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January 2009 | Back to Table of Contents

Feature Story

Medicine in the Era of Web 2.0

Physicians discover the benefits (and downsides) of social networking.

By Melissa Rethlefsen and Colin Segovis

When Julia Shekunov was accepted into Mayo Medical School’s Class of 2012, one of the first things she did was join her incoming class’s Facebook group. “It made me feel less anxious about starting school because, to some extent, we were able to bond through the group prior to meeting in person,” she said in an email about the experience. “I met my current roommate through the group, and the group also helped us get many questions answered such as where to live and how to get Internet access.”

At 8 p.m. on a Friday, Dr. X logged on to Sermo, an online networking site for physicians, asking for advice about a patient who had been prescribed two drugs he thought might be contraindicated. Within a few hours, he received 10 responses from other physicians who drew from research findings and their own clinical experience to answer the question. Thanks to the web consultation, Dr. X (Sermo members use pseudonyms to identify themselves) was able to make a more informed decision about the risks and benefits of stopping one of the medications.

Social networking websites such as Facebook (facebook.com), Sermo (sermo.com), and LinkedIn (linkedin.com) have changed the way many physicians, fellows, residents, and medical students communicate. But what is social networking, and how does it work? More important, how can it benefit you?

Social networking is part of a larger phenomenon known as Web 2.0. More than just a buzzword, Web 2.0 describes a combination of technologies and content that has shifted the World Wide Web from an information repository to a collection of communities in which individuals can interact with one another. One of the hallmarks of Web 2.0 is user-generated content. Sites such as Wikipedia and YouTube, for example, are made up of content that is produced by the people who use them, rather than traditional publishers or content generators such as businesses. But social networking isn’t only for connecting with others or sharing that irresistible video of the evolution of dance. Businesses also are leveraging it. For example, Amazon.com uses it to encourage customers to recommend and rate products.

Create a Conference

Web 2.0 tools make it easy for anyone to create their own social networking site. Two web tools in particular, Ning (ning.com) and CrowdVine (crowdvine.com), are frequently used to create networks for small groups and even conference participants. The New England Journal of Medicine recently used Ning to connect individuals attending its Horizons conference. Through this community, conferences attendees interacted with each other and worked on group tasks, such as researching and preparing presentations on various technologies months before meeting in person. They are still using it to keep in touch.

The countless social networking sites that exist on the web for students, scientists, knitting fanatics, or people with any other hobby or interest generally have two key features. The first is the user profile, which includes information about you. For some sites such as Sermo, user profiles encourage you to use a pseudonym or “handle”; others such as LinkedIn, a business-oriented social networking site, require that you use your real name. The second is the relationships you create with other members (they may be called friends, followers, connections, favorites, or fans, depending on the site). Connecting with other members is often referred to as “friending” someone (ie, “I just friended you on Facebook!”). Different social networking sites can help you accomplish different goals. We’ll describe some of the most popular and interesting ones used by physicians and that physicians should be aware of.

Facebook: Not Just for Students Anymore
Facebook is one of the largest traditional social networking sites, second only to its predecessor, MySpace. Originally designed for college students, Facebook is still the place where students share photos, invitations to events, videos, and more. After Facebook opened up access to anyone with an email address in September 2006, student members were joined by millions of others, including its fastest-growing demographic, people 25 and older. 

Although Facebook has been much maligned for encouraging narcissism, in medical circles the greater concern has been about its implications for medical professionalism. Posting photos of patients on Facebook and MySpace has been grounds for the dismissal of several health care professionals. Also, recent studies have shown that medical students and residents, the majority of whom use Facebook, don’t use most of the privacy settings available to them, allowing anyone in cyberspace, including potential employers and patients, to stumble on content they might not want them to see. Discussing the impact of social networking sites on students’ careers may soon be a necessary aspect of teaching professionalism in medical school. Mayo Medical School already advises its students to be careful what they post on their Facebook profiles.

