By analyzing case records that had been presented and the subsequent comments which were posted in WeChat groups, our study demonstrated that members of WeChat groups preferred to post cases to present their surgical results (which might receive more ‘likes’) rather than present cases for diagnostic and treatment purposes. A substantial part of the case records posted on WeChat were incomplete, and the results of WeChat group discussions might not be recommended to clinicians, especially in regard to incomplete cases discussions.
In contrast to previous studies about the questions asked by clinicians, which indicated that treatment and diagnosis were the most frequently observed types of clinical questions [11, 12], the work presented showed that cases posted for ‘surgical results show’ represented a high proportion (40%),followed by cases for ‘treatment’ (39%), both of which were greater than cases for ‘diagnosis’ (9%) in WeChat groups. Diagnosis classifies the patient as having or not having a particular disease. Historically, diagnosis was regarded as the primary guide to treatment, and it is still considered the core component of clinical practice [13–15]. Clinicians in WeChat groups did not seem to care about the diagnosis. If the diagnosis was incorrect, discussions about treatment and surgical results did not make sense. To further compound this issue, ‘surgical results show’ received more ‘likes’ than the other two purposes. From this viewpoint, clinicians who show surgical results in WeChat might do so simply to obtain ‘likes’. Discussions such as these had no meaning. Such case discussions should not be encouraged.
To our knowledge, this was the first research study to assess case records posted on social media. We know that diagnoses and treatment options should be based on complete case records which should include the patient’s medical history, physical examinations, and auxiliary examinations. The clinical case records that were posted on the WeChat groups were rarely complete. In addition, physical examinations and medical histories were the most frequently omitted sets of data, especially physical examination records. Diagnosis provides clinicians with the means to organize and interpret a range of information about the patient symptoms, signs, tests, and investigations, which forms the basis of decision-making. Furthermore, the patient’s medical history and physical examination results have been the foundation of medical diagnoses for centuries [16, 17]. In the past several decades, however, laboratory tests and imaging modalities have expanded in number and their availability, and clinicians can now see patients in ways that were previously unimaginable. As a result, physical examination skills and techniques have been underemphasized in medical education, and these providers rely more on tests and imaging than ever before . Members of WeChat groups often presented an X-ray in order to obtain advice about a diagnosis or treatment. The patient’s medical history and physical examination record was also required. Perhaps this is why, in our study, the top three experts refused to engage in discussions and offer advice concerning the nine cases, which were all incomplete, and WeChat group members prefer to reply to the relatively complete cases rather than to those that are incomplete. Moreover, the trustworthiness of case sources is very important in a health environment . Physical examination records, even if posted in case discussions, might not be able to reflect the patient's true situation, due to its subjective nature. A lack of understanding about what constitutes effective communication may contribute to medical errors that endanger patient safety [10, 19]. The high engagement in case discussions indicated that clinicians were interested in the cases . However, to our surprise, the clinicians who participated in the WeChat groups preferred to award their ‘likes’ to cases for ‘surgical results show’, most of which were incomplete cases. The clinicians who posted the cases did not obtain any advice from other members of the WeChat group, and the other members also did not learn anything from the communication. In this sense, those discussions proved largely futile.
All of the three top experts from the GATH held senior titles in China and had extensive clinical experience. The final opinions were formed by the experts according to the relevant published evidence-based resource and their clinical experience. Their views were considered to represent the correct decision. A considerable part of the case discussions produced different results from the experts. Furthermore, the cases for ‘diagnostic’ purposes and the complete cases had a high consistency rate. Table 1 shows that the presentation of cases for ‘diagnostic’ purposes was associated with a higher number of complete cases than cases presented for ‘treatment’ and ‘surgical results show’ purposes. Therefore, we believe that if case records are complete when presented, such cases could play a role in terms of the conclusions reached in case discussions that are carried out using WeChat groups.
Social medical case discussions are popular [21, 22], and patients are actively using health networks for the diagnosis or treatment of their diseases. However, we do know that clinical processes, including diagnosis and treatment, are often based on articulation and effective communication among physicians from various disciplines across time and space [10, 19]. Many healthcare professionals fear that social media use by patients for health-related purposes often spreads misinformation among patients . What about clinicians? We should consider if case discussions in WeChat groups are important, and whether the results of such discussions were beneficial to the members, especially for those who uploaded the cases. Loai Albarqouni et al.  found that evidence-based resources were infrequently used to support answers to the posted clinical questions in their study of general practitioners’ use of social media networks to answer their clinical questions. The opinions obtained from social media might be not reliable. In our study, a considerable part of the case discussions produced different results from the experts. The results of social medical discussions should be treated with caution. We have to ascertain the validity of the answers provided, and there is the possibility of providing and perpetuating unsound answers to a large group of people who use social media. A systematic review of the clinical questions raised by clinicians reported that clinicians were highly effective in finding answers to questions by referring to evidence-based resources [1, 24]. Clinicians may pursue their questions by this means.
A limitation of this study was that the WeChat groups that we analyzed might be narrow in their scope. Figure 4 shows that WeChat group members preferred to reply to the relatively complete cases rather than to those that were complete, which made no sense. This may be due to the small sample size. Nevertheless, we believe that the recent advancement of case discussions on WeChat was reviewed in our study. Undeniably, due to the anonymity of WeChat or to the different times and locations, case discussions in WeChat groups were more lively than face-to-face discussions. If some efforts were made to standardize case records, especially medical histories and physical examinations, as well as the subsequent comments which rarely referred to evidence-based resources, the case discussions in WeChat groups might be significant.