Social media stewardship: Finding the right balance as an ID physician

In infectious diseases, we promote all sorts of stewardship activities: Antimicrobial stewardship, diagnostic stewardship, device stewardship. How does social media fit into our stewardship model?

Merriam-Webster defines stewardship as “the conducting, supervising, or managing of something; especially: the careful and responsible management of something entrusted to one’s care.” (emphasis added) Our clinical stewardship roles typically involve education and some sort of gatekeeping. We help devise policies for when — and when not — to order Clostridioides difficile testing and, likewise, when — and when not — to use broad-spectrum antibiotics. Should we view social media in the same way? Is there a time to use the social platform X, formerly known as Twitter, and a time not to use it?

Looking at the literature

Many articles have looked at ID involvement in social media. One of the first I found was by Goff et al. from 2015, which gave practical advice for how to use Twitter (as it was then called), who to follow and other pearls. Fast-forward to 2022 when Marcelin et al. outlined a social media strategy for ID. In that same journal supplement, Desai et al. looked at how to identify and respond to misinformation and disinformation. They eloquently noted that in a pandemic with changing information, what seems to be misinformation one day may turn out to be fact later — or vice versa. They concluded that “Partnerships between social media platforms, national and international public health organizations, and domain experts must be forged in order to collectively combat the widespread dissemination of health misinformation, particularly during a public health crisis.”

But where does that leave ID physicians in the meantime? There are benefits to participating in social media — education, networking, sharing expertise and highlighting accurate information and literature to a wider audience. A recent research letter published in JAMA found that a random sampling of X’s Community Notes pertaining to COVID-19 vaccine misinformation were accurate and relied on moderate or highly reputably sources. Many of our colleagues have played critical roles in combating misinformation during the pandemic. The benefits of having educated, front-line physicians squashing disinformation and promoting real science are clear. It makes the field of ID more visible and likely inspires future ID specialists.

Balancing risks and benefits

However, Marcelin et al. noted that while X is the platform of choice within academia, most physicians within academia are not engaged on X. Similarly, Goff et al. noted that 30% of physicians did not use any social media platforms, a group wherein I find myself. The downsides to social media are well known: depression, anxiety, fear of missing out, insomnia and many others. Do physicians risk some mental health harms for the public good? Should we share information on social media harms — and how to watch for and guard against them — when we recruit physicians to engage in these platforms?

Every physician has to define their own relationship with social media. While others step in cautiously, and still others are swimming vigorously, I find myself staring at the water’s edge unsure of how to navigate this whirlpool. Perhaps the best approach is to recognize and balance it with the multiple other domains in which the principles of stewardship and responsible management can be applied: public and community involvement, professional goals, personal time and mental health.

Acknowledgements: I want to thank Christopher Graber, MD, MPH, FIDSA, for his help in editing an earlier version of this blog post.