The Influence of Modern Social Media on Dermatologist Selection by Patients

Objective Social media have become the platform of choice for people seeking immediate access to information. They have become so ubiquitous and pervasive that many people are using them to research health care providers and communicate with them about their issues. This study looks into this phenomenon, focusing on how it affects people’s thinking when deciding which doctor to see for skin-related concerns. Methodology A cross-sectional study was conducted among patients at Derma Clinic in Riyadh, Saudi Arabia. Data were collected using a validated self-administered questionnaire. A total of 365 patients were included in the analysis. Results Out of 365 participants, 44.9% visited the center for medical purposes, while 45.8% visited for cosmetic purposes. Sixty-six percent of the participants (n=241) went to a dermatologist they knew, and only 21% of those participants knew their dermatologist from social media (Twitter, Instagram, Snapchat, Facebook, and Telegram). About 44.54% preferred to know more about their dermatologists from Twitter, followed by Instagram 27.96%, Snapchat 24.64%, and Facebook 2.84%. A significant proportion of Instagram users came to the dermatology clinic for cosmetic purposes. Conclusion As per the findings of this study, we found the highest preferred way of knowing the doctor for medical or cosmetic purposes was through a friend, followed by a family member and social media. Although most of the participants still preferred to visit a dermatologist based on their friend’s recommendation, social media offer patients a platform upon which to launch their search for a dermatologist. Among social media users, patients who visit dermatology clinics for medical reasons preferred Twitter, while those who came for cosmetic reasons preferred Instagram to follow their doctors, underlining the importance of aesthetic dermatology as a visual field.


Introduction
The first major social media network began in 1997, expanding in popularity and application from virtual non-existence to an estimated 1.43 billion users by the end of 2012 [1,2]. An astounding 728 million persons view over 24 billion pages on Facebook daily, making it the second most popular website in the world and the United States [3]. Following closely behind, Twitter has risen to the ninth most visited website globally, with over 39 million users viewing 253 million pages daily [4]. On Instagram, approximately 75 million daily users have shared 16 billion photos to date [5]. Snapchat is a relative newcomer in the social media space, having been developed in 2011. Snapchatters watch over 10 billion videos and spend an average of 25-30 minutes per day on the application [6].
Social networking sites allow users to easily construct profiles and connect with other users with whom they share information through various integrated tools within the network, including updates, messages, pictures, and video uploads [7]. These sites also facilitate online support communities and provide engaged patients with platforms to discuss specific conditions and diseases [8]. They are emerging as a place for scientific journals to reach broader audiences and as a potential tool for education and conversation between patients and health care providers.
Apart from using social media to support patients, patient organizations are also taking advantage of these platforms as a source of patient-focused information on medical illnesses, issues, treatments, prevention, and awareness [9].
There are thousands of groups within these online communities, connecting individuals with similar interests and affiliations from all over the world [10]. Indeed, more than 40% of the health care consumers nowadays use social media for their health care information requirements [11]. Such practice is more pronounced among users between 18 and 24 years old, as compared to the 45-54 year age group. Moreover, 90% of health care consumers in the 18-24 year age group utilize and believe in medical content shared on social media [12].
Social media have offered health care professionals a unique way to overcome gaps in delivering medical services, enabling them to reach their patients more easily [13]. They have also helped improve self-care skills among patients by keeping them up to date on specific diseases, apart from providing physicians with tremendous opportunities to conduct research in their relevant fields [14]. Some physicians even say social media are among the best ways to formulate, collect, and analyze data for scientific studies meant for journal publications [15]. Our study aimed to assess social media use among patients to determine how they affect their choice of dermatologists.

Study design, setting, and participants
The research was a cross-sectional study using a self-administrated questionnaire among patients seen at the Derma Clinic in Riyadh, Saudi Arabia. The sample size was calculated using a statistical formula for a cross-sectional survey design. Following computation, we found that the minimum sample size to achieve a precision of a 5% and a 95% confidence interval was 372, of which seven had almost empty questionnaires, so the final number was 365.

