Social media is broadly defined as a category of internet-based resources integrating user-generated content and user participation. These span a wide range of platforms including social networks such as Facebook and Twitter and blogs and photograph- or video-sharing sites 1.
The ubiquity and widespread adoption of social media sites such as Facebook and Twitter by everyone – medical professionals included – has changed the way people share and exchange their ideas and opinions 2.
Unlike mailed print media or electronic mail, social media provide highly customized user experience in which the user has control over the flow of information. This, in turn, increases the potential utility of interaction between physicians and patients. As patients seek more and more health-related information online, dermatologists using social media have the opportunity to connect, educate, and build relationships and trust with patients who are seeking information. Moreover, the active participation of dermatologists in social media strategies can contribute to improved quality of information accessible to patients who go online to learn more about their health. Of equal importance to the opportunities to connect with patients are the risks to a dermatological practice that can occur from inadequate or outdated understanding about the roles that social media play in the lives of not only patients but also staff and practitioners 3.
The global steady increase in usage of the internet in general and social media networks in particular was paralleled in Egypt. The figures of the Egyptian ministry of communication 4 indicate that the number of internet users has increased exponentially during a 5-year period to reach 22 million users in 2013 compared with 12.3 million users in 2009. The proportion of Egyptian university hospitals using the internet increased between 2011 and 2012 by 73%. Ninety-eight percent of doctors in these hospitals benefit from such access. Among these doctors, the highest percentage (55%) used the internet to get information about recent remedies. In 2013, 11% of the total Egyptian households used social networks on a weekly basis, whereas almost 3% of them used it on a daily basis.
Information about the use of social media by Egyptians dermatologists in their practice is lacking. The present study was carried out to evaluate and quantify the extent of involvement of dermatology residents on social networking sites and their attitudes toward dealing with patients online.
Participants and methods
Ethical approval from the Research Ethical Committee of Faculty of Medicine, Benha University, was obtained to conduct the present study (4 May 2016) and an informed written consent was obtained from all the participants.
We included 126 dermatology residents attending the annual meeting of the dermatology department of Benha University during the period from 19 May to 21 May, 2016. As we found that 92% (116 residents) of responders who accepted to participate in our study were females, only their questionnaires were included. Their ages ranged from 25 to 29 years.
Our choice of a group of young doctors was based on the findings of Brown et al.5 that there is a linear relationship between increasing age and decreasing social media use. Younger doctors, who use social media frequently 6, may be more comfortable communicating online than senior doctors who have limited familiarity with the technology 7,8.
The tool used was a self-filled questionnaire designed by Brown et al.5 with a few modifications – for example, changing the order of some items, deleting repeated items, merging related questions, and replacing the examples mentioned with dermatology-related ones. These changes have been made to suit the culture of our participants. The questionnaire included questions about demographic data, participants’ current online usage, general online behavior, participants’ online behavior, patients’ online behavior, and appropriate patient–doctor online interaction.
Collected data were tabulated using an excel sheet, and analyzed by a computer software (SPSS, version 15.0; SPSS Inc., Chicago, Illinois, USA) using appropriate statistical methods. P<0.05 was considered statistically significant.
Table 1 shows that most participants are living in urban areas (73.28%) and practice dermatology in a public hospital (58.62%).
General online behavior
The most commonly used social media was Facebook (91.38%) followed by Instagram (24.14%). Most users (43.97%) used social media for 1–3 h/day. The most common method for interaction with patients was the telephone (61.21%). A Facebook page was the most common online media available to patients to communicate with the dermatology residents (45.69%). Most of the participants never discussed social media usage with their patients (66.38%); however, 50% of responders found it appropriate to interact with their patients professionally through e-mail (Table 2).
Online information of doctors and patients
Among responders, 73.28% thought that doctors have a duty to rebut inappropriate or inaccurate health information posted online. Concerns about public access made most participants (54.31%) hesitant to immerse themselves completely into social media. ‘Yes, sometimes’ was the most common answer of doctors (39.66%) to a question about discussing publicly available online information about their patients to assist in their treatment – for example, the nature of their work or their recent travels (Table 3).
Appropriate patient–doctor online interaction
Most dermatologists (43.97%) mentioned that they would be uncomfortable conducting a consultation with a patient via online telecommunications; 49.14% of the doctors found it appropriate to maintain a personal Facebook profile that could incidentally be found by patients. A ‘friend request’ on Facebook was never received by 48.28% of the sample from their patients, and 39.66% mentioned that they would do nothing if they receive such a request (Table 4).
Relationship between demographic data and social media usage
Doctors living in urban areas used Facebook less commonly than those living in rural areas (92.90 vs. 96.80%). Dermatologists in public practice used Facebook more than dermatologists in private practice (97.1 vs. 90.0%). The number of hours our participants used social media per day was comparable with doctors living in rural areas versus urban areas (45.2 and 43.5%, respectively). The most common choice regarding time consumed on social media was 1–3 h by dermatologists in public practice (47.1%) versus 3–6 h (40.0%) for dermatologists in private practice. The online media that patients could access were the Facebook pages of doctors living in rural areas (51.6%), doctors living in urban areas (43.5%), doctors with private practice (50.0%), or doctors with a public practice (44.1%). Views of doctors living in rural and urban areas were similar concerning response to a ‘friend request’ sent by a patient (accepting 48.4% for rural vs. 49.4% for urban). Half of the privately practicing doctors would reject the request and do nothing more. On the other hand, 54.4% of public practice doctors would accept the friend request of patients on Facebook (Table 5).
