proved valuable in forming and maintaining meaningful relationships with other surgeons and team members in orthopaedics, particularly during this pandemic. By engaging in conversations about clinical and research topics, we have deepened our understanding and furthered our love for the field, and we hope to translate this growing passion and knowledge to provide better care to our patients.