A view from the coffee room…is it the duty of medical specialist to share information on social media and on what terms?

I was asked to give a little talk in the annual congress of Young Plastic Surgeons association in Finland. I was given a topic: Is it the duty of medical specialist to share information on social media and on what terms? This title didn’t frighten me at all. ICYMI, I have been active in social media (SoMe) for some time now. I manage a relatively popular educational account in Instagram,  where I share videos on how to do procedures, e.g. suturing, wound treatment, and of course I share my accumulated valuable wisdom on ethical and moral aspects of our profession1.  

When I started my account, my target population was medical students and young residents. Very soon it became clear, that there was a demand for such content. I noticed nurses, doctors of other specialties and laymen starting to follow me. Another indication that content such as mine is needed is that I receive DMs in strange hours, usually during night shift hours, thanking for showing the procedure. There is actually a name for this: just-in-time learning2 or microlearning also known as heutagogy. There you have it: your word of the day. Heutagogy means self-determined distance learning using technological developments3.  

To answer the first questions of the title: No. Rest assured, there is no obligation for anyone to start a SoMe-influencer career. Let’s face it, most people don’t have skills or messages to share. Interestingly, most active SoMe-influencers have a good academic track record based on H-index4-7, on Twitter/X that is. Different SoMe platforms have different profiles and Twitter profiles itself disseminating research and scientific content. Communicating science and highlighting accomplishments is never a bad idea in SoMe, besides gaining personal benefit by improved article citations8 it also benefits the whole surgical community9.

This leads me to another aspect: communication with the patients. It has been estimated that billions of people use SoMe every day; already in 2019 over 7 billion people used SoMe10 and that was before the Covid-19 pandemic. The pandemic increased the use of  SoMe and especially in the older generations11. AFAIK, we are the doctors, and our patients are in SoMe.  Why not go there were they are?

Hear ye, hear ye some SoMe commands. First and foremost, communication with the patients in SoMe never replaces clinical evaluation; never endanger patient confidentiality in texts or images; and never lose your professionalism12. The Finnish Medical Association – IMO – has put it best:  Physicians must follow the same ethical boundaries, principles and ethical guidelines in the use of social media as in all other medical work13. It is good to know, that patients are seeking health information that falls under the category of technical information14 such as specific disease or treatment, procedures, doctors, or hospitals. Pretty basic, and you can discuss, in general about health care activities, diagnosis, and treatments. BTW most of the global population is not like us surgeons, they don’t want to see images of blood, bloody tissues, intestines, broken bones etc.  Really strange and makes you think…

Much of the communication in SoMe is visual, and especially in platforms like Instagram or TikTok. Most of SoMe medical visual content is… how to say it…  not as accurate it should be. I have seen procedures that should be sterile or aseptic made with bare hands, no gloves. I have seen before and after pictures, that are not comparable with terms of position, lighting, background or zoom15,16. Likewise, not all the content is medically accurate, and not disseminated by specialists17,18. Thus, leading to frequent misinformation9.

There might be temptation to use real clinical photographs to illustrate the clinical topic you are talking about. You can never share images without patient´s consent, in some cases written consent19. Careful consideration should be exercised, when a patient is elderly or very young and may not comprehend the entity of SoMe and that online images are permanent and difficult to remove, or a person who is legally incompetent or under the influence of intoxicating substances, when thinking about asking for consent. When sharing visual communication, such as photographs or videos, in SoMe, special care must be taken to ensure that the environment, time of day, details, metadata, tattoos, birthmarks, amputation stumps and other similar individual characteristics do not lead to patient identification.

In my account, as it is educational, I use medical education models, because I can re-shoot the procedure until I am happy with it, with lighting and angles just right. This suits me, for my target population and for my content. Now some of you may say, how about those closed social media groups? Well, I am not sure if they are really closed, and remain closed in the distant future, and therefore I personally would not share images or texts with confidential information in closed social media groups. Others see this differently19.

IMHO, I  have answered the latter part of the title, on what terms, and hopefully I did not scare you, from becoming a surgery SoMe influencer.