key: cord-0834437-58mn00wo
authors: Ahmed, Fahad; Lipoff, Jules B.
title: The role of dermatologists in social media: exploring the benefits and risks
date: 2022-02-08
journal: Hautarzt
DOI: 10.1007/s00105-022-04946-1
sha: c4f818f32db10aac3660d9bf5cb89f2f598fa83b
doc_id: 834437
cord_uid: 58mn00wo

nan

Physicians' presence on social media platforms has become more prominent, especially since the COVID-19 (coronavirus disease 2019) pandemic. Numerous studies have documented the benefits for physicians' own personal and professional growth as well as for their patients' benefit. However, these benefits come with potential risks for providers and patients. The aim of this article is to discuss the benefits and challenges associated with physician social media use, and for dermatologists specifically, in allowing them to better understand potential impacts of their online presence.

As social media has become a mainstay in peoples' lives, the need for physicians on these information-sharing platforms has increased as well. The use of social media by physicians comes with numerous personal and professional growth benefits such as networking, sharing research, and even learning from patients. These benefits do not come without risks, however, as physicians can be misinterpreted, held accountable for messages deemed inappropriate, and be at risk for causing breaches of privacy. In this article, we discuss reasons physicians should adopt social media, roles for their effective use, and potential challenges they may face in the process.

One factor that contributes to achievement of personal and professional goals for physicians is reputation. Regardless of a physician's attitude to their reputation, it will exist nonetheless, and social media may prove a useful tool for intentionally shaping reputation, rather than it being defined by others' perceptions. By strategizing and intentionally focusing on the messaging utilized, physicians can foster their own reputation, which can support them in achieving their own goals. For example, one study demonstrated the importance of social media for dermatologists building their own practices; select groups of patients, such as younger patients, often reported valuing a dermatologist's social media in selecting their provider [1] . Similarly, another study of dermatologists located in New York City found that the presence of a physician on social media was associated with increased ratings of physicians by patients [2] .

Beyond using social media to establish their reputations, physicians can also be active in public and private group conversations and build their reputation around their specific expertise. For example, if a dermatologist is consistently active on social media, reads articles, and engages with patients, providers, professional societies, and manufacturers regarding new studies on emerging systemic medications being introduced into the market, if well argued, they can position themselves as experts on the topic. Anecdotally, dermatologist colleagues have reported that such social media reputation building has led to speaking opportunities and research collaborations.

The benefits of social media may depend on how active a role doctors adopt. In one survey study of four health systems in the United States, approximately 70-80% of healthcare-associated social mediausers used platforms to passively read and inform themselves of educational materials, hence "lurking" and receiving content, rather than creating content [3] . These users benefited from following conference highlights, keeping updated with medical agency posts, and reading medical articles shared by other users. On the other hand, approximately 30-50% of healthcare-associated social media users in this study reported beingmoreactiveand would post information themselves. The role of these so-called informers could be to increase awareness for certain medical issues, share research, and teach trainees. In another study, researchers found that the presence of a Twitter feed contributed to a higher impact factor for urological and pediatric journals from 2012 to 2016 [4] . Although this study was not at the provider level, it did suggest that social media can contribute to an increased audience for medical research, which is often siloed within the academic community. Perhaps the most active users (approximately 10%) are those that use social media for networking and research collaboration. These users actively seek and connect with other users with similar interests or complementary skills, provide feedback on others' ideas, and discuss future research directions for example.

Physicians have also engaged in academic and didactic conversations in social media. For instance, many tweetorials, or threaded tweets combining educational points, linked articles, and teaching, have become a preferred method of medical teaching on Twitter [5] . Other active users, including dermatologists with the #dermtwitter hashtag, have created Twitter-based journal clubs [6] . Typically, at a set time, physicians who are part of these journal clubs discuss a selected research article and share their own knowledge and experiences. One of the first dermatologyrelated journal clubs was #dermpathJC; over the span of October 2017 to July 2018, this community and their posts garnered over 7 million impressions [6] . Unlike the collaboration that occurs at medical conferences, Twitter-based journal clubs include a greater number of perspectives, including those from patients, trainees, scientists, and providers at every level across specialties. In addition to advancing research via collaboration, these journal clubs also are sessions through which trainees can be introduced to potential physician mentors [7] . Particularly in the COVID-19 era, trainees have turned to virtual opportunities to network and learn more about the field.

