There is an ever-growing variety of social media platforms, which, depending on the reader, can be either exciting or not. For the enthusiastic early adopter, these channels offer a new experience and the chance to broaden social and professional circles. For others, the growth of social media is overwhelming, and with each new medium, they may become even less willing to explore any of them.

	Patients Are Online and They Want Information About You

However, it is important that clinicians engage with social media primarily because we risk our reputations by not knowing what is being said, shared, and discussed about us online. In this article we will expand on these points and provide steps to help harness the Web and manage your online public persona.

The Internet has become a staple of society, both on a local and a global scale. It has resulted in the formation of online platforms and communities, and has changed the ways we can interact with others. By some reports, there are almost 1.3 billion people on Facebook

 and 255 million monthly active users on Twitter.

Estimates are that 35% of adults in the United States have gone online to diagnose a health condition,

 and other data suggest that patients might be choosing their healthcare providers based on online peer reviews.

 As a testament to this, online physician rating sites are widely available and appear to be frequently utilized.

The reach of social media extends to clinicians as well. In the 2014 American Medical Association Insurance’s survey of over 4000 US physicians, social media usage was noted by 79% of those under age 40, 62% of those age 40 to 59, and 53% of those age 60 to 69.

 Some physicians have recognized the shift from traditional models of information seeking and sharing, and actively discuss healthcare issues in a public way. Physician-led blogs such as Kevin MD (www.kevinmd.com) and 33 Charts (33charts.com) publicly discuss issues that affect those that work within healthcare.

In the oncology space, online blogs also have gained in popularity. Connection (connection.asco. org), the American Society of Clinical Oncology’s (ASCO) forum for the exchange of views on topical issues in the field of oncology, was recognized for its relevance and credibility with a 2014 Award for Publication Excellence (APEX) for site content. The blog authors write frankly about issues relating to oncology practice. Readers are invited to comment on the public blog posts, which often leads to authors answering questions directly from the reading public.

In recognition of these shifts in information gathering and sharing both amongst clinicians and the wider public, as well as the evolving working relationship between clinician and patient, we will suggest ways to cultivate and monitor your online persona and methods to approach using social media in your daily life.

These issues are relevant to oncology because information seeking has been changed by widespread access to the Internet. Indeed, some data show that among those who search for cancer information, 55% turn to the Internet as their initial source; only 25% went to their healthcare provider first.

	Protecting Your Online Reputation: The Digital Footprint and Beyond

However,clinicians must not assume that all information that’s available is accurate. In today’s Internet culture, anyone can write, post, or tweet an article, opinion, or otherwise. This access to “unfiltered” information can be misleading to patients, or even dangerous. A recent example concerned the dissemination of cancer information reported from “John” Hopkins University,

 which necessitated a point-by-point vigorous defense by the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University with input from its faculty.

The digital footprint is the track that remains online after you have engaged in any activities on the Web. Conceptually, it is integral to your online reputation.8 It has both a passive and an active component, and understanding both is important.

The “passive” component is generated by identifying information from your computer or mobile device and by the way in which you access the Internet (eg, via the unique identifier attached to the computer you use to go online — the Internet protocol address—and your Internet service provider). Furthermore, passive data are recorded in your Internet browsing history (which records the sites you visit) and in the “cookies” that are collected by websites (cookies are small pieces of digital information that enable a previously visited site to recognize you immediately). Such information can be potentially collected, stored, and indexed online. While these pieces of virtual information (or “metadata”) are not easily linked with you personally, they could be.

The “active” component of your digital footprint is a record of what you write, blog, tweet, or post online, whether that is the pictures you post on a site like Instagram or the video you post on YouTube. If you’re not careful, who you are in your private life may blur with the image you are projecting as a professional. This has led for some to call for a separation of professional and personal personas on social media, such as Mostaghimi and Crotty’s concept of dual passports,

 in which two different identities are utilized—one strictly for a professional presence and the other for personal activities. However, others have argued that such a separation is not only impossible (there is no anonymity on the Web), but may be unfair to the patients we serve because it robs those we care for of the opportunity of knowing us as people, not providers.

Whether clinicians choose to share their personal lives on social media sites is an individual choice. However, being cognizant that those reading your posts may indeed be your own patients is critical.

Taken together, the footprint is a key to your online reputation. Information shared online can be accessed widely and can give others an idea of who you are—both professionally and personally. Indeed, there may be very little distinction between them. If your reputation were solely under your control, it would not be worth worrying about. Unfortunately, it is not this easy&mdash;it takes work.

Although you cannot exclusively control your online reputation, there are various ways to curate it, and we propose a framework of four “Ds” to explain these steps: (1) discovery; (2) definition; (3) dissemination; (4) defense (

: All clinicians should actively monitor professional information available online; this can be done by performing an audit of what is readily available online about you, your practice, and your reputation, sometimes referred to as a “professional audit.” This involves conducting a Web-based search on the most common search engines (Google, Yahoo, Bing, and Ask). Search by your full name and various combinations of your name, along with your associated practice, institution, city, state, etc. Perform the same search on public websites that specialize in rating clinicians, professional society websites, patient-related websites, and content-sharing sites (

). An audit will give you a sense of what information is currently available and an indication of what potential patients and colleagues will see when they search for information about you or your practice.

		Table 2. Examples of Sites to Utilize for Personal and Professional Self Audits

					American Society of Clinical Oncology

					American Association for Cancer Research

 After gathering the search results, perform a thorough analysis. Use the information to visualize something of a “narrative arc” that represents the sum total characterization, sentiment, and tone of the information. With a clearer definition, decide whether that story is accurate or not. If you are satisfied with what is presented, no further action is necessary, although you should continue to perform these professional audits online at least every quarter or so. In most cases, clinicians will discover content that is either inaccurate or, in their opinion, unfair, making further action appropriate.

Curating your online reputation means actively disseminating the information you want to be available. This can be done by creating a digital “biography” to serve as your preferred narrative and placing it on multiple platforms (listed in 

) to increase the likelihood that the information you want to be seen actually appears first in search engines. In addition to creating a personal narrative, engaging in social media networks is another means to disseminate your professional presence.

		Table 3. Examples of Oncology-Specific Social Media Sites

					Treatment Diaries tweet chat (#treatdiarieschat)

					Hospice and Palliative Medicine (#hpm)

					American Society of Clinical Oncology (ASCO) Connection

					What We Talk About - Massachusetts General Hospital

					Dr. Len’s Cancer Blog - American Cancer Society

Articles

It is important that clinicians engage with social media, since reputations are at risk by not knowing what is being said, shared, and discussed online about them online.

Claire H. Johnston

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Clinical Oncology in the 21st Century: Reflections on how Healthcare Providers Should Manage Their Public Personas on Social Media