In many areas of service provision the voice of the consumer is the strongest driver for change and innovation. That voice has been suprisingly subdued with regards to Australia’s public health system, however, as Professor Enrico Coiera from UNSW’s Australian Institute of Health Innovation reports, that that could all be about to change…….
Professor Coiera writes:
Can you smell revolution in the air? Social media like Twitter and Facebook helped catalyze the Arab Spring, and the Occupy movement’s global protests. Social media are often beyond the control of government, and allow citizen groups to form, share information and respond more quickly and with greater reach than ever before. With so much disaffection with modern healthcare, will healthcare too soon have its own Arab spring? Will old power structures be taken apart, and the compact between clinician, patient, industry and government reassembled into something new?
The rising engagement with social media by clinicians and patients is indeed hard to ignore. Social media will inevitably be used to “name and shame”, coordinating community action whenever the public feels healthcare delivery has failed it 1. However that may not be the big story. Social media, because they provide new ways of interaction and engagement with the community, have great potential to transform many aspects of health service delivery 2, 3.
For health service providers social media offer communication channels that reach out to the community, hear what it is saying in a way that is immediate, direct, and for some clinicians, uncomfortable. Social media also have a promising role in tracking diseases. For example, Tweets and Facebook are a mechanism for spreading information to the public in pandemics or natural disasters, and can even help track pandemics in real time 4. Social media are also being harnessed for disease management, creating online spaces where patients can access services and disease information, and quickly interact with clinicians and other patients.
I have just reviewed these emerging roles for social media in healthcare in a new paper published in the BMJ [5]. However, as I point out there, this may all be only the small story. Social media may turn out to be a way to manage some of the biggest health challenges we face. Researchers have only recently come to the realization that many major health problems such as obesity, smoking, and depression all “spread” along social networks[6, 7, 8]. It is not that obesity is literally infectious, but that humans have an innate desire to conform within their social group. The individual lifestyle choices we make that impact our health are shaped by the behaviors we see around us.
So, at this very moment in history where we begin to see how social networks govern the spread of these health conditions we have also been given a set of tools that may help us. Online social media may be perfectly positioned to directly target socially mediated disease networks. Online social media provide a powerful vehicle to redefine social ties, and reshape individual views of conformity and normality. If one’s social group is obese, it’s hard to avoid sharing common behaviours that lead to obesity. If a virtual social group can be harnessed to redefine diet and exercise norms, then that disease destiny may also be redefined.
No one is saying Facebook or Twitter are the solution to changing health patterns (although they might help). The opportunity we have is to learn from the success of these technologies, and to understand how we can use similar tools in healthcare. We need to work through issues around consent and privacy, and not everyone will want to be connected, nor to have new people dropped into their social group to help them change their current ways.
If this feels like social engineering, then remember we have already been doing for a long time. It is the same social engineering that makes alcoholics anonymous work, where we create supportive new groups to help people on a journey that they could not undertake on their own, or that their existing social network did not allow.
Marshall McLuhan famously contended that the “medium is the message” because he saw that the manner in which any communication channel structures our interactions is at least as important as the things we say over it[9]. Today’s social media seem to demonstrate this principle in abundance. One only has to sit on a bus or train carriage to see the competition for our social attention in the many faces transfixed to mobile devices. McLuhan probably got it more right than he ever imagined. In this case however the (social) medium is not just the message. The medium is the medicine [5]
Coiera’s perspectives as usual provide exciting challenges to the “health professions” not just doctors. It is the whole health system. Because of the slowness to accept the “culture of change” (Lucien Leape. “Five Years after to Err is Human”) one of the great stumbling blocks to the effective use of social media in health may be the profession itself. What I believe Coirea is also stating is that the “tsunami” of social media access to information by “patients” and the population as a whole will see a complete re-defining of health care as we know it now and the medical profession and associated organisations will be caught treading water in the historical past.