HLPM300 SUNY at Buffalo Impact of Social Media on Healthcare Paper

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Hi, there are two assignments for healthcare management. One is topic paper and other is presentation. Same topic for both assignments. This paper need to be professional writing, thinking, and presentation. The presentation should be include speech writing. I attached the instruction files, sources, and annotated bibliography files for you. Please look at it first and read them clearly. Please let me know if you have any questions.

Here is a link for number 8 source,

https://www.sciencedirect.com/science/article/pii/S2212567115010448

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Phyu 1 Asiodu, I. V., Waters, C. M., Dailey, D. E., Lee, K. A., & Lyndon, A. (2015). Breastfeeding and Use of Social Media Among First‐time African American Mothers. Journal of Obstetric, Gynecologic & Neonatal Nursing, 44(2), 268-278. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359664/ This article is written by three highly respected college professors from the University of California and two affiliated authors from the Department of Women, Children, and Family Health Science at the University of Illinois. They effectively discuss African- American first- time mothers who are breastfeeding. The participants are breastfeeding mothers, they are first time mothers, and they are African- Americans. This article demonstrates that this population is continuously using the internet and social media to find more information on parenting. They also use mobile apps to find information about infant development. The high usage of social media, the internet, and mobile apps to get information on parenting and infant development, as well as infant feeding, means that social media plays a vital role in finding information on parenting issues. Thus, this article is relevant to my research because it shows how social media is helpful to learn information on maternity care and parenting. The authors interview not only pregnant and nursing women, but also the individuals who offer women support, which makes the research findings more accurate. Apart from interviewing participants, they also used other journals to get more information on the topic, thereby increasing the quality and accuracy of the study. Azu, M., Lilley, E., & Kolli, A. (2012). Social Media, Surgeons, and The Internet: An Era or an Error? The American Surgeon, 78(5), 555–558. Retrieved from http://search.proquest.com/docview/1018553334/ Phyu 2 In this article, the authors at the Cancer Institute of New Jersey, discuss surgeons' information found on the internet, and then explain how it affects patients and physicians. They draw evidence from the National Research Corporation to support their argument. Many patients go online to find information on the doctors before meeting them, and any negative information they find builds doubts and mistrust. Therefore, the authors discuss the importance of clinicians having a presence on the internet and monitoring the information available about them. This article focuses on examining rating sites and how they negatively and positively affect a physician. Also, to reduce some of the conflicts that may arising, it is crucial to separate their personal and professional accounts. They need to avoid sharing information on the wrong channel/website such as Yelp. While acknowledging that it is hard to deal with negative information on rating sites, these authors provide ways to mitigate such occurrences. This article is relevant to my research. The authors also use resources other than their own experiences and ideologies, which makes the article well- researched and a great reference for my research. Benetoli, A., Chen, T., & Aslani, P. (2018). How Patients’ Use of Social Media Impacts Their Interactions with Healthcare Professionals. Patient Education and Counseling, 101(3), 439–444. Retrieved from https://doi.org/10.1016/j.pec.2017.08.015. In this article, the authors focus on groups with chronic conditions and their research as corresponding authors of the Department of Pharmaceutical Sciences at the State University of Ponta Grossa. They discuss how acquiring information on social media affects the patients’ interactions with physicians. They explore how patients use social media to help make decisions regarding their health, and the attitude patients and HCPs have towards the use of social media for healthcare research. Patients are empowering Phyu 3 themselves by looking for health-related information on the internet and this results in better communication with doctors. Patients never interact with HCPs on social media, but their interactions with peers and discussions on health-related issues help them gain sufficient knowledge about various health conditions. Also, the interactions help them prepare questions, which they eventually ask their HCP about. These interactions also provide them with an understanding of the decision-making process. Its exploration of the attitude of HCPs towards the use of SM made the study more relevant since it looked at how SM affects both parties (patients and HCPs). Therefore, this article is reliable, and it provides an overview of how social media is relevant in their healthcare, which is the area of focus for my research. Breland, J., Quintiliani, L., Schneider, K., May, C., & Pagoto, S. (2017). Social Media as a Tool to Increase the Impact of Public Health Research. American Journal of Public Health, 107(12), 1890–1891. Retrieved from https://doi.org/10.2105/AJPH.2017.304098. This article is written by four highly respected college professors at the Center for Innovation to Implementation. They approach the traditional methods of communication and how social media has influenced communication in public health. Social media came in as a platform for individuals to interact and make “friends,” but, over the years, it has turned out to be one of the most crucial communication technologies. Most of the population is on a social network, and this has made organizations reconsider their views about social media. Professional institutions, like the health sector, have adopted social media as the primary channel to distribute information to the public. The author relies on information from certified doctors and other researchers on these platforms who are dishing out credible and accurate information to people searching for health empowerment. Phyu 4 Additionally, practitioners have the chance to connect and forge relationships that help them grow professionally. This article is relevant to my research because it is published under the American Journal of Public Health. It proves that, other than assisting people in connecting, communicating, or being conversant with current happenings in the world, it also helps them in conducting health research and being informed on health issues. It also shows how scientists and policymakers in healthcare can use social media platforms to their advantage. Denecke, K. (2014). Ethical Aspects of Using Medical Social Media in Healthcare Applications. Studies in Health Technology and Informatics, 198, 55–62. Retrieved from https://primo.alfred.edu/discovery/fulldisplay?docid=medline24825685&context=PC&vi d=01SUNY_AUA:01SUNY_AUA&search_scope=MyInst_and_CI&tab=Everything&la ng=en. In this article, the author, who is affiliated with the Innovation Center Computer Assisted Surgery in Leipzig University, carry out their research with their experience in social media. Denecke also analyze various literature reviews to support their argument on the ethical issues of social media usage in healthcare. There are ethical issues that physicians have to consider when interacting with patients through social media. A physician researching this site must find a few things, such as issues of privacy and confidentiality. The article also has illustrations on the increased usage of social media in healthcare. For example, the recruitment of individuals for research on the internet raises some ethical issues. It is no secret that many adolescents under the age of 18 are active on social media and are quick to jump to volunteer for survey and research without the consent of their parents. This article is relevant for my research because physicians and researchers need to Phyu 5 know how to conduct themselves when using social media. Patients also need to understand what to do to protect their privacy when using social media to seek information about specific conditions. So, until there are well-stipulated frameworks to function with, ethical concerns will always be an issue. He, Z. (2019). Understanding and Bridging the Language and Terminology Gap Between Health Professionals and Consumers Using Social Media. Social Web and Health Research, 103–121. doi: 10.1007/978-3-030-14714-3_6. The author of this article, He, is an assistant professor at Florida State University in the School of Information. The author conducts his research on technology advancements and their influence on the health professionals. He outlines various advancements, especially social media, and how they have influenced the public. He argues that there is a need to understand the existing gap between language and terminology. This article describes eHealth literacy and various methods of harnessing social media to lead to the understanding of the existing gap between professionals and consumers. The author relies on his own research that the advancements on technology have led to various effects on healthcare. According to the author, there is room for development for health applications for the consumers, as they need to ensure that they are more adaptive to health literacy. People often seek health information online and seek social support. This article is vital for my research as it outlines the importance of social media in healthcare. Househ, M., Borycki, E., & Kushniruk, A. (2014). Empowering Patients Through Social Media: The Benefits and Challenges. Health 10.1177/1460458213476969. Informatics Journal, 20(1), 50–58. doi: Phyu 6 In this article, the authors are as a professor in the College of Public Health and Health Informatics. They support his argument through a study of various literature, as well as his research as a public health professional. The authors note that the involved parties in the health sector use social media for different purposes. The organizations use it for reaching out to the customers, fundraising, provision of information, and advertising. The doctors and other professionals handle it for both professional and personal purposes. Interestingly, he states that physicians rarely use social media to communicate with the patients in observance of the AMA guidelines on the patient-physician relationship. Finally, this article touches on how the patients use social media to acquire information and educate themselves on health matters. This article also points out challenges facing the integration of this technology and ethical crossroads. Therefore, I will use this article to show the negative effects of social media on healthcare, and I will outline the various uses of social media and how they positively impact healthcare professionals. Nadel, S. (2017). Healthcare Professionals Encounter Hurdles When Faced with Negative Reviews on Social Media. The Health Lawyer, 30(2), 30–36. Retrieved from http://search.proquest.com/docview/2089335383/ According to this article, Nadel is an Executive Director of American Council for an Energy-Efficient Economy (ACEEE) organization. Nadel highlights the challenges health practitioners meet when they get negative reviews online and discusses how to deal with such instances. As a qualified