All the dermatology residents included in the present study were females, because the vast majority of dermatologists in Egypt currently are females. Although accurate figures about the prevalence of women dermatologists in Egypt are not available, official figures about the percentage of females enrolled in the government universities are available. The percentage of female students rose from 49.99% in 2013–2014 to 51.53% in 2014–2015 9. In the USA, the prevalence of women dermatologists continues to increase; women represented 26.8% of dermatology residents nationally in 1980, 39.9% in 1985, and 47.8% in 1990 10. In 2011, the number of female graduate members of the American Academy of Dermatology was 991 compared with 601 male members. The male proportion barely increased at all in the previous 8 years 11.
In the present study, the most commonly used platform was Facebook. This is similar to what was found in other specialties – for example, urology (93% of responders) 1 and radiology (51% of all responders) 12. However, Facebook ranked fourth in a study surveying Canadian plastic surgeons (20% of all responders) 13.
Telephone interaction was the most commonly used method for communication between dermatology residents and their patients. This reflects the fact that still a majority of patients are unable to use electronic platform to communicate with their doctors, especially in rural areas. This is supported by the finding that most participants never discussed social media usage with their patients, and that 50% of responders found it appropriate to interact with their patients professionally through e-mail. Our figures may also indicate that the residents may be afraid of the improper use of social media – for example, the potential for professional penalties. In the USA, there is a considerable debate about how physicians should engage patients with social media. Although official organizations might call for separate accounts, many physicians view this as operationally impossible and inconsistent with professional identity. As social media grow, separating professional identity from personal identity is essentially impossible. Moreover, professional and personal identity separation may be more harmful than helpful 14.
Almost three-quarters of our sample (73.28%) thought that doctors have a duty to rebut inappropriate or inaccurate health information posted online. Commonly, one reads about ‘recipes’ for hair, good ‘natural’ products to lighten skin color, or ‘magic’ equipment that treat acne. The dangers of unprofessional information posted on social media or violation of patients’ confidentiality are highlighted by Chretien et al.15. They surveyed 78 medical schools in the USA, and found that 60% of the medical schools surveyed reported incidents of students posting unprofessional online content. Violations of patient confidentiality were reported by 13% of schools. Student use of profanity (52%), frankly discriminatory language (48%), depiction of intoxication (39%), and sexually suggestive material (38%) were commonly reported.
The discussion about the dangers of social media in medicine has largely overwhelmed consideration of its potentially positive applications 16. However, social media technologies are rapidly evolving to encourage greater privacy controls. There is emerging evidence demonstrating that medical professionals are finding ways to safely and productively integrate social media into healthcare 17.
Brown et al. 5 conducted a national survey in Australia. Their participants were drawn from all states and territories of Australia and were representative of a broad range of specialties. Among their participants, 65.8% were hesitant to immerse themselves completely in social media and online communication because of worries about public access and legal concerns. Similarly, most of our residents (54.3%) gave this answer. In fact, their concerns are understandable. Their images as ‘angels of mercy’ can be tarnished easily if patients are able to visualize some of the posts on Facebook such as jokes, complaints, or even posts about ‘what is in their mind’. Legal consequences are expected if they post photos of their cases identified by patients. Response to a ‘friend request’ from a patient was variable in the study of Brown et al. 5, but most of their participants mentioned that they would decline the request and do nothing more (34.8%). This is in contrast to the response of our participants where only 9.48% mentioned that they would do it. Moreover, 27.59% of our responders mentioned that they would accept the request compared with only 2.6% in the Australian study. This reflects cultural differences between the two countries. Another aspect of the cultural difference is the fact that the telephone is still the most commonly used method for communication with patients, which is because of the high percentage of patients who are unable to use the internet due to economic or other reasons, including the high prevalence of illiteracy in Egypt.
Nearly half of the dermatology residents in our study found it appropriate to maintain a personal Facebook profile that could incidentally be found by patients. However, their opinions were divided about whether it is appropriate for a doctor to interact with his or her patient professionally through social media (37.07% yes vs. 32.76% no). This shows that despite the wide use of social media by dermatologists, they are still uncomfortable or maybe unaccustomed to the use of social media during their practice. This is similar to the results of an American study 18 where 73.8% of the responders used online social media; however, a majority did not feel it is ethically acceptable to interact with patients within social media for either social (68.3%) or patient-care (68.0%) reasons. Almost half of the respondents (48.7%) were pessimistic about the potential for online social media to improve patient–doctor communication, and a majority (79%) expressed concerns about maintaining patient confidentiality. Their study was later criticized 19 for a low response rate (16%) and the significant over-representation of female physicians.
The use of social media, especially Facebook, is very common among female dermatology residents either in rural or in urban areas. However, the most common method for interaction with patients is still the telephone. Correcting inaccurate information on the net was seen as a duty of doctors by most of our participants. Although one half of dermatologists found it appropriate to interact with their patients professionally through e-mail, most of them never discussed social media usage with their patients, which reflects the technological gap between doctors and most patients, especially in rural areas. The inability of many patients to access internet services is surely depriving them from obtaining proper medical information and from saving a lot of effort to meet their dermatologists face to face.
Conflicts of interest
There are no conflicts of interest.
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