Speaker 1: You are listening to Your Practice Made Perfect; support, protection, and advice for practicing medical professionals, brought to you by SVMIC.

Brian: Hello, welcome to our podcast. My name is Brian Fortenberry. Thanks for joining us today. We have a great opportunity to hear from someone that knows a lot about podcasts in general, and also social media. I'd like to introduce you to Dr. Kevin Pho. Dr. Pho, thanks for being here.

Dr. Pho: Brian, thank you so much for having me. It's an honor to be here.

Brian: Well, fantastic. And before we get started with some questions that I feel that you're really gonna be able to help us with today, tell us a little bit about yourself, about your background.

Dr. Pho: Sure. I'm Kevin Pho, I'm an internal medicine physician. I practice primary care in Nashua, New Hampshire, which is about 45 minutes North of Boston. I'm originally from Toronto, Canada, but I came to Boston to do undergraduate medical school and residency at Boston University. And when I finished, I decided to stay around the area and moved up to Nashua, New Hampshire and I've been here for 16 years now at the same clinic that I started at. And I have also started my site, KevinMD.com, back in 2004 and I'm sure we're gonna get into its story and how social media has played a role in my life.

Brian: Absolutely. And let's just start with that. You encourage physicians to share their healthcare story, would you mind starting it by sharing with us about yours?

Dr. Pho: So, I started my site back in 2004 and at that time there were only a handful of physician bloggers. In fact blogging was just in its infancy and there weren't a lot of doctors who were online and they didn't necessarily see the need for being online. And I thought blogs were a wonderful way to directly communicate with patients. And I found that out when one day there was a major drug recall and I remember writing a blog post on that. And a few days after I walked into the exam room and a patient remarked, "You know, Dr. Pho, I read your blog post this morning." And to me that was really a light bulb moment because that's when I realized that I can connect with patients not only in the exam room, but outside the exam room as well. And it was a great tool to talk to many patients at once rather than talking to patients one on one in the exam room.

And of course social media has evolved since then. Not only on blogs of course, but various media like podcasts and video and Twitter and Facebook of course. And it's just been so exciting to see these platforms grow and seeing more and more physicians go on these platforms, not only to directly communicate with patients, but to manage their online presence and share their stories, share what their opinions and what goes on behind closed doors. And it's just fascinating to see how uniquely powerful social media is to all of us in healthcare.

Brian:        So you started, like you said, in 2004. You've been going at this now for 14 years and it has become this enormous entity. Did you think it was going to become what it has become today? And what really made you decide to keep pushing forward with this project?

Dr. Pho: Well I would like to tell you that I had a business plan in the very beginning back in 2004 and it's been planned flawlessly until now to be what it is. But of course I'd be lying if I said that. When I started of course I had no idea where it was gonna lead. There at the intersection between social media and medicine was really in its infancy and it could've gone either way. And I think that the response I got, not only from patients, but also from my colleagues as well I think that has absolutely grown exponentially within the first few years.

And I think discovering that physicians can have a voice, not only to talk to patients but really to talk about healthcare reform and the state of the doctor/patient relationship, and directly communicating with the public as well as influential policy makers, and connecting with mainstream media. I think that has really kept me going and having some type of influence, especially someone like me who has really no media background. I mean learning this on the fly and experimenting and see what sticks and see what resonates and having a response and having that type of influence and making a difference really has been the fuel that's kept me going.

Brian: Well, and you've obviously been extremely successful with it. I mean like three million monthly page views, 250,000 social media followers with KevinMD has really expanded. Why is the online reputation important for a physician? Really any physician that might be listening. Why is that valuable?

Dr. Pho: I think it's critically important because more patients today aren't just going online to research diagnoses and treatment options. They're going online to research their doctors as well. I talk to patients all the time and when I meet them for the first time in the clinic they say, "Dr. Pho, I googled you online and I know this and this about you. I know where you went to school." They know more about me than I know about them.

Brian: Right.

Dr. Pho: And I think if you look at some statistics it's like 60 to 70% of patients, they google their doctors online. They do research. Just like they do research with like a hotel or restaurant, they do research on their doctors as well. And if doctors don't have an online presence that they control, like it or not they have one already. You have these third party rating sites that are out there and-

Brian: Sure.

