Medicine in the Era of the Public Physician

By Jennifer J. Salopek

book-coverBryan Vartabedian, MD, pediatric gastroenterologist and clinical faculty member at Baylor College of Medicine in Houston, Texas, is well-known in the world of health care social media. An early adopter, he has been blogging since he launched his first Typepad site in 2006. His current blog, 33 Charts, draws thousands of readers every month, and he has more than 24,000 followers on Twitter. In 2013, he penned the Socialized Medicine column for Wing of Zock. Vartabedian is strategic and intentional about his online presence. Yet, he asserts that even doctors with little or no social media involvement are, in the digital age, “public physicians.” To that end, he has authored a helpful guidebook, The Public Physician, available for free download on iTunes.

“I wrote the book because there was no resource for helping doctors transition into the public space,” Vartabedian says. “This is not about social media. It’s about the world of medicine changing from a secluded, siloed, face-to-face practice to one that is open and public. The tool you choose is less important than what you do with it.”

Many doctors and health professionals have found the transition into the world of social media, citizen journalism, and online ratings very difficult. Formerly, a doc’s public image wasn’t an active issue; access to the media was only for the elite. While readers might have seen articles in the popular press by a handful of doctors, everything was carefully vetted by editors and fact-checkers. Now, anyone can share their stories by writing and publishing them online, completely eliminating the gatekeepers.

Doctors may struggle to find guidelines on how to operate within these proliferating channels. “Doctors are not trained to create content or even communicate one to many, and there is very little discussion about the rules,” says Vartabedian. “Medicine is different from law or business because we carry with us the intimate details of our patients, so people are not clear about what’s okay to say.”

“The public conversation is inevitable. What we must ask and answer is, ‘How can we participate in that conversation responsibly and in such a way that it furthers medicine and our careers?’”

You’re a public physician whether you like it or not, and whether you control that public image or not. Sites such as HealthGrades and Zoc Doc aggregate publicly available information and organize it in directory form, then invite users—who may or may not actually be your patients—to comment on and rate you. It’s important, Vartabedian says, to review that information periodically for correctness and accuracy, just as you do your credit report: “Others are telling your story.”

But social media offers so much more. “Sharing your opinions forces you to confront who you are and what you believe,” says Vartabedian. It’s something today’s increasingly knowledgeable, engaged patients want too. “It’s almost unsustainable not to have a digital footprint, to have patients search for you online and be unable to find your thinking.”

Participating in public dialogue presents an opportunity to “do no harm,” to be part of a conversation that can serve the greater good. Vartabedian cites the Disneyland measles outbreak earlier this year as a great example of a potential public health crisis in which many pediatricians, speaking publicly, shepherded the dialogue away from panic and prevented a digression into anti-vaccine rhetoric. Westby Fisher, MD, took on the Maintenance of Certification requirements promoted by the American Board of Internal Medicine via his blog, an example of citizen journalism that Vartabedian calls “one of the most dramatic examples of physicians in the public realm” that he has seen.

Vartabedian notes that his med students at Baylor have a tough time understanding how to de-identify patient information, and that many go totally silent on social media during the match process. He believes that teaching future doctors to understand their roles as public physicians and to navigate the often turbulent waters of digital discourse should be fundamental to medical school curricula. The same may be useful for more experienced practitioners as well. Vartabedian and colleague Kirsten Ostherr, PhD, offered “Medicine in the Digital Age” as a massive open online course in May, covering the digital revolution in health and how it is affecting doctors and patients. One participant, a medical student, wrote in a review:

As one of the future MDs who will have to deal with all the changes addressed, I found the information… an invaluable opportunity to expand my knowledge…. I especially enjoyed learning about the origin of the e-patient and what the term really means. I also found the discussion on how doctors will have to assimilate the digital world more fully into their practice and treatment of the more informed, empowered, engaged e-patient both stimulating and critical to expanding my understanding of what it will mean to practice medicine in the future.

Blogs, Twitter, Instagram, and other new venues and channels, according to Vartabedian, bring empowerment and freedom: “Doctors have always marched in lockstep. This new capacity to publish allows us to express ourselves in a way never before possible.

“The public conversation is inevitable. What we must ask and answer is, ‘How can we participate in that conversation responsibly and in such a way that it furthers medicine and our careers?’”

Jennifer-1990-webJennifer J. Salopek is founding editor of Wing of Zock. She can be reached at jsalopek@aamc.org or follow her on Twitter @jsalopek.

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