Social Media

Dear Arizona Pain Specialists,

My partner and I run a large interventional pain medicine practice, and we recently have begun discussing a new marketing campaign that uses social media in our practice. However, we have been somewhat hesitant to employ this marketing strategy. We are extremely uncertain if it even makes sense to use social media in a health care setting, especially considering all the possible risks inherent in such an endeavor. Is it possible to create a successful social media campaign for our practice that maximizes its benefits while limiting the disadvantages? Furthermore, how can we best create content that is going to help us reach such a goal?

Thank you,
Ambivalent About Social Media


Dear Ambivalent About Social Media,

You present some interesting questions that many health care professionals currently are asking. Social media is an extremely hot topic in the health care industry, in large part because it has become a very popular, powerful form of communication in a short period of time. More than 120 million Americans visit Facebook and Twitter monthly; 57 million also spend time reading blogs. Although social media includes things like wikis, blogs, podcasts, picture sharing and other online groups, it is mostly known for ultra-popular sites like Facebook, Twitter, YouTube, MySpace and LinkedIn. These popular social media sites often are considered exclusively as places to check friends’ statuses and profile updates, follow celebrities’ tweets or watch the newest viral amateur videos. It is also quickly becoming a stop for those seeking health care information.

A survey by the National Research Corporation found that 94% of respondents used Facebook to search for health care information, 32% searched YouTube and 18% used Twitter and MySpace. According to a study conducted by the Pew Internet Project and California HealthCare Foundation, 80% of Americans now go online to research health information, including diseases, procedures, doctors, drugs and test results. Moreover, the survey results indicated that seeking health information ranks third in online pursuits, behind only email and using a search engine.

In a recent random sample survey of our patients at Arizona Pain Specialists, 66% said they go online to get information about pain, including pain conditions, their causes and treatments. This was second only to getting information about their pain directly from doctors. Imagine if there were a way to somehow combine these two sources so that patients could obtain expertinformation about pain management in a convenient, online format. Social media is such a vehicle.

The Pew study also found that 14% of Internet users went online to look for information about how to manage chronic pain conditions. This suggests that an estimated 10 million to 20 million people seek out chronic pain information on the Internet. Chronic pain sufferers now are creating their own support or discussion groups on Facebook, MySpace and Twitter. These groups allow people with fibromyalgia, chronic low back pain or other chronic pain conditions to go online and share information, resources and tips with others.

The results of these surveys make a clear statement: More patients are turning to the Internet to obtain health care–related information. In the era of lightning-quick health care appointments in which patients spend less and less time with a physician, it is no surprise that studies show that nearly half of all patients do not understand the information they receive during an office visit. This suggests that a new method of connecting with and educating patients is needed. Smart, savvy social media campaigns could easily address the ongoing need for patient education and communication. However, it is currently unclear whether the benefits of using social media to connect with patients outweigh the risks.

The advantages of using social media are that it is affordable (free in most cases), relatively simple and an effective form of communication. Social media also has advantages over traditional media—such as print and radio advertisements—in which you pay to put your brand and your message in front of an audience of a certain size. You cannot buy Twitter followers or “likes” on Facebook; sharing drives social media. The way to reach a broad audience is to create value for your audience that justifies their attention and causes them to want to share your content with others. Social media also affords physicians the ability to establish an online network by developing a professional presence and cultivating new relationships.

Twitter and Facebook

The most common use of social media in pain management is from patient to practice or from practice to patient. Pain physicians or pain management practices can create a Twitter page that provides regular tweets to patients of interesting pain information, including new research findings and treatments for pain conditions, as well as exercise or nutrition tips or other suggestions regarding treatment of chronic pain. We regularly “tweet” such items on our Arizona Pain Specialists’ Twitter page and currently have more than 1,600 followers (http://twitter.com/arizonapain).

Facebook is a simple, effective method for providing updates on office closures, business hour changes, changes in services offered, promotion of new products and so forth. Pain management clinics can post regular discussion questions, or trivia-type questions, related to various pain topics. This is a simple way to educate patients about pain management without physicians having to dispense medical advice or answer specific medical questions that could lead to violations of the Health Insurance Portability and Accountability Act (HIPAA). Currently, we operate two Facebook pages that have nearly 2,600 members: a support group that permits patients suffering from chronic pain to communicate and support each other online (http://chronicpainsupportgroup.com, with almost 200 different discussion groups formed) and an Arizona Pain Specialists fan page, where individuals can “like” our page and follow our content, news and updates, as well as answer our online discussion and trivia questions or participate in our online polls (http://facebook.com/arizonapain). These posts on our fan page currently are being viewed more than 200,000 times annually. Since we began posting interactive, call-to- action items six months ago, we have maintained more than 2,500 active followers monthly. The strength of social media, and Facebook in particular, is that it can be used to interact with possible patients while not violating any boundaries.

YouTube

YouTube is another great site for patient education. Physicians can create videos explaining complex and esoteric procedures, like spinal cord stimulation or vertebroplasty; they can show parts of the procedures (either live or via animation). In these situations, when videos of actual procedures are posted on the Internet, steps to protect patient health information must be taken(e.g., patients have to sign waivers to be included in videos, patients’ faces are not shown in videos and patients’ names are not used). Arizona Pain Specialists has 58 videos posted on YouTube showing success stories of patients, live video procedures and discussions about chronic pain (http://youtube.com/arizonapain). Collectively, these videos have been viewed 194,381 times in the past year—evidence that patients with chronic pain are actively searching for information on the Internet.