psychologist, Nadel draws information from legal entities to complete this study. Online consumer reviews present a significant impact on medical care professionals, and in this article, Nadel argues that there is no guaranteed legal leverage for negative ratings and reviews on the internet. So, physicians should choose other ways to Phyu 7 counter negative comments. The author provides numerous ways to handle this issue, and they range from reaching out to the patient to suing for violation of confidentiality. One of the standout methods is encouraging loyal patients to write positive reviews to outweigh the negative ones, which makes them look like isolated cases. Being a lawyer representing health practitioners makes Nadel resourceful, and the information he gives in his article is beneficial to clinicians who might find themselves in a critical situation. I found this article is relevant because it shows how reviews on social media sites negatively affect physicians, and Nadel suggests actions that can be taken to combat such issues. Pentescu, A., Cetină, I., & Orzan, G. (2015). Social Media’s Impact on Healthcare Services. Procedia Economics and Finance, 27(C), 646–651. Retrieved from https://doi.org/10.1016/S2212-5671(15)01044-8. According to this article, the researchers at the Faculty of Economic Sciences in Lucian Blaga University, and the Faculty of Marketing in Bucharest University of Economic Studies acknowledge the vital role that social media plays in the healthcare sector. This article also recognizes the latest technological advancements that make it easy to share information. This article reveals that social media does benefit not only the patients but also health care professionals. As much as social media has been helpful, there are significant concerns about its relevance in the healthcare sector. The authors examine these concerns and try to see whether they apply to the healthcare system of Romania. Accordingly, this article is of good quality because it specifies its target audience. The authors do not target a general reader, but specifically those from Romania. I found this article to be reliable and credible to my research because it evaluates the concerns that both Phyu 8 healthcare professionals and patients have toward the use of social media. One of the concerns includes misinformation, as people can share wrong information on social media. Price, A. M., Devis, K., LeMoine, G., Crouch, S., South, N., & Hossain, R. (2018). First Year Nursing Students Use of Social Media Within Education: Results of a Survey. Nurse education today, 61, 70-76. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0260691717302538. In this article, all the authors are affiliated with the Canterbury Christ Church University, and they are all in the university’s School of Nursing, except Hossain. The purpose of the study is to evaluate the use of social media by student nurses before and after starting the pre-registration program. In total, there were 121 participants. Most of the students who participated in the survey said that the use of social media was beneficial. They said that it provided them with a platform where they participated in discussions and shared information. Through these platforms, they were able to increase awareness of nursing issues in their course. This article also uses tables and other illustrations, which make the results of the study easy for the reader to understand. This article is relevant to my research because it takes a different angle from other studies by looking at nursing students and how social media is relevant to them. Read, C. (2014). The Growing Influence of Social Media in Healthcare. Nursing Times, S2–S3. Retrieved from http://search.proquest.com/docview/1535384388/ In this article, Read draws information from different documentaries that focus on the nature of communication over the decades. He also does his research as a qualified journalist to illustrate the growing influence of social media in healthcare. The article focuses on the enormous growth of the online social networks over decades and their Phyu 9 impact on healthcare. Today, a Tweet by health personnel can reach millions of people in a single click without someone having to write press releases, which only reach a few people. Moreover, health practitioners have platforms like We Nurses, where they can connect and exchange ideas regardless of their geographical locations or institutional affiliations. Social media also provides individuals with the same ailments to come together and share concerns, which creates awareness about where people can get treatment and assistance. That said, the piece does not point out any downsides of online networks, but it is clear that a single misleading message can cause damage. This article is published in a reputable Nursing Journal, Nursing Times, which means it is reliable. Also, it covers all the essential areas needed in my research, making it relevant to my topic. Ventola C. L. (2014). Social Media and Healthcare Professionals: Benefits, Risks, and Best Practices. P & T : A peer-reviewed journal for formulary management, 39(7), 491–520. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103576/ In this article, Ventola is a consultant medical author in New Jersey, relies on information from various sources such as blogs and wikis, to support his argument about social media practices. Ventola explains that healthcare professionals are using social media for multiple purposes such as professional networking and development, patient care and education, and many others. There are some sites like Doximity, Doc2Doc, and QuantiaMD that exclusively deal with healthcare professionals and also provide a stage to share experiences, ideas, and other things affecting the sector. Apart from these benefits, social media has its negative aspects such as dissemination of imperfect information, which lacks credibility and reliability. Ventola points out that when professionals get too close to patients on the internet, the boundary lines become blurry, and it becomes easy to violate Phyu 10 the ethical code. That said, social networks provide a great avenue to enhance the healthcare field, and the possibilities will only keep growing. This article is relevant to my research because I need to understand the benefits, risks, and best practices HCPs should be aware of before using social media. SOURCE #1 How patients’ use of social media impacts their interactions with healthcare professionals Author links open overlay panelA.BenetoliabT.F.ChenaP.Aslania Show more https://doi.org/10.1016/j.pec.2017.08.015Get rights and content Highlights • Patients were empowered by using social media for health-related purposes. • Patients could participate more actively in the treatment decision-making processes. • The use of social media by patients improved their relationship with their healthcare professionals. • However overt or tacit opposition from healthcare professionals was reported. Abstract Introduction Patients are increasingly accessing online health information and have become more participatory in their engagement with the advent of social media (SM). This study explored how patients’ use of SM impacted their interactions with healthcare professionals (HCPs). Methods Focus groups (n = 5) were conducted with 36 patients with chronic conditions and on medication who used SM for health-related purposes. The discussions lasted 60– 90 min, were audio-recorded, transcribed verbatim, and thematically analysed. Results Participants did not interact with HCPs on SM and were not expecting to do so as they used SM exclusively for peer interactions. Most reported improvement in the patientHCP relationship due to increased knowledge, better communication, and empowerment. Participants supplemented HCP-provided information with peer interactions on SM, and prepared themselves for consultations. They shared online health information with HCPs, during consultations, to validate it and to actively participate in the decision-making. Although some participants reported HCP support for their online activities, most perceived overt or tacit opposition. Conclusion Participants perceived that their SM use positively impacted relationships with HCPs. They felt empowered and were more assertive in participating in decision-making. Practice implications HCPs should be aware of patients’ activities and expectations, and support them in their online activities. • • Previous article in issue Next article in issue Keywords Social media Patients Chronic conditions Decision-making Empowerment Healthcare professionals 1. Introduction The Internet has increased access to a range of health-related information, and its evolution to Web 2.0 has provided a more participatory environment where users develop and disseminate online content. Web 2.0 has provided the technological foundation for the appearance of social media platforms [1]. Web 2.0 has allowed the development of easy-to-use and interactive platforms where individuals and communities share, co-create, discuss, and modify user-generated content (e.g. texts, images, audios, videos, games) employing mobile and web-based technologies [2]. Social media (SM), dubbed the “participative Internet” [3], has therefore been enabled through the evolution of Web 2.0. Putting it simply, SM consists of a wide range of websites and applications whose content is created by Internet users [1]. It has provided a new venue for public communication, including health communication [4]. As a result, SM has turned out to be not only an emerging trend for patients seeking health information [5], but also a venue for them to interact with one another. Online communities of patients with a shared health problem have become common [6]. Popular topics discussed include disease symptoms, prognosis, examinations and procedures, and treatments [7]. Besides getting additional useful information directly from peers [8], online patients have also obtained social support for self-management of their chronic conditions [9]. It has been argued that patients’ access to online health information can impact their relationship with healthcare professionals (HCPs) [10]. As Web 2.0 and SM are dynamic communication technologies with increasing penetration in people’s daily lives, it is vital to keep abreast of changes in its use by patients. Additionally, it is important to fully comprehend how patients are accessing health services and interacting with their HCPs after engaging with peers on social media. Findings from the literature have revealed that patient participation in health-related discussions on SM and other online forums could have an impact on the patient-HCP relationship. Patients have felt empowered and confident with the knowledge and support obtained online [11], [12] and consequently have asked more relevant questions and communicated better with HCPs [11], [13], [14], [15], [16]. However, on the flip side, it has been claimed that patients’ active participation in online health activities with peers could threaten HCP expertise in some cases [17] leading them to negatively react to patients’ online autonomous health activities. This in turn could have a disempowering effect on patients [18]. Patients have ended up looking for other health providers in response to a physician’s negative attitude or due to the recommendation of “good doctors” from peers [15]. Chiu and Hsieh [13] investigated how cancer patients wrote (and read) blogs about their condition and the impact of such activity on their illness experience. Cancer patients reconstructed their life story in the blog, articulated their expected end of life and how they wished to be