Dr. Pho: - they get a lot of public data that may or may not be accurate and put it on a profile to make profiles of every single physician in the United States. And a lot of times it may not be to that doctor's liking. So I've always say it's imperative to control one's online reputation, be proactive about defining yourself online, and never be defined by someone else. And I'm sure we're gonna talk later on about some of the ways that we can do that, but when we talk about how important that is, it's really that first impression online that you give to patients because they're gonna be googling you.

Brian: Absolutely. I mean that is just the way that business is done these days. I can go out and buy something for my home and I'm going to go on the internet and read reviews and find out background about it. It only makes sense that with important decisions with your healthcare you're gonna be doing that as well. There's some physicians out there that are really hesitant about getting involved because just as you said I didn't really understand the broadcasting side, they don't really understand it at all either. And really don't understand anything about social media and having a presence out there. Why would they want to do this and where do they even get started I guess is the main question. How would you give advice of someone of I see the importance, but what do I do next?

Dr. Pho: Sure. So I think the point that resonates with most physicians is really that online reputation piece. The fact that patients are googling them and if they don't have an online presence already, they're gonna have one made for them by these third party rating site. And we're talking about places like RateMDs, Vitals, Healthgrades, and Yelp. And it only takes a few hours to claim and make an online presence. I think every online presence they have things in common. They have your bio and your headshot and I think that it's important to start there. Have a professional headshot, have a bio that's well written so people who find you on the web can know about you.

And then go to one of these rating sites and claim your profile. You can go to a Vitals and Healthgrades and claim your profile and personalize that page. And you could leverage your online presence with them already and personalize it by putting in a bio that you custom wrote, or a headshot. Then there are two sites that I recommend, LinkedIn and Doximity. These are professional physician social networks. Well Doximity is, LinkedIn of course is a professional social network. And a profile on these sites are really just digital translations of a physician's CV. And I think that it's important to be on these sites specifically because they actually rank high when your name is googled. And if they google your name and they find you on these sites and they see professional information, that's something that you can define online that you would want patients to see. And I think all of these things takes no more than hour or two to do and at minimum every physician should at least start there.

Now whether they choose to move forward and go on Facebook, Twitter, YouTube, or start a blog, that's really up to them. And it depends on what a physician's goals are because there are some doctors who may want to use social media to educate patients, like I mentioned earlier. There are some doctors who may wanna connect with their colleagues and learn from them. There may be some doctors who want to discuss healthcare reform and some of the more provocative and controversial issues of healthcare. And I think it depends on what those goals because there are specific platforms that fit those goals. And of course there are some doctors who may not wanna do any of those things, in which case they can stop after creating a profile on LinkedIn, Doximity and there. And for that they will be already ahead of the curve. So once they start that basic step, whether they wanna move forward is totally up to them.

Brian: I think you make an extremely valid point that I would want the physicians to pick up on is it really is up to you of how small or how big you go with this. And that it is vitally important that you have some presence, because like you were saying, if you don't write your own story someone's gonna write it for you. But the other thing is there's a lot of different branches of this that I'm hearing you talk about. Interaction with other physicians, interaction with patients. It just goes everywhere. Is there a service that you could go to to help you set this up? Or is it simple enough that they can do on their own?

Dr. Pho: I mean there are services that can help a physician build their online presence, but I think when you use a third party service or if you outsource it, you lose your authenticity. You lose your voice. If you don't have any time and you wanna outsource it, certainly it's better than nothing. Be careful who you outsource it to. But I think that a lot of these social media platforms are easy enough for the individual physician. And I do wanna highlight what you said earlier about it being an individual decision. I talk to a lot of doctors and they say, "Why do I have to use social media? A lot of people are telling me that I have to use social media. I don't know where to start." So I think that gets a little bit backwards.

Physicians shouldn't use social media for the sake of using it. They need to start with specific goals in mind and that's what I try to impress on doctors when I talk to them. Why do you wanna do it? And then they start thinking, "Hey I want to educate patients. I want to talk about the latest in healthcare reform." And that really clarifies the goals for them. And once they have those goals there are, like I said earlier, there are specific platforms that fit those goals. For instance Facebook I think it's a wonderful way for physicians to connect directly with patients and educate them. You could have a professional Facebook page for your practice where you could do that. I think Twitter specifically is great for doctors to talk to one another and learn from other thought leaders. For doctors who may be more comfortable on video, then of course you could YouTube or Facebook. Or even Facebook Live and have real time interaction. The beauty about social media is that there are so many tools that fit not only an individual physician's strength and personalities, but their individual goals as well.

