Currently, case discussions using social media are becoming popular [10–14]. In particular, an increasing number of Chinese orthopedists are using WeChat groups to engage in case discussions and share information. However, online case discussions in WeChat usually have no standards or constraints. The present study was designed to observe and analyze the current situation of case discussions using WeChat groups among orthopedists and try to find some potential problems of such online behavior. By analyzing 44 case discussions in 7 WeChat groups, our study demonstrated that orthopedists preferred to show surgical results and obtain treatment advice, and broadly acknowledged opinions were difficult to reach for the incomplete cases.
The initiator started a case discussion for different purposes. We found that the most common purposes of case discussion using WeChat groups among orthopedists were showing surgical results and obtaining treatment advice, and only a small group of initiators wanted to request diagnostic advice. However, previous studies indicated that treatment and diagnosis questions were the most frequently asked questions by clinicians on social media [15, 16]. Diagnosis should be regarded as the primary guide to treatment and the core component of clinical practice [9, 17, 18]. Orthopedists in WeChat groups seldom discussed the diagnosis, but discussions of the treatment and surgical results did not make sense if the diagnosis were incorrect or incomplete. We also found that the cases showing surgical results received more likes than other purposes. The main motivation of initiators for showing surgical results in WeChat groups was to obtain likes from other members and to advertise themselves using social media. Case discussions about showing surgical results had no virtual meaning and should not be encouraged.
The diagnosis establishment and treatment option should be based on complete case information, which should include the patient’s medical history, physical examinations, and auxiliary examinations [19, 20]. In this study, the orthopedic case information discussed in WeChat groups was rarely complete. The physical examination records and medical history were the most frequently lacking data, especially the physical examination records. In fact, the medical history and physical examination of patients are the foundation of medical diagnoses [21, 22]. In the past few decades, laboratory tests and imaging examinations have been widely expanded and applied in clinics, while physical examinations have been underemphasized in medical practice . Many clinicians now have formed a habit of relying excessively on auxiliary examinations to give diagnostic and therapeutic advice . For example, many members in WeChat groups often presented an X-ray image to obtain advice on diagnosis or treatment. We found that the WeChat group members preferred to participate in and gave effective comments for the complete and relatively complete cases rather than the incomplete cases. The reason might be that the incomplete cases only provided part of the patients’ clinical information, which was inadequate to give diagnostic or therapeutic advice. Most of the cases with the purpose of showing surgical results in our study were incomplete cases. These cases did not obtain much advice from other members in the WeChat groups, and other members did not receive much information from the discussions.
In the present study, the opinion consistency of case discussions using WeChat groups among orthopedists was analyzed by comparing opinions between the majority of members and three experts in related fields. We found that the opinion consistency rate was proportional to the degree of case completeness. This result again confirmed the importance of case completeness. The total opinion consistency rate in our study was only 63.4%, indicating that a considerable number of the case discussions reached different opinions. This means that the opinions obtained from social media might not be reliable and that the results of medical discussions using social media should be treated with caution. A systematic review of the clinical questions raised by clinicians has reported that clinicians were highly effective in finding answers to questions by referring to evidence-based resources [25, 26]. In fact, evidence-based resources were infrequently used to support answers to posted clinical questions during the use of social media networks . Undeniably, orthopedic case discussions in WeChat groups are more convenient than face-to-face discussions. If some efforts are made to standardize case discussions using WeChat groups among orthopedists and evidence-based resources are well used, the case discussions in WeChat groups will become standard and meaningful.