* In this article, social media is defined as electronic communication platforms (such as professional forums, blogging sites, Facebook, Twitter, Instagram, and the like) that allow users to communicate with an online community to share ideas, messages, information and opinions through an array of media such as text, photo, audio and video.
Peer-reviewed research publications are the primary outlet for disseminating scientific information;1 however, many barriers (such as restricted membership, subscription-only access and cost) limit open access to high-level scientific literature. Fortunately, the free and unlimited reach of today’s social media* allows physicians the opportunity to advance evidence-based medicine and contribute to discussions on a global scale—thus mitigating the barriers of the past.2
While the role of social media in medicine is not without risk,3 social media plays a potential role in many points in the research workflow, from hypothesis generation to publicity and even post-publication dialogue regarding results. The process and outcome of meaningful research no longer need be sequestered in “members only” archives. It is imperative to the advancement of evidence-based medicine that all those involved in scientific research welcome the opportunity to share their work via social media.
The foremost barrier to accessing published research is cost. Since the majority of academic journals are not open access,4 to read these findings in print or online one must subscribe and pay for journal access at an institutional or personal level. It is true that with the emergence of the Internet, publishers have taken the opportunity to expand readership online instead of limiting access through print. Many publishers now also email journal highlights and links to their membership. While this timeliness of access has improved the accessibility of publications to readers, it does not fundamentally change the dissemination of knowledge, which is still limited by costrestricted access to scientific literature.5
Physicians and publishers embracing social media have created a new venue for education and the dissemination of impactful research. In fact, many studies show that social media has been integrated into formal and informal education at many levels.6 In medical education, social media appears to be commonly used to learn, engage and discuss material.7 Interestingly, users span the spectrum from undergraduate pre-medical students to practicing physicians.8 Social media also presents new opportunities to collaborate across institutional and geographical boundaries, expanding readership far beyond what has previously been possible.
Patient Education & Support
Instant sharing of article content online via social media at the time of publication allows authors to reach not only healthcare decision makers but also patients. Although social media is often stigmatized as unregulated and ergo false content,9 misinformation may be combatted directly, and physicians can play an active role in educating the lay public via accurate content generation shared through social media.10
Examples of how the medical community has used social media to educate the public about research updates are many, including these: content-generation of educational materials by medical professionals (i.e., Medscape, WebMD), public health updates (i.e., real-time flu trends11) and outreach during times of public health catastrophe (i.e., use of Twitter during flu pandemic12).
Social media has also changed the face of patient support groups. Traditional medical support groups are often seen as time-consuming and inconvenient for already-distressed patients. On the other hand, a study of patient-reported outcomes of the use of social media for patient education and support showed increased perceived knowledge regarding one’s illness and decreased anxiety.13
Further, educational tools and research can be publicized online using audio-video platforms, such as YouTube, targeted directly to patients14 as these may be highly regarded when developed by qualified medical professionals. Web-based broadcasting of information is now a common means of educating patients and the pubic, and many healthcare institutions are utilizing social media to create an interactive learning environment.15
Physician Engagement & Outreach
The positive impact of social media on patient education and support extends to physician engagement and outreach as well. This statement is not based on casual observation or high hopes. The impact of social media is measurable with altmetric analysis, which evaluates the impact of a publication via tracking tools that measure the online exposure of a publication on social media, including Twitter, Facebook and news outlets, among others.16 Typically, altmetrics are calculated using forms of interaction (such as online article shares, comments and other forms of discussion). Many journals make the altmetric score freely available for each publication, so authors can see the impact of their work in real time.
The altmetric score is separate from but akin to the more commonly known citation score, which counts how many times a publication is cited in a new paper.17 While altmetric scoring systems have not yet been formally validated, they are increasingly used in practice to evaluate the actual impact of research given that they possibly reflect a more meaningful form of outreach not accounted for in citation score alone.
For example, on December 13, 2017, The New England Journal of Medicine published an article entitled “Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia.” This article reported on the use of radiotherapy to ablate treatment-refractory ventricular tachycardia.18 Using its Twitter handle @NEJM, the publisher tweeted out the link to this article. The tweet was retweeted hundreds of times, reflected by its high altmetrics score of being in the 99th percentile of its social media impact compared to articles in other medical journals.19 In addition to increasing the immediate exposure of this article, utilizing Twitter to share the article facilitated an online conversation that previously would not have been possible. Many of the article’s authors also discussed their research with others on their own Twitter accounts and were asked direct questions such as “What’s your next step? Do you have a larger trial enrolling?”20 This discussion on Twitter allowed individuals not involved in the study to learn about the research immediately after publication and, more importantly, to engage with the researchers themselves in ways not possible when reading the publication in the traditional way.