remembered after death [13]. Using in-person and virtual focus groups, Rupert et al. [18] found that patients used online health communities or support groups to obtain information not provided by HCPs and discussed information obtained online with their clinicians, positively impacting the patient-HCP relationship [11], [18]. An Australian study [17] employing interviews explored the use of online support groups by men with prostate cancer. It showed that the online environment allowed patients to share private information without the constraints imposed by face-to-face social interactions. However, medical specialists perceived this behaviour as a threat to their expert status and control over decision-making processes [17]. A recent review by Smailhodzic et al. [19] about the use of SM in healthcare incorporated studies dealing with patients’ use of SM and its influence on their relationship with HCPs. While recognizing the limited number of studies on this topic, the authors proposed that SM use by patients increased their empowerment leading to a more equalized power balance between patients and HCPs. Considering the relative novelty and relevance of the topic, further research is deemed necessary. A comprehensive understanding of patients’ use, perceptions, and opinions about the use of SM for health-related purposes is important in order to design services that meet their needs and expectations. Moreover, further research is necessary in order to better understand SM’s potential for supporting patient-HCP relationships [20]. Therefore, the aim of this research was to explore patients’ experiences, opinions and perceptions about their use of SM for health-related purposes. Specifically, the study objectives, reported here, were to determine the impact of these online activities on patients’ inperson healthcare services use and health decision-making behaviour; and its effect on patient-HCP relationships. 2. Methods 2.1. Focus groups A qualitative approach was used to allow participants to articulate their experiences, and help elicit in-depth information from them [21]. Focus groups were chosen because they are an efficient way of gathering the views of several individuals simultaneously [22], uncovering important constructs that may not be tapped through individual interviews [23]. A focus group guide (Appendix 1 in Supplementary materials) was developed to address the broad research aims. Findings pertaining to the questions on impact of SM on healthcare services use and healthcare professional interactions have been reported here. 2.2. Participants and recruitment 2.2.1. Inclusion criteria Participant inclusion criteria were: 1) adults with a chronic disease, 2) taking a medication for that disease, 3) had used SM for health-related purposes in the last 12 months, and 4) able to participate in the study without the assistance of a translator. 2.2.2. Recruitment All participants were recruited from the Sydney metropolitan area by a market research company. They received detailed verbal and written information about the study. Forty participants were recruited and thirty-six participated in the discussions. Each participant was reimbursed AUD$80 for their time and travel expenses. 2.3. Data collection Five focus groups were conducted in three separate dedicated venues in Sydney, Australia. All participants provided written consent and completed a demographics questionnaire. Discussions lasted 60–90 min and were facilitated by PA, a female pharmacist and academic experienced in conducting focus groups. The discussions were guided by the focus group questions (Appendix 1 in Supplementary materials) and audio-recorded. Focus groups were conducted until data saturation [24], which was at the conclusion of the fourth focus group. One additional focus group was conducted for validation purposes. 2.4. Data analysis Note taking during discussions and debriefing immediately after ensured that important information was not ignored and constituted a preliminary analysis [23]. Therefore the data analysis started during and in parallel with data collection [25]. All audio-recordings were transcribed verbatim and thematically analysed [26]. Thematic analysis was chosen as it is not aligned with a particular epistemological, philosophical, or theoretical approach and is a flexible tool to generate themes in qualitative research [26]. Repeated reading of notes and transcriptions afforded familiarity with the data. Transcriptions were then coded line-by-line, by AB, with the assistance of NVivo 11® (QSR International), and discussed with PA. Coding was open, not restricted by theoretical assumptions and was dynamic and iteratively developed throughout the analysis. An inductive approach [27] assured a data-driven analysis. Codes with a repeated pattern across the data were collated together and grouped into sub-themes and later assembled into overarching themes. 3. Results A total of 36 participants (Table 1) took part in the focus groups (n = 5). A wide range of chronic disease states (e.g. hypertension, depression, anxiety, cancer, arthritis, Crohn’s disease) was represented among the participants. Table 1. Participants’ demographics. Characteristic Participants (n = 36) Sex Female 17 (47%) Characteristic Participants (n = 36) Male 19 (53%) Age Range 27–71 Mean ± SD 47.3 ± 10.2 Country of birth Australia 26 (72%) England 2 (5.5%) New Zealand 2 (5.5%) Other 6 (17%) Education Less than High School 3 (8%) High School 11 (30%) College or Technical Education (TAFE)a 6 (17%) Undergraduate 12 (33%) Postgraduate 2 (6%) Data missing 2 (6%) Employment status Full-time 18 (50%) Part-time 9 (25%) Home duties 3 (8%) Retired 2 (6%) Unemployed 4 (11%) Self-reported health status Excellent/very good 14 (39%) Fair 17 (47%) Poor/very poor 5 (14%) Three overarching themes related to the impact of SM in patients’ interactions with HCPs and health care services emerged from the analysis. Table 2 provides a sample of quotations illustrating such themes. Table 2. Overarching themes and respective quotation sample. Themes Illustrative quotations “I think, if you know the language and you're familiar with concepts and closer to a level that a doctor understands or operates in, it’s a little bit easier, the interaction” [Focus group (FG)2, female participant (f)10] SM use and its impact on interactions with HCPs “I think if you prepare yourself for a session with the doctor, you know what exactly you want to ask; they can answer” [FG5, f31] “I think they [HCPs] probably take you a bit more seriously when you know your stuff, because they can’t fool you around, because they know that you have the answers” [FG2, f12] “I have questions mentally prepared, questions which I think are going to be pragmatic for me and kind of get the information directly from a professional” [FG5, m35] “I’ve gone to my doctor with the information. So, I don’t just take it literally until I get further into it and then I’ll decide or speak to the doctor about it” [FG4, f27] “I was like pretty helpless … other times just gets really confusing if I tell them my stuff and then they tell me other stuff” [FG3, m19] Decision-making process “I was on a discussion group on polycystic ovaries. And there was this talk about metformin. Well, that’s for diabetes. Where’s the connection? But some doctors had discovered that metformin worked really well for polycystic ovaries because are insulin resistant. So I went to my doctor with that and he gave me puzzled look. He said ‘give me a week and I’ll read up’. And within that week I went back and he immediately put me on it” [FG1, f8] “I was having a problem with a high blood pressure tablet. I was getting dizzy, sick. And I said to the doctor ‘there's something wrong with me’. He said ‘just give it some time’. So I went on to the forum and people had the same problem. They said ‘tell your doctor he’s wrong and get off that, and tell him you want to try Drug XX or something else’ … then I went back to the doctor and I told him and he changed the medication. Perfect. But if I stayed with the doctor’s advice and never checked it myself, I’d feel sick all the time” [FG2, m13] “I go to my doctor once a fortnight. I skipped the last two meetings. I was getting more online than I was in the office” [FG3, m20] SM use and its impact on healthcare services usage “I have one [GP], but then … I would do research and come to idea that I have some problem … I would ask and insist on certain tests and then if she refused … I found few other doctors that are completely okay with that” [FG3, f16] “Maybe it saves you the trip to the doctor… because you're informed and can go to the pharmacist” [FG5, m35] “I used SM to figure out who are the good doctors and who are the bad doctors” [FG5, m35] 3.1. SM use and its impact on interactions with HCPs No participant reported interacting with HCPs via SM. Only digital communication technology predating SM (e.g. chatroom) was used for communicating with HCPs. For example, non-government organisations like BeyondBlue (beyondblue.org.au) and Black Dog Institute (blackdoginstitute.org.au) were cited as useful online resources where psychologists and psychiatrists could be accessed for live chats. Participants received private counseling and referral to other services if needed. A private service named “Ask the Doctor” (askthedoctor.com), where patients could ask health-related questions, was also mentioned. No other online interactions with HCPs were reported. Most participants did not expect to interact with HCPs on any SM platforms they were using. In fact, they thought it would be strange if a HCP participated in online communities: “I probably would be quite dubious if somebody sort of popped up and messaged saying ‘hi, I’m a professor or I’m a brain surgeon’ … I would be wary” [FG1, f3]. However, some did expect that “undercover” HCP researchers could be among virtual community users. Interestingly, it was mentioned that not only HCPs’ credentials, but also the advice provided in these circumstances would be questionable since this service would be dissociated from a HCP’s regular workload and employment. Even though not interacting with HCPs on SM, participants reported that being active online improved their face-to-face relationship with HCPs. This effect was perceived to be due to their empowerment, manifested as improved health literacy and better communication. Participants stated that interactions with online peers helped them to better prepare and to articulate questions during consultations: “I think it helps also to ask your doctor the right questions because you understand your conditions better” [FG2, f12]. Some participants even hypothesised that HCPs would have a higher regard for well-informed patients; consequently providing better services for them. This improved interaction was perceived to facilitate participants to obtain more useful information from their doctors: “to make use of your time with your specialist, to ask the right questions … you're going in armed with information so you can engage and get as much information” [FG2, f10]. They believed that improved communication and being better prepared for consultations meant more efficient consultations, especially as they are often short. Moreover, participants believed that HCPs, particularly specialists, did not have to spend time explaining basic information about the disease, prognosis, and treatment options because they were better informed. 