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Brian: So, Dr. Pho, for someone that's just getting started what things would you give advice on staying away from? What are some pitfalls of this that they could find out hurting themselves, like I guess HIPAA violations or things of that nature.

Dr. Pho: So just as social media is a wonderful platform to amplify your voice, it could of course be for good or for harm as well. So you have to be careful when you're online of course because more people can hear what you say and the repercussions of what you do is only gonna be more amplified. And you mentioned HIPAA violations. So it sounds like common sense, but you do have to tell physicians explicitly that they can't reveal any patient information online. Whatever you post online needs to be appropriate. If you say it aloud in a crowded hospital elevator, that's the metaphor that I like to use. And whatever you write online, as you know and as we tell our kids, whatever you say online it stays online. And that goes for physicians as well. And there are plenty of cases where whatever a physician did online comes back to haunt them. So I always recommend physicians thinking twice before they hit return and use that hospital elevator metaphor. Whatever you post or say online, just ask yourself, "Is it safe if I said this aloud in a crowded hospital elevator?" And if it is, then you can go ahead and hit enter.

You see this in other fields outside of medicine about how social media are getting a lot of these celebrities and people in trouble. And I think that's doubly true for physicians as well. So be careful, before you hit enter think twice.

Brian: That's certainly great advice. I wanna pick up on something we were talking about and you hit on a little bit earlier about this clinician rating sites that we were speaking of. And often whenever you go out and google a physician that's one of the first things that pop up. What would your recommendations or advice be on interacting with those clinician rating sites? Other than going out, like you said, and kinda claiming your story. Is there any other type of interaction you're able to have with those sites?

Dr. Pho: Sure. So I have four tips for doctors who maybe apprehensive about these clinician rating sites. So my first one of course would be just to listen to that feedback because a lot of times when patients leave reviews on these sites it's the only way they have a voice. And when they share a review that may be less than complimentary, it may be feedback that you simply don't know about. A lot of times patients write negative reviews, not necessarily because of the physician, but it could be because of the staff or the experience, it could be not enough parking, or the magazines in the waiting room were out of date. And all of these issues are fixable and they may not even be aware by the physicians. So listen to that criticism and fix anything that you may not be aware of.

Number two is that you never wanna respond online. As we know with a lot of other online arguments there's really nothing productive that comes of it. Take that conversation offline. I recommend perhaps writing a general message thanking that patient for his comment and asking him to call the clinic. And if you could resolve that dispute offline, I've heard cases where patients may even take down their comments or even add addendums saying, "You know what? This office is listening to what I have to say."

So my third tip is simply asking more patients to rate their clinicians online. A lot of times these rating sites simply don't have enough ratings for specific doctors. And if you ask more patients to rate their clinicians online, it's gonna negate the impact of anything negative. There are many studies that actually show that the majority of online ratings are in fact a lot better than a lot of doctors would think. So asking more patients to rate their clinicians is gonna increase the denominator of the reviews and reduce the visibility of impact of negative feedback.

And my fourth tip is simply just be careful about suing. I'm sure you've heard cases where clinicians sue patients because of one star reviews. And I think that just brings more attention to that criticism because mainstream media always picks up on these sensational lawsuits. And once mainstream media picks up on this and attaches lawsuits to your name, that's really gonna permanently damage your online reputation and make things exponentially worse than they had been. So think twice about suing patients or suing rating sites to take down negative reviews because often times it's not worth the time, money, or expense.

Brian: I think those are fantastic four points that just about anybody can use, but certainly physicians. A lot of what it is is just using common sense, isn't that right?

Dr. Pho: Absolutely. And again, what may seem like common sense in the heat of the moment or when a physician's in an emotional state going in a contentious situation online with a patient, sometimes they lose sight of common sense. So sometimes we just need to take a deep breath, take a step back, and really think rationally about the situation.

Brian: What is your advice for using the platform of social media to make a difference or at least make your voice heard in the healthcare reform conversation that's so prevalent out there? You were saying that social media is certainly a way to be out there. How are some ways you can do that?

Dr. Pho: So I've always thought that healthcare is changing as we speak. And the voice of the practicing clinician often isn't included in those discussions. And over the years I found that writing articles on my blog and that's led to op-eds in USA Today and other mainstream newspapers and amplifying that voice has been tremendously effective. I think that patients are often in an adversarial position against clinicians when we should be on the same side. So I think that means that some of the issues that are important to physicians, we need to communicate that better. We need to share our stories and let patients know that hey, what benefits physicians can also benefit patients.