Physician engagement and peer-to-peer learning are also facilitated by the evidence-based moderation of open blogs or forums. For example, TheMedNet.Org is a free, online, physicians-only community that allows users to search and ask controversial clinical questions as well as contribute to other discussions. Access to the site is granted after users are verified by name, credentials, specialty and institution. Discussions with the most engagement are routinely emailed out to all users as a newsletter. Some healthcare institutions (such as the Mayo Clinic) also create employee-based online platforms for open communication, reflection and discussion.21
Clinical Trial Enrollment
The potential outreach provided by social media offers new tools for researchers and patients to engage in clinical trials. Many pilot studies have shown success in this regard.22 Clinical trial accrual remains a restrictive factor to unanswered medical questions of significance. By disseminating information regarding novel treatment options and clinical trials, social media represents a tangible way to improve the quality of care delivered to patients.
Some research institutions post on dedicated clinical trials blogs that aim to increase awareness of ongoing studies.23 Doing so allows patients to engage directly with recruiters while remaining anonymous and without any obligation to enroll. In addition, open clinical trials can be discussed among interested clinicians in physicians-only networking sites as many physicians have patients who stand to benefit from enrollment but do not have such options at their local institutions. These forums represent an opportunity to discuss and facilitate eligibility, funding and other barriers to care.
Conferences and Education
Conferences have always been an important venue for physicians to educate, learn, collaborate and network. Social media now offers new tools for physicians and the lay public to connect with the conference even when not physically present at the meeting. Medical conferences often share updates on Twitter, including photographs and quotation excerpts from presenters in real time. The conference organizers often create a conference-specific hashtag and encourage attendees to share updates with their followers by including this hashtag, which will be visible to anyone who searches this hashtag on Twitter. For example, the American Society of Clinical Oncology designated the hashtag #ASCO18 for its annual meeting in 2018. The American College of Physicians designated the hashtag #im2018 for its Internal Medicine Meeting in 2018.
Conference attendees also have the opportunity to share the latest information presented at research conferences, and non-attendees have the opportunity to engage via social media in real time. One study of tweets from an emergency medicine scientific conference showed that most speakers felt positive about the dissemination of their work online and that almost all tweets retained their scientific accuracy.24 Symplur (an online healthcare analytics service that helps analyze impressions, popular tweets and influencers in medical social media) is now being used to monitor and optimize online engagement at conferences. For example, according to one Symplur analysis, over a three-year period, the number of participants at one urology conference increased by nearly ten-fold, leading to an increase in the number of tweets from 347 to almost 6000.25
Potential To Impact Policy
The impact of social media in increasing readership, patient education/support and physician engagement in research is clear. Moving forward, the potential exists to use this impact for shaping healthcare policy.26 Traditionally, the press has played a powerful role in pressuring government bodies to prioritize matters of importance.27 Increasingly, social media has replaced the traditional forms of free press and is becoming a primary means of unregulated global communication.28 This change opens an opportunity for physicians and researchers to use social media to communicate directly with policy makers, engage their following and play an active role in designing/implementing healthcare initiatives.
Potential Dangers Of Social Media
Social media use is not without its limitations; cybersecurity remains a concern for healthcare professionals. One’s online identity can be stolen or hacked, opening the possibility of non-credible information being posted under the professional’s name.29 Also, online interaction dampens one’s barriers to privacy, often allowing the worldwide online community access to personal information.30 Social media facilitates interactions with individuals around the globe, who may freely comment on a physician’s posts behind the mask of anonymity; this can falsely reduce the credibility of accurate information and promote false claims. Comments by individuals can be seen publicly and may pose a risk to one’s own credibility, such as false claims of physicians being reimbursed for vaccinations,31 which erodes trust between doctors and the public.
Perhaps most importantly, online information is unfiltered and ergo often unverified, placing a grave responsibility on physicians who use social media. Any physician who puts out medical posts via this unedited portal must make extraordinary efforts to assure readers that the information is credible and warn them to be vigilant in their search for medical knowledge, demanding accurate facts from reliable sources. In the same way, any physician who comments publicly to the social media posts of others must be absolutely sure that the person posting the information is a credible authority.
As those who use social media become more adept at applying the skills of digital literacy and thus more reluctant to jump on any “new research” as true just because “I read it on the Internet,” the value of using this medium for sharing scientific research increases. Though users should be aware of potential pitfalls, education regarding research updates, engagement and outreach are a few of the many benefits achievable with the proper use of this platform.
In summary, social media offers unprecedented tools for learning, educating, collaborating and networking with professionals and the general public. Physicians must not ignore this incredible opportunity to share impactful research, push the boundaries of the physician-public relationship and engage with the lay public, potential patients and the scientific community with ease.
Miriam A. Knoll, MD, DABR, is a radiation oncologist at the John Theurer Cancer Center, an HMH-MSKCC partnership in Hackensack, New Jersey.