EVIDENCE-BASED MEDICINE is the paradigm of our day, and researchers have begun to document doctors’ motivations to use the Internet. In a 2012 study of online German doctors, researchers at an Austrian university divided motivations for Internet use into three main groups:
• Being on the cutting edge of technology, as well as self-expression.
• Valuing online tools for efficiency and effectiveness, such as centralized and indexed information.
• Introducing diversity and convenience into their lives.
This study found that prescribing behaviors did not differ between doctors with different motivations to use the Internet. While the doctors in the study differed on their opinions of patient-obtained Internet research, they generally agreed that patients had a proclivity for becoming misinformed. Nonetheless, the majority of the doctors surveyed forecasted increased need for online communications between doctors and patients.(1) The expanding variety and strength of online tools available to doctors may help drive that need.
Practice-building software, social media management and website development companies promote heavily to any health care specialty with small-business activities, including chiropractors. Each of these services seeks to help doctors to establish a broad, comprehensive online presence and strategy. Reputation management companies offer to track and improve the publicly visible reviews, posts, blogs and other online content that might tarnish a practice’s image. But doctors may do that work themselves. Mike Sevilla, MD, is a family physician in Salem, Ohio, who believes in controlling a practice’s social media presence. “Physicians can take control of their social media footprint by posting positive information on the Internet, by having even Facebook, Twitter or a blog where they write clinical or advocacy-related information that can raise their presence on social media,” he says.(2) He explains his success in online promotion: “I have had more new patients coming in during the past five years who have said, ‘Dr. Sevilla, we are here because we Googled your name.’” Online interaction no longer stops at finding patients.
Patient portals and telemedicine are growth sectors of the health care industry. “The industry is growing so rapidly that I think we’ll be hard-pressed to find any physician not providing some sort of telemedicine within the next two to three years,” says Justin Stone, of MDLive, a large telemedicine service provider. The company offers utilities for patients to access doctors and therapists on call nationwide, including through kiosks in retail stores and a mobile app.(3) Such services blur the line between professionalism in the online setting and in real life but the same tenets of professionalism expected in an in-office appointment apply to a mobile web-based interaction. Similarly, patient portals offer direct access to home-care assignments, appointment scheduling and even some health records, requiring doctors to provide an interaction that is continuous with the office visit. [Editor’s Note: New rules from the Texas Medical Board allow only a physician who has seen a patient in person to interact with that patient remotely. As a result, telemedicine provider Teladoc has filed a lawsuit that accuses the medical board of artificially limiting supply and increasing prices. The issue is expected to make its way to the U.S. Supreme Court.]
The Austrian Internet motivations study suggests that general practitioners are most likely to use their Internet time for advocacy,(4) and Dr. Sevilla’s writing for Medscape backs this up. “I write about primary care. I write about family medicine. I record YouTube videos. I share conversations on social media to help change some of the perceptions on primary care and family medicine,” he says, listing health advocacy among his top three priorities.(2) By taking advocacy online, doctors are able to begin educating their patients from the moment those patients search for information.
Doctors have many purposes for being online, and their web presence offers great opportunities to develop their professional identities and contribute to the health care community. However, a trickier situation arises when doctors and patients connect personally on the Internet, as HIPAA still must be followed. How does a doctor interact with this ballooning digital community without jeopardizing the basic tenets of professionalism? In September, this SACA communication series will look at best practices in online communication.
[This article is part 1 of a three-part series about communication. It is adapted from an essay written for Applied Ethics of Chiropractic, an online course taught by Stuart Kinsinger, DC, MA, also a bioethicist at New York Chiropractic College. Brendan McCann is a T9 student at NYCC and immediate past chair of SACA. With thanks to SACA Chair Deepa Gulrajani]
1) Moick M, Terlutter R. (2012) Physicians’ Motives for Professional Internet Use and Differences in Attitudes Toward the Internet-Informed Patient, Physician–Patient Communication, and Prescribing Behavior. Medicine 2.0, 1(2).http://doi.org/10.2196/med20.1996.
2) Sevilla M. (2015). How I Use Social Media as a Family Physician. Medscape Family Medicine. WebMD, LLC. Retrieved May 29, 2015, www.medscape.com/viewarticle/844770.
3) Chesanow N. (2014) Do Virtual Patient Visits Increase Your Risk of Being Sued? Medscape. WebMD, LLC. Retrieved May 29, 2015, www.americanwell.com/wp-content/uploads/2014/12/www.medscape.pdf.
4) Karimkhani C, Connett J, Boyers L, Quest T, Dellavalle RP. (2014) Dermatology on Instagram. Dermatology Online Journal, 20(7). Retrieved May 29, 2015, http://escholarship.org/uc/item/71g178w9.