Doctors and Social Media – Good , Bad or Both ? A Malaysian Perspective

Whether we like it or not, social media has become part and parcel of daily living. We use it not only for personal, but also daily use. Social media may offer many benefits for the healthcare professionals, however we also must not ignore the harmful impact it may cause. This article discusses the trending issue of use of social media among doctors.


Introduction
Social media is the new trend in communication.
The creation of the smartphone has revitalised digital communications. Nowadays, the internet; social media platforms such as Facebook, WhatsApp, Telegram and Instagram have progressed leaps and bounds as main sources of daily communication. It has become part and parcel of normal daily routine. Personal blogs and accounts on social media platforms are also popular, where doctors can post articles or comments on just about anything from expressing personal opinions to posting the latest viral health issues. Professional platforms such as LinkedIn and ResearchGate also form the means of communication between doctors and also with other professionals. This has opened a new novel way of communication between both health and non-health professionals, which includes doctors and the public. This often leads to many issues including ethical considerations such as confidentiality, privacy, data sharing and safety of personal information. 1,2 This article will discuss the challenges surrounding this form of doctor-patient and professional peer relationship.

Available tools
It is estimated there are 4 billion internet users worldwide with 3 billion of those active on social media alone. 3 In Malaysia, WhatsApp and Facebook are the most popular, followed by Instagram, Telegram, Twitter and also Linkedin. 4 There are also notable other social media platforms commonly used by doctors such as ResearchGate, used mainly to form networking and for promotion of their own research.

Convenience and Easy Usability
In terms of data accessibility, medical data can easily be shared especially in relations to patient management. This is often done as part of a consultation from one doctor to another. This has recently expanded to groups of healthcare professionals and also as doctor-patient communication. Easy access to information also enables faster decision making benefiting both the patient and the treating doctor. This would include organisation of critical medical events. Examples include emergencies such as disease outbreaks and medical disasters. 5 Doctors now have rapid access to current and latest information on various medical conditions. These are mainly via published articles and professional websites, creating a healthy up-todate environment.

Enhancement of Professional Networking
Apart from the consultations among health professionals as mentioned earlier on, the use of platforms such as LinkedIn and ResearchGate can enhance networking between physicians and researchers from across the globe. Networking is now recognised as one of the criteria for promotion, especially for academics. There is ample opportunities for this via social media. These platforms ability of matching individuals with common interests is a notable plus point.

Promotion of Lifelong Learning
As a continuation on the first earlier mentioned point, accessibility to up-to-date professional medical information promotes acquiring of new knowledge. Currently, with the requirements of mandatory 20 continuous professional development (CPD) points in order to renew the annual practising certificate, social media offers a convenient way for the busy medical professional to achieve this end.

Feasibility of Networking Towards a Common Goal
Many doctors are involved in voluntary work, organising not only healthcare services but also expanding to other needs of the marginalised section of the population. This involves commitment in terms of manpower and finance where there is often a lack thereof. Hence, there have been many instances of Non-Governmental-Organisation (NGO) works publicised via social media and got favourable and fast responses. This has made projects -such as outreaching programmes to vulnerable communities and fundraising-more feasible. Organisations such as the Islamic Medical Association of Malaysia (IMAM) Response and Relief Team (IMARET) and IMAM Children's and Teens Super Team are among the many organisations that had strategically adopted this method of communication. 6

Public Education
It is undeniable that public education is made much easier with the use of social media. 7 Many doctors have taken to social media to educate public on health-related issues. There is a need to combat the overwhelming issue of unqualified personas to give unsolicited opinions on health-related facts. This poses as a great threat as personalities and social media influencers are more popular compared to the average doctor. Medical MythBusters Malaysia (M3), and Malaysian Integrated Medical Professionals Account (MIMPA) are among the societies actively involved in combating health myths or false health news by spreading health education online. 8

Safety issues
Despite the claims by some platforms that their services use encrypted messages, there is still the possibility of breaching confidentiality when exchanging patient information. 2 This can contravene one of the main pillars of medical ethics held by doctors and bring out various detrimental effects. Occasionally, there may be cases of personal information being hacked where user's personal data are compromised. This can lead to detrimental effects such as the hackers using professional platforms to spread false information leading to scams, or the use of confidential data for monetary gain.

Social Media Misuse by Patients
Some physicians have been known to share their personal contact with their patients in good faith. There are many reasons why this happens. It may be due to the urgency of the condition or due to the dynamics of the doctor patient relationship. Any issues that can be answered by a simple personal message via social media without clogging up the already overworked and understaffed healthcare system is much envied. 9 However, patients have been known to misuse this system by failing to prioritise this mode of communication to limit only professional matters. This may result in an initially good willed-relationship turning the opposite direction.

Illusion of anonymity
Anyone can be anonymous on social media. Creating an online account is simple, and the identification of the account holder does not have to reflect the person's true identity. With this in mind, some doctors may feel they can be lax in their professionalism as their identity will remain unknown. A study reports that unprofessional content being uploaded among medical students as not uncommon. 10 However, this statement does not always hold water. It is not impossible to uncover the person hiding behind a nickname. This may cause untraversable detrimental effects to the professional's career.

Breach of Doctor-Patient Relationship
There may be a breach to the doctor-patient relationship if they start interacting as friends on the social media. The physician should try their best to maintain their professionalism at all times and treat all patients equally. 11,12 There should not be any form of favouritism. Treatment guided by sympathy and not empathy may lead to unprofessionalism and favouritism.

Risk of Litigation
Any unintended breach of confidentiality or accidental posting of patient data on social media may lead to serious litigation problems for the physician. They will be also possible repercussions from the medical council with the grave possibility of even being struck off the medical register i.e. a doctor's worst nightmare. This double-edged sword kind of deal should make doctors extra careful before resorting to social media for posting sensitive topics such as their own personal frustrations with the healthcare system or sensitive patient-related data. Challenges exist even with maintaining a simple personal blog or social media platform such as a Facebook or Twitter account. First is the need for regular postings, thereby the need of commitment and time. Second, is the need to maintain high standards of professionalism at all times to keep up the name of the medical profession. Any mistakes will once again lead to the serious risk of litigation. 13

Conclusion The Future and beyond
The role of social media among doctors are undeniable. It continues to expand and will probably play a more prominent role that it is already doing. Failure to embrace this technology may leave some health professionals out of touch with the current digital reality. 14 Examples may be as simple as missing important appointment dates posted via social media to more complex issues such as the latest 'trend' and/or new evidence in treatment. It may very well have an impact on employment prospects in the future as more employers are turning to modern technology to solve previous work-related red tapes such as embracing the paperless working environment. It is important to recognise the online boundaries and at the same time to maintain the code of professional conduct. It is something that needs to be taught to the younger generation of doctors as an immediate stop-gap measure. [15][16][17] As social media invades the doctor's professional life, it is essential to use it responsibly; to pave the way for an enhanced quality healthcare service for the community.

Conflict of Interest
No conflict of interest has been disclosed by the authors.

Funds
This study did not receive any funding.

Authors Contributions
Conception and design: NKD, AAR Critical revision of the article for important intellectual content: AAR, NKD