Health-Related Social Networks

Ozmosis
(ozmosis.com)
For physicians

radRounds 
(radRounds.com)
For radiologists

ANANurseSpace 
(ananursespace.org)
For American Nurses Association members

NurseLinkUp (nurselinkup.com)
For nurses

SpineConnect (syndicom.com/
spineconnect/
)
For spine surgeons

sdn: Student Doctor Network (studentdoctor.net)
For medical students

Nature Network (network.nature.com)
Nature Publishing Group social network for scientists

Healtheva 
(healtheva.com)
For physicians and researchers

PatientsLikeMe.com (patientslikeme.com)
For patients with medical conditions including ALS and multiple sclerosis

My Cancer Place (mycancerplace.com)
For cancer patients

DailyStrength.org (dailystrength.org)
For patients with physical or mental illness

Can Facebook be useful in spite of those concerns? As Shekunov discovered, it is the way to connect and share information with classmates, even before starting medical school. Because of the sheer number of medical trainees using Facebook, faculty should become familiar with the site simply to understand how it works and potentially use it as a vehicle to contact and work with students. For example, faculty could set up private groups for their classes—places where students can collaborate, submit questions, get updated information about assignment deadlines, and more.

Facebook can be a good marketing tool for a hospital or clinic, a school, a program, or even an event. In 2007, Facebook introduced “Pages” for organizations, where a business or group, rather than an individual, can present information. Mayo Clinic’s Facebook page includes basic information about the clinic as well as the latest news and podcasts from the main Mayo Clinic website, event listings, medical videos, and patient testimonials written on the “wall”—the public area of a profile page where Facebook members can add comments and notes. Clinic staff members even respond to questions and comments on the page, giving it a personal touch.

LinkedIn, Sermo, and Other Sites for Physicians
Other social networking sites are designed specifically for working professionals, including physicians. The largest professional networking site is LinkedIn, which was created to connect people looking for jobs, the premise being that it’s easier to find a job through a friend of a friend than on your own. With the recent addition of a listing of events and conferences in various fields and tools to display presentations, a portfolio, reading lists, and more, LinkedIn has become most useful for building an online presence. LinkedIn profiles rank high in search results for names because of the popularity of the site.

A number of social networking sites exist specifically for medical professionals. One of those is Sermo, the official social networking site of the American Medical Association. Sermo is open only to physicians licensed in the United States. The registration process keeps the site closely regulated and considerably more private than other social networking sites. In order to join, physicians must provide regulatory information such as their state license and DEA numbers and either fax Sermo a copy of their current state medical license or hospital or practice ID, or provide the name of the hospital at which they practice and the phone number, so a member of the Sermo team can call to confirm their identity.

Although Sermo has a number of features useful to physicians, including a job-search tool, a PubMed search interface, and a list of CME activities, its best feature is the “Postings”—questions posed by physicians that members can answer curbside consult-style. For physicians in solo or small practices, this opportunity to consult with dozens of colleagues across the country can be extremely valuable. When responding to a post, Sermo members can comment, rate it for usefulness, and add the post to their list of favorites. Many Sermo members quote research studies when responding to clinical questions, building a bank of information on a particular topic. (Sermo divides postings by specialty and topic, making it easy to skim through new and relevant postings.) Although clinical questions are common, even more common are posts about the current state of medicine.

In addition to partnering with the American Medical Association, Sermo has been developing relationships with a number of other organizations, one of which is the Nature Publishing Group. Sermo members now have access to the full text of articles from 12 Nature Publishing Group journals, including Nature Clinical Practice Cardiovascular Medicine, Nature Clinical Practice Endocrinology and Metabolism, Nature Clinical Practice Neurology, and Nature Clinical Practice Urology. In addition, articles from these journals display “Discuss on Sermo” links, making it easy to quickly create a Sermo post about an article of interest. 

Although relatively new to the social networking scene (Sermo got started in September 2006 and became the AMA’s official social networking site in June 2007), Sermo has already gained traction among physicians. As of July 2008, more than 70,000 physicians had signed up for an account. In a single day in November 2008, more than 1,500 physicians had logged onto Sermo and made comments about postings.

