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December 22, 2008

The Physician’s Online Tool Kit — Emerging Resources for Collaboration and Communication in the Digital Age
By Jason Bhan, MD
For The Record
Vol. 20 No. 26 P. 6

The black bag has long been a recognizable symbol of the prepared physician. From the stethoscope to medications, it contained the requisite tools to practice medicine. However, the black bag has mostly disappeared and in its stead has emerged a new physician’s tool kit for the digital age.

Today, physicians are increasingly turning to social media and online communication formats, such as blogs, podcasts, social networks, wikis, and even microblogs, because they are searching for new and innovative ways to access medical information and improve patient care. Physicians are beginning to recognize that new online venues for professional communication and collaboration can be used to leverage their collective knowledge and experience. They are now able to learn from their colleagues in real time and, through these tools, they can discuss ideas, share emerging practices, evaluate collective insights, and disseminate information more quickly and efficiently than ever before. 

While many physicians visit social networking sites such as Facebook and MySpace to connect with friends and family, far more have found new homes on medically focused sites such as Ozmosis, QuantiaMD, Medscape Physician Connect, Within3, and Sermo. On these sites, physicians participate in professional communities where they can share medical information or network with colleagues. For example, discussions about different ways to treat migraine headaches have allowed many physicians who were unaware of the latest options to adopt new practices and improve patient care.

Meanwhile, physicians who once relied on nonattributed information on Wikipedia can now try new wiki-based entrants (a wiki is a page or collection of Web pages designed to enable anyone who accesses it to contribute or modify content) such as Google Knol or medical variations such as Dr. Wiki and Medpedia, sites that invite physician contributions. They can even experiment with next-generation medical education through virtual worlds on Second Life.

Just as consumers share videos with friends through YouTube, physicians and other healthcare professionals are sharing brief, medically focused videos on The Doctor’s Channel. These videos feature physicians from around the country discussing a variety of clinical and practice management topics. In addition, physicians who are getting their feet wet in microblogging are sharing short messages and links on clinical and nonclinical issues with thousands of consumers and healthcare professionals on Twitter, which limits messages to 140 characters.

Physicians on Twitter regularly share snippets of their daily experiences in real time, often with successful results. For example, a recent exchange about how to save the tip of an amputated finger yielded many good insights for consideration.

Even searching has gone medical as physicians migrate from popular search engines such as Google or Yahoo! to physician-focused sites such as SearchMedica and Medical World Search. Consumers have started to benefit from medically filtered results on sites such as Healthline or Medgle.

Physicians must now decide how to recommend and participate in popular patient social networking sites such as PatientsLikeMe, ReliefInsite, DiabetesMine, and Health Central, which connect patients who suffer from common ailments and enable them to share their experiences and learn from one another.

When recommending and using these sites, physicians should consider the following:

• Become familiar with quality patient sites by reading expert reports such as “The Wisdom of Patients: Health Care Meets Online Social Media.”

• Provide patients with criteria about how they can review and select appropriate online patient support groups and forums, as well as caution them about their potential dangers.

• Make sure to visit a group before recommending it; learn about the community and consider becoming a physician contributor.

• Warn patients not to make medical decisions based on patient support group advice without input from their physician.

Whether physicians choose blogs, online professional communities, video sharing, or podcasts, as reflected in sites such as Pediacast, they are in the process of breaking free of old patterns of accessing and sharing medical information and knowledge in new and innovative ways.

Blogging has also become more prevalent among physicians, with some emerging as power bloggers. For regular insights and anecdotes, consider physician-authored blogs such as KevinMD, GruntDoc, Aggravated DocSurg, CancerDoc, and EM Physician.

Whether physicians choose to launch their own blog or to post entries on the blogs of others, they face several choices:

• Decide whom to target. Should it be other physicians and healthcare professionals, healthcare consumers, or patients and family members?

• Make sure to commit the time necessary for developing and maintaining a blog, which typically requires at least one post every one to two weeks. Study popular consumer and medical blogs, such as DB’s Medical Rants and ScienceRoll, for mission, function, scope, content, audience, popularity, and areas of uniqueness.

• Consider placing the blog or blogging on an already established site, such as Healthline, that hosts physician blogs.

• Make conscious decisions about the blog’s purpose, audience, structure, frequency, style, and content features, such as personal stories, health updates, new technologies, and treatment breakthroughs.

• Refrain from using patient identifying data and avoid using derogatory language or significant negativity toward patients.

• Consider all postings to be permanent and give thought to each post’s potential implications before publishing.

In addition to following individually authored blogs, physicians are accessing the collective wisdom of their peers through question and answers, social bookmarking, virtual case presentations, and group discussions taking place on sites such as Ozmosis. Physicians who participate in trusted, peer-driven collaboration may be in a better position to build a referral base or network, enabling them to balance scientific evidence with practical experience, connect academic research with patient care, and develop new and effective ways to communicate with colleagues.

While online physician communities can provide a trusted environment for the exchange of clinical, practice management, and health policy information, questions still remain about the longevity, impact, and power of these sites, including the following:

• Does online collaboration help physicians learn more efficiently?

• How does online collaboration integrate with other forms of communication and learning?

• Will online collaboration bridge long-standing communication gaps between and among specialties, healthcare disciplines, and sectors?

• How will online physician communities facilitate interactions with other healthcare providers?

One thing is certain: Not all online collaboration and knowledge-sharing opportunities are alike. When considering membership in an online physician community or social media site, evaluate the following:

• Security: How does the site facilitate and ensure secure communications? How well is the physician’s privacy protected? 

• Anonymity: Does anonymity provide a false sense of security? Is anonymity necessary or does the level of discourse actually improve when physicians know the true identity of their fellow members?

• Expertise and trust: Has the site created an authentic professional community by verifying members’ medical licensure and identity? Does the site ensure that physicians know whom they are learning from and collaborating with?

• Knowledge sharing: Do physicians have access to the tools needed to effectively engage in knowledge-sharing activities? Will creating a professional network on the site provide greater access to trusted sources of medical information? Does the site maximize time by providing personalized information feeds and intuitive ways to contribute and search for information?

• Editorial oversight: What are the site’s editorial principles?  Do they inject editorial bias based on personal or commercial priorities?

With the proliferation, acceptance, and evolution of so many social media options, physicians will need to decide how, when, and where they want to engage patients and colleagues in this medium. When they discover which sites best fit their needs, they will find a new and exciting world awaiting them. In sharing their expertise, insights, and experiences with colleagues through these forums, physicians can use their 21st century tool kit to transform medicine from within.

— Jason Bhan, MD, a practicing family physician and an assistant clinical professor and a community preceptor at the Medical College of Virginia, is cofounder and chief medical officer of Ozmosis