Negative Secular Trends in Medicine: Part VIII: Practicing Physicians Posting on Social Media

Abstract

When I was in practice, my typical work week was 68-70 hours. 6 AM to 6 PM, Monday through Friday, and we rounded on our own patients on Saturday morning. This was prior to hospitalists, so we took call on our own patients during the week. I had to go back to the hospital after hours once or maybe twice a month. Then, 2 to 3 weeknight calls per month, and one first-call or one second-call weekend per month. Add to this, reading about my patient's problems and trying to keep up with the medical literature in general. I was busting my chops every second.This Commentary is not about practicing physicians posting once a week or once a month on social media about their kid's birthday party, that they received an award, or reconnecting with high school friends. That's the upside of social media. This is about practicing physicians who post while they are seeing patients.Consider: a loved one is in the intensive care unit, their life in the balance. You have every reason to expect—no, demand—that their physician devote every ounce of their energy to their well-being. Then you see they made multiple inane posts that day on Facebook about physician burnout, or what is your favorite movie?, or their displeasure that the home sports team lost on a disputed call.Here is the basic point of this Commentary:The more a practicing physician posts on social media,The less likely I would be to entrust them with my care.You are not first on their list.I ran this by some long-time subscribers of The Physician Investor Newsletter.1)A retired businessman. “I have changed physicians only when I felt I didn't have his/her full attention, such as stepping out of the exam room to discuss personal business. A physician is held to a higher standard than the average person.”2)Another retired businessman. “It's a sign of the times. Fewer young doctors seem as devoted as you were. Be careful with your comments. Some folks will be offended.”3)A retired executive. “If I saw my doc making multiple daily posts on social media, I would find another physician. Not everyone will agree, especially younger people. Your comments are edgy, but will cause people to think about the issue.”4)A physician extremely attuned to the business of private practice. “I think multiple daily postings on social media is very unprofessional behavior and should come under review of the Quality Care Committee of the hospital, although it would require a complaint from a patient or third party. Social media is a sewer, yet is frequently the standard of behavior. There is a general lack of accountability to patients and colleagues. “Toughness” used to be a prized characteristic of physicians. It's no longer valued, and, in fact, denigrated.1Doroghazi RM Negative secular trends in medicine: training needs more emphasis on maturity, independence, and self-reliance.Am J Med. 2021; 134: 423-424Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar I'll start monitoring social media on my physicians. I will love to see what others think.”5)From a medical professional, married to a physician. “Very prescient. Our daughter is in Medicine. She and her colleagues have been instructed NOT to post ANYTHING (emphasis in the original) about patients on social media. They were very surprised such advice was needed, but quickly found the activity was common. A physician who posts on any social media tells me patients are not their primary interest. I would be appalled to find a physician in charge of a loved one's care posting regularly on social media. I can't imagine a professional doing this.”6)An MD-PhD who manages 10 figures of investments. “Irrespective of posting during off-hours, there is no good reason to be posting during work hours while taking care of critically ill patients. The potential medical-legal hazard is also of concern (vida infra).”7)From a man who rose to the top of Academic Medicine. “I agree that multiple daily posting during the work week raises the question of focus on patient care. My guess is that you will receive significant pushback from physicians younger than 40.”8)So I queried younger people. A young man still in training. “I agree that too many physicians are using social media. But people are incentivized to do what they do, and unfortunately, this type of marketing works well. Patients get much of their info from Facebook-Twitter, so this is the space you will need to fill to be busy with elective stuff. But Medicine has a higher calling, and shouldn't lend itself to self-promotion. Conversely, institutions engage in it to push their programs. A physician personally touting their accomplishments stinks of egotism and narcissism. Your comments will ruffle some feathers, but a good thing.”9)From a young man in marketing at a medical instrument maker. “Having a large following on social media won't make you a better doctor, and is unlikely to attract new patients. Social media personalities make money through advertising and sponsorships. A health care or medical device company would never touch that. The only potential value in social media would be some kind of side business, but a practicing physician would be hard pressed to find a side hustle better than just working more hours as a physician.”2Doroghazi RM What is your spare time worth?.Am J Cardiol. 2019; 123: 2058Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar10)A young man who finished training 2 years ago. “Social media is a complete waste of time, and condones fabricated lifestyles of excess and irrelevance. A recent trend for many professional organizations is to incorporate social media, not only at meetings, but day to day, for marketing. I find it obnoxious. I know a resident who went to many meetings to manage the social media. He was a terrible doc, but very ‘social’.”11)From an attorney about 40 years old. “Depends on what type of social media. Some physicians post on Twitter, and have big followings. If you're a dermatologist, plastic surgeon, etc., you would be foolish not to be on Instagram. It's where people concerned with image go. Facebook is the least valuable for a physician. Medical practices, as compared to physicians, must have an Internet presence. I agree that posting constantly on social media as a practicing doc is very concerning. Either they aren't getting work done, or aren't focused, or don't have many patients. You must also be careful of HIPAA [Health Insurance Portability and Accountability Act] violations [mentioned by many] There is a medical malpractice perspective. Say a patient dies, and you are accused of negligence, and it is discovered you made 12 posts on social media that day. The plaintiff's lawyer will have a heyday telling the jury about that.”In summary, there are probably some situations where a practicing physician might profit from posting on social media, but I believe that most of the time, the negatives far outweigh the positives. This applies not only to physicians, but to all professionals. Who is your personal hero? Who do you most admire? Who do you want to be like? The best physician, or executive, or military officer, or jurist in the world. Do they post on social media? When I was in practice, my typical work week was 68-70 hours. 