3.1.1. Sharing information obtained online with HCPs Most participants tended to discuss the information obtained online with their HCPs, especially with their doctors. It was pointed out that verifying the validity of the information found online was an important activity performed by HCPs: “I read, take note, compare … then when I go see the doctor, I ask to get more clarity” [FG1, m1]. Similarly, pharmacists were mentioned as HCPs who could be accessed for doublechecking online health information: “I tend to ask the professionals … I was with the pharmacist at the hospital, and I asked him about something. I talk to my chemist too” [FG1, f5]. However talking to pharmacists was problematic due to lack of privacy in the community pharmacy setting: “I tend to prefer my doctor because my pharmacist has a thousand people around with no privacy” [FG1, f3]. 3.1.2. Participants’ experiences and perceptions of HCPs reactions to their use of SM Some participants reported on their HCPs’ reactions when they visited them with health-related information found online or discussed in SM groups. The majority felt that HCPs did not appreciate that their patients were accessing online health information. In fact, some participants reported that some HCPs overtly expressed opposition: “I went to a sports injury physio, and when she talked about something she knows I want to check online, watch YouTube, then she tells me ‘don’t go to websites … don’t trust websites”' [FG3, f17]. They believed that this opposition may be because HCPs were concerned about patients being more inquisitive: “maybe they feel that because we know what they’re going to talk about, we may ask more questions. I find doctor doesn’t really like you to ask questions” [FG3, f17]. In some cases, participants experienced hostility: “he rolls his eyes and goes ‘another one’s been to the Internet again”' [FG2, m9]. Indifferent reactions were also reported. In general, several participants had the impression that HCPs do not support patients’ autonomous search for health information and participation in online forums and SM: “doctors don’t even like SM. I know one that hates it” [FG5, m36], “I think the [healthcare] professional people are very against it [SM]” [FG3, f17]. On the other hand, there were some participants who reported that HCPs were receptive to their online health-related activities. Patients’ increased knowledge about their condition and treatment options not only led them to be more assertive when interacting with HCPs but also sometimes changed the way HCPs approached them, i.e. HCPs were more interested in their comments and opinions. A few participants reported strong support from physicians for their online activities: “my doctor tells me to get whatever information I can and if I’m not sure about it, just give him a call” [FG3, m21]. With a few even reporting that doctors would recommend patients to go online to find ways of helping themselves, particularly when no actual treatment or procedure was indicated. This helped to establish a respectful and collaborative patient-HCP relationship. 3.2. Decision-making process SM had a significant role in fostering decision-making: “listen to another people’s thoughts if they’ve had the same experience … help me to make a decision” [FG3, f17]. Online engagement increased participants’ willingness to be actively engaged in therapeutic decision-making: “if you’ve got knowledge, then you can negotiate, suggest, and talk about it more successfully rather than just being told ‘this is what you're going to take”' [FG1, f5]. Several participants highlighted that decision-making was an agreement between the HCP and themselves and for most, discussing the information obtained online with HCPs before acting on it was the rule. However, a few expressed a firm resolve to follow what they themselves believed was right, regardless of HCPs’ opinions. Participants bringing and discussing online treatment information during consultations, influenced medication selection and initiation. A few participants reported that their doctors could be persuaded to change their treatment even though acknowledgment of the patient’s contribution was not always explicit: “they might change it [treatment] but they won’t tell you they’re changing it for that reason [information brought by patient]” [FG4, m23]. Suggestions to discontinue or change medications due to side-effects were also common after participants had discussed these matters with online peers. Participants felt they could better discuss treatment options with their doctors and treatments could be modified as they would suggest new treatments according to what they had learnt on SM. Being knowledgeable about health, however, did not change participants’ reliance on HCPs. Most articulated that HCPs were the most trusted and well-trained people: “I want to be able to read and look, research, have all this knowledge. But you still got to go take it to people who do all that training” [FG1, f8]. Despite most participants acknowledging that their online activities empowered them for the decision making process, some participants felt frustrated in the decisionmaking process when doctors did not acknowledge their contribution by disregarding the information they were presenting. Moreover, the negative impact on patients’ ability to participate in the decision-making process was strongly felt when HCPs expressed hostility towards their online activities: “disempowers you pretty quickly” [FG1, m9]. 3.3. SM use and its impact on healthcare services usage The use of SM for health-related purposes seemed to influence the frequency with which healthcare services were accessed by the participants, though a clear trend was not established in this study. On the one hand, a few participants accessed fewer healthcare services since some of their health needs were met by the virtual peer interactions and the information obtained. But on the other hand, there were participants who increased their healthcare services use due to improved health knowledge. One participant even identified HCPs inclined to accept suggestions obtained from online sources. Accessing other health services was also mentioned. For example, a few participants reported that with the information obtained on SM they could get their health needs addressed by their community pharmacist rather than their doctor. It is important to note that the selection of health services, in particular HCPs, was influenced by online peer interactions as patients were seeking recommendations. While some participants preferred to obtain a HCP recommendation from strangers within large online forums or SM groups, others believed that recommendations from close friends on social networking sites were more appropriate and trustworthy: “sometimes I put out a message on my page saying, ‘I’m looking for a practitioner, has anyone got some good referrals?”' [FG2, m11]. SM was used as a platform to post complaints about health services and the health system: “I use it for venting quite a lot about frustrations to do with access to services, stigma when it comes to using those services” [FG3, m21]. 4. Discussion and conclusions This study has demonstrated an overall positive impact on the patient-HCP relationship due to patients’ use of SM as clearly articulated by the participants, and has provided new insights into the specific aspects of patient-HCP relationship. This study also corroborated previous research indicating that patients’ use of SM for health-related purposes positively influenced their relationship with HCPs [11], [14], [18], [28]. Whilst previous research found that patients did not disclose their Internet activity during clinical visits [29], this current study demonstrated that they did. Participants stated being open about their online sources when interacting with HCPs. Therefore it can be hypothesised that SM use by patients can increase their openness about online activity compared to other types of Internet sources. Furthermore, it is also possible that the increased use of the Internet for information, in general, and for health, specifically, has shifted the “societal norm” to patients being more likely to report seeking and finding health-related information on-line (Internet and SM). The findings presented here are in line with previous research that has shown that patients’ access to online health information tended to diminish the paternalistic approach to care experienced since patients were more prepared and able to participate and take more responsibility for their health outcomes [10]. The interactive environment provided by SM can help not only to consolidate knowledge that could have been acquired from traditional sources and websites, but also provides a more informal and user-friendly mechanism for information transmission, expanding the chances of obtaining further knowledge. Such improvements in patients’ knowledge and empowerment are therefore reflected in a new patient-HCP relationship. Therefore, it is possible that SM is providing more opportunities for patients to learn, especially to gain first-hand experiences and opinions from peers, which can also support better engagement with HCPs. Additionally, the study has shown that patients were not only resorting to online peer interactions to supplement information from HCPs as shown in the literature [18], but also they were preparing themselves prior to clinical consultations. For this reason, the findings substantiate a prediction made in 2003 that one of the key features of the future patient would be to bring a list of questions to consultations [30]. Irrespective of how and when patients were seeking health-related information on SM platforms, the availability of SM and their online activities have transformed their health-related behaviour as demonstrated in this study. Online peer interactions increase patients’ health-related knowledge [15] because patients share both relevant health information and their own experiential stories [31]. Such increased knowledge has been conducive to patient empowerment [11], [12], [32], which is then reflected in patients’ ability to better articulate doubts and concerns [33] and to actively participate in the decision-making process, particularly treatment choices. The findings corroborate previous studies that have reported improved patient-HCP communication when patients actively participate in online discussions [11], [32], [33]. This study also revealed that patients believed the improvements in patient-HCP relationship were due to patient empowerment and the higher regard from HCPs towards informed patients. This study, however, did not investigate if patients with a relatively good relationship with their HCPs would be the ones to perceive the most improvement. Therefore future studies should address this point. This study highlighted that despite the health information accessed online and the increasing online discussions among patients about health-related matters, HCPs remained a trusted source to validate information. This is in line with studies reporting that most patients or carers relay the information found online with their doctors [34]. Such approach seems to be an important component of the improved communication previously discussed and a vital element for patients’ participation in decisionmaking. It has been found that peer-to-peer online discussions provide patients with useful quality information [35] and by discussing this information with their clinicians patients were asserting themselves during consultations and influencing treatment decisions. Although this active role in imparting their own information can be interpreted as a sign of patients’ concern that HCPs may not be aware of the latest treatment breakthroughs [33], it is most probable that patients are increasingly taking responsibility for their own health. Interestingly, participants’ perceptions of improved relationships with HCPs