Hi. Welcome to the social mediasphere.


OK, you don't really need to be told where you are, do you? You got an email and you clicked on a link that opened this American Hospital Association site in your web browser. Now, out of simple curiosity or dawning interest, you're reading these words — crafted by your humble content provider.

Should you persist to the end and feel so inclined, or if you experience a sudden midpoint access of rage, bile or, less commonly, delight, you might append your own comment. You can correct a perceived error, expand on a thought contained in these paragraphs, argue against it from superior knowledge or experience, or chime in with a hearty olé. Please feel free.

Crawling down the right side of this page you'll see a Twitter feed — brief links to this and other H&HN articles. If you wish, you can "join the conversation" and respond with your own 140-character tweet. Maybe it'll get retweeted. You might also choose to copy and paste a link to this piece on your Facebook wall, so your Facebook friends can share the fascinating insights it offers and "like" or comment themselves, even pass it along via some similar application like LinkedIn, MySpace or Pinterest, or write about it on their blogs … .

This is what defines a medium as social. Host, content provider and readers rub virtual elbows on an electronic platform that allows them to interact and exchange information as readily as if in frivolous chatter at a cocktail party, BELLOWING TRUCULENTLY BACK AND FORTH ACROSS AN ALLEYWAY, or engrossed in meaty colloquy at a seminar — even though they may be far-flung around the globe.

The capacity to engage in these reverberating polylogues, in which rank holds little advantage and patients actually may be more up-to-date on the literature than their doctors, is already transforming health care relationships.

The Third Millennium's Defining Communications Trend

Like the AHA, 1,501 of the nation's 5,754 hospitals report making use of social media in some way. Let's abbreviate that occasionally to SM. Almost 85 percent — 1,264 — market themselves through a Facebook presence. Almost as many — 1,116 — try to attract patient traffic through Foursquare, a mobile application in which users can earn perks for checking in with friends from locations like hospitals, corroborated by their device's global positioning system. Close to 1,000 health care institutions subscribe to Twitter. Some 685 have posted at least one video to YouTube. But only 185 maintain blogs.

Foremost among that tiny minority is the Mayo Clinic. Through its pioneering Center for Social Media, Mayo hosts no less than a dozen blogs, updated frequently by eight full-time employees. They also keep busy firing off a daily fusillade of tweets to 400,000 followers, Facebook posts that have garnered 180,000 "likes" to date, YouTube videos mostly shot in-house with off-the-shelf equipment, text messages and feeds to you-name-it SM apps … all promoting the Mayo brand via tips for healthy living, links to Mayo-centric features in the mainstream media, authoritative overviews of diseases and conditions by Mayo subspecialists, popular documentation of noteworthy accomplishments by the system's physicians and researchers … and more.

The Mayo Clinic Center for Social Media began life as a one-man show — the consuming interest of a media relations rep named Lee Aase (pronounced Acey). In 2006, he launched a personal blog to trumpet his conviction that "social media are the third millennium's defining communications trend."

Neglecting social media's power, he argued, "can cripple an organization." For communications and marketing professionals, he declared, failure to understand and exploit SM is tantamount to malpractice.

"Social media tools," he insisted, "offer unprecedented opportunity for transformational change and productivity." (These are among "35 Social Media Theses" digitally nailed to the wall of Aase's blog, now styled Social Media University, Global, or SMUG — of which he claims the title "chancellor." SMUG remains a go-to source for "courses" in best health care SM practices.)

Before long, Aase had demonstrated to Mayo leaders the effectiveness of his pet new messaging vehicles. In July 2010, the center was staffed and launched under his direction. Some 140 health care organizations now receive training and share resources as members of Mayo's Social Media Health Network. The precise numbers of SM players among organizations cited above comes from a list started by SM guru and University of Maryland Medical System Web technology director Ed Bennett in 2008. Mayo's social media center took over the project last September. Since it depends on self-reporting, the state-by-state tally may not be all-inclusive, so SM-savvy hospitals that haven't yet might want to check in.

Filling the Niches

Social media are obvious, natural marketing instruments for hospitals, but their social value derives from content that is substantive. Peer-reviewed posts, links and videos, even whittled to the bone, can contribute to decreased diffusion time for medical research and health care innovations, Aase promises. Mary Anne Arnold, whose Prospect, Ky.-based Care Publications provides customized, evidence-based dead-tree-, Web- and mobile-adapted, condition-specific newsletters and patient guides for distribution under a hospital's own logo, sums it up succinctly: "Marketing is education."

The benefits patients can derive from SM participation have been attested to over and over. Stories abound — propagated, of course, through the social media grapevine. Here are just two of them:

Erin Turner. Suffered from a mysterious pain in the wrist for five years. Mother called her attention to a Twitter chat featuring an expert on a little-known condition called UT ligament split. The expert, Mayo physician Dick Berger, M.D., had shot videos with Mayo's social media center about saving the career of baseball star Jayson Werth by identifying and treating his subtle UT tear several years earlier. A clip had just been picked up belatedly and retweeted by USA Today. Turner jumped into the chat; she and Berger exchanged tweets and emails; soon she was en route to Minnesota where her wrist was successfully repaired. (More here.)