Data collection methods
The participants were informed about the content and purpose of the questionnaire and were asked to fill out the questionnaire. The data collection started in September 2016 and ended in July 2017 using a selfadministered interview sheet validated by three experts in the field. The questionnaire consisted of six questions. Three questions pertained to patients' personal information (gender, the purpose of the visit, if the patients came to visit a certain doctor). Two questions were aimed at knowing more about how the patients knew of their doctors and their preferred way of gathering more information about them. Still, another question was about the social media application that the patients used to obtain more information about their dermatologist. The questionnaire was administrated in both Arabic and English languages.

Statistical analysis
Data were first cleaned, with those missing values being removed before statistical tests were carried out. Statistical analysis was done using the SPSS 24 statistical software package (IBM Inc., Armonk, USA). Results were presented as mean frequencies and percentages for qualitative data. A chi-square test was used for comparing qualitative variables between groups. A probability value of less than or equal to 0.05 was considered statistically significant.

FIGURE 2: Responses on the preferred social-media applications to know more about the doctor FIGURE 3: Responses on the preferred social-media applications to follow the doctor
There was a statistically significant association between participants who chose Instagram as their preferred way to get more information about the doctor's reputation and performance and the purpose of visit (p=0.009), where the larger number of participants who used the application came to the dermatology clinic for a cosmetic purpose ( Table 2). Moreover, there was a significant association between the purpose of the visit and participants' use of both Twitter and Instagram to follow their doctors (p=0.021 and p=0.003, respectively). Most of those who came for a medical purpose preferred to follow their dermatologist on Twitter, while those seeking cosmetic consultation or treatment preferred Instagram ( Table 3).

Discussion
This study aimed to determine how social media applications affected the clinical practice of dermatology and influenced patients' selection of dermatologists. In recent years, social media and the internet have grown in popularity, developing into new communication tools between patients and physicians [16]. About 4% of daily searches on the internet globally are health-related [17]. Our results show that most of the participants visited the dermatology clinic for cosmetic purposes. Furthermore, a large proportion of participants chose a doctor they knew previously. The preferred way of knowing the doctor for medical or cosmetic purposes was through a friend, followed by a family member and social media.
The findings are consistent with the study by Aydin et al., which reported that the recommendation by former patients primarily dictated the choice of a physician by patients [18]. Furthermore, in a US study, a high proportion of patients preferred to seek reputable healthcare providers' services [19].
Studies on the prevalence of social media use in patient-physician communication and the effects of social media and the internet on patients' choice of physician, hospital, or treatment options have intensified in recent research [16,20,21]. Our research found that the number of participants who knew about their doctors from social media (Twitter, Instagram, Snapchat, Facebook, and Telegram) was 9.7 times higher than those who knew them from traditional sources (newspaper, radio, and TV). A quantitative study conducted in Egypt by Younis et al. in 2017 reported that among 116 dermatology residents, 91.38% were into Facebook, but their most common method for interaction with patients was the telephone (61.21%) [20]. Our research supports this finding, as we found the use of Facebook and Telegram were less common in patientphysician communications. This can be attributed to the fact that private social networking sites are mainly based on close-friendship and friendship requests [22].
Social media offer a potentially effective and credible platform to obtain and engage new patients. Our research found a significant association regarding the use of Twitter and of Instagram applications by our participants to follow their doctors (p=0.021 and p=0.003, respectively).
The use of social media and the internet in the dermatology field is increasing. Patients can share their health-related experiences or issues via social media and in discussion forums with experienced physicians. But despite the benefits and advantages of social media for seeking medical advice or treatment, legal liability and possible risks of sharing information online should be kept in mind. There is yet much to learn about best practices for social media use by health professionals, and this is something dermatologists should look into. As in other studies, our research was limited by its cross-sectional design and small sample size.

Conclusions
Even though social media use among dermatology patients for looking up and following their doctors was more common than the traditional media, most of the participants still preferred to visit a dermatologist based on their friend's recommendation. Overall, those who used social media to choose and follow their doctors preferred Twitter. Among social media users, patients who visit dermatology clinics for medical reasons preferred Twitter while those who came for cosmetic reasons preferred Instagram to follow their doctors, which is understandable given that Instagram enables people to showcase their looks, influencing many to try aesthetic dermatology, a visual field. The available literature on how social media influences dermatology practice is still scarce, and further research is needed.