Thursday, March 28, 2013

When Care Becomes Virtual

I was using a weight machine at the gym yesterday when an abs class was ending. Participants must’ve been discussing social media, because I overheard the teaching saying, “I have four Facebook friends who died, and they still have pages.”

I didn’t hear what preceded that statement, or anything that followed. But the teacher’s words were on my mind this morning when, with two colleagues from the Community Ethics Committee, I met with social workers and other medical staff at Beth Israel Deaconess Medical Center. The subject was social media and the wariness we felt about its place in serving the best interests of patients. (The CEC’s report on Social Media, from 2010, has needed an update essentially since the day it was published; you’ll find it here.)

The idea that someone might be survived by his Facebook page hadn’t occurred to me before, and now I can cite at least one medical professional who will never experience a patient being survived by their page. This medical professional reported, with a certain pride, not being on Facebook or any other social media, and having no intention of ever communicating with a patient that way.

There’s something to be said for that, as the CEC determined in its 2010 report. The gold standard in patient care is face-to-face communication, and always will be. The phone is not as good, but it’s OK. Same with email, for certain exchanges. But Facebook? Twitter? Linked-In? Carepages or personal blogs?

I think the Facebook-averse carer is smart; she’s been in practice a long time, and her methods of communication in the healing arts seem to be working, even in an time when new communication avenues emerge with frequency.

And yet, except for a privileged few, physician-patient face time is decreasing, and social media present new means of addressing what is lost in that trend. Twitter, Facebook and the rest present unique challenges and shortcomings, and yet they are unquestionably connective for increasing numbers of people.

The Wall Street Journal recently quoted a physician who discovered from a Facebook post that her patient was waking up repeatedly at night to use the bathroom; the patient had neglected to mention this during a physical exam, and the information led to a phone call and prescribed treatment. Another physician in the same story called a patient to set up an appointment after learning via LinkedIn that the patient had been in the hospital.

And in Canada, amid disappointing participation in an H1N1 vaccination program, an investigation of online media discovered widespread anti-vaccination dialogue. This was an important piece of information in promoting vaccination, and was only discovered through smart use of social media.

Thaddeus Pope, a professor of law and specialist in the ethics of end-of-life medical care, is a proponent of social media’s potential in selecting substitute decision-makers, locating SDM unbefriended patients, and for promoting and facilitating both advance care planning and public health.

And just this week, the med student Brittany Chan makes a compelling case on KevinMD.com for using Twitter to “stay up to date on news and literature, ... share ideas and learn from others ... (and) help patients.” 

“As medical professionals, we can help disseminate accurate health information on the web,” Chan writes. “Twitter provides a great avenue for physicians to steer people to reputable websites for health information, dispel myths, share helpful articles, and educate people on medical issues.”

I recently watched a TED lecture on social media by the psychologist Sherry Turkle. It was the second such TED lecture by Turkle, the first coming in 1996 when she was on the cover of Wired magazine touting the life-changing potential of new technologies. My wife is a psychologist, too, and it was a patient who referred her to Turkle's latest lecture. I sat down and watched it with her. And one thing Turkle said stood out in explaining why social media might be so compelling a subject to a mental health professional: These devices, Turkle said, are so powerful that not only do they change what we do, but they change who we are.

Turkle tells a powerful story. But as she tells it from a stage to a large audience, this irony is just as powerful, the distracting way she looks back and forth from an earnest connection with her audience to the monitor screens that keep her place in the story. She relies heavily on them, and I note that not in criticism but in recognition of the challenge of pulling one’s attention away from the screen.

These devices, so immediately and globally connecting, can be equally disconnecting and isolating. As an 18-year-old told Turkle, sometime soon, he was going to need to learn conversation skills.

"But there are 50 ways to use something like Twitter to make your world, or the world of those around you, a better place,” writes Dr. Bryan Vartabedian, who blogs on medicine and social media at 33charts.com. “YouTube’s potential application in health care is limited only by the imagination. While no one has to use any of these tools, believing that Twitter is only a place to share what you’re eating for breakfast is to live with your head in the sand. We can’t value what we don’t understand. And we’ll only understand what something can offer by poking at it and trying it in different ways. The world is increasingly networked.  And when you find the right place to connect, share and create, you’re likely to find value."

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