I'm fortunate enough to spend a lot of time interacting with physicians, entrepreneurs, and investors on the bleeding edge of digital health - and it's a consistently thrilling experience.
At the same time, the continuous exposure to the imaginative and the extraordinary can also be a bit deceptive. Self-associating groups, as Sunstein has discussed, tend to adopt relatively extreme views, and it's easy to envision this happening in Silicon Valley in general, and to digital health innovators in particular.
Consequently, it was probably healthy, and certainly arresting, to attend a breakout session on social media at recent a medical conference; the audience members were mostly physicians, seemed passionate about patient care, and were explicitly interested in learning about social media. Yet, most of the clinicians were not prepared to embrace it, and many were poignantly struggling to come to terms with a phenomenon they recognized as important, yet which viscerally troubled them.
Their concerns seem to fall into four categories, two involving patients, and two involving physicians.
1. Patients Receiving "Bad" Information
Many physicians described the challenges of dealing with patients who had retrieved wrong or incomplete information from the internet. This turns out to be a remarkably common problem, and doctors reported spending a lot of time undoing bad information.
The challenge was highlighted by the observation that 25% of Google searches for headache reportedly discuss brain tumors, even though such a diagnosis would be exceptionally uncommon. The thought was that while physicians have learned during their training to appropriately weigh pre-test probabilities, patients have not, and are likely to fixate on extreme diagnoses rather than those that are most likely.
It seemed to me that "Dr. Google" upset many doctors not only because it complicated office visits, but also because it fundamentally altered the traditional doctor/patient relationship; as one physician said - verbatim - "I've lost my authority." It's hard not to see this as a profound shift in perspective many experienced physicians understandably struggle to manage.
2. Patients Transmitting "Bad" Information
Many doctors in the audience were also visibly troubled by the ease with which patient could share "misleading" information, whether about medicine or the doctors themselves.
Despite the clear repudiation of a link between vaccines and autism, for instance, many patients continue to worry, a concern reportedly spurred on by an active internet anti-vaccine community.
Doctors were also fretting about the ease with which disgruntled patients could use the internet to besmirch reputations -- one physician complained that when he Googled himself, the first links that came up were bad reviews he said represented a small number of extremely vocal patients.
3. Physicians Receiving Information Badly
While some senior physicians worried that young doctors might start to rely on tweets rather than peer-reviewed articles, it seemed that the most significant concern raised was the impact that the "internet culture" was having on the practice of medicine. "We need to teach students that traditional values are still important," one audience member said (again, verbatim), suggesting that students have become progressively less reflective.
The use of mobile devices - what consultants call "phone hygiene" - emerged as a particular source of physician aggravation. Rounding residents would routinely look at the cell phones rather than pay attention to either the patients or the senior doctors, leading at least one doctor to prohibit the use of mobile devices on rounds - except for a 5' phone break he built into the schedule, to accommodate what he described as the young doctors' obvious addiction.
Another senior doctor, in a complaint evocative of this recent, much-discussed NYT article, noted that residents would routinely update her by text, rather than by phone. She suggested this reflected a more general trend of young physician disengagement, evidently preferring to interact with devices rather than with other people.
4. Physicians Transmitting Information Badly
The ability afforded by social media to share information rapidly and broadly was another source of concern. Many senior physicians worried young doctors might use social media in unprofessional ways - sharing things they shouldn't, saying things they shouldn't - potentially placing themselves and their institutions at risk.
In some cases, even seemingly innocent activities might be deemed inappropriate. One young physician offered as an example a (medically-related) internet survey research project he wanted to do. He said that while he could do this very easily, nearly instantly, and essentially for nothing using Google, he learned from his department this would violate institutional policy, and to conduct the research with the required protections in place would cost at least $25,000; naturally, the research has not progressed.
Predictably, medicine seems to be reacting to change the way it often does - by publishing (see Figure below) an ever-increasing number of journal articles (such as - not kidding - "Twitter for Neurosurgeons"), and by issuing well-intentioned (albeit largely unreadable) guidelines; this just-published position statement, from the American College of Physicians and the Federation of State Medical Boards, represents the genre well.
It could be that doctors have to go through familiar, well-established processes as a way of coping with things that seem so new. At the same time, it's hard not to get the feeling that organized medicine is effectively solemnizing the vitality out of social media. From reading all of the dry documentation discussing social media, you'd struggle to come away with any real sense of why it's so exciting and engaging.
To be sure, many of the critiques offered by senior physicians who offer the wisdom of their experience are spot on. They're right about the hazards of online diagnosis, and right to worry about the potential harm that can be associated with the disproportional amplification of voice the internet can offer. They're also right to urge young doctors to remember the value of professional behavior, and to celebrate reflection as a virtue.
But I also suspect many senior physicians are struggling - not always successfully -- to envision a world that operates in a very different way, at a very different speed, and in a very different style than that to which they've grown accustomed.
I reject the view that the internet and social media are somehow degrading the culture of medicine, or causing it to change for the worse. Instead, I see emerging modalities as offering the profession an urgently needed chance to radically update its approach, and interact with patients, data, and each other in important new ways. Care can evolve from episodic to continuous, and physicians, increasingly accountable, will appreciate the opportunity to partner with patients who are informed, empowered, and engaged.
Rather than isolating doctors, the new technology promises to be fundamentally enabling, allowing doctors to redefine and strengthen their relationships -- with patients and with colleagues. The result: a new sense of connection and meaning.
Medicine could be fun again.