contrasted with most of them reporting overt or tacit HCP opposition to their online health-related activities. HCPs negatively reacting to patients presenting online information during consultations have been reported previously [29]. There may be several reasons explaining this behaviour. For example, it is known that HCPs struggle between paternalism and patient autonomy as they see their expertise and judgment undermined by online informed patients [36]. HCPs who may feel threatened in their expertise may react negatively during consultations with patients who bring online content [17], [18]. Other reasons that may lead HCPs to express opposition include concern about misleading health information, improper use of health services (e.g. delayed visits), incorrect disease self-management [37], and limited time [38]. Regardless of the underlying reasons, HCPs’ resistance to patients’ use of SM for health-related purposes was found to disempower patients, as also reported by other researchers [18]. Additionally, HCPs should be mindful that their opposition can lead to patients not only getting a second opinion, but even to change their healthcare provider [15], [18]. As SM use might represent an important element in the evolving nature of the patient-HCP relationship [39], it is thus suggested that HCPs should move to information exchange (dialogue) rather than transfer [40], favouring a patient-centred interaction involving collaboration in obtaining and analysing the information [41]. As a result, patients’ contribution would be acknowledged strengthening their relationship with their HCP. Lastly, patients’ use of SM may impact healthcare services usage. This finding contrasts with a previous research reporting that Internet use by patients had no impact on healthcare services usage [42]. One explanation for this difference could be due to the interactive nature of SM having a more pronounced effect on patients than the use of regular websites and emails. Nevertheless, it is important to emphasize that the findings presented here prevent the establishment of a trend as it pointed to both directions: increased and decreased use of healthcare services. While some participants reported decreasing use of health services, others reported that peer interaction and more knowledge led them to demand more health procedures (e.g. laboratory tests). There are some study limitations. Firstly, all participants were recruited from the Sydney metropolitan area, restricting the transferability of findings to other populations. Secondly, group heterogeneity in demographic factors (e.g. age) and diseases states might have impacted the way experiences and usage were discussed. Thirdly, although our focus was on SM platforms, some participants occasionally reported on their online activities on websites. Finally, as all findings were selfreported, they may have been influenced by recollection bias, social desirability and focus group dynamic. 4.1. Conclusions SM can assist in empowering patients primarily through increased knowledge, leading to a more engaged patient during HCP consultations, willing to participate in health and treatment decision-making processes. Despite reporting that better communication improved the patient-HCP relationship, patients still experienced HCP opposition to their online health-related activities. Nevertheless, HCPs were trusted to ultimately validate health information obtained online. 4.2. Practice implications Peer interactions on SM are already shaping how patients experience healthcare services and its impact may increase as more and more people start to use SM for health-related purposes. HCPs should be prepared for the new SM savvy patient. Although genuine concerns exist regarding patients’ use of SM for health-related purposes, HCPs cannot alienate themselves from this increasing activity and should consider information brought to them during consultations. Conflicts of interest None. I confirm that all participants’ personal identifiers have been removed or disguised so the persons described are not identifiable and cannot be identified through the details of the narrative. Acknowledgements The authors would like to thank all patients who participated in this study providing their valuable experiences and opinions. This study was partially funded by a grant awarded to Arcelio Benetoli for Professional Innovation offered by the Young Pharmacist Group (YPG) – International Pharmaceutical Federation (FIP) and FIP Foundation for Education and Research at the 75th FIP World Congress of Pharmacy and Pharmaceutical Sciences. Dusseldorf, Germany 29 September – 3 October 2015. Arcelio also holds a scholarship from the Brazilian Government/National Council for Scientific and Technological Development (CNPq) “Science Without Borders” Program. Appendix A. Supplementary data The following are Supplementary data to this article: Download Word document (23KB)Help with docx filesDownload Word document (25KB)Help with docx files References [1] M.A. Kaplan, M. HaenleinUsers of the world, unite! The challenges and opportunities of social media Bus. Horiz., 53 (2010), pp. 59-68 View Record in ScopusGoogle Scholar [2] J.H. Kietzmann, K. Hermkens, I.P. McCarthy, B.S. SilvestreSocial media? Get serious! 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Patient Education and Counseling, 101(3), 439–444. https://doi.org/10.1016/j.pec.2017.08.015 SOURCE #2 Social Media as a Tool to Increase the Impact of Public Health Research Abstract Translate Roughly 69% of US adults use at least one kind of social media, with similar rates across racial and ethnic groups and rates near 90% for adults younger than 30 years.1 Professional organizations, public health agencies (e.g., the Centers for Disease Control and Prevention [CDC] and the World Health Organization), and hospitals routinely use social media for science and health messaging. Disseminate Public Health Research Posting links to scientific articles or media pieces on social media can expand readership to a wider audience; for example, three tweets about a Cochrane review increased hits to its webpage threefold, and readers linking to the Web page via Twitter spent threefold more time on the page than those arriving from other sources.3 Another study comparing views of two journal articles and a blog post summarizing the articles showed that the blog post was viewed approximately 30 000 times, which equated to more than 10 times as many views as either journal article.4 Although these findings are impressive, the reach of work shared on social media will depend on the size of the sharer's audience (i.e., number of followers). Influence Policy Social media provides a way to share evidence for or against health policies with the public, policymakers, and other key stakeholders. Because politicians are motivated to please their constituents, using social media to educate constituents about proposed policies and encouraging them to contact political representatives to voice opinions can affect politicians' actions. Aid Public Health Research Social media can be used for numerous research purposes, including surveillance activities and behavioral interventions.6,7 Given social media's ubiquitous use, lack of geographic barriers, and equal representation of traditionally underserved populations, study recruitment through social media has the potential to produce more representative study samples. Less Full Text Translate The traditional methods that public health researchers use to communicate their work, including conference presentations and journal articles, have limited reach. Professional conferences are not attended by the public, and few scientific papers receive mass media attention. Furthermore, not all presentations and journal articles will be of interest to the media, and, among those that are, some control over the message can be lost depending on how journalists frame the work. Social media, by contrast, allows public health researchers to both shape messages and disseminate their work to any audience they choose to build. Social media posts can also complement media coverage by assisting in the dissemination of press releases and providing forums for discussion. To the extent that public health researchers effectively and efficiently leverage social media, it provides an unprecedented opportunity to directly reach the public, shape public discourse, and affect policy. Social media refers to online platforms that allow users to generate content, exchange information, and communicate with one another. Popular platforms include Twitter, Facebook, Instagram, Snapchat, and YouTube. Blogs, which allow for longer-form content, are another form of social media. Roughly 69% of US adults use at least one kind of social media, with similar rates across racial and ethnic groups and rates near 90% for adults younger than 30 years.1 Professional organizations, public health agencies (e.g., the Centers for Disease Control and Prevention [CDC] and the World Health Organization), and hospitals routinely use social media for science and health messaging. All major news outlets and many local news outlets also use social media, providing additional dissemination portals and ways to combine news and events with the capabilities of smartphones. The US President and almost all members of Congress use social media, presenting opportunities to interface with legislators. Researchers have been slower to adopt social media for professional use. One study revealed that just 47% of US scientists surveyed had ever used social media to discuss their work.2 Although further research is needed to explore how public health researchers use social media and to determine the extent to which it is used to engage the public versus professionals, public health researchers have much to gain from disseminating their work on social media. Here we describe five such benefits. We also developed a primer to guide public health researchers in the use of popular social media platforms (see the appendix, available as a supplement to the online version ofthis article at http://www.ajph.org). BENEFITS OF A SOCIAL MEDIA PRESENCE The benefits described subsequently are not an exhaustive list, but do represent the breadth of areas in which social media can increase the impact of public health research. Disseminate Public Health Research Posting links to scientific articles or media pieces on social media can expand readership to a wider audience; for example, three tweets about a Cochrane review increased hits to its webpage threefold, and readers linking to the Web page via Twitter spent threefold more time on the page than those arriving from other sources.3 Another study comparing views oftwo journal articles and a blog post summarizing the articles showed that the blog post was viewed approximately 30 000 times, which equated to more than 10 times as many views as either journal article.4 Although these findings are impressive, the reach of work shared on social media will depend on the size of the sharer's audience (i.e., number of followers). If few people follow a social media account, reach may be limited. However, once a follower shares information, that follower's audience can share it with others, expanding reach exponentially. Building an audience takes some work (see the appendix) but can pay big dividends. Combat Misinformation More than 70% of Internet users say that they look for health information online5; unfortunately, such searches often result in misinformation. Dr. Oz, lauded as "America's doctor," has millions of Twitter followers despite being widely criticized for making unsubstantiated health claims. Similarly, Dr. Mercola, another