Reddit's Ask Me Anything forums have proven to give physicians a chance to connect with and educate thousands of people at once.
Mark Pimentel, MD
The more things change, the more they stay the same — even with the physician-patient relationship.
However, with the advent of more advanced technology and the rise of telehealth, physicians can reach more than just the patients in their practice, allowing for new avenues to be explored for physicians provide the public with the best information.
Websites like WebMD offer the public a place to go for trusted information on general medicine topics. But even so, the answers these places can provide for patients are still limited and not as valuable as speaking to a physician.
“The problem with WebMD is it is not up to date - it can’t be,” Mark Pimentel, MD, Director of the Medically Associated Science and Technology Program, and associate professor of medicine and gastroenterology at Cedars-Sinai Hospital, told MD Magazine. “Being an expert in the field that I am, I know things that aren’t even fully published yet. They may have been presented at a meeting 2 weeks ago, so they’re public information, but the public isn’t aware of it. If there’s something important like a side effect or a new benefit that was unexpected, I can provide that, whereas it might not be on WebMD for 2 years.”
Pimentel stressed that patients want the most immediate and as-close-to-the-latest information as possible, where services like WebMD struggle. “WebMD type products are great for generalized information, but for the latest information, it is a little bit more challenging,” he added.
Additionally, as incredible a tool as the internet can be, it does not always lend the best environment for the spread of information. Pimentel noted the ability of companies to infiltrate the internet with their products, providing only limited information and possibly confusing patients.
A forum site with thousands of communities, called subreddits, specified for anything and everything from cars to video games to science and more, Reddit provides many physicians a way to provide up to date information to the public. Through Ask Me Anything (AMA) posts, physicians can introduce themselves to the community of online posters and field questions — sometimes thousands – about a variety of topics related to their specialty.
“I was shocked at how many people tuned in and how many people had really, really intuitive questions that weren’t really clear for them through their own research on the internet,” he said. “What made me a believer was how many people tuned in.”
For Pimentel, the biggest pro of Reddit's AMA service is that it presented an opportunity for patients to get their information directly from a reliable source. His fear is that too many patients may be getting limited information and start taking something without knowing if it is the right thing to take or not for their condition.
Mark Bicket, MD
“If you want to specifically ask a question of somebody who is the real expert in the field, and that expert is doing something on Reddit, it’s a great opportunity to connect,” he said. “Nobody can call my office and just get through to me and ask me a question, but this affords people who are of interest to get on there and ask their question.”
The forum also opened the door for the physicians, too. Pimentel said it gives him an opportunity to see where the real problems for the public are, which in turn helps him guide his research as a scientist.
“These forums provide a good deal of transparency as well as associability to the medical establishment,” Mark C. Bicket, MD, the director of the Pain Fellowship Program and assistant professor of anesthesiology and critical care medicine at Johns Hopkins Medicine, told MD Magazine. “I think there are a number of advantages. It’s a great way to interact with the public and to speak with individuals that aren’t patients you care for but may have another perspective. That engagement was healthy and helpful.”
Bicket and Pimentel were not alone in thinking that the AMA program is a positive. Barbara Ostfeld, PhD, the program director of the SIDS Center of New Jersey, and professor of pediatrics at Rutgers' Robert Wood Johnson Medical School, participated in an AMA in October 2017, receiving almost 1000 comments from the community.
“For me, it provided a huge and wide range of individuals. I could appreciate what thoughts were on their minds, what questions they had, what information they needed to better understand a topic,” she said. “Questions were all focused and articulate, and there was a good discussion. Since the audience is so enormous, you probably have to make sure you’re programming a lot more time than you expect for the activity. I could have stayed on for 24 hours.”
Barbara Ostfeld, PhD
The communities on Reddit vary as greatly in size as they do in topic. While a community like r/AskDocs has more than 35,000 subscribed users, r/science (where Ostfeld’s AMA was hosted) boasts more than 17 million. This opens the door for reaching an even larger audience than expected.
“It’s like having a conversation with 5,000 people. It may be tapping into a unique array of audience members, but I don’t know,” Ostfeld said. “Given the way that it’s organized, - that it’s respectful, evidence-based - it reins in the merit of the topic. It’s revealing because when people are misinformed or uninformed, it’s a way to educate or aid them. It gives you an opportunity to offer evidence-based information and provide a discussion that can expand people’s thinking.”
