Many clinicians went online to combat misinformation about Covid-19 this past year. Their collective effort shows how people can benefit from a clinical community that is increasingly online. But the rapid growth of online medical discourse carries inherent risks and may contribute to the spread of misinformation among providers and patients.
Clinical discourse moving online
Online medical discourse isn't new, but it has become common practice within the clinical community. Even before the emergence of Covid-19, clinicians were increasingly engaging in contentious scientific debates in real time on social media channels and digital platforms. For example, over 1.3 million verified doctors across 150+ countries are members of Sermo1, and 80% of U.S. doctors are members of Doximity2, two popular online clinician communities. One survey of 500 physicians conducted by Real Chemistry found that 90% of physicians use social media professionally3.
Social media discourse complements (and replaces) the debates that traditionally happen at private conferences or in-person meetings. But when Covid-19 caused conferences to go virtual, clinicians became more reliant on online channels. For instance, clinicians planned Clubhouse chat rooms to debate information and data shared at the ASCO 2021 virtual meeting. Those chats were open to the public and allowed clinicians to comment on and discuss new studies and findings.
ASCO itself actively encouraged4 participants to engage with each other via Twitter, noting that "Twitter is your most valuable channel during the Meeting. This is where presenters and attendees tend to post the most content that directly relates to the science presented."
Online conversations like these are part of an effort to quicken the pace of translating new research into clinical practice, broaden access to and inclusion within scientific discourse, and encourage the use of more real-world evidence (RWE) in routine decision-making.
This coincides with the increased acceptance of pre-prints and the acceleration of "open access" and "open science" movements, which aim to democratize medical knowledge and hasten publication of new findings. And sometimes they do speed up improvements in patient care. One example was when The Lancet retracted its hydroxychloroquine RWE study in April 20205, after the online medical community found flaws in study methodology.
The risk of misrepresentation and misinformation
But these conversations lack the structural moderation of traditional medical journals and conferences—and they can cause harm. Some clinicians report seeing the same types of vaccine disinformation6 in closed networks as they do on the big social media platforms. But problems can also arise from good faith dialogue.
When clinicians took to social media to debate whether the FDA's pause on Johnson & Johnson's Covid-19 vaccine was warranted, they broadcast their conflicting opinions to the public. Some experts praised the FDA's cautious stance as boosting the agency's credibility; others feared the pause was draconian and unnecessary. The resulting confusion left room for misinformation and increased vaccine skepticism.
Online communication platforms require clinicians to distill complex and constantly changing science into digestible, salient points for the benefit of their colleagues—and their public followers—in real time. As a result, clinicians can inadvertently oversimplify or decontextualize new studies while rushing to share new evidence. In one notable exchange, an influential scientist and digital opinion leader, once incorrectly misrepresented emerging data in a Tweet about Covid-19. A researcher with over 15,000 followers tweeted to him "(P)lease please please don't spread these numbers," recognizing the potential impact that the misrepresentation could cause.
Another issue is the allure of popularity in social media. The incentives to be popular don't always align with the incentives to be right. Many clinicians on social media see themselves as activists in combatting misinformation and advancing care, but a growing number are also trying to increase their following and influence.
There's even a current debate in the medical community over the role of social media influence in an individual's academic promotion. As "retweets" and "likes" increasingly serve to validate ideas and people in the medical community, and with algorithms preferencing content with high engagement (whether negative or positive), there's also a risk that clinicians could use controversial means to gain influence. In the future, it might become harder for clinicians and the general public to identify which clinicians have ulterior motives online.
Separating the wheat from the chaff
So, does scientific discourse within the medical community, when conducted online and in public, help or hinder the spread of medical knowledge? It's faster and arguably more democratic and inclusive—but is it more effective at producing reliable medical information for providers and patients?