physician, has more than a million followers on Facebook despite being accused of false claims by the US Food and Drug Administration and the Federal Trade Commission. An increased presence of public health experts on social media could increase the availability of accurate online health information, which might offset the impact of individuals making false claims and support fact checking efforts (e.g., @factcheckdotorg). Influence Poiicy Social media provides a way to share evidence for or against health policies with the public, policymakers, and other key stakeholders. Because politicians are motivated to please their constituents, using social media to educate constituents about proposed policies and encouraging them to contact political representatives to voice opinions can affect politicians' actions. The president's enormous Twitter following and use of Twitter to communicate directly with the public suggest that social media is increasingly relevant to discussions of policy and politics both in the United States and abroad. Aid Public Health Research Social media can be used for numerous research purposes, including surveillance activities and behavioral interventions.6,7 Given social media's ubiquitous use, lack of geographic barriers, and equal representation of traditionally underserved populations, study recruitment through social media has the potential to produce more representative study samples. Furthermore, patients increasingly use social media to connect with each other in public and private forums. Conversations in these online patient communities often center on health behaviors and probably provide more nuanced and realistic information about health-related attitudes and beliefs than traditional survey measures. Enhance Professional Development The increasing presence of academics, clinicians, industry professionals, public health departments, and health care systems on social media provides many opportunities for professional connection outside traditional settings. Several public health chats on Twitter allow public health researchers to engage with the public, including CDC chats and #hcsm (health care social media; see the appendix). In addition, social media-based metrics are becoming part of professional evaluations at many institutions, including the Mayo Clinic. Tools are available to evaluate social media impact, including Altmetric, which measures a study's total mentions in media, social media, and blogs. Similarly, ImpactStory.org compiles information for a researcher's total body of work. These tools are likely to become important features of promotion materials in the future. CAUTIONS REGARDING SOCIAL MEDIA USE Social media posts are generally public and create searchable records, so transgressed boundaries can have serious consequences, including termination of employment. Separating professional and private social media accounts, treating online interactions the same as other public interactions, and being informed about institutional policies (e.g., the Hatch Act forfederal employees) can prevent complications. Many institutions have media or public affairs offices that can also provide advice. Even with highly professional feeds, the public nature of social media means that users may receive unwanted comments. In such cases, it can be helpful to disengage and use platform features to block or report inappropriate users or comments. A final consideration is time management: checking Twitter once a day is a nominal time commitment, but hosting a blog or managing multiple feeds may require professional training and assistance (see the appendix for additional information on time management). CONCLUSIONS Social media can be an important tool for public health researchers to disseminate their work, affect policy, conduct research, and engage in professional networking. Although social media use is not yet ubiquitous among public health researchers, it is among the general public and therefore provides an enormous opportunity for science communication. Developing a social media presence requires some time investment; however, the investment is likely to benefit the user, the field of public health, and the public at large. Â1PIİ Jessica Y. Breland, PhD Lisa M. Quintiliani, PhD Kristin L. Schneider, PhD Christine N. May, PhD Sherry Pagoto, PhD CONTRIBUTORS J. Y. Breland, L. M. Quintiliani, K. L. Schneider, and S. Pagoto contributed to the conceptualization, writing, and editing of the editorial. C. N. May contributed to the writing and editing of the editorial. ACKNOWLEDGMENTS Jessica Y. Breland is supported by a Department of Veterans Affairs Health Services Research & Development Career Development Award (CDA 15-257) at the VA Palo Alto. Sherry Pagoto is supported by grant K24HL124366 from the National Heart, Lung, and Blood Institute. At the time of writing, Christine N. May was supported by grant R25CA172009 from the National Cancer Institute. We thank Jazmin Reyes-Portillo and Vivian Yeh for their feedback and Elon Hailu for her help in editing the editorial. Note. The views expressed herein are those of the authors and do not necessarily represent the views of the Department ofVeterans Affairs or the United States government. Sidebar Correspondence should be sent to Jessica Y. Breland, Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd (MPD-152), Menlo Park, CA 94025 (email:jessica.breland@va.gov). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints" link. This editorial was accepted August 16, 2017. doi: 10.2105/AJPH.2017.304098 References REFERENCES 1. Pew Research Center. Social media fact sheet. Available at: http://www. pewinternet.org/factsheet/social-media. Accessed September 8, 2017. 2. Rainie L, Funk C, Anderson M. How scientists engage the public. Available at: http://www.pewinternet.org/2015/02/ 15/how-scientists-engage-public. Accessed September 8, 2017. 3. Jayaram M, Moran L, Adams C. Twittering on about mental health: is it worth the effort? Evid Based Ment Health. 2017;20(1):1-3. 4. Hoang JK, McCall J, Dixon AF, Fitzgerald RT, Gaillard F. Using social media to share your radiology research: how effective is a blog post? J Am Coll Radiol. 2015;12(7):760-765. 5. Fox S, Duggan M. Health online 2013. Available at: http://www.pewinternet. org/2013/01/15/health-online-2013. Accessed September 8, 2017. 6. NaslundJA, Kim SJ, Aschbrenner KA, et al. Systematic review of social media interventions for smoking cessation. Addict Behav. 2017;73:81-93. 7. Sinnenberg L, Buttenheim AM, Padrez K, Mancheno C, Ungar L, Merchant RM. Twitter as a tool for health research: a systematic review. AmJPublicHealth. 2017; 107(1):e1 -e8. Word count: 1610 Copyright American Public Health Association Dec 2017 APA Breland, J., Quintiliani, L., Schneider, K., May, C., & Pagoto, S. (2017). Social Media as a Tool to Increase the Impact of Public Health Research. American Journal of Public Health, 107(12), 1890–1891. https://doi.org/10.2105/AJPH.2017.304098 SOURCE #3 Social Media, Surgeons, and the Internet: An Era or an Error? Abstract Translate According to the National Research Corporation, 1 in 5 Americans use social media sites to obtain healthcare information. Patients can easily access information on medical conditions and medical professionals; however physicians may not be aware of the nature and impact of this information. All physicians must learn to use the Internet to their advantage and be acutely aware of the disadvantages. Surgeons are in a unique position because, unlike in the primary care setting, less time is spent developing a long-term relationship with the patient. In this literature review, we discuss the impact of the Internet, social networking websites, and physician rating websites and make recommendations for surgeons about managing digital identity and maintaining professionalism. [PUBLICATION ABSTRACT] Full Text Translate Headnote According to the National Research Corporation, 1 in 5 Americans use social media sites to obtain healthcare information. Patients can easily access information on medical conditions and medical professionals; however physicians may not be aware of the nature and impact of this information. All physicians must learn to use the Internet to their advantage and be acutely aware of the disadvantages. Surgeons are in a unique position because, unlike in the primary care setting, less time is spent developing a long-term relationship with the patient. In this literature review, we discuss the impact of the Internet, social networking websites, and physician rating websites and make recommendations for surgeons about managing digital identity and maintaining professionalism. PATIENTS USE THE INTERNET to ''Google'' a physician with the same ease one ''Googles'' a local eatery. In fact, according to National Research Corporation, 1 in 5 Americans use social media sites to obtain healthcare information.1 Most physicians accept the fact that patients search them online before committing to an initial visit, but do physicians know what information their patients' searches reveal? Information on education, training, board certification, publications, disciplinary actions, and malpractice claims are frequently available online.2, 3 Personal information, such as address, mortgage, marriage records, court filings, and social networking profiles can also be obtained online, which may have obvious professional ramifications when it comes to maintaining a reputable practice.4-6 In an era where social media and the Internet are king, physicians must learn to use the Internet to their advantage and be acutely aware of the disadvantages. The question regarding extent of professional information to share is not a new issue, nor is it unique to social media or the Internet. The first bill supporting the public's demand for more information on health care providers was introduced in response to 1993 legislation by the Massachusetts Teachers Association's insistence that the Massachusetts Rate Setting Commission obtain detailed facts about physicians, and make it accessible to the public. The Massachusetts Medical Society, in collaboration with the Board of Registration in Medicine, fiercely lobbied for changes regarding the extent of information the public should be allowed to view. The bill addressing physician profiles was subsequently passed in 1996. This was quickly followed by similar laws in other states, and in 2000, guidelines from a special committee of the Federation of State Medical Boards were published detailing what is acceptable to include in a publicly accessible state medical board physician profile.7 Now, 15 years later, the debate over personal versus pertinent data appropriate for public review remains relevant to physicians, but the issue has spiraled from a state-wide level right into cyberspace. Multiple studies have examined issues surrounding the availability of personal and private information on the Internet in relationship to a physician's professional integrity, but more research is needed to address reasonable guidelines for physician Internet presence and appropriate social media discourse. In 2010, Mostaghmim and colleagues6 randomly selected 250 internal medicine physicians from the Massachusetts Board of Registration in Medicine and performed Google searches to characterize professional and personal information that is available on the Internet. They found that 93.6 per cent had professional information and 32.4 per cent had personal information searchable online. Rating sites existed for 86.4 per cent of the providers and three providers had five or more reviews on a single site. The most commonly encountered personal information included social networking sites, hobbies, charitable