Expanding people’s thinking was just as important for Joshua Safer, MD, the director of the Endocrinology Fellowship Training Program at Boston Medical Center, and associate professor of medicine and molecular medicine at Boston University School of Medicine.
As a physician that works mainly with transgender patients — a topic that the public is generally less educated on – Safer often encounters family members and friends that are either uneducated, doubtful, or nervous about the situation. While he may be able to help in that instance, as he says, he is only educating 1 family.
“It’s a field where education is just a crucial element to what needs to be happening right now. Being able to reach people in a relatively safe space is big,” Safer said. “I’ve participated in interviews that appeared online, and a lot of people might watch that interview, but then they have a follow-up question. That’s not going to be addressed further. And even then, the interviewer going to give me easy questions. There are going to be people out there rolling their eyes or who are skeptical. This allowed a few more of those people to get through with those kinds of questions.”
Joshua Safer, MD
One of the most important qualities of the Reddit AMA for Safer is the anonymity. Users on Reddit are identifiable only by their usernames and occasionally subreddit-specific “flairs,” allowing them to remain anonymous. Safer noted this as a huge advantage for a physician attempting to educate on transgender issues.
“People might be looking for nuance but they’re afraid to ask their own doctor,” he said. “People that are skeptical but aren’t wanting to be perceived as bigots or anything - they’re just not convinced, or they have wrong information - and they want to express those thoughts. They can have a reasonable expert address them on those thoughts.”
As helpful as it can be, though, the forum still can’t take the place of the physical doctor’s office visit. Bicket’s AMA, which featured more than 100 comments, included some questions that inquired about specific conditions based on individual situations.
While Bicket was responsive to those posters as well, he remained adamant about forums not taking the place of the physical doctor-patient relationship, and often advised them to contact their physician.
“There’s hesitancy from moving away from physical examination as that’s a vital part to diagnoses,” he said. “It’s a fairly integral part of the physician-patient relationship. That’s true for the majority of medicine. These AMAs can be kind of a compliment to the transition toward telemedicine. These Reddit forums are similar to interactions with individuals in the public.”
With technology and health becoming more and more interwoven as time goes on, Bicket and the others fear that the average patient may look elsewhere for answers. That hesitancy can result in the patient obtaining misinformation, and as previously mentioned, finding reliable information can sometimes be a struggle.
“When we do these AMAs, we are specifically not providing precise or specific medical advice to an individual,” Pimentel said. “So, if they’re asking, ‘What should I do, I have these symptoms,’ we can’t provide medical advice 1-on-1 like that without seeing them in clinics.”
John Bisognano, MD
John Bisognano, MD, the director of Outpatient Services, and professor of medicine in the Division of Cardiology at the University of Rochester Medical Center, shared the sentiment.
“I think that there are certain things in medicine that are really based on the 1-to-1 physician-patient relationship. Patient-specific issues, you know, like making a diagnosis, recommending a treatment plan for a specific patient,” he said. “Whereas social media, like Facebook and Reddit is great for general topics and general questions that if hundreds of thousands of people knew more about them, it would change their approach to things.”
That being said, Bisognano noted that the experience offers more pros than cons. He, like the other physicians that have done AMAs, sought to educate the public on topics that they otherwise may not be up to date on.
In the early 2000s, both hypertension and lipid guidelines were updated within a few weeks of one another, he said, which caused a stir for people. “They want to know, in general, what that means for them,” he said.
Similar to Pimentel’s experience, Bisognano noted the benefit that the discussion provides is not just for the audience, but for the physician as well. While the experts know the most up to date information, they may not realize what the issues are that the public wants to be addressed.
“It gets information out there, but it also enables people to let you know what they feel is important,” he said. “Sometimes there’s a mismatch between what we [in the medical community] think is important and what other people [in society] think is important. I would have never necessarily predicted that medical marijuana and plant-based diets were going to be a hot topic in hypertension, but they were.”
“It gives me an idea about what people out there are thinking, and what’s important to them,” he added.