The answers to these questions will depend on the actions of those who control the conversations and those who follow them. Here are the three things that must happen:
Promote good "digital citizenship." Medical schools, professional organizations, and employers must promote guiding principles for clinicians on social media. Mayo Clinic, for example, developed the Mayo Clinic Social Media Network to enhance the use of social networking tools among their workforce; they even created a Mayo Clinic Social Media Residency program to teach best social media practices. Other institutions that share responsibility for the professional behaviors of clinicians (such as academic medical centers, clinician groups, medical education providers) should provide social media training as part of onboarding and ongoing training efforts. For example, Mount Sinai Health System and the Icahn School of Medicine created the "Mount Sinai Digital and Social Media Department" which offers social media guidelines directing clinicians and medical students how to appropriately use platforms like Facebook and Twitter.
Be conscious of your audience. The medical community—including conference convenors, associations, and individual providers—must weigh the benefits and risks of engaging online in public versus closed communities. Today, many clinicians gravitate toward open social media channels like Twitter and LinkedIn to have medical discussions. These channels can help clinicians reach a wide audience, but they can also be hot spots for misinformation to rise and spread.
Although open social media channels will continue to play a large role in online medical discourse, younger and mid-career doctors increasingly prefer closed-door platforms like Doximity, Figure 1, and Sermo to share clinical cases and discuss findings in a secure space. This accelerates advancements in patient care, and does so within a closed, moderated, and HIPAA-secure space.
In fact, data from Figure 1 found that 40% of clinicians who are unable to resolve a patient case on their own find a resolution through peer-to-peer collaboration on their platform7. Clinicians should gravitate toward closed communities for contentious or complex topics, where the potential for misinformation to arise and spread to the public is lower.
Be skeptical of individuals' motivations. Most clinicians who have online influence today use it with the goal of advancing patient care. But there are some who are out to gain fame and become "influencers." The medical community must help the general public—and individual patients—develop appropriate skepticism and know whom to trust. One way to do this is by assessing whether clinicians frequently post affiliations, hashtags, or tag controversial individuals, that may indicate the presence of hidden motives.
The medical community is already evolving to be skeptical of highly publicized opinion leaders who speak at conferences and author publications. Clinicians should also look for signs of bias, promotion, or special weighting of topics and treatments in online discussions and actively check the rise of "influencer clinicians" with suspect motives.
In addition, local primary care providers and clinicians should take time to learn where their patients get medical information and what voices resonate. While patients themselves might be less attuned to signs of bias, their providers may be able determine sources of potential misinformation.
Medical mis- and dis-information isn't exclusive to Covid-19, and will continue to circulate within both online clinician communities and the general public. While today's focus on combatting misinformation should certainly focus on how the general public or vocal individuals exacerbate misinformation — and how leading tech platforms and regulators must play a role in mitigating the spread of that misinformation—the response from clinicians is fraught with complexities and challenges.
We are just beginning to observe the impact of online networks and social media channels on medical research, clinical decision-making, and society's relationship with the "white coat." There is—without doubt—tremendous potential for these tools to promote public health and accelerate the translation of science into medicine.
As the digital landscape for the medical community continues to evolve, clinicians, the public, and online platforms must prepare for and continue to react to the potential impact of medical misinformation and poorly wielded influence. The clinician's role is to protect patients from harm on all sides, including online.
Pamela Divack is a consultant, Advisory Board and Solomon Banjo is a managing director, Advisory Board.
1. Sermo. Accessed September 22, 2021. https://www.sermo.com/about/
2. Doximity. Accessed September 22, 2021. https://www.doximity.com/
3. Narayanan, M, Saitta, JA. Five Things to Know about Digital Health Acceleration. Real Chemistry. Published April 1, 2021. https://www.realchemistry.com/article/5-things-to-know-about-the-rapid-acceleration-of-digital-health
4. Foy, M. Using Social Media During ASCO 2021. ASCO News. Published April 15, 2021. https://dailynews.ascopubs.org/do/10.1200/ADN.21.200512/full/
5. Mehra, M, Desai S, Ruschitzka F, Patel A. Retracted: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet. Published May 22, 2020. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2820%2931180-6/fulltext
6. Levy, A. The social network for doctors is full of vaccine disinformation. CNBC. Published August 6, 2021. https://www.cnbc.com/2021/08/06/doximity-social-network-for-doctors-full-of-antivax-disinformation.html
7. Figure 1. Accessed September 22, 2021. https://www.figure1.com/