and political donations, and family information. They concluded that physicians should monitor the content that is available online, because much of the personal information is not typically considered appropriate to share with patients (i.e., religion, sexual orientation, political views) and may undermine the doctor-patient relationship. Although there are inherent concerns with professional boundaries surrounding physicians' presence in cyber social circles, a lack of Internet presence should perhaps be of equal concern. Failure to have an easily accessible ''digital identity'' may pose a problem largely due to the public's expectation of ''digital connectedness''. In a 2008 article, Gorrindo and Groves4 recommend creating web pages with contact information, hours of operation, services, etc. By having factual, neutral, or positive data easily accessible, patients may be less likely to search further and find negative or private information. The authors further recommend using privacy settings for social networking sites, responding to defamatory comments, monitoring digital identity, and addressing concerns with patients searching for personal information. Additionally, many authors advise physicians to take a proactive approach to fostering their Internet images by creating an interactive website with professional background information highlighting credentials, practice philosophy, and patient testimonial.4, 8-11 Physician rating websites are increasingly common and comprise a sizeable share of a physician's digital presence, providing patient-initiated appraisals of a physician and/or practice. Patients use these websites for various reasons that include learning more about other patients' experiences, making decisions to establish or continue a relationship with a particular physician, or to make comments regarding their interaction with a physician; however, the accuracy of statements on these websites is unverified. Furthermore, patient ratings are not a measure of clinical skill or good medical practice and patients' assessments, based mostly on interpersonal interaction and/or perceived physician ability, may not reflect quality of care, clinical knowledge, or clinical judgment.12, 13 Even a glowing comment may mislead a patient into overestimating a physician's expertise or skill. Although comments of praise are not expected to negatively impact one's practice, they may provide patients with an unfounded sense of security regarding skill sets most patients are not qualified to evaluate. In 2010, Reimann and Strech13 conducted a study evaluating the use of 13 comprehensively identified patient experience and satisfaction elements in American and German physician rating websites. The authors found only five to six of 13 elements were evaluated in the three most commonly used American physician rating websites. Unfortunately, physician rating websites are presently ungoverned; however they are an unquestionably powerful means by which patients can communicate about their experience. In fact, extremely unfavorable comments written in such sites have the great potential to damage a physician's practice indefinitely. Although it is important for patients to have a voice, and their satisfaction with physicians assessed, posting anonymous comments to an unregulated website does not offer a patient any means of constructive recourse, or an opportunity for proper investigation of their claim. Physicians with negligent patient care practices should not be shielded from disciplinary action, but physicians, like anyone else, deserve to have appropriately sanctioned organizations decide if a claim is justified. In 2007, one author described her experience with a bad rating after a patient used a rating website to find her office location, and found a vehemently negative review.14 The patient had transferred from her previous practice and told her, ''If I didn't know you, I might have cancelled my appointment.'' The doctor e-mailed the site administrators, asking for a retraction. They edited the reviewer's comments, but the numerical ratings were not changed. Anonymous ratings may be based on a single visit, are subjective, and may not be representative of a physician's practice.15 Physicians have little ability to respond to complaints due to privacy issues. Additionally, it would be difficult to create a strong legal case for defamation, and in an effort to defend one's reputation the lawsuit may result in further tarnishing. Although the majority of ratings are favorable,many physicians are concerned and frustrated by negative ratings because they have little control or recourse.16 The United States Supreme Court protects anonymous comments posted online as free speech. Legal action against the websites is also challenging due to Section 230 of the Communications Decency Act of 1996,17 which protects a website operator from being held responsible for publishing content written by someone else, even if that content is defamatory. If individuals can be identified, they may be liable for posting comments with intent to harass or defame, however many cases fail to meet the legal standard for libel15, 16, 18, 19 although repeated postings by an individual may constitute harassment or stalking via an electronic medium.16, 17 Interestingly, Canadian law is different, and a Canadian physician may have cause for a libel lawsuit against both the reviewer and the publishing website.16, 20 The law regarding defamatory libel in the Criminal Code of Canada holds the publisher of comments responsible for their content.19 Fortunately, the American Medical Association (AMA) has taken an interest in anonymous Internet evaluations of physicians and has written recommendations regarding the issue.21 They oppose the publication of inaccurate, unreliable, or meaningless healthcare data, and advocate that physicians be allowed to review any information before its online publication. The AMA also encourages such websites to establish safeguards against false or defamatory statements. However, because such safeguards are not presently in place, various strategies can be used to manage negative web content. One option is to request removal of negative comments by the website administrator, but such a request may not be honored. Even if the website removes the comment, the damage may already be done given the indelible footprint Internet content is designed to leave. Another option is to hire legal counsel, but options for recourse may be limited. A third option is to use companies dedicated to helping professionals build or enhance a favorable online reputation, like Reputation Defender.8 A fourth option is responding directly to negative postings on a physician rating website. However, it is difficult to know if responding to comments using such websites as one's vehicle to do so is valuable, as it may only lend credibility to websites that allow the posting of subjective, and possibly inaccurate information; the harm is potentially misleading earnest patients seeking valid information about their physicians. In their 2010 article, Santry and colleagues11 raise interesting points regarding use of social media specifically in the surgical practice. They comment that e-mail and texting patients may improve compliance and help maintain relationships, but raises questions of liability, compensation, and lack of interaction. For example, intraoperative ''Tweeting'' can keep a patients' family updated in real time, but can be distracting and may violate patient privacy. Researchers from Vanderbilt University Medical Center's Department of Surgery investigated use of Facebook by residents and faculty.22 They found that 64 per cent of their 88 residents (n456) and 22 per cent of 127 faculty members (n428) had Facebook pages. Of those with profiles, 50 per cent were accessible to the public. Of the 50 per cent publicly accessible pages, 31 per cent had comments related to work and 14 per cent referenced specific patient encounters or care information. The authors caution that use of social media websites must be done with care to uphold professional integrity and maintain patient privacy. Physicians must consider the benefits and potential harms of self-disclosure using online forums and social-networking sites.23-26 Use of social-networking sites and blogs is more commonplace with younger physicians who are still in the nascent phases of carving out a professional identity. In this regard, it is not surprising that the AMA Resident and Fellow Section and the American College of Surgeons Resident and Associate Society have been principal forces directing their respective organizations' attention to the issue. More established clinicians frequently take the role of mentor and ethical compass in navigating rules of professionalism, however their own inexperience with Internet-based social forums may pose additional challenges to the less established physician seeking guidance in establishing a 21st century professional career.4, 24 Although most agree that not everything read on the web should be internalized as gospel truth, it is human nature to be curious. This curiosity also extends to the patients' desire to learn about their conditions as well as their clinicians. Like a sommelier with an educated palate, physicians are trained to read with a skeptical eye and recognize evidence-based research against a background of myth, anecdote, and opinion. The patient of the past approached the initial encounter seeking both medical command and technical competence. Today's ''Web 2.0'' savvy patient enters the exam room armed with questions and answers gleaned from ''surfing the net,'' but lacking the ability to discern what is valid. Thus, surgeons find themselves entering a novel physician-patient relationship. Although the Internet can be an excellent educational tool for both surgeons and patients, some information may be unreliable, outdated, or open to misinterpretation. Reflecting on this point, Santry et al. pose a pertinent question, ''What is the surgeon's role for patients who rely more on the Internet than on professional experience and judgment to dictate care?''11 Surgeons are in a unique position because, unlike in the primary care setting, less time is spent developing a long-term relationship with the patient. In fact, surgical patients often take a leap of faith when urgent or emergent surgery is needed. In a setting where trust is established in an expedited manner so may be a patient's interest in using social media and the Internet to discuss their dissatisfaction with a surgeon with whom a weak rapport has been established. Surgeons need to actively participate in building their Internet presence to have some control over the media content displayed when an Internet search is performed using their name or practice. Although it is difficult to prevent negative media content, it is possible to promote and initiate positive media content about one's practice. Benefits of the Internet include a wide audience and an inexpensive mode of advertisement; however, great care must be taken to avoid blurring the professional relationship between a patient and surgeon. Although voluntarily posting personal information on the Internet and social networking sites seems contrary to the historical notion of ''professional distance,'' for younger surgeons attempting to establish a bustling practice, no Internet presence may be as detrimental as a negative review. Patients can shop for a doctor based on ratings and Internet marketing, pushing surgeons to monitor their online images and create websites to attract new clients.11 Experienced surgeons often rely on referrals from established primary care