Social Media Networks

YouTube (youtube.com)
The world’s largest video sharing website

SciVee 
(scivee.tv)
Shares research presentations over video

Slideshare (slideshare.net)
Hosts millions of presentation slides in Flash format

Connotea (connotea.org)
Nature Publishing Group social bookmarking tool designed to help researchers store links to important research papers and share them with colleagues

Delicious (delicious.com)
Social bookmarking site where links are the shared content

Flickr 
(flickr.com)
Image and photo sharing tool

Sermo isn’t the only social networking site for health care professionals. Healtheva is a general site for medical professionals and researchers that allows members to create their own blogs. Another popular site is Ozmosis, which is restricted to physicians licensed in the United States. radRounds is a social networking site for radiologists that includes case studies, forums, news about radiology, and more. SpineConnect is for spine surgeons from around the world.

Networks for Patients
No discussion of social networking would be complete without mentioning the proliferation of sites for patients. Patients have long gravitated to the web to share their stories through forums, bulletin boards, and blogs.

Patient social networks are an extension of the desire to connect with others suffering from a particular disease or undergoing treatment for it. Some of the more popular sites such as PatientsLikeMe.com have thousands of members. Although the main benefit of these social networking sites is the support of peers, they may prompt patients to ask why they are not receiving the same treatments as others on site. For that reason, physicians should become familiar with them.

YouTube: Connecting Around Content
Whereas traditional social networking sites focus on individuals, others are defined by specific types of content: images and photos, videos, presentation slides, bookmarks, research articles, and more. YouTube is the most popular of these types of social networking sites, and physicians, medical educators, and medical organizations have embraced it.

Through YouTube, anyone can post and comment on videos. Videos of histology slide interpretation, clinical procedure how-tos, and course lectures, for example, abound on YouTube. Organizations can create YouTube channels to share news on medical breakthroughs or research conducted by their staff. For example, the Mayo Clinic channel on YouTube features research discoveries, patient stories, and health information about issues such as long QT syndrome and eczema. Subscribers can rate offerings and post comments about them.

Other media-based social networks include SciVee and Slideshare. SciVee is a video-sharing site on which members can discuss their latest research. Researchers can create short videos about the work they’re doing and upload them along with relevant content. Users can then comment on the videos and add their own. Slideshare is a similar service for sharing slide presentations.

Twitter: 140 Characters and Unlimited Communication
An unusual entry in the social networking space is Twitter (twitter.com). Technically a microblogging application, Twitter has become a way to network with colleagues and friends. What is microblogging? Unlike blogging, which requires generating a significant amount of content, microblogging requires only a few words per entry. Indeed, microblogging tools typically limit users to 140 characters or fewer per post.

Twitter began largely as a way to post status updates to share with friends. It implores users to answer the question, What are you doing? It then transfers the information quickly and efficiently among groups of friends and colleagues. Although Twitter was initially berated for its seemingly inane chatter and frivolity, it and other microblogging sites are now being taken seriously by individuals and enterprises alike. Twitter users now carry on conversations (called “tweets”) with each other, share information learned at conferences and CME events, and query peers about professional concerns. Physician bloggers Ves Dimov, M.D., of Clinical Cases and Images (clinicalcases.blogspot.com) and Kevin Pho, M.D., of Kevin, M.D. (kevinmd.com) use Twitter to communicate information rapidly without writing a traditional blog post. Others use Twitter to rapidly share information gathered at conferences that colleagues are unable to attend.

Organizations are also using it to pass along critical information to their members and employees. The Red Cross, for example, uses Twitter (http://twitter.com/RedCross) to rapidly deliver information about disasters and response efforts. Some physicians are using it to keep patients informed about office hours and other practice information. And hospitals and medical systems including Allina Hospitals and Clinics and the Mayo Clinic have started using Twitter to communicate press release-style information (“Watch a live total knee replacement surgery online Dec. 18” was one recent example found on Twitter/AllinaComm). The Medical University of South Carolina and Sutter Medical Center Castro Valley in California use it to share local stories, provide information about events, and converse with other Twitter users.

Creative Communication
The myriad social networking sites open up new avenues for communicating with colleagues, peers, and patients. In a matter of minutes, you can get a clinical consultation, feedback on a recent research project, and access to a wealth of information and tools, all of which seemed unimaginable just five years ago. Social networking sites are simple to use and offer enormous benefits. The only question is what creative use health professionals will put social networks to next. MM

Melissa Rethlefsen is an education technology librarian and Colin Segovis is an M.D./Ph.D. student at Mayo Clinic.

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