6 AM to 6 PM, Monday through Friday, and we rounded on our own patients on Saturday morning. This was prior to hospitalists, so we took call on our own patients during the week. I had to go back to the hospital after hours once or maybe twice a month. Then, 2 to 3 weeknight calls per month, and one first-call or one second-call weekend per month. Add to this, reading about my patient's problems and trying to keep up with the medical literature in general. I was busting my chops every second. This Commentary is not about practicing physicians posting once a week or once a month on social media about their kid's birthday party, that they received an award, or reconnecting with high school friends. That's the upside of social media. This is about practicing physicians who post while they are seeing patients. Consider: a loved one is in the intensive care unit, their life in the balance. You have every reason to expect—no, demand—that their physician devote every ounce of their energy to their well-being. Then you see they made multiple inane posts that day on Facebook about physician burnout, or what is your favorite movie?, or their displeasure that the home sports team lost on a disputed call. Here is the basic point of this Commentary:The more a practicing physician posts on social media,The less likely I would be to entrust them with my care.You are not first on their list. I ran this by some long-time subscribers of The Physician Investor Newsletter.1)A retired businessman. “I have changed physicians only when I felt I didn't have his/her full attention, such as stepping out of the exam room to discuss personal business. A physician is held to a higher standard than the average person.”2)Another retired businessman. “It's a sign of the times. Fewer young doctors seem as devoted as you were. Be careful with your comments. Some folks will be offended.”3)A retired executive. “If I saw my doc making multiple daily posts on social media, I would find another physician. Not everyone will agree, especially younger people. Your comments are edgy, but will cause people to think about the issue.”4)A physician extremely attuned to the business of private practice. “I think multiple daily postings on social media is very unprofessional behavior and should come under review of the Quality Care Committee of the hospital, although it would require a complaint from a patient or third party. Social media is a sewer, yet is frequently the standard of behavior. There is a general lack of accountability to patients and colleagues. “Toughness” used to be a prized characteristic of physicians. It's no longer valued, and, in fact, denigrated.1Doroghazi RM Negative secular trends in medicine: training needs more emphasis on maturity, independence, and self-reliance.Am J Med. 2021; 134: 423-424Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar I'll start monitoring social media on my physicians. I will love to see what others think.”5)From a medical professional, married to a physician. “Very prescient. Our daughter is in Medicine. She and her colleagues have been instructed NOT to post ANYTHING (emphasis in the original) about patients on social media. They were very surprised such advice was needed, but quickly found the activity was common. A physician who posts on any social media tells me patients are not their primary interest. I would be appalled to find a physician in charge of a loved one's care posting regularly on social media. I can't imagine a professional doing this.”6)An MD-PhD who manages 10 figures of investments. “Irrespective of posting during off-hours, there is no good reason to be posting during work hours while taking care of critically ill patients. The potential medical-legal hazard is also of concern (vida infra).”7)From a man who rose to the top of Academic Medicine. “I agree that multiple daily posting during the work week raises the question of focus on patient care. My guess is that you will receive significant pushback from physicians younger than 40.”8)So I queried younger people. A young man still in training. “I agree that too many physicians are using social media. But people are incentivized to do what they do, and unfortunately, this type of marketing works well. Patients get much of their info from Facebook-Twitter, so this is the space you will need to fill to be busy with elective stuff. But Medicine has a higher calling, and shouldn't lend itself to self-promotion. Conversely, institutions engage in it to push their programs. A physician personally touting their accomplishments stinks of egotism and narcissism. Your comments will ruffle some feathers, but a good thing.”9)From a young man in marketing at a medical instrument maker. “Having a large following on social media won't make you a better doctor, and is unlikely to attract new patients. Social media personalities make money through advertising and sponsorships. A health care or medical device company would never touch that. The only potential value in social media would be some kind of side business, but a practicing physician would be hard pressed to find a side hustle better than just working more hours as a physician.”2Doroghazi RM What is your spare time worth?.Am J Cardiol. 2019; 123: 2058Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar10)A young man who finished training 2 years ago. “Social media is a complete waste of time, and condones fabricated lifestyles of excess and irrelevance. A recent trend for many professional organizations is to incorporate social media, not only at meetings, but day to day, for marketing. I find it obnoxious. I know a resident who went to many meetings to manage the social media. He was a terrible doc, but very ‘social’.”11)From an attorney about 40 years old. “Depends on what type of social media. Some physicians post on Twitter, and have big followings. If you're a dermatologist, plastic surgeon, etc., you would be foolish not to be on Instagram. It's where people concerned with image go. Facebook is the least valuable for a physician. Medical practices, as compared to physicians, must have an Internet presence. I agree that posting constantly on social media as a practicing doc is very concerning. Either they aren't getting work done, or aren't focused, or don't have many patients. You must also be careful of HIPAA [Health Insurance Portability and Accountability Act] violations [mentioned by many] There is a medical malpractice perspective. Say a patient dies, and you are accused of negligence, and it is discovered you made 12 posts on social media that day. The plaintiff's lawyer will have a heyday telling the jury about that.” In summary, there are probably some situations where a practicing physician might profit from posting on social media, but I believe that most of the time, the negatives far outweigh the positives. This applies not only to physicians, but to all professionals. Who is your personal hero? Who do you most admire? Who do you want to be like? The best physician, or executive, or military officer, or jurist in the world. Do they post on social media?