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As we speed into the 21st century, online social networking is becoming an increasingly popular mode of communication. Since the rise of Twitter three years ago, it has been easier than ever, especially for professionals, to take advantage of this Internet phenomenon. Celebrities and athletes are not the only ones who embrace such technology: healthcare professionals such as doctors and nurses are also beginning to open accounts on services such as Twitter and Facebook. Early this week, for example, a hysterectomy and uterine prolapse surgery was broadcast on Twitter at the Cedar Rapids St. Luke’s Hospital in a series of 126 short updates (from bottom to top):

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Right now doctor is cutting across some vessels & ligaments that connect the ovaries to the uterus.

We are cutting the neck of the cervix right now. This is done so doctors can put a graph or a mesh around it to hold the vagina in place.

Dr. Rozeboom has removed the uterus now and will place it near the belly & remove it later.

Having a good assistant surgeon like Dr. McCarron is very important. He is helping move the bowel out of the way to put the mesh in place.

Surgical nurses are getting equipment for removing the uterus ready. The tool twists the uterus and cuts it in tiny pieces.

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Several photographs were published along with the textual stream. (The patient knows about this event, by the way, and agreed to participating weeks prior to the surgery. Sarah Corizzo, who wrote the updates, was sitting outside the sterile field, ensuring patient safety. The surgeon was not tweeting himself, obviously.)

From an observer’s point of view, the twittercast provided a simple and accessible account of a typical procedure. Such use of technology not only brings medical insight to the public, but it also helps alleviate fears of something that may be difficult to understand. There was quite a bit of buzz around this stream of updates, ranging from disgust to curiosity, but as a student I found the experience immensely educational and fascinating.

Facebook is a different networking platform that centers on building communities as opposed to open publishing of information. Through it, patients are beginning to send private messages to physicians who also use the service. A half-year ago, a Deloitte survey found that “55 percent want the ability to communicate with their doctor via email to exchange health information and get answers to questions” and showed that a substantial population of patients would like to be able to communicate online with their doctors.

Doctors are not as enthused about conducting their work online, however. Traditionally, doctors have preferred a direct relationship with the patients, avoiding intermediating factors. A doctor may be able to gain some understanding about a patient’s condition over the phone, for example, but would usually ask for a formal visit. The reasons for this are threefold:

• Face-to-face interaction allows the doctor to find out more about the patient’s condition. Non-verbal communication is impossible to achieve online, and a physical examination is required for most diagnoses and treatments. While it is sometimes possible to make a diagnosis online, a direct visit is often preferable because it allows the doctor to actually treat the disease.
• Those who participate in online communities often expect each other to be instantly available; after all, the purpose of such networking is improve availability during times when people are not able to see each other. A medical professional who is online for personal reasons may be expected to respond instantly to their patients’ queries. While doctors do want to help as many individuals as they could, they also need time away from their practice. Online interactions thus blur the line between private life and business.
• Finally, insurance companies typically do not reimburse doctors for interacting with patients online, and social networking tends to consume a lot of time. In addition, doctors have the same liability whether they work with their patients online or away from the keyboard.

While it is not always medically appropriate to diagnose and treat illnesses online, social networking does hold potential in healthcare. Care and cure go hand-in-hand in medicine, and online communication can enhance the patient-doctor relationship. Such communication may include notifications about prescription refills and clinical visits, answers to general health questions, and public education. The aforementioned surgical twittercast is an excellent educational use of networking technology. In a world where online networking has gained substantial momentum, traditional modes of communication may no longer be sufficient for patients.

The healthcare system is changing, however. Many current college and medical students already participate in online networking and are likely to continue doing so in their careers, if only for housekeeping tasks. Insurance companies are also beginning to recognize the work that physicians do for their patients online.

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