Wednesday, April 6, 2016

Bias in Social Media: A Warning Against Crowdsourcing Your Medical Care

By Emily McCullar, MD
Austin Family Physician

Whether big questions or small, medically related or otherwise, social media users love to take their ponderings and perplexities to their friends to gather advice. Certainly, social media is a great place to poll opinions about the latest movie or book, and some might find asking friends for medical advice online easier than going to the doctor. Some might even feel that this collective problem-solving protects them if they believe physicians’ or health care providers’ financial motivations might preclude sound medical advice. But asking people outside the medical community for health advice carries its own set of risks.

It’s natural to assume family, friends, and Candy Crush competitors would offer medical advice purely out of the goodness of their hearts. But their own life experiences can color this advice and may not be in the patient’s best interest. For example, the patient asking about solving a high cholesterol problem with diet and exercise instead of pharmaceutical treatment might win encouragement from his Facebook friends. He may hear about someone’s terrible side effects while on a cholesterol-lowering medication. These comments will certainly lead him to believe that he is better off without medication, but is he really making a well-informed decision?

In asking friends if he should forgo this medication, the patient likely would not offer the full picture including his medical history. Readers of this man’s status update might assume his doctor is a bully who has never given him a chance to make some lifestyle changes. The 140 character-or-less blurb omits months or even years of ongoing dialogue between patient and physician. Perhaps during the patient’s prior three visits his doctor suggested diet and exercise (most physicians would), but the patient continued to gain weight, making medication the next most appropriate step. The patient is probably unlikely to share this with his online community.

Similarly, the patient’s friends might withhold their own unflattering, socially unacceptable, or simply poor medical experiences. For example, friends who suffered a stroke or heart attack after refusing medication or failing to make lifestyle changes might not admit that on social media. Likewise, the woman who questions taking antibiotics before her baby’s birth will not likely hear rebuke from someone who has lost a child to infection, as loss of a child is painful for everyone involved and typically kept private. Aside from those who turn to social media as their own personal tell-all live feed, friends online typically won’t discuss the risks of going against medical advice, because to share this information is often uncomfortable or socially inappropriate. Or some simply refuse to believe they’re wrong, despite evidence to the contrary.

On the other hand, members of the medical community are trained specialists well-versed in offering advice without bias. Evidence-based medicine is the gold standard for physicians when determining treatment options, and learning to operate within the limits of evidence-based medicine is a primary focus of medical training. Doctors are trained to distinguish appropriate medical studies from those containing bias. That’s part of our expertise on which patients rely. Most patients and friends do not benefit from that experience, so how could we expect their anecdotal “evidence” offered via social media to be accurate? Personally, I could not stand the possibility of harming my patients, either medically or emotionally, so evidence-based medicine has become my strength in offering well-supported treatment to patients.

When physicians suggest a treatment plan, there is usually a body of evidence that supports their advice. Years of education and personal concern for their patients (and possibly a touch of fear of litigation) have trained them to offer the best-supported and least-biased information they know. While friends on social media may offer opinions on medical matters, it is crucial when considering your own health to keep in mind the expertise, motivation, and bias of your source.

Dr. McCullar is a family medicine resident physician caring for patients in the Austin area. 

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