Social media may mean different things to different people.

One element could be a bulletin board or forum, where relationships develop over months or even years, while another could be the quick flash of a 'take-it-or-leave-it' Tweet. It can be media rich and socially enveloping like Facebook, or a staid professional networking environment like LinkedIn.

Many surgeons have little idea how to become involved in social media at all and are even unsure about what it is. And I can understand that because it has become the medium of a younger faster generation.


The social media story on KNEEguru

The KNEEguru bulletin board existed before the concept of social media, so it is just a matter of understanding how it fits into the other social medial models that abound today. Before the 1980s medical education was the quiet and very private preserve of specialist libraries of pricy books and medical journal. From the perspective of the general public a request for a book loan or article reprint had to be made through one's local library, and would take ages to arrive. Then, of course, there was the barrier of the language of medicine and most material was already very dated.

Most patients accepted that it was a world apart, and were reliant on their doctor to explain things to them. Such traditional paper-bound media was permanent, high quality but locked away and difficult to access. How different things are now since the explosion and democratisation of the internet.

The first KNEEguru website in the early '90s was designed as a suite of simple forums for question and answer. One section was for patients, one for surgeons, one for physiotherapists, one for trade etcetera - we were amazed when it was only patients who participated and they were hungry and excited and finding at last a medium for acquiring information. The other forums were totally ignored, and after a short while we simply closed them down.

As the forum morphed into something a little more sophisticated, with separate topic boards and linked replies, it became clear that some of the more vociferous and heated discussions related to patients not having really authoritative information at their fingertips. So we created a sister area on the site and invited experts to write content for us at a language level that was easy to understand. This was embraced, but any attempt at actual participation of a surgeon on the forum was less happily accepted. The two social groups could not readily mix in this environment, and yet I was hearing from surgeons how interesting and enlightening they found the patients' own discussions to be.

Then in the mid '90s the 'wiki' became a new phenomenon. Medical information could be posted online, and could be reviewed and edited by others so that content improved over time. [The Wikipedia was born in 2001, and although I love it the medical articles have sadly now become heavy with medical jargon just like the textbooks of old.]

Blogging hit the headlines towards the end of the '90s and now patients had the tools to really give voice to their own experiences. The concept of 'following' a blogger became something new and exciting - the beginning of viral networking which has reached its extreme in microblogging (eg Twitter). Nowadays it is common to see who is following you and to display who you are following, but it was fairly revolutionary then.

The iPod launched in 2001, and led to the concept of podcasts where one could listen to discussions. Syndication of content was akin to 'following' and allowed one to keep up with topics of special interest while dozing on a train. Before too long this was followed by videos of webcasts.

Myspace (2003), Facebook (2004), LinkedIn (2003), Flickr (2005) - they just kept coming and the youngsters embraced them all, while the medical profession was cool to this whole revolution. Often doctors felt antagonistic to patients arriving in their consulting rooms armed with information from the internet.

But by the end of the decade surgeons had become intrigued with the concept of 'the educated patient' but in general they simply did not know how to get involved themselves. Consultancies were springing up to help them exploit the potential of social media in their practices, whether for altruistic educational motives or for frank solicitation. The professional medical bodies were concerned about how they could regulate this new environment, and a few standards have crept in, such as HIPAA (Health Insurance Portability and Accountability Act). As soon as a doctor discusses a case he is involved in or engages online directly with a patient there are legal issues involved.

So how best can knee surgeons be drawn into the social medial world and is it in anyone's interests that they are?


Knee surgeons and social media

Knee surgeons and clinics initially responded with paper handouts of the sort of problems commonly experienced in their offices. This was a useful advance but not of the sort of viral power of real social network.

Medical websites appeared where knee surgeons were invited to present their content.

The surgeons then started to make their own websites, although this was slow to develop largely because of the professional bodies frowning on any form of self promotion, although there is a big difference between an informative website with contact details and the surgeon's curriculum vitae and flagrant self-promotion.

It fact is becoming common now for knee surgeons to professionally introduce themselves via a video, such as this YouTube video from knee surgeon Peter Millett, which is also embedded on his own website. His Clinic's Facebook Page is imaginative and interesting, and the Twitter feed  has a good number of followers.

YouTube itself has become thoroughly embraced as an education platform, as this series of videos from orthopaedic surgeon Nabil Ebraheim demonstrates. He uses his Twitter page to draw attention to new videos, which duplicates the role of the 'subscribe' button on YouTbe and he does not seem to have made really good use of his Facebook page. I think this mirrors what most surgeons are finding - that one is drawn to one or other of these new media and it takes a while to learn the optimal ways of using them.

Dr Howard J Luks' 'Tips for getting started'is a very useful guide for any doctor planning to invest time in social media.

Surgeons do seem to be embracing social media more collectively in relation to networking with one another -

  • LinkedIn - LinkedIn is a 'facebook' with a professional look and feel acceptable to most knee surgeons. Although most of the knee surgeons in my network are still just using in a simplistic address-book way, it could be used creatively to offer a full profile, as well as a medium for to showcase their other social media efforts and knee products or clinic establishments.

    I note that a lot of knee surgeons use it to keep in touch with other colleagues such as physiotherapists, trade representatives and conference organisers.
  • Vumedi - VuMedi is the YouTube for specialist physicians. It is very popular with knee surgeons, and most videos have animated discussions.
  • OrthoMind - This social network is just for orthopaedic surgeons. It is a whole portal, with not only educational material, but forum discussions, chat rooms, a business room and many other sections.
  • Doximity - This is a social media tool for direct exchange with other doctors in a close network, discussing in confidentiality a patient's medical problem. It allows direct and immediate transfer of notes and photos/X-rays and by-passes the tedious business of one professional having to manually send the patient's file to another colleague.
So really all the tools one could want to socially network as a knee surgeon are already there, and it is just a matter of working out how best to use them. Certainly I believe that in this day and age a website for each surgeon, or a dedicated page of a clinic website, is essential, and on this can be embedded the sort of information that is useful to patients.

The surgeon's website should include at least -

  • Clear contact details with a map, and details about access
  • A simple email form
  • A biography that includes the work they routinely undertake and those areas in which they have a special interest
  • When they qualified
  • Board certifications or their equivalent in other countries
  • Specialist training fellowships and with whom
  • What languages they are fluent in
  • The insurances they accept

Many of the surgeon websites I look at are frustrating as they list every honour and every position the surgeon has ever held, but fail to mention what procedures the surgeon routinely performs or even how to make an appointment. Once a site has been well-crafted for the benefit of patients, it can link to other social network content the surgeon has produced for the benefit of patients (on YouTube, Facebook, Twitter or any other medium). These media should be focused upon the particular disorders in which the surgeon has an acknowledged skillset - not random posts and re-posts that have no direction. Patients are interested in 'getting to know' their knee surgeon's interests and expertise before they make the appointment.