physicians in the community, but less well-known surgeons may have to rely more on establishing credibility using the Internet. Concepts regarding integrating social media into surgical patient care were discussed at the 96th Annual Clinical Congress of the ACS in a workshop forum so the topic is certainly recognized as important. In a 2011 research study, Chretien et al.27 examined the Twitter pages of 260 users who self-identified as physicians. Of the 191 subjects (73.5%) who identified their specialty, surgeons were the most represented group, accounting for 20.4 per cent (n 4 39). As more surgeons explore web-based venues for connecting with patients and colleagues, the ACS may need to define new rules for ethical behavior online. Unfortunately, for now, the right balance between traditional, officebased patient-surgeon communication and the burgeoning need to compete with Internet technology to maintain a viable surgical practice remains a pressing, unanswered question. Ultimately, groups like the AMA, the ACS, and others need to continue to address acceptable means of integrating cyber technology into one's practice. Healthcare has changed dramatically over the years with patients not only becoming more informed about their needs but who is a qualified provider. In a patient's journey as healthcare consumer, the Internet is often used to obtain more information about their condition as well as the physicians who are candidates to serve as their provider. Unfortunately, the quantity of publicly searchable information may be far greater than some surgeons realize. Worthy of equal concern is the abundance of physician rating websites and the trust many patients place in the largely subjective, and certainly unsubstantiated content found within them. Almost 20 years ago, the Massachusetts Medical Society recognized the need to determine the impact of impending legislative changes on its members. By their proactive approach, physicians gained a voice in resolving the balance of physician privacy, professional integrity, and public demand for more access to physician profile detail. Faced with the new challenges posed by technological evolution, medical societies must again assume a presiding role in this new discussion. In addition to increasing physician awareness about monitoring and maintaining a credible Internet presence, lobbying for regulations of physician rating websites is paramount. References REFERENCES 1. National Research Corporation. 1 in 5 Americans use social media for health care information. Lincoln, NE. Available at: http://hcmg.nationalresearch.com/public/News.aspx?ID49. Accessed February 21, 2011. 2. Guglielmo WJ. Shaping your profile on the web. Med Econ 2001;78:28-30, 35-6. 3. Hallam K. Physicians caught in the web. Mod Healthc 2000; 30:30-2. 4. Gorrindo T, Groves JE. Web searching for information about physicians. JAMA 2008;300:213-5. 5. Thompson LA, Dawson K, Ferdig R, et al. The intersection of online social networking with medical professionalism. J Gen Intern Med 2008;23:954-7. 6. Mostaghmim A, Crotty BH, Landon BE. The availability and nature of physician information on the internet. J Gen Intern Med 2010;25:1152-6. 7. Federation of State Medical Boards. Report of the Special Committee on Physician Profiling. Available at: http://www.fsmb.org/ pdf/2000_grpol_Physician_Profiling.pdf. Accessed May 21, 2011. 8. Aungst H. Patients say the darnedest things: you can't stop online ratings, but you can stop fretting about them. Med Econ 2008;85:27-9. 9. Pasternak A, Scherger JE. Online reviews of physicians: what are your patients posting about you? Fam Pract Manag 2009;16: 9-11. 10. Peregrin T. Time to tweet: social networking for surgeons. Bull Am Coll Surg 2011;96:46-8. 11. Santry HP, Dehmer JJ, Nelson JS, Raman SR. Modern surgical communication and the practice of surgery. Bull Am Coll Surg 2010;95:33-9. 12. Cassel C. No stars for satisfaction ratings. Mod Healthc 2008;38:22. 13. Reimann S, Strech D. The representation of patient experience and satisfaction in physician rating sites. A criteria-based analysis of English- and German-language sites. BMC Health Serv Res 2010;10:332. 14. Meyer C. My web rating: oh no! Med Econ 2007;84:51-2, 55. 15. Rice B. Trashed on the web? Now what? Med Econ 2007; 84:32-4, 36-7. 16. MacKay B. RateMDs.com nets ire of Canadian physicians. CMAJ 2007;176:754. 17. Federal Communications Commission. Title V Telecommunications Act 47 U.S.C. § 230. Washington, D.C. Available at: http://transition.fcc.gov/telecom.html. Accessed May 21, 2011. 18. Segal J. The role of the internet in doctor performance rating. Pain Physician 2009;12:659-64. 19. Segal J, Sacopulos MJ, Rivera DJ. Legal remedies for online defamation of physicians. J Leg Med 2009;30:349-88. 20. Minister of Justice of Canada. Criminal code of Canada R.S.C. 1985, c. C-46: Part VIII offences against the person and reputation, defamatory libel. Available at: http://laws-lois.justice. gc.ca. Accessed May 1, 2011. 21. American Medical Association. Resolution 822, I-09: anonymous cyberspace evaluations of physicians. Annual Meeting of the Board of Trustees 2010;91-9. 22. Landman MP, Shelton J, Kauffmann RM, Dattilo JB. Guidelines for maintaining a professional compass in the era of social networking. J Surg Educ 2010;67:381-6. 23. Chin JJ. Medical professionalism in the internet age. Annals Academy of Medicine 2010;39:3457. 24. Guseh JS, Brendel RW, Brendel DJ. Medical professionalism in the age of online social networking. J Med Ethics 2009;35:584-6. 25. Jain SH. Practicing medicine in the age of Facebook. N Engl J Med 2009;361:649-51. 26. Jain S. Googling ourselves - what physicians can learn from online rating sites. N Engl J Med 2010;362:6-7. 27. Chretien KC, Azar J, Kind T. Research letter: physicians on twitter. JAMA 2011;305:566-8. AuthorAffiliation MICHELLE C. AZU, M.D.,*[dagger] ELIZABETH J. LILLEY, M.P.H.,[dagger] APARNA H. KOLLI, M.D., M.S.*[dagger] From the *Cancer Institute of New Jersey, New Brunswick, New Jersey and the [dagger]University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey Address correspondence and reprint requests to Michelle Azu, M.D., Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903. E-mail: azumc@umdnj.edu. Word count: 3236 Copyright Southeastern Surgical Congress May 2012 APA Azu, M., Lilley, E., & Kolli, A. (2012). Social Media, Surgeons, and the Internet: An Era or an Error? The American Surgeon, 78(5), 555–558. Retrieved from http://search.proquest.com/docview/1018553334/ SOURCE #4 HEALTHCARE PROFESSIONALS ENCOUNTER HURDLES WHEN FACED WITH NEGATIVE REVIEWS ON SOCIAL MEDIA Abstract Translate [...]through nothing more than the use of this process, the aforementioned client was able to restore her rating back to five stars. Positive reviews further serve the purpose of making a negative review seem like an isolated incident or simply the product of an unreasonable patient, rather than evidence of a practitioner's substandard care. Because healthcare services can be of a more sensitive and personal nature than those of restaurants or auto mechanics, special care should be taken in encouraging patients to leave reviews. By way of example, a fertility clinic in California required its patients to sign a contract stating that the patient would not leave negative reviews regarding the practice.30 Despite being located in California, the clinic provided nationwide egg donation services, and the validity of the contract clause was challenged by the state of New Jersey, which deemed the clause to be in violation of the New Jersey Consumer Fraud Act and thus unenforceable.31 In a separate case, a dentist attempted a different and more novel approach to the issue by requiring her patients to sign an agreement prior to treatment stating that they would refrain from publishing commentary related to the dentist's practice and, if they did choose to publish such commentary, that the intellectual property rights and copyrights to the published content would belong to the dentist.32 A lawsuit ensued when one of the dentist's patients posted negative reviews in spite of the agreement, and the agreement was struck down by the court, which cited a misuse of copyright law and a violation of dentists' ethics among the reasons why the agreement was legally invalid.33 Further undermining any attempt to limit negative reviews through contract, President Obama subsequently signed into law the Consumer Review Fairness Act, which imposed a blanket invalidity to all contractual terms going forward that seek to suppress the posting of negative reviews on the internet.34 Finally, clinicians should be extremely wary of "reputation management firms," as such firms will often take it upon themselves to violate the terms of service of internet review sites by submitting fake reviews. [...]there is no guarantee that a demand letter will be effective. More ...
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Running head: IMPACT OF SOCIAL MEDIA ON HEALHCARE

Impact of Social Media on Healthcare
Student`s Name
Institution
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IMPACT OF SOCIAL MEDIA ON HEALHCARE

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Currently, 74% of the individuals using the internet are active in the social media platforms,
and approximately 80% of the users are searching about health information. Majority of the
healthcare managers are effectively working to engage the consumers and patients. Most of the
organizations are able to move from old advertising techniques and effectively use the internet to
interact with the consumers through the effective marketing, and the communication tactics.
Majority of the consumers rely a lot on the online information because they use the internet to
gather information about the healthcare and also to connect with other patients (Azu, Lilley, &
Kolli, 2012). Other individuals utilize the resources for purposes of research or sharing the
experiences with the providers of healthcare.
The patients have a tendency of seeking information through the social media platforms
which aid in selecting doctors, specialists, and hospitals. The information aid the patients in
seeking the best possible healthcare. The patients will also post reviews on the social media
platforms either supporting or deterring others from seeking medical assistance from the hospitals.
It is vital for the healthcare providers and management to be active on the social media to provide
reliable information, connect with the individuals reading, and implement the techniques of
marketing where they should be applied.
The healthcare managers are utilizing the social media platforms in several ways to
enhance their services and provide patients with reliable information.
Sharing information
The aim of the social media is providing individuals with the ability of accessing
information in time and enhance communication. The healthcare organizations make use of the
social media and websites in sharing information with the consumers in several ways such as

IMPACT OF SOCIAL MEDIA ON HEALHCARE

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sharing information about flu shots and how individuals could avoid catching a cold. Sharing
information concerning outbreaks or hazards in an effective manner to enhance accurate
information to the patients (Benetoli, Chen & Aslani, 2018). It is vital to put into consideration
that the patient specific information requires a permission and also a signed release. Other ways in
which healthcare information is shared in the social media include providing updates concerning
latest technologies, introducing new doctors on the social...


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