Social Media is a Suitcase Too Heavy for Clinicians To Carry

November 2011

I’m uncertain about the potential utility of current social media tools in health, and I suspect I’m not alone. I’ve been struggling for a term to help me articulate my feelings towards the use of the terms “social media” in the context of “health” and “healthcare” for a while. Struggling to the point where I’d avoid conversations for fear of the inevitable twitch in my left eye as I recognise, yet again, that I simply can’t compartmentalise the concepts as well as I’d like.  This is despite malignant curiosity leading me to use most major new communication and technology trends around since Boyz II Men groupies were still teenagers.

Following almost every discussion around the use of social media in health (and healthcare) I’m left with a recurring feeling that people are taking part in the one same conversation, using identical words, but talking about different concepts.  I’m sitting here at the kitchen table after a weekend of anaesthetising unwell patients, trying to crystallise in my own mind what these different concepts are, and how they relate to these unwell patients, their well relatives, and the staff caring for them.

I’ve recently understood that “social media”, “health”, and “healthcare” are best described as a “suitcase words”.  Artificial intelligence researcher Marvin Minksy described “suitcase words” as words containing many different concepts. These evolve to improve the efficiency of daily conversations, but can be singularly unhelpful when trying to match these jumbled concepts to real actions and outcomes. I feel it’s the difficulty in matching of words and concepts during these conversations to real improvements in outcomes that hopeful, but confused, clinicians are struggling with.

Minsky talks about unpacking these suitcase words into smaller, more actionable concepts.

Lets start with the term “social media”.  These can be roughly unpacked into public networks based on common interests (, private networks based on social and organisational relationships (,, or mixed public/private networks (google+).  Social media in its essence is networked multi-directional content. Email and chat channels, widely available since the early 90′s fit this description, but various factors have meant that the network effect fuelling the uptake of newer communication tools never developed to the same extent.  Content creation and distribution has since become more efficient with advancements in technology and evolution of culture, and now almost anyone can create content via their affordable devices and data plans with a unique human behaviour that has been “shaped” to share.

What about the word “Health”?  Are we talking about wellness and its tremendously broad determinants, or are we discussing the management of illness (healthcare).

What about “Healthcare”? Lets unpack this to slightly more focused suitcase terms of quality of care, productivity, and branding (staff and patient recruitment).

At a recent Sax Institute forum entitled “Bringing the social media revolution to healthcare“, I sat in a mixed audience of administrators, clinical staff, journalists, private hospital body representatives, marketers, and various other stakeholders in healthcare.  We listened to Mayo Clinic‘s experience of exposing their already successful brand to the unpredictably stormy seas of social media.  I came away thinking that social media led to positive improvements in Mayo Clinic’s brand, as well as improvements in patient outcomes through distribution of information to patients for which Mayo Clinic had the expertise to manage.

I spoke to attendees whose primary interest was in organisation branding and its potential for staff and patient recruitment and who thought primarily about twitter, linkedin, and facebook.  I spoke to health promotion practitioners whose primary interest was in assessing sentiment and promoting behaviour shaping to improve population health through tools such as twitter, facebook, and youtube. The benefits flowing from the evolution of communication has been obvious to private healthcare services and health promotion researchers because their primary roles are to assess sentiment and shape behaviour as marketers, and that’s what the two-way mass communication platforms of twitter and facebook are particularly good for.

I spoke to administrators in healthcare organisations thinking about how to grapple with privacy, legal, and productivity risks. Why their staff would want access to youtube, twitter, SMS, facebook, what they are likely to overshare, and what social media policy documents need to be put in place.

Unwell people are beginning to think about tools to help them connect to people with shared experiences (patientslikeme, curetogether ), illness information produced by experts (mayoclinic, Wikipedia, quora), and the people and services that help them get well (ratemydoctor), as well as tools that improve communication with their clinicians (hellohealth, healthvault, teleconferencing).

Healthy people have picked up on the potential of tools that connect them with people and information that keep them healthy.  They think of twitter and blog streams dealing with nutrition, exercise, and wellbeing. They think of socially connected health metric applications that they hope will positively shape their behaviour (the eatery, runkeeper, dailymile, trackyourhappiness).

Clinicians’ interests at this point in time seem to be in the understanding of the implications of social media tools to them and their patients. They are, for good reasons, unable to provide specific clinical advice through public networks, and the vast majority of clinical staff have no access private organisational communication networks that may improve productivity within their organisation. The default position for people directly responsible for the health outcomes of others is one of well-deserved skepticism. They are unable to crystallise in their own mind which of the jumbled concepts in “social media” would help them do their job better.

Over the next few years communication tools will evolve and clinicians will be given access to communication networks with more appropriate privacy controls for the information being exchanged.  Discussions will also start to focus on narrower and more relevant concepts, and as this happens, the use cases for clinicians and the problems these connected technologies are able to solve should become clearer.


Note: I’d like to attribute the concept of “suitcase words” to @arcwhite and the clarification of behaviour “shaping” vs “change” to @yhpo and @bjfogg

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  • kishan

    Thank you Pieter for a bringing up such an important question. I think we are making a big mistake by not being accurate in our description of the reality of social media and healthcare and its intricate connections.
    Language is vital in order for us to communicate and come up with solution but maybe we are in such early stages that even broad terms are yet confusing. The same experience I had at the Youth Health 2011 Conference.

  • Deborah Verran

    The challenge in my mind is how to facilitate the take-up of the technology as a worthwhile tool by clinicians. I can envisage ‘social media networks’ being developed to facilitate knowledge management[and sharing] to help deal with the current overload and prevent duplication and redundancy of effort

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  • TheCardiologist

    This is a great piece Pieter. Congratulations. As a clinician, I couldn’t agree more about the difficulties in seeing where this is all heading and whether it will do any good. Something has been twittering in my ear for some time so I have had to get on board. Irresistible, but worthwhile? efficient? valuable? safe? Who knows. I’ll stay ‘on the fence’ with you for a while if there is space!

  • Anonymous

    There’s always more room for one more.
    My doubts are really about how the web and its communication tools currently stand to help clinicians. We can see these evolving to a point where they will be more useful and appropriate for the things we want to do, its just that they aren’t there quite yet. Will be watching out for you on the fence.

  • Frances

    Hi Pieter,

    I work at the Sax Institute, and just wanted to let you know that the link to the wrap-up of this event has now changed. It should point here: