Disruptive innovation in neuromodulation: What can we learn from #SocialMedia disrupting our communication style?

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Twenty-four per cent of doctors are using social media daily to conduct medical research, and 85% of healthcare companies now implement social media marketing, says Georgios Matis. Although calling for patients and practitioners alike to “proceed with caution” when using social media for medical purposes, he elaborates on the benefits of these platforms, such as how new voices are beginning to emerge to challenge the status quo within the medical community.

Communication can be hard; as G B Shaw once said, “The single biggest problem in communication is the illusion that it has taken place.” Communication is also the core element of social media, and is defined as a two-way process of reaching mutual understanding, in which participants not only exchange (encode-decode) information, news, ideas and feelings but also create and share meaning. The challenge of clearly conveying meaning takes on new dimensions in social media, a world of human interactions driven by content and supported by use of technology. Meanwhile, the importance of its growing reach and clout was noted in 2006 when Time Magazine chose an unconventional “Person of the Year”: the readers; you, me, all of us.

The number of active social media users worldwide was estimated in 2018 as over 3.1 billion (42% of the total population) with 448 million in Europe. There are likely several reasons active users contribute to social media. Perhaps out of a sense of altruism? Or maybe because of “anticipated reciprocity”; receiving valuable information in return. Or aiming for increased recognition or community? Maybe it is for all these reasons. In any case, social media is a disruptive innovation, and it’s here to stay. And, “disruptive innovation” is not a buzzword. It is reality. Social media enables a whole new population of consumers: patients, physicians, industry, to use this service for “communication”.

This new mode of communication directly impacts patients’ activities and outlook. Patients today are informed (80% of internet users have searched for health information online), engaged (27% of patients comment or post about health) and social (30% of patients view other patients’ related experience). Plus, they are decision-makers; 77% use search engines before making an appointment and 40% report that information from social media affects their choice of doctor, hospital or medical facility.

Looking specifically at the involvement of physicians, 24% of doctors use social media daily or many times daily to conduct medical research; 88% to research pharmaceutical, biotech, and medical devices. Interestingly, 60% of physicians believe social media improves the quality of care delivered to patients.

Social media channels leverage marketing efforts through reach, provision of a platform to develop or reinforce an authoritative voice, and a relatively minimal material investment. In the commercial sphere, in Germany, 85% of healthcare companies currently use social media marketing compared to 58% in 2012. The scenario makes sense. A mutually beneficial partnership (physicians/industry) emerges. The physicians increase visibility in the neuromodulation community (boosted Twitter profile, engagement with key opinion leaders), get referrals, and save costs by utilising industry resources to build educational materials. On the other hand, industry builds strong collaborations with hospitals, increases the number of implants, and recruit’s patient ambassadors.

On the whole, the potential of social in neuromodulation is tremendous. Patients can achieve autonomy, empowerment, self-efficacy and support. For example, patients with rare diseases may feel less isolated, while patients with fecal incontinence can access information about sacral neuromodulation without embarrassment. Professionals can make healthcare decisions aligned with patients’ or families’ priorities. Medical knowledge, attitudes and skills (e-learning modalities) are also improved. Moreover, social media helps clinical trial recruitment and patient follow-up. The promotion of awareness campaigns (CRPS), fundraising and dissemination of news and research, including journals, societies, conferences and trials, are all advantages. Furthermore, it can enhance professional networking and telementoring (e-mentorship), increase a doctor’s credibility as a thought leader and open doors to other medical leaders in the field.

Also, with social media providing some empowerment for professional development and recognition, new voices are pushing to influence an old status quo. Over the last years many women (and men) spent time and energy on social media to support professional development of underrepresented women physicians in medicine. Lastly, but certainly not least, it seems social media could benefit academic careers. For example, the number of tweets can predict highly cited articles within the first three days of article publication and corresponding “tweetation metrics” have been proposed.

In medicine, practitioners must bear in mind contraindications to any modality. Likewise, it is responsible to anticipate the downsides to social media and always proceed with caution. For instance, concerns have been raised about the quality and reliability of information (“echo-chamber effect”: following content that agrees with established viewpoints), medicolegal liability (personal opinions, no medical advice), and confidentiality/privacy (preserving professional boundaries between patients and physicians; accepting a patient´s friend request allows access to potentially personal content, whereas extending a friend request to a patient may pose pressure due to the inherent power differential). Moreover, social media activity could become an end in itself and distract from the learning process.

The internet is about content and conversation. Social media channels are only as evidence-based as the content they reference and any information stream is only as good as what you let in.

These imperatives benefit from a dedicated focus, with a web presence and social media activity being hallmarks of modern organisations. Many years ago the International Neuromodulation Society recognised the importance of social media in transforming the neuromodulation field and hired a consultant, Nancy Garcia, to penetrate the social media market and expand its journal’s influence.

In closing, using this medium responsibly requires always keeping principled values foremost. To be provocative, one might ask: Do we need less social media? Do we need less marketing in neuromodulation? I would say no. However, enthusiasm for neuromodulation as a field must not veer toward deceptive marketing. In the era of “alternative facts” we should underline the necessity of eliminating misrepresentation of facts about company products, procedures and studies.

Misleading patients and physicians about capabilities of specific products must be also a no go. As author C S Lewis wrote, “Don´t use words too big for the subject. Don´t say ´infinitely´ when you mean `very`; otherwise you’ll have no word left when you want to talk about something really infinite”. Companies, healthcare professionals and key opinion leaders all bear responsibility.

In this light, best practices and codes of ethics are urgently needed and more than welcome. The bottom line in how the potentially disruptive mode of social media communication is approached should all be about credibility and trust. As Robert Levy (INS president) once commented: “We need to evaluate what really drives us and ensure that these are reasonable, appropriate and necessary values and if so, then we must take back our culture and convince others of the value of our mission”. We owe this to ourselves and our patients because we love what we are doing. And, with the following words of Gaudí, “To do things right, first you need love, then technique,” I would like to extend an invitation to join us for the 15th INS World Congress in Barcelona, Spain (1–6 May, 2021)! A great future lies ahead!

Georgios Matis is an INS Public Educa­tion committee member and a senior con­sultant at the Department of Stereotactic & Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany.

The author would like to thank Nancy Garcia, INS Public Education and Website Manager, for her editorial assistance.


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