I know a lot of doctors always say they don't have enough time with patients. We have just a lot of administrative burdens that we have to, a lot of clunky EMRs that we're forced to use. And all of these issues aren't just physician specific. They also matter to patients. So I think it's important to tell these stories on social media and let patients understand that hey what affects us, effects you as well. And by getting patients on our side, I think that's gonna really help effect change and change the minds of the decision makers who may not be listening to physicians themselves. But if we can combine our advocacy efforts with patients, I think that's gonna be much stronger.

So I talked earlier about writing articles from blogs and I've seen other physicians go on Facebook Live and really share medical news and opinion from that perspective of a clinician. And then a lot of doctors I've seen on social media, they've also had mainstream media opportunities where not only are they invited to write articles from major newspapers, but they've been invited to talk shows and really amplifying that platform. Or they're making jump from social to mainstream media and making their voice heard. And these are physicians who may not have had any media training, but purely got their voice heard through the power of social media.

Brian: I think it is so critical that you make sure that you are writing your own story. And that was something you said very early in the podcast that really resonated with me is if you don't write your own story or give your own opinion then it's gonna be left up to others to write that story for you. And as much that goes into medicine today and with all that they have going on and the difficulty of just maintaining a practice, I think you're exactly right. It is important for everyone out there to understand what the behind the scenes, a day in the life of a physician is and what these laws mean and how they affect the practice and what that could look like from a physician stand point going forward.

Brian: Have you known of situations that these types of social media have taken off and really made difference to the point of legislation being changed because of that?

Dr. Pho: I think that some of the Medicare changes that are taking place, I think they are on open forums, they are listening to doctors. And sometimes when it comes to the professional medical societies, like the American College of Physicians or the American Medical Association, I know that they listen on my site. They consider and read the opinions of the physician stories that they hear. One of the common themes that I'm hearing loud and clear is physician burnout. And this isn't something that was as publicized five to 10 years ago. But now that we have story after story of doctors who are finding it difficult to practice, if you look at some recent studies almost half of doctors and medical students are exhibiting some signs of burnout. And physicians who are burned out make twice as many medical errors. So not only do clinicians and other healthcare professionals need to care about this, but patient as well.

And this is another example where we need to get patients on our side and deal with the issue of physician burnout. And by telling these stories and sharing these tragedies, we have these professional medical organizations including it as part of their agenda and realizing how important and how frightening the situation is. So, again, this is an example of how we can use social media and I liken these issues like a spark and social media is like the fan changing the spark into a fire and fanning those flames and hoping that it spreads. And then eventually making a difference.

Brian: That is how grassroots types of movements often get started. Dr. Pho, as we get ready to wrap up here, what are some of the best practices that you might recommend for physicians looking to create, manage, and maintain their online presence? We've talked about a lot of them. If we had to just get a few tidbits of these are the things you definitely do or do not want to do, what would you leave us with?

Dr. Pho: The thing I said earlier, but I do wanna emphasize it, is that you wanna start with your goals first and then choose the platform that fit those goals. And second you wanna choose a platform that fits who you are. I don't think social media is one size fit all. And as you mentioned earlier it can be very tailored to who that doctor is and how comfortable they are. I always advise them to go incrementally, so never have someone force social media on you. Never be in a position where you have to use it when you don't want to. So go with what you're comfortable with, your comfort level online, your personality, whether you're comfortable writing versus being on video versus being recorded on a podcast like this. And tailor make the presence that best suits you and your goals.

Brian: Dr. Pho, how can those interested in maybe reaching out to you or getting more information about your blogs or your social media, where can they get in contact with you?

Dr. Pho: Sure. You could go to my site at KevinMD.com. You can reach me on Twitter @Kevinmd, and I also have accounts on Facebook and LinkedIn. So if you go to my site at KevinMD.com my social media accounts will be in the upper right corner.

Brian: Fantastic. What we will do as well is we will link to those in our show notes for this podcast. Dr. Pho, I can't thank you enough for taking time out of our busy schedule to talk with us and hopefully enlighten these physicians on the abilities that social media brings and the different avenues that they can go down. Thank you for being with us today.

Dr. Pho: Thank you so much for having me.

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect with your host, Brian Fortenberry. Listen to more episodes, subscribe to the podcast, and find show notes at svmic.com/podcast.The contents of this podcast are intended for informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice as specific legal requirements may vary from state to state and change over time.