What is social media? And its use in Healthcare


Social media is a generic term used to describe a range of online applications that enable – and specifically encourage –

interactive communication between users. Millions of people around the world use social media to ask questions, network, learn and share their interests. Some, like Mums Net ( have become nationally influential with their targeted audience.

 Among the G20 developed countries, Britain combines unusually high internet penetration with widespread use of social media like Facebook and Twitter.   The social media ethos is all about engagement, participation and relationship building. Every platform encourages its users to take part, by commenting on what they see and getting involved in conversations with others. This makes it a particularly useful vehicle both for informing patients and for gaining their feedback. Used well, social media can be part of collaborative working and co-production. As well as having conversations and giving their opinions, visitors to social media sites also like to share information.  This can have a powerful amplification effect (known as going viral), where articles, videos or images are shared between thousands or even millions of people.

 There are many social media platforms, but the most useful ones in the UK for patient and public engagement are:



This started out a photo-sharing site for students but has become the most popular platform. Facebook claims to have

more than 845m users worldwide and most are under the age of 30. Companies and organisations are increasingly using

Facebook – as well as their websites – to put a face on their activity and interact with a generally younger, media-savvy user

group. The Facebook tone of voice is informal and friendly so corporate speak won’t do.



Twitter is a vast, web-based messaging network, where each tweet is a single message that must be less than 140 characters

long. It is more like texting than emailing.  Users can send messages both to people who are interested in what they have to say (their followers) or people who are interested in any topics they are writing about (via tagging).  Twitter is best used via a separate dashboard application; otherwise the sheer volume of data can make it unmanageable.


There are several to choose from (see the end of this document for the most popular options) and all are free to download. The

best ones act in a similar way to a web browser and enable the user to search the entire Twitter network for specific topics,

words or names. In this way you can monitor responses to your messages, subjects of interest or even how many mentions (or

re-tweets) you get.  Most Twitter users are aged 25 to 45 and the tone of voice is informal but often abbreviated because of the space constraint.

 There are a series of communication conventions:

  • Handle – a user’s name or individual identity
  • Tweet – a message
  • Re-tweet – a message that has been repeated by someone else
  • Hash tag – the # symbol, placed in front of a word to turn it into a search term
  • The @ symbol – put directly in front of a Twitter handle, signifies a direct message to that person.



A free website devoted to viewing, sharing and commenting on video clips. Government and NHS bodies routinely use YouTube to make video and podcast material widely available. CCGs can do the same and establish their own video channel.

Blogs  Originally called web-logs, and now shortened to blogs, these are small websites set up and run by individuals and organisations and used as a vehicle for their own writing. Blogs have become an essential marketing and publishing tool for most businesses.  Unlike traditional publishing vehicles, however, they encourage interaction with their audience – offering them the chance to comment on what they are reading.



Often overlooked in favour of more glamorous platforms, forums have been around since the start of the internet. They are

generally based around a specific subject area and work on a question-and-answer format. They can be powerful tools for

patient participation because visitors to a forum will already have an interest in the topics covered (or they are seeking specific

information). This means they are more likely to participate. Its diversity does not mean that social media is a free-for-all.

There have to be ground rules and norms clearly laid out and accepted by people who engage with you. Moderation of social

media traffic is not censorship but rather making sure that everyone respects the rules. Someone at the CCG who understands

social media has to be in charge.


Social media – far more than let’s have a Facebook page


It used to be sufficient just to have a website. But NHS organisations soon realised the internet had to be part of a

comprehensive communications strategy. They must do the same with social media.  CCGs should not rush in without first having a plan about what they are trying to achieve, who they are targeting, with what messages, how they will respond to what flows back to them and – most importantly – what will happen to the intelligence that social media generates. To engage successfully using social media, CCGs need to do more than simply set up a Facebook page or get on Twitter.

 The lesson is: don’t waste your social media opportunities. Done badly, it can work against you. But done well – and it

isn’t difficult – it could expand your range of engagement assets. Your approach should be part of a comprehensive

patient, carer and public engagement strategy, looking at what insight is needed, the knowledge you already have, who you

need to fill the gaps and the best way to achieve this. It fits with the engagement cycle very well.

 All social media communication is a two-way process. It can be an effective tool for disseminating important messages, but

expect, and make sure you invite, your audience to tell you what they think. The two-way nature of this communication

has obvious positive implications for patient engagement:

  • Use it to broadcast public health messages and information about your services, post questionnaires and even ask

questions directly to specific groups of users and carers

 Use it to gain feedback from patients on your services, their wider care or their own individual health. Social media can help you listen and learn from asking this key question:

Having experienced it yourself, would you recommend this service to someone else?

 Before starting any new project that will use social media, be clear about:

  • What you are trying to tell people
  • What you want them to tell you
  • How you will handle what you learn.

