a more perfect union

I was working on my Grand Rounds (about the ever-scintillating topic of perioperative antibiosis--a topic that I personally find engaging and endlessly fascinating, mostly due to the influence of Drs. Garvey, Prince, Lowy et al., but I understand most people find...uh, pretty dry) when a couple of colleagues steered me instead towards the admittedly sexier topic of the role of social media in medicine.  It's a topic that other people have covered much more extensively, and I daresay with much more eloquence and expertise than I; though I've personally been writing online for coming up on eleven years, in some ways I feel like Willy Loman, who built his little house in the middle of a field and later found himself surrounded by skyscrapers.  I'm not an expert by any means, and I'm not a pundit, nor do I aim to be.  But do I have any opinions about the interface of social media with medicine?

Why yes, yes I do.

Let me say first that medicine, above all fields, is slow to adopt change.  Sure, medical technology is evolving rapidly, but the culture of medicine, the technological change within our own ranks, moves at a glacial speed compared with other industries.  See, for example, the excruciating pace with which we have moved to adopt electronic medical records.  No other field in which the essential importance of recorded orders or observations, and the critical nature of interpretation error would be so inextricably tied to the the ability (or, as I see every day, the utter inability) to legibly hand-write notes with paper and pen.  And don't even get me started on dictation.  Or pagers.  Who else in this day and age still carries a pager?  I could go on, but at this moment I am chained to my dictaphone, hand-writing a patient note with quill on parchment while working the butter churn with my feet.  Fresh butter in an hour, guys!

But the fact that medicine is slow to change does not mean that the rest of the world will follow suit.  As we all have seen, the evolution of technology and how we use it has progressed at a blistering pace since I started writing this online journal as a med student in 2000.  The year 2000 was before Friendster and MySpace--remember those?  It was before Facebook and Twitter.  It was before YouTube, Flickr, LinkedIn, and whatever other incorrectly punctuated, problematic vowel/consonant ratio site has evolved in the last decade.  It was before blogs.  Really, it wasn't that long ago, but the Internet was a very different place since then, and as both the Internet and the way we interface with it has evolved, the learning curve has been steep, particularly when it comes to the world's oldest profession (no, not prostitution) dealing with the world's newest media.

In many ways, medicine is like the military.  It is a combination of a hugely public and yet extremely private field, and both are intensely scrutinized and regulated.  So it is not surprising that medicine has been slow to adopt (or to even acknowledge) the Internet.  Sure, the medical world has long viewed the Internet as an incredible repository for information--even the most steadfast of medical Luddites will use PubMed and be the better for it--but when it comes to social media in medicine, I think I'm safe in saying that at best, most established doctors think: why bother? and at worst, think that the personal and professional risk of engaging in social media is well beyond whatever marginal benefit can derived from it.

Do doctors have to have a web presence in order to do their jobs?  No, of course not.  Having a blog does not help me take care of my patient with the ruptured abdominal aortic aneurysm.  Having a Twitter account does not help me intubate my patient with the critical airway.  In some ways, interaction over the Internet is utterly peripheral to my everyday life of taking care of patients and my family, and possibly a distraction from those essential tasks.  Medicine is about triage, and over the course of a busy day, with a lot of other pressing obligations, it's easy to look at something as seemingly frivolous as social media and think: it's not important.

But it is important.  Certainly it's important to patients, who by overwhelming majority, and for better or worse, look to the internet as a source of medical advice before seeing any of us.  It's important to hospitals and medical schools, who are finding out more and more how indispensable a strong web presence is from a business and marketing point of view.  And I'm willing to bet that young doctors-in-training, most of who are in that key 18 to 34 year-old demographic, think that social media is very, very important.  Look at this infographic from Mashable about how we interact with Facebook and tell me what you think.  You can decry it, you can shake your head in rue, but you have to at least acknowledge that this is the direction in which society is moving.  And then either bury your head in the sand and wish it away; or, as our training in medicine has taught us to do, you can observe and adapt your treatment plan.

Some medical institutions around the country have taken the stance that they will not allow their trainees to partake in social media at all.  And forgive me for being blunt, but: that's dumb.  First of all, most of our future doctors are already engaged in Facebook or Twitter probably both.  Most of them read blogs, some of them may write them.  So you can either ignore that, and place a blanket edict stating NO SOCIAL NETWORKING EVER, YOU KIDS DON'T KNOW WHAT'S GOOD FOR YOU AND WE DON'T TRUST YOU ANYWAY SO SIT DOWN AND SHUT UP AND READ YOUR DAMN SYLLABUS.  Or we could start talking about it.  We could start educating our medical students and residents about what is appropriate interaction with social media, and what could be construed as unprofessional.  Instead of closing our eyes and wishing it away, we could start to be proactive and do what we were trained to do.  Educate.  React.  Adapt.  Here's a start.  So is this.  And this.

Let me just say right here that if there is ever anyone who was in the position to make mistakes with respect to social media in medicine, it's me.  Having come of age writing a blog way before there were conversations about this topic (let alone newspaper articles, lectures, or studies) I just had one thing, and really it's all that each of us are left with and the end of the day when the noise dies down and the dust settles.  That thing, quite simply, is common sense.  You can't tell doctors to stay off social media entirely, and many would argue (myself for instance) that you shouldn't.  Because social media has tremendous power for good.  Dissemination of quality information.  Access.  Building community.  Breaking down barriers between practitioner and patient.  Humanizing the practice of medicine, and humanizing the experience of those in our care.  But with the incredible power of social media comes great responsibility, particularly for those who see the human condition at its most vulnerable.  And we need to start teaching our young medical trainees, from an earlier age, about common sense when it comes to its use.

Because common sense is not obvious.  Sometimes it needs to be learned.  Now, as an attending, if I have a patient in the OR now who is desaturating, I instinctively go through a series of "common sense" steps to troubleshoot the problem.  At this point, it is ingrained.  But would it have been as obvious to me as a medical student, or even a resident?  Of course not.  I had to learn it.  Someone had to teach me.  It feels like common sense now, sure, but only through experience did it become instinct.

The world outside of medical school is changing, and it will continue to change over the next few decades in ways that we can't imagine.  The Internet isn't going away, and the way we interact with it as individuals is only going to get more fraught and more inescapable.  This is progression.  This is fact.  So  sure, we can hide or dismiss or disdainfully pretend we're above it all.  Or, we can do what we do best, which is to roll up our sleeves, learn for ourselves how to deal with this brave new world, and then teach a new generation of doctors to do the same.