To Tweet or Not to Tweet? Is Social Media Right for your Practice?

By Tory McJunkin, MD, Paul Lynch, MD, Ryan Tapscott, MS, and Kelli Donley, MPHpmnlogo

Dear Arizona Pain Specialists,

My partner and I run a large interventional pain medicine practice and we have recently begun discussing a new marketing campaign that utilizes social media in our practice. However, we have been somewhat hesitant to employ this marketing strategy to this point. We are extremely uncertain if it even makes sense to use social media in a healthcare setting, especially when considering all the possible risks inherent to such an endeavor. Is it possible to create a successful social media campaign for our practice that maximizes the benefits of social media, while limiting the consequences? Furthermore, how can we best create content that is going to help us reach such a goal?

Thank you,

Ambivalent about social media

Dear Ambivalent about social media,

You present some interesting questions that many healthcare professionals are currently asking. Social media is currently an extremely hot topic in the healthcare industry, in large part because it has become an extremely popular, powerful form of communication in a short period of time. More than 120 million Americans visit Facebook and Twitter monthly; 57 million also spend time reading blogs – online web logs. While social media includes things like wikis, blogs, podcasts, picture sharing and other online groups, it is most known for ultra popular sites like like: Facebook, Twitter, YouTube, MySpace, and LinkedIn. These popular social media sites are often considered exclusively as places to check friends’ statuses and profile updates, to follow celebrities’ Tweets, or even to watch the newest viral amateur videos.  However, social media is much more diverse, and it is quickly becoming a significant trend for those seeking health care information.

Results of National Research Corp.’s Ticker survey found 94% of survey respondents used Facebook to search for healthcare information, 32% searched YouTube, while 18% employed the used of Twitter and MySpace. According to a study conducted by the Pew Internet Project and California HealthCare Foundation, 80% of Americans now go online to research health information including diseases, procedures, doctors, drugs, and test results. Moreover, the survey results indicated that seeking health information ranks third in online pursuits, behind only email and using a search engine.

In a recent survey of a random sample of our patients at Arizona Pain Specialists, 66% said they go online to get information about pain, including pain conditions, its causes, and treatments. This was second only to getting information about their pain directly from doctors. Imagine if there was a way to somehow combine these two sources — doctors and the Internet — so that patients could obtain expert information about pain management in a convenient, online format? Fortunately, social media is such a vehicle.

The Pew study also found 14% of Internet users went online to look for information about how to manage chronic pain conditions. This may not seem like a large number, but the sample surveyed is representative of the entire population of Internet users. This suggests that an estimated 10-20 million people search out chronic pain information on the Internet. Chronic pain sufferers are now creating their own support or discussion groups on Facebook, MySpace, and Twitter. These groups allow those with fibromyalgia, chronic low-back pain, or other chronic pain conditions, to go online and share information, resources, and tips with others.

The results from these surveys make a clear statement – more patients are turning to the Internet to obtain healthcare-related information. In the era of lightning quick healthcare appointments in which patients spend less and less time with a physician, it is no surprise that studies show nearly half of all patients do not understand the information they receive during an office visit. This evidence suggests that a new method of connecting with and educating patients is needed. Smart, savvy social media campaigns could easily address the on-going need for patient education and communication. However, it is currently unclear whether the benefits of using social media to connect with patients outweigh the risks.

Advantages of using social media are that it is affordable (free in most cases), relatively simple, and an effective communicatio tool to connect with patients. It also has advantages over traditional media. With traditional media – such as print and radio advertisements — you pay to put your brand and your message in front of an audience of a certain size. Social media functions differently: you cannot buy Twitter followers or “likes” on Facebook. Sharing drives social media. The way to reach a broad audience is to create value for your audience that justifies their attention and causes them to want to share your content with others. Social media also affords physicians the ability to establish an online network by developing a professional presence and cultivating new relationships.


The most common use of social media for those in healthcare, including pain management, is from patient-to-practice or practice-to-patient. For example, pain physicians or pain management practices could create a Twitter page that provides regular tweets to patients regarding interesting pain information, including new findings and treatments for pain conditions, as well as exercise or nutrition tips, or other suggestions regarding treatment of chronic pain. We regularly “tweet” such items on our Arizona Pain Specialists’ Twitter page and currently have over 1600 followers (

Facebook is a simple, yet effective method to provide updates such as office closures, business hour changes, changes in services offered, promotion of new products, etc.  If a pain management clinic created a fan page the clinic could post regular discussion questions, or trivia-type questions, related to various pain topics and allow patients to answer.  This is a simple way for patients to get educated about pain management without physicians having to dispense medical advice or answer specific medical questions that could lead to HIPAA violations. Currently, we operate two Facebook pages that have nearly 2600 members:  1) A chronic pain support group that permits patients suffering from chronic pain to communicate and support each other online ( To this date, there have been almost 200 different discussion groups formed through the chronic pain support group; and 2) An Arizona Pain Specialists fan page, in which individuals can “like” our page and follow our content, news, updates, etc, and even answer our online discussion and trivia questions, or participate in our online polls ( These posts on our fan page are currently being viewed over 200,000 times a year. In addition, since we began posting interactive, call-to-action items six months ago, we have maintained over 2500 active followers per month.   As you can see, social media, and Facebook in particular, can successfully be used to interact with possible patients while not violating any boundaries.


