“Social media is only the latest disruptor in the history of medical and scientific communication.”
– Harrison et al, The British Journal of Psychiatry 2019
Writing in the highly-regarded British Journal of Psychiatry, Harrison St al argue that internet-based social media platforms are just the latest change in the way doctors and scientists share information. This claim has particular relevance to psychiatrists working through a global pandemic which has driven more and more of our patient and colleague communication online.
Social media refers to online forms of communication, such as Twitter, Facebook, Instagram and TikTok, which are widely available and which build networks or communities of “friends” and “followers”. A disruption is something which challenges and displaces the status quo. Medical and scientific communication refers to the way clinicians and researchers share information.
Only the latest disruption
From a historical perspective, Harrison et al are correct that social media has arisen as the latest in a long line of advances in medical and scientific communication. From Ancient Greece, where Hippocrates taught followers beneath a plane tree, to the invention of the Gutenberg printing press which made written material widely available, to modern scientific conferences, clinicians and researchers have always found ways to share their knowledge. Across history, these means have adapted to the social norms and technologies of the day. Many of these changes were initially greeted with skepticism and wariness – including fears that access to books would make people’s minds lazy – echoing some of the negative predictions about social media. Yet, in each case, the benefits of wider access to information have on the whole been positive.
Not just another disruptor
On the other hand, several features of social media set it apart from all prior inventions in medical and scientific communication. The most important of these is the way it democratises access to information. This plays out in two ways. First, anyone anywhere with a mobile phone and access to the internet can use these technologies. Unlike medical textbooks, journal subscriptions, or medical conferences which cost hundreds to thousands of dollars, the barriers to entry are low. Secondly, the extent to which people’s views are heard – whether someone achieves “likes, followers, and leading” – depends not on conventional markers of status and authority, but rather on whether they have something to say that others perceive as worth hearing.
Implications for psychiatrists
These features of social media have implications for clinical practice, professional ethics, and recovery from mental illness.
An increasing body of research shows that social media is immensely valuable for clinicians in staying up to date with latest developments, connecting with colleagues, and disseminating research findings. In addition, almost all of our patients’ lives are touched in some way by social media. A sound grasp of these platforms is needed to provide effective clinical care especially in relation to issues such as online bullying and internet use disorder (not yet a DSM 5 diagnosis, but often seen especially in adolescent populations).
From an ethical perspective, social media brings new challenges. As recognised in the RANZCP Position Statement on social media, these fall into three categories: first, concerns about the confidentiality of patients and colleagues (Principle 4 RANZCP Code of Ethics 2018); second, concerns about professional boundaries (eg looking up patient information or contacting patients online); and third, concerns about the accuracy and professionalism of information being shared. Social media guidelines, such as those promulgated by the College, are important for all psychiatrists and trainees to be aware of as we seek to fulfil our roles as communicators and advocates as well as medical experts (CanMEDS Framework).
Finally, social media has profoundly influenced the consumer-led recovery movement. For people with lived experience of mental illness, social media is not “only the latest disruptor” in medical and scientific communication; it offers a complete paradigm shift. For the first time, people with lived experience have wide access to new research findings and opinion leaders in psychiatry. And rather than being a heavily one-way channel of communication – like textbooks, journals, or conferences – social media gives patients the opportunity of an equal voice. Author Arundhati Roy says “there is no such thing as the voiceless, only the deliberately silenced and the preferably unheard”. With the advent of social media, mental health activists like Indigo Daya can no longer be silenced, as they accrue many thousands of followers and engage in meaningful dialogue with clinicians, politicians, and policy makers.
In the end, social media is the latest disruptor in a long line of evolutions from face-to-face clinical teaching to the printing press, journals, and conferences. However to say it is “only the latest” understates its importance. By opening up access to medical and scientific information, social media brings patients, clinicians, and researchers into conversations as active partners. We are only just beginning to see the resultant paradigm shift. Psychiatrists can choose to be late followers or to step forward as leaders: with or without our “likes” the democratisation of access to medical and scientific information through social media is happening.