Videos detailing intricate and innovative procedures—or pain doctors discussing them—could put a patient who is going to have an upcoming surgery more at ease by giving insight into the details of the procedure and recovery. Also, this is a great way for other pain physicians to learn new techniques. The field of pain management is in its infancy; new and exciting treatments for chronic pain are commonly being discovered, along with development of new equipment that allows for such advances in pain management. YouTube is an ideal platform for the dissemination of these materials to other physicians and patients.

Social Media and Marketing

The advantages of using Facebook and YouTube extend to the marketing arena as well. Specifically, Facebook tracks a wide array of free data on fan pages. If your practice created a fan page, Facebook can track trends over time of visitors to the page, views, likes, posts and other feedback made by guests. For example, if you begin regularly posting questions to your fan page in November, Facebook will track how visits to the page (as well as changes in visitor feedback during that time) have changed since implementing the new format. This record basically provides a measure of efficiency for various marketing iniatives undertaken on the page.

Similarly, YouTube collects data on viewed videos. Some of the collected data include demographics such as age and sex of the viewer, geographic region in which viewers watch a video, visit duration of the viewer, video popularity and video ratings. Because YouTube offers the option of pay-per-click advertising, the statistics provided indicate the effectiveness of the advertisement. This information can be of great value for marketing campaigns, as it allows you to truly brand your videos for a particular demographic. This technology allows you to know which videos are most popular, whether the ads they place are effective and the demographics of those likeliest to go online and watch videos of pain treatments as well as post comments and feedback. Plus, it provides another way for a practice to reach out to the larger community.

Dangers of Social Media Use

Physicians must be extremely careful if and when they publicize information regarding a patient. Names of patients should never be used, yet other legal issues may arise (including HIPAA violations) if the physician provides enough detail about a patient’s case that he or she could be identified from the description. For example, Alexandra Thran, an emergency department doctor in Rhode Island, was fired last year for posting information about a trauma patient on a social media site. She did not include the patient’s name in her post but did include enough identifiers that others in the community could identify the patient. Other risks include breaching boundaries by “friending” patients on Facebook or practicing medicine outside one’s licensed jurisdiction by providing direct medical advice to patients online.

Pain physicians often encounter unique pain conditions that require unique treatments. Posting information about these rare cases on social media sites can provide great educational material for peers who encounter similar cases. However, it is also a gamble to distribute such sensitive information over the Internet because of HIPAA. Physicians must ensure that the necessary safeguards are in place to avoid any violations of privacy. With this burgeoning technology and method of communication, the decision to employ social media is ultimately a judgment call by the physician—one that must first, always, protect patients. Physicians should first ask, “How much of my professional livelihood am I willing to put at stake in order to post content on a social media site?” The growth of social media sites has occurred so rapidly that laws used to police the safe use of them have not been able to keep up. It may be better for physicians to play it safe rather than be sorry later.

The American Medical Association (AMA) has developed a set of guidelines to advise physicians on how best to protect themselves when using social media sites:

  • Use privacy settings to safeguard personal information and content to the fullest extent possible on social networking sites;
  • Routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and content posted about them by
  • others is accurate and appropriate;
  • Maintain appropriate boundaries of the patient–physician relationship when interacting with patients online and ensure that patient privacy and confidentiality are maintained;
  • Consider separating personal and professional content online; and
  • Recognize that actions online and posted content can negatively affect their reputations among patients and colleagues and even may have consequences for
    their medical careers.

Physicians who own pain management practices also can be put in harm’s way by the online postings of their employees. If employees discuss patients and the practice online, the physician- owner may be held liable. Something very similar to this recently occurred in a California hospital emergency department: Nurses and other staff took photos of a dying man and then posted them on their personal Facebook pages. The four nurses were fired and three other employees were reprimanded. A case such as this one places the hospital at great risk for being sued by the patient or the patient’s family, although there is no indication that legal action was ever pursued.

So What Can You Do?

Physicians should work with an attorney to develop specific policies on social media use for their staff members to protect the practice. Such a policy would provide a set of guidelines not dissimilar from those provided by the AMA and may include maintaining confidentiality, posting factual and meaningful comments, correcting mistakes, not “returning fire” by responding to a negative post with a negative post and not offering or appearing to offer any medical advice. Beyond solely providing a list of guidelines for employees to follow, pain management facilities also should create a social media user agreement that all employees must sign.

Physicians should exercise restraint and common sense when using social media to protect their patients and practice. Items posted to the Internet are permanent. Furthermore, once material is posted it can take on a life of its own, so extreme caution must be exercised regarding what content to share. Although there are a number of risks and potential complications associated with posting on social media sites, with a conservative policy that emphasizes caution and discretion, they can be great tools to aid in the success of a pain management practice.



Drs. McJunkin and Lynch founded Arizona Pain Specialists, a comprehensive pain management practice with three locations, seven pain physicians, 10 mid-level providers, three chiropractors, onsite research and behavioral therapy. They teach nationally and are consultants for St. Jude Medical and Stryker Interventional Spine. Through their partner company, Boost Medical, they provide practice management and consulting services to other pain doctors throughout the country. For more information, visit ArizonaPain.com and BoostMedical.com.