Answering these effectively will help you hone the messages you want to convey and get more targeted and useful feedback from patients.


Avoiding possible pitfalls


Social media use is not an end in itself, even though it represents a big culture change for many primary care

organisations. Traditional forms of engagement will still be necessary to target certain sectors – for example, elderly

people and those who, for whatever reason, do not routinely use electronic media. But don’t stereotype. Many older people are social media savvy already and see it as a convenient way to communicate, especially when getting out to meetings is inconvenient.

 Discussions can develop so quickly that control of agendas can be lost and the balance between proactivity and reactivity can be challenging. This is why the use of moderation must be carefully thought through and clearly communicated.

 Active management and moderation of all social media platforms is necessary for any project to be a success.

This investment will generate a return in terms of patient participation but if their questions and feedback do not get a response they will quickly leave a community.

Social media may improve outcomes in the long term but it won’t reduce costs.  Use the right tone of voice for each platform and always communicate in a professional manner. Common sense should be the guide here – don’t say things on a social media network that you wouldn’t say in front of your colleagues!

Social media is a public environment and rules on patient confidentiality should reflect this.


   (Author: Caroline White, Associate, Primary Care Commissioning (PCC)

Working with Doctors Working for Patients

Doctors’ use of social media

Dr Anne-Marie Cunningham (@amcunningham), a GP and Clinical Lecturer at Cardiff University, wrote on the role of social media in doctors’ lives.

More than half the UK population now use Facebook. And more new users are over 50 rather than under 50. The dominance of Facebook means that if you are not there you are likely to miss out on what is happening with your family or friends. For most of us our use of Facebook has nothing to do with being a doctor. It is about being a mother, nephew, or friend. And it is because we want to protect these people that we care about, and ourselves, that we check our privacy settings and make sure that we are not publishing photos of our nearest and dearest to the world.

So if most of our social media use is about who we are when we are not at work do we need guidance from the GMC? What does using social media have to do with being a doctor at all?

Useful guidance or ‘moral panic’?

Some might think that the development of this guidance is a response to a near moral panic about what may be seen as the portrayal of unprofessional behaviour by doctors and medical students in their use of Facebook and other social networking sites. Breaking patient confidentiality is always wrong but these days what does it take to reduce trust in ourselves or the medical profession? Research seems to indicate that the main determinant of trust in doctors is their interaction with patients in consultations. Patients value doctors who listen to them and take their concerns seriously. They trust them. So are we worrying excessively about how the public may respond to the depiction of minor misdemeanours and hijinx which may not reflect how well an individual will carry out their professional role?

Blurred boundaries

In the past, the private life of a doctor living in a small community may have been well known to her patients. Social media facilitates this same kind of blurring of boundaries. We all have to consider how much of our private and personal lives should be revealed to the public and patients. Will ‘professional distance’ be a meaningful or helpful term in the 21st century? Medical decision making is no longer seen as objective and the role of the doctor, but as a shared task with the patient which acknowledges their values and subjectivities. Might this process be helped or hindered if patients understood our values and subjectivities too?

Doctors may also choose to use new technologies to interact with patients. What then are our responsibilities? As we have a duty to protect patients’ confidentiality we must assure ourselves of the appropriateness of any communications platform. If there are risks then we must make these clear to patients.

The importance of maintaining trust

We might also use social media to connect with other professionals. There can be many benefits to opening up the flow of knowledge within networks. Again, discussing the details of any clinical case should be done with patient consent. In the past when considering if a patient may be identifiable we tended to focus on whether others would be able to recognise the individual concerned. But if discussing a case in near real-time in a public space we have to consider whether the patient will be able to identify themselves even if no one else can. Without their explicit permission, this in itself may reduce trust in us as practitioners.

Looking forward

Will social media have a major impact on the practice of medicine? We do not know yet, but the pace of change is rapid. It took 100 years from invention of the telephone for it to reach 50% of UK households in the mid-1970s. Has the telephone radically changed medical practice? Facebook reached 50% of the UK population in 5 years. Will it be a more powerful disruptor?

When discussing technological change we have to remember that social divides also exist. Julian Tudor Hart coined the phrase the ‘inverse care law’ for his observation that those who most need good medical or social care are least likely to get it. The digital divide describes inequalities in access to information and communication technologies. In 2011, 99% of those with a household income above £40,000 had internet access, whilst only 43% of those with household income below £12,500 did. The gaps are narrowing, but if we change our practices we need to consider how the digital divide will impact on access for the poorest, and most vulnerable.

So do we need guidance on the use of social media and networks? If the publication gives us cause to reflect on how use of these technologies fit with our professional roles and our professional practice then this can only be a good thing.

Anne-Marie Cunningham

April 2012