In addition to Facebook, YouTube is another great site for patient education. Physicians could create videos explaining complex and esoteric procedures, like spinal cord stimulation or vertebroplasty; they could also show parts of the procedures (either live or via animation). In such situations where videos of actual procedures are posted on the Internet, measures to protect patient health information would have to be taken (i.e., patients would have to sign waivers to be included in video, not showing patients’ faces in videos, and not using their names). Currently, we at Arizona Pain Specialists have 58 videos posted on YouTube showing success stories of patients, live video procedures, and discussions about chronic pain ( Collectively, these videos have been viewed 194, 381 times over the last year, which provides evidence that chronic pain patients are actively searching for chronic pain information on the Internet.

Videos detailing intricate and innovative procedures — or pain doctors discussing them — could put a patient who is going to have an upcoming surgery more at ease by giving insight to the details of the procedure and recovery. Also, it is a great way for other pain physicians to learn new techniques. The field of pain management is in its infancy; new and exciting treatments for chronic pain are commonly being discovered, along with the development of new equipment that allows for such advances pain management. YouTube is an ideal platform for the dissemination of such material to other physicians, and patients.


The advantages of using Facebook and YouTube extend to the marketing arena as well. Specifically, Facebook tracks a wide array of free data on fan pages. If your practice created a fan page, Facebook can track trends over time of visitors to the page, views, likes, posts, and other feedback made by guests. For example, if you begin regularly posting questions to your fan page in November, Facebook will track how visits to the page (as well as changes in visitor feedback during that time) have changed since implementing the new format. It basically provides a measure of efficiency for various marketing movements undertaken on the page.

Similarly, YouTube also collects data for videos that are viewed. Some of the data collected include demographics such as sex and age of the viewer, geographic region in which viewers watch a video, stay time of the viewer, video popularity, and video ratings. Because YouTube offers the option of pay-per-click advertising, the statistics provided are indicative of the effectiveness of the advertisement.  Possessing this information can be of great value for marketing campaigns, as it allows you to truly brand your videos to a particular demographic. This technology allows you to know which videos are most popular, whether the ads they place are effective, demographics of those most likely to go online and watch videos of pain treatments, as well as post comments and feedback. Plus, it provides another way for a practice to reach out to the larger community.


Although there are clear benefits of using social media to connect with patients and promote a pain practice, there are also risks and consequences associated with using social media. Specifically, physicians must be extremely careful if/when they publicize information regarding a patient. While names of patients should never be used, other legal issues may arise (including HIPAA violations) if the physician provides enough detail about a patient’s case that could identify the patient from the description. For example, Dr. Alexandra Thran, an ER doctor in Rhode Island, was fired last year for posting information about a trauma patient on a social media site. She did not include the patient’s name in her post, but she did include enough identifiers that others in the community could identify the patient. Other risks include breaching boundaries by befriending patients on Facebook, or practicing medicine outside one’s licensed jurisdiction by providing direct medical advice to patients online.

Pain physicians often encounter unique pain conditions that require unique treatments to solve. Posting information about these rare cases on social media sites can be great educational material for peers who encounter similar cases. However, it is also a gamble to distribute such sensitive information over the Internet because of HIPAA. Physicians must ensure the necessary safeguards are in place to avoid any violations of privacy. With this burgeoning technology and method of communication, the decision to utilize social media is ultimately a judgment call by the physician – one that must first, always, protect patients. Physicians should first ask, “How much of my professional livelihood am I willing to put at stake in order to post content on a social media site?” The growth of social media sites has occurred so rapidly that laws used to police the safe use of them have not been able to keep up. It may be better for physicians to play it safe, rather than be sorry later.

The AMA developed a set of guidelines to advise physicians how best to protect themselves when using social media sites:

  • Use privacy settings to safeguard personal information and content to the fullest extent possible on social networking sites
  • Routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and content posted about them by others is accurate and appropriate
  • Maintain appropriate boundaries of the patient-physician relationship when interacting with patients online and ensure patient privacy and confidentiality is maintained
  • Consider separating personal and professional content online
  • Recognize that actions online and content posted can negatively affect their reputations among patients and colleagues, and may even have consequences for their medical careers

Physicians who own a pain management practices can also be put into harm’s way by the online postings of their employees. If employees discuss patients and the practice online, the physician-owner may be held liable. Something very similar to this recently occurred in a California hospital emergency room. Nurses and other staff took photos of a dying man who had been stabbed and then posted them on their personal Facebook pages. The four nurses were fired and three others were reprimanded. A case such as this one puts the hospital at great risk for being sued by the patient or patient’s family, though there is no indication that legal action was ever pursued.


Physicians should work with an attorney to develop specific social media policies for their staff members to protect the practice. Such a policy would provide a set of guidelines not dissimilar from those provided by the AMA, and may include: maintaining confidentiality, posting factual and meaningful comments, correcting mistakes, not “returning fire” by responding to a negative post with a negative post, and not offering or appearing to offer any medical advice. Beyond solely providing a list of guidelines for employees to follow, pain management facilities should also create a social media user agreement that all employees must sign.

Physicians should exercise restraint and common sense when using social media to protect their patients and practice. Items posted to the Internet are permanent. Furthermore, once material is posted it can take on a life of its own, so extreme caution must be exercised on what content to share. While there are a number of risks and potential complications associated with posting on social media sites, with a conservative policy that emphasizes caution and discretion, the use of social media can be a great tool to aid in the success of a pain management practice.


Dr. McJunkin and Dr. Lynch founded Arizona Pain Specialists, a comprehensive pain management practice with three locations, seven pain physicians, ten midlevel providers, three chiropractors, on-site research, and behavioral therapy.  They teach nationally and are consultants for St. Jude Medical and Stryker Interventional Spine.   Through their partner company, Boost Medical, they provide practice management and consulting services to other pain doctors throughout the country. For more information, visit and