Social Media: domains of interaction?

I’ve just attended a couple of exciting study days on social media (SoMe). The first was about digital interaction between patients and clinicians to support those living with and beyond cancer. My colleagues Julie Stein-Hodgins and Jo Taylor presented the clinician and patient perspectives respectively and have blogged about their experiences of the day.

The second day, #SuSoMe, presented an overview of how SoMe can be used to support professional practice and celebrated some of the SoMe-related projects happening at the University of Salford in three areas: professional networking, teaching & learning and research. If Twitter metrics are anything to go by, this was a resounding success. Although the audience numbered around 50 or so, there were 178 contributors through Twitter, 1424 tweets and a reach of 5,771, 795. Astounding!! There’s certainly an appetite for SoMe.

However, it might be argued that Twitterers tweeting about a SoMe study day are going to be pretty engaged on-line! Nevertheless, reflecting on these two days it seems there is a growing passion for SoMe to support professionals and enrich the patient experience. This has also been evident in the active twittering at #UKRC2015 this week.

Yet there are some common issues emerging from both study days and UKRC2015 that need to be tackled if we are to see a more active SoMe community in the imaging and radiotherapy disciplines. Three in particular stick in my mind: i) the dilemma of on-line identity and safety: how does a health professional separate their private face from their public face, and should they?, ii) the need to balance the dichotomy of transparency (inherent in on-line communication) versus confidentiality (the cornerstone of a health professional’s code of ethics) and iii) funding; many of the fantastic projects are woefully under-resourced generally relying on enthusiastic volunteers. Whilst this is an inevitable feature of innovation there is little sign of integration of SoMe as part of everyday practice yet.

This blog considers the first of these issues: professional identity and the fear professionals have expressed about communicating in an on-line space, but in doing so touches on the others.

First let’s consider what happens in our face-to-face world. Interactions can take place in private or in the presence of others. I’ve put this into a table using the labels ‘private space’ and ‘open space’ respectively. Second, as professionals we learn to identify when to present our professional face, i.e. where we communicate in ways that reflect our professional identity and as others might expect a professional to behave. I have called this the ‘professional face’. We also learn when that type of communication is not required, such as when we are socialising with family and friends. I have called this our ‘private face’. (The notion of face is not new – see Erving Goffman’s work, very interesting). Thus in face-to-face encounters this simple model presents us with 4 domains within which we interact.

Table 1
Table 1: Domains of face-to-face interaction for professionals

However, social media presents us with 4 more domains; (table 2) or does it? The answer depends on how we interpret the word social and how we conceptualise ‘social’ media? Some might assume that ‘social’ pertains to interactions of an informal nature, where friendly companionship and relations are developed and confidences shared. For these people ‘social media’ is associated with ‘private-face’ oriented communication spaces, i.e. primarily on-line domain ‘2’ in table 2. Understandably, such people might find it hard to see how professional interactions can take place with patients and colleagues using social media. They may see this as an invasion of their own private space, be concerned about finding an appropriate level of formality in their communication and be confused about the identity or face they should display.

Table 2

Table 2: Domains of face-to-face and on-line interaction for professionals

However, a more anthropologically-oriented definition of ‘social’ in social media is the existence or development of communities or organised groups with a common purpose. The common purpose in this instance would be all those activities which constitute our day-to-day professional activities. Considering the ‘social’ of social media in this way emphasises activity in domains 3 & 4 rather than domain 2. In this regard, it is easier to see how we can retain our ‘professional face’ and therefore ensure we are working within our professional and legal boundaries. This is because as professionals we are easily able to manage such dilemmas in face-to-face public encounters and so our interactions in on-line open spaces should be no different.

Table 3

Table 3: Examples of SoMe interactions in domains 3 & 4
(Domains in red would not be recommended for professional use of SoMe)

With this in mind we can see that on-line dialogue between patients and health professional is merely an extension of the clinical encounter. Remaining professional at all times, whether on-line or face-to-face should be our aim. The on-line space just permits us to communication at different times and with like-minded people we might never have previously encountered. Realising this, opens up potential for changing the way we engage with patients. Some examples are indicated in the table but we need to explore how we can harness this technology and operate within domains 3 & 4 to resolve some of our service problems and enhance the patient experience in imaging and therapy.

Is this too simplistic an overview? I’d be interested in your views.


7 thoughts on “Social Media: domains of interaction?”