The path of information from physician to public is not unidirectional. Patients not only consume medical information, but they also produce content. Data researchers can analyze these posts to assess patients' knowledge, attitudes, and behaviors outside of the clinical encounter. A recent study of Reddit (the sixth largest American social media platform) dermatology posts demonstrated that 84% of posts were from individuals requesting diagnoses of their dermatologic conditions [8] . In this study and in others, researchers note that patients turn to medical forums to discuss their diagnoses, treatments, experiences, and own knowledge. Undoubtedly, as a medical community, further research in these natural and anonymous environments can serve as opportunities to learn what patients are discussing regarding caring for their medical ailments, and perhaps also as an opportunity to discover potential areas for research [9] . Additionally, health misinformation on the internet remains a concern. In one study, only 3% of dermatology influencers on Instagram were found to be board-certified dermatologists, and approximately one third of dermatologic educational videos on TikTok (Culver City, CA, USA) were posted by patients and differed significantly (p < 0.001) in their reliability compared to information from board-certified dermatologists [10, 11] . Strategies to combat any misinformation or material driven by promotion may include active physician engagement, or even the use of artificial intelligence [12] . Researchers can identify knowledge gaps, attitudes, and experiences that may never have come up during a clinical encounter and which could now be addressed either in person or in online settings.

Despite the benefits of social media, there are certainly risks and challenges that come along with increasing the number of providers on social media. At the most basic level are risks that all social media users face, such as wasted time, privacy breaches, or unwanted negative interactions. However, more specific to providers is the potential for harming their own reputations, by posting inappropriate or poorly received content, or even to be simply misunderstood despite any good intentions. As scientists, physicians are trained to update guidelines and practice patterns according to evidence, which may change over time. During the COVID-19 era especially, physicians were targeted or misquoted when their advice regarding mask wearing changed according to newly released evidence [13] .

Social media adoption in the healthcare realm is certainly increasing and has the potential for numerous benefits for patients and providers alike [14] . Despite challenges that providers may face in implementing social media into their medical practice routine, judicious use of social media in alignment with institutional social media use guidelines may expand career growth and opportunities while minimizing any possible negatives.

Physicians can adopt social media and be active on platforms and may help contribute to developing their own brand and in achieving personal and professional goals. Researchers should consider using social media posts as a data source for assessing patients' knowledge, attitudes, behaviors, etc. in future research, and further studies on the impact of physician social media use on professional and patient-centered outcomes are necessary.

The influence of dermatologists' use of social media on attracting patients

Social media activity is associated with higher physician ratings by patients

Healthcare practitioners' views of social media as an educational resource

The effect of social media (#SoMe) on journal impact factor and parental awareness in paediatric urology

Why is a cow? Curiosity, Tweetorials, and the return to why

Twitter journal clubs: medical education in the era of social media

DermTwitter and digital mentorship in the COVID-19 era

Patient crowdsourcing of dermatologic consults on a Reddit social media community

Natural language processing of Reddit data to evaluate dermatology patient experiencesandtherapeutics

Dermatology without dermatologists? Analyzing Instagram influencers with dermatology-related hashtags

Overview of TikTok's most viewed dermatologic content and assessment of its reliability

Identifying and responding to health misinformation on Reddit dermatology forums with artificially intelligent bots using natural language processing: design and evaluation study

Fact check: Outdated video of Fauci saying "there's no reason to be walking around with a mask

Social media in dermatology: clinical relevance, academic value, and trends across platforms

We would like to acknowledge the presentations of Ms. Stephanie Taitano and Dr. Jason Moore which helped inspire this paper.

Conflict of interest. F. Ahmed and J. Lipoff declare that they have no competing interests.For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.