Katherine Leon. Had a rare condition called spontaneous coronary artery dissection. Joined Inspire.com, an online community that includes 7,000 female heart patients. There met — virtually — a fellow sufferer, Laura Haywood-Cory. They decided to pack off to a heart disease conference at Mayo where they plumped for more research into their under-investigated condition. Outcome: Mayo launched a pilot study and is now developing a DNA databank from patients and their relatives worldwide. (Full story of this remarkable patient-prompted research project here.)

Many patients turn to social media not only to tease out information about the diseases and medical conditions that affect them and their families, but also to spread more widely the hard-won knowledge they've amassed. Melissa Hogan, for example, self-described as "a lawyer by training, a writer by passion and an advocate by necessity," has set up a blog and multiple social media accounts to support and spotlight resources for parents with children like her son Case, who has an ultra-rare disorder called Hunter syndrome. Social media have created unprecedented meet-up opportunities for otherwise lonely physicians, researchers and laypeople like Hogan grappling with "niche diseases" so uncommon they've eluded the attention of Big Med.

Joining the Party

Patient experience detailed in the social media can be inspirational to physicians, too, says medical student and blogger Danielle Jones.

"Yes, I follow patients on Twitter," she writes. "Not my patients, but patients who share their stories. I follow patients who explain how their doctors have affected their mental and physical health — how their physicians have failed them or fought for them and how it made them feel. I follow patients to understand, to avoid complacency, to maintain compassion."

The American Medical Association acknowledges that physician participation in social networking and "other similar Internet opportunities" can "support physicians' personal expression, enable individual physicians to have a professional presence online, foster collegiality and camaraderie within the profession, provide opportunity to widely disseminate public health messages and other health communication." But it also warns that doctors "must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students), and can undermine public trust in the medical profession."

Because of bleak warnings like that, says Bryan Vartabedian, M.D., a pediatric gastroenterologist at Texas Children's Hospital/Baylor College of Medicine in Houston, "physicians have been late to the party." Himself an early adapter, a blogger since 2006 and a peripatetic advocate for what he calls the "social health revolution," Vartabedian muses that doctors have to overcome a visceral reluctance to engage in the sort of "public thinking" that has earned him a faithful blog readership and 11,000 claimed Twitter followers.

"Physicians are naturally cautious," he suggests. "We're conservative when it comes to new technology. And one hallmark of social media is transparency — opening oneself up to public conversation. A lot of physicians have issues with transparency. Sharing is not in our blood."

But a world in which physicians can cloak themselves in the authority of "white coats buttoned up, presenting a certain front" is rapidly crumbling, Vartabedian points out. He was embarrassed recently when a patient showed him a study downloaded from the Internet that he hadn't seen. He didn't admit his unfamiliarity with the paper to the patient, but he felt chagrin at his lapse. In fact, he reflects, "We're rapidly moving from a model where physicians memorize to one where they get access to what they need to know through knowledge-based networks. We need to promote a culture of participation among patients. I call information ‘the third person in the room.'"

Everyone a Potential Publisher

Probably the greatest barrier to wholehearted embrace of social media by physicians is fear of liability, notes Vartabedian. But concerns that "a public presence is going to increase the risk of a lawsuit" are largely exaggerated, he maintains. "There are real simple rules for docs to follow that keep them safe."

In addition to those summarized in the AMA code of ethics, practical guidelines to professional engagement in social media aren't hard to find online. One set, compiled by cardiac electrophysiologist/eponymous blogger Kevin R. Campbell, M.D., was recently reprinted by perhaps the most prominent physician blogger on the Internet, Kevin Pho, M.D.

"It used to be that the voice of the physician was represented by the office of public affairs," observes Vartabedian. "But with the democratization of social media, every physician is potentially a publisher. You just put a webcam on top of your laptop and go on YouTube."

That scares the pants off many health care control freaks. How can they supervise what their doctors and nurses are telling the world? How can they make sure their brand isn't being smirched?

Purely and simply, they can't, declares Aase. Organizations that try to block employee access to social media are not only misguided and sending a terrible message about openness and trust, they're doomed to failure. For one thing, he points out, proliferating smart phones and handheld devices put SM sites at staffers' fingertips 24/7. And while there are many reasons cited by nervous health care executives to justify no-social-networking-at-work policies, says Aase, "None of them are really good." Indeed, Mayo's Social Media Health Network is right now preparing a white paper that will refute those objections one by one, he says. The paper will argue forcefully for an open-access SM policy and provide a tool kit for implementing it.

"In the past 300 years," exults Vartabedian, "this is probably the most exciting time to be a physician! Medicine is undergoing its most radical transformation in centuries!"

He isn't talking about Obamacare.

David Ollier Weber is a principal of the Kila Springs Group in Placerville, Calif., and a regular contributor to H&HN Daily.