  1. Interesting Leslie!
    I find we use different tools and mentally might classify them (e.g. Instagram might be more social, LinkedIn more professional) but the boundaries are fluid. On Twitter (e.g.) I find side conversations drift into “private” but are rarely conducted with a DM. The model for me would be more Venn diagram-like.
    Maybe in the era of blurry work-family balance this is yet another merging area? I think it takes some self-refection and perhaps professional confidence to step into the space as it does sometimes feel risky (and misunderstood) – I like the word “liminal” – it seems to fit well here.

    Liked by 1 person

    1. Hi Amanda, yes, I think this is a very fluid ‘moment’ for us all. I wrote this for those who are still struggling to use SoMe as a professional. Someone at the UKRC conference said to me he was frightened to use Twitter in case he said something wrong that could be taken out of context. I found that really fascinating, especially as this was someone in a key position at the College of Radiographers. Perhaps for such people they need to start with a more rigid set of boundaries such as those I have proposed so they can manage who they are and what they say to whom. Then when they realise it’s not ‘scary’ then they can move to a more fluid approach perhaps??

      I actually think that domain ‘2’ in my diagram is the most tricky. Not from a professional identity point of view but from a personal identity point of view. This is a domain where I might chat to my family on facebook and, although this is not a space where I aim to present my professional face, I do need to take measures to protect my professional face’ because as we all know there are no ‘private’ spaces on line. Consequently, I may not come across to my family and close friends as the person they know in private. So it’s my personal identity which is compromised rather than my professional face. Interesting!


  2. I think the whole concept of “social” media is changing, and perhaps blurring around the edges. Twitter for example – for sure, when I first joined twitter it was a medium I used in a more professional capacity, i.e. with my colleagues and counterparts in my industry – which certainly doesn’t cross the patient/professional confidentiality paradigm.

    Gradually, I began to share more personal things, perhaps to give people who interacted with me an insight into me as a person as opposed to a professional in the IT industry. When I was diagnosed with breast cancer 2 years ago, initially finding and exchanging information on twitter was immensely useful, but also interacting with like minded people at times was a god-send. I do think Amanda’s observation of “liminal” fits very well around patient/clinician interactions. Without a doubt we all have our professional stance and our personal views. Oftentimes, because we are human, these tend to blur too.

    In this digital age, we can create highly interactive platforms on which to share knowledge, experience, and create content. Technology is disrupting all of our traditional means of learning, communicating, collaborating and extending our reach. This disruption of course can have both positive and negative effects.

    I enjoy the interactions of social media, but I also have concerns, for example, around privacy issues, censorship and content copyright.

    As with all things technology based, mostly these are transitional and in 5 years time there may be totally different platforms, governed in different ways, by which we communicate.

    Liked by 1 person

  3. Hi Liz, I love your comment. Yes, this is where I would love the patient/professional relationship to ultimately end up. A beautifully balanced relationship where knowledge and experience are mutually exchanged without fear. We are a little way off in many areas of health care yet but we are making massive strides with WOMMeN!


  4. One of the comments after the last #MedRadJClub was “I am surprised no one mentioned #SoMe”. The topic was supporting/educating/informing patients who may be anxious about their imaging appointment. I think we’re seeing why in Leslie’s blog post – and perhaps a “training wheels” approach like the domains model would be helpful to help guide novice tweeters. We seem to have a long way to go before we can confidently pop onto someone’s timeline and offer 140 characters of support for their MRI or PET scan!
    Organisations would also benefit from this – there’s a disconnect between the positive (mostly!) and dynamic world we might see when we interact on Twitter and what some organisations perceive as a huge area of potential risk to be avoided (worst case) and controlled (best?). Practitioners are even more reluctant if the messages from above are negative.


  5. Absolutely, Amanda, I like this idea of a phased approach to start thinking of novice Tweeters and SoMe practitioners, then moving them towards shared decision-making and the liberation of the patient in the clinical encounter. Lots of work to be done but it is very exciting to be at the edge of this ‘liminal’ space 🙂


  6. I founded a Facebook based private support network for young women with a breast cancer diagnosis. We also communicate and reach out via twitter and via a public Facebook page. Our FB groups have now had 1700 members from the UK/Ireland who were diagnosed with breast cancer at age 45 or under. The appetite for this network has been huge. What started as a way to connect people local to me in Manchester in 2012, after my own dx in 2010 stage 36, had to be adapted to include women across the UK with a couple of days as demand was huge. We are a voluntary network run by members for members, facilitating peer support and empowerment of our members too. The Younger Breast Cancer Network UK now has a series of private chat groups within our network, including amazing hub group, moving on, secondaries, fertility, research, pregnant when diagnosed and we are an essential part of supporting our members path through dx, Treatment and beyond. This couldn’t have been achieved without the benefit of social media.

    Liked by 1 person

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