First-place essay—Pro: Social media: An essential tool for the academic surgeon

In 1440, a blacksmith in the community of Mainz, Germany, developed a revolutionary device: a movable type printing press with just 26 characters.¹ From its inception, the printing press stood to revolutionize the dissemination of knowledge and information throughout the world. However, the printing press faced significant opposition. In many parts of Europe, a broad segment of the clergy believed the printing press would promote laziness among the monks, whose services of transcribing ancient texts would be rendered obsolete by the apparatus.¹ As a consequence, the printing press was outlawed in the Ottoman Empire until 1729.² In hindsight, these concerns seem heedless, resulting from uncertainty and myopia as opposed to forward thinking and reason. A similar negative reaction is sometimes seen today with regard to the professional use of social media in surgery. This article discusses how social media, when used appropriately, is an essential tool for the academic surgeon.

A modern, academic surgical practice encompasses three major domains: delivery of care, research, and the education of patients and colleagues alike. Social media platforms such as Facebook and Twitter, with a collective audience exceeding 1 billion users, can maximize a physician’s impact in all three areas of academic surgery.^3,4 The social media audience has a broad reach, spanning all socioeconomic and demographic profiles, including Americans 65 years of age and older.⁵ Research has revealed that 41 percent of social media users would allow information featured on these platforms to affect their choice of health care provider, and 90 percent of those in the 18- to 24-year-old age group state they trust health care information distributed by social media networks.⁶ Notably, the broad reach and accessibility of social media is one of the reasons many leaders in academic medicine use this tool to communicate with the public and with colleagues. For example, leaders in health care, such as the Mayo Clinic, Rochester, MN, have committed to the use of social media to engage and educate patients.^7,8 Similarly, training programs around the world have used social media to increase knowledge sharing and decrease the professional isolation of rural practitioners and trainees.^9,10

The medical academic community also has started to recognize the power of social media, not only to disseminate new research, but also to resurrect old publications once lost to bookshelves and archives. In addition, recognizing the influence of social media, the research analytic tool Altmetric now formally incorporates an article’s dissemination on social media into its assessment of the article’s research impact.¹¹ Finally, when financial intake of the Amyotrophic Lateral Sclerosis (ALS) Association failed to meet even half of the organization’s annual needs for research, education, and community service in 2013, patients and family members used social media to raise more than $100 million dollars for research and advocacy for the disease in just a few months.^12,13 The dissemination of current research findings is a cornerstone of academic surgery, and social media’s capacity to stimulate and deliver such information surpasses the capacity of any traditional print media to do the same.

Still, critics of social media in the workplace find it difficult to overlook the threats to professionalism and privacy inherent to these platforms. Common questions include the following: How should physicians address “friend requests” from patients? Should attending surgeons be Facebook “friends” with their residents? How can potentially damaging social media content be regulated?

Such concerns were elucidated in a 2014 study in the Journal of Surgical Education, which summarized the dangers of social media. In this study (n=996), 12 percent of surgical residents posted “unprofessional” content on their personal Facebook profiles, and an additional 14 percent had “potentially unprofessional” content visible. Notably, most of the surgical residents surveyed (74 percent) refrained from posting “unprofessional” content on their Facebook profiles.¹⁴ This study highlights not just the unprofessional decisions of a minority of residents but, more importantly, an opportunity for improved resident education on this topic. Without such education, can we fault the implicated residents of this study? As in others aspects of medical practice, social media misuse can be avoided with dedicated education and feedback. It is not social media that is inherently dangerous; rather, it is the people who use it who pose the risk. Still, such behaviors are correctable through focused education, rather than avoidance.

Ethical concerns similar to those regarding social media use abound in medicine and surgery, but we do not allow them to impede our social and academic progress as a community. Akin to ethics rules that provide clear guidelines on the do’s and don’ts of personal and financial relationships with patients, professional societies and hospitals can establish sensible best practice guidelines to educate providers on appropriate use of social media and ways to avoid its pitfalls.

There is no universal approach to these guidelines, although it is recommended that hospitals and professional societies create standards that are specific to the needs of their communities. Residents, ancillary staff, and attendings alike should take part in developing these guidelines to ensure that all parties are represented and that the inherent power dynamic associated with professional hierarchy is leveled. Without such regulation, residents, medical students, and even junior faculty who are accustomed to acquiescing to their superiors’ requests in the professional setting may feel compelled to share elements of their personal lives that would otherwise be kept separate from a colleague’s eye.

Social media use comes with a level of intrinsic risk, but those hazards should not stop surgeons from progressing in a judicious and deliberate manner with this form of communication. In the 1840s, when clergymen claimed that anesthesia for a woman in labor was a direct affront to the Lord’s plan, medical professionals continued to use ether to provide painless surgery.¹⁵ Anesthesia’s obvious benefits outweighed the voices of its staunch opponents. Although social media may not be as overtly beneficial as ether or the printing press, the social media revolution is progressing at a rapid pace, and surgeons can choose to spend their energy resisting it or improving it.

More than 80 percent of teenagers online use at least one social media platform, and these adolescents will soon be our trainees and colleagues.¹⁶ Discouraging social media use from surgical practice will only deepen the stereotypical chasm that often exists between the surgeon and the patient. Social media provides one means of narrowing that gap, not just by posting content, but also by providing the means to listen, such that a better understanding of where our patients find their motivation and information—regardless of its veracity—may be gained. Social media is an essential, multifaceted tool to the academic surgeon who serves to learn from and to educate patients and colleagues alike.

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References

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