Twitter Profile

As the popularity of social media has increased during the past few years, it is not surprising that the number of physicians using these tools has steadily increased.  In general, I would argue that this is a very good thing.  Social media can be an excellent tool for disseminating health information, and I know many physicians who use it extremely effectively to that end.  The American Medical Association came out with a set of guidelines for physicians using social media in November of last year, and it seems to share my positive view of the benefits that physicians can experience online.  From the guidelines:

The Internet has created the ability for medical students and physicians to communicate and share information quickly and to reach millions of people easily. Participating in social networking and other similar Internet opportunities can support physicians’ personal expression, enable individual physicians to have a professional presence online, foster collegiality and camaraderie within the profession, provide opportunity to widely disseminate public health messages and other health communication.

But the guidelines go on to point out that things can also get a little hairy online if you let your guard down.

Social networks, blogs, and other forms of communication online also create new challenges to the patient-physician relationship. Physicians should weigh a number of considerations when maintaining a presence online:

(a) Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online.

(b) When using the Internet for social networking, physicians should use privacy settings to safeguard personal information and content to the extent possible, but should realize that privacy settings are not absolute and that once on the Internet, content is likely there permanently. Thus, physicians should routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate.

(c) If they interact with patients on the Internet, physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context.


So how are physicians doing with their conduct using social media?  This issue was explored in a Letter published last month in the Journal of the American Medical Association. In this new paper Dr Katherine Chretien and colleagues examined the behaviour of physicians on Twitter.  They focused specifically on physicians who identified themselves as doctors in their profiles, and who had >500 followers (why they focused only on those with >500 followers I’m not sure, but since they went through 5000+ tweets as it is, it was probably to make it a more manageable process).  The 20 most recent tweets were extracted and analyzed for the 260 physicians who met all entry criteria.  The search strategy was pretty interesting so I have included it below in full.

So, what did they find?

The Good

Not surprisingly, 49% of the tweets were health or medical related, which single-handedly disproves the myth that all the messages on twitter are about what people had for lunch.  I’d also argue that this shows that physicians are not just using social media, but they are using it with the express purpose of disseminating health information.  Since physicians should theoretically know a lot about health, this is probably a very good thing.

Not surprisingly, there is some self-promotion going on – the authors report that 13% of tweets were self-promotional.  That won’t be a shocker to anyone who has used Twitter, and seems like a very reasonable number to me (that means that 9/10 posts are not self-promotional, which is probably a much better content-to-self-promotion ratio than most Twitter users, myself included).

The Bad

Three percent of tweets were identified as being unprofessional.  This included tweets that contained profanity (0.6%), potential privacy violations (0.7%), sexually explicit material (0.3% ?!?) and discriminatory statements (0.1%).  Unfortunately the authors don’t list what these tweets were, because quite frankly I can’t say that I’ve seen many physicians tweeting messages that would fall into those categories, and I am very curious to see what exactly they said.  And finally, 12 tweets were identified as conflicts of interest such as making unsupported claims about a product they were selling on their website (*cough* Joe Mercola *cough*) while 10 other tweets were about medical therapies that went against current medical knowledge or guidelines (I assume that the authors mean that the tweets were promoting these unsupported therapies, rather than simply mentioning them).

The take-home message

All in all, I would argue that the results are pretty positive!  They suggest that roughly half of all tweets by physicians with a large following relate directly to health, while a very small minority can be considered unprofessional.  That seems to be a very good sign that in general, physicians are using Twitter exactly the way that we would hope they would.  That being said, it’s still disturbing that there were any possible breaches of patient privacy, and I can’t even imagine what would lead a physician to make tweets of a sexually explicit nature.  So not a perfect record, but it’s certainly not a bad start.  And though the authors don’t mention this in their paper, I would expect that the unprofessional tweets, especially those related to conflicts of interest and the promotion of unproven therapies, are likely limited to a fairly small group of the 260 physicians included in the study (doctors don’t tend to dabble in pseudo-science – they either speak out against it, or dive in head first).

If you’re a physician who is considering moving onto Twitter or another form of social media, following the AMA guidelines (and common sense) should help you steer clear of trouble.

I know there are lots of physicians who are already using social media to great effect – any advice on what to look out for?


ResearchBlogging.orgChretien, K., Azar, J., & Kind, T. (2011). Physicians on Twitter JAMA: The Journal of the American Medical Association, 305 (6), 566-568 DOI: 10.1001/jama.2011.68