HEY DOC, WANT TO BE FRIENDS?
A tricky situation arises when patients and doctors connect personally on the Internet. Many of today’s social media outlets, such as Facebook or Twitter, found their origins in personal use; they were built for keeping up with close friends. An online study published in 2015 found that among 253 family medicine residents and physicians, 90 percent of residents cultivated a social media presence. Even among physicians over the age of 45, greater than one-third of doctors had a social media account of some variety. Yet across age groups, only about one in five users maintained separate accounts for personal and professional purposes.(1) As this pattern of usage suggests, the term “blurred boundaries” comes up a lot in literature about health care providers and social media. Dr. Naeem Nazem is an adviser for a Scottish group that provides medico-legal counsel and indemnity. “As a doctor, the reality is you are never off duty, and their status in the public eye demands a high standard of conduct at all times,” he told OnMedica, an online publisher for the health care industry.(2) He continues, “By interacting with patients online, doctors are exposing themselves to be scrutinized from their own homes.” How, then, does a health care professional interact with this ballooning digital community without jeopardizing the basic tenets of professionalism?
Guidelines for Internet Use
Many health care organizations provide guidelines and recommendations for ethical, professional social media and Internet use. The United States Centers for Disease Control and Prevention (CDC), for example, develops and maintains extensive guidelines for electronic media. As the organization closely tracks user engagement with its own campaigns and resources, these guidelines reflect compliance with federal standards and professional practices, as well as efficient design and proven effectiveness. Emphasizing this point, a short survey on site use and feedback appears after a few minutes of exploring site offerings. Clearly, the concerns extend beyond avoiding conflict in online interactions; the CDC seeks to eliminate barriers to health information dissemination. “As a health communicator, you craft health and safety messages that can have a profound impact on the public,” the CDC says. “Using social media, these messages can reach more audiences and have an even greater impact on the public.” The CDC identifies four goals as the core of clear, accessible, professional outreach efforts: identify a target audience, determine the objective of your messaging, select the appropriate channel for your message, and decide up front how much time and effort you can invest.(3)
These instructions, as well as the rest of the guidelines and best practices, present an effective starting point for educated online interactions. Thoughtful content creation is likely to lead to purposeful, attentive posting.
While the CDC’s guidelines focus more on what to do in online settings, many other groups have created guidelines to avoid future problems. ACA and hundreds of other health care professional organizations have released basic expectations to guide their members. An investigation of these guidelines reveals a number of commonalities that can lead professionals to harness the communications powers of the Internet safely and successfully.
ACA and other groups acknowledge a level of risk in “friending” patients on social networks such as Facebook.(4,5) Although making such a connection is not explicitly forbidden, they remind doctors that publicly acknowledging the doctor-patient relationship may constitute a breach of the privacy requirements set forth by the Health Insurance Portability and Accountability Act (HIPAA). A 2015 study of family medicine providers found that young doctors were highly unlikely to friend their patients, with absolutely no medical residents stating that they would if a patient asked them to do so. While a majority of doctors in the study stated that they did not feel it was ethical to friend a patient, interestingly, older doctors were more likely to agree that this is an ethical practice.1 The authors posit that this may be due to more enduring physician-patient relationships or fewer negative experiences with social media among older doctors.
The professional organizations also remind members that what is posted on the Internet in any capacity has the potential to be publicly disseminated. (4,5) A 2008 study of medical students and residents at the University of Florida, Gainesville, found that public access to profile information was common even without friending patients. The information therein goes beyond the typical level of disclosure in a doctor-patient relationship, the study found.(6) Profile information is not inherently damaging, particularly without direct patient contact, but must be considered to be part of the doctor’s total available information.
Your Digital Footprint
A 2010 article from the Journal of General Internal Medicine presents a concept from the Pew Internet and American Life Project: the digital footprint. With this concept, the Pew project intends to plant a more tangible idea of the collective impact and legacy of any individual’s online actions: These actions should be considered for their total overall impact and potential consequences.(7) Additionally, the article’s authors emphasize that this footprint remains as part of the aggregated impact of a given profession. Therefore, each member of the chiropractic community shapes our highly visible footprint.
One great benefit of membership in a true profession is the option – and responsibility – to self-monitor. This behavior must also carry into the digital realm. In this way, doctors not only encourage best practices for their peers’ sake but also seek to cultivate the best digital footprint for the profession. “We also believe that the best way to develop institutional concepts for online professionalism is to engage various users of these technologies in a consensus-oriented dialogue that involves students, patients, educators, clinicians and administrators,” state the authors of the 2010 Internal Medicine article.(7) This collaborative approach to policymaking and policing is commonly encouraged throughout the literature, merited by the varied experiences of different groups of Internet users and necessitated by the rapid evolution of services and usage.
On a practical level, thorough familiarity with an Internet service prior to extensive use may solve some of the problems of privacy and publicity. These problems are most prominent in social media, but long-standing social media services have worked to develop solutions for professionals. For example, Facebook offers the following guidance: “Personal profiles are for non-commercial use and represent individual people. You can follow profiles to see public updates from people you’re interested in but aren’t friends with. Pages look similar to personal profiles, but they offer unique tools for businesses, brands and organizations.”(8) Therefore, users should make an effort to learn the best practices put forth by individual websites where they hold accounts. Education may just be the solution to a number of online concerns.
There is a growing call to implement specific, pragmatic social media instruction during the education of health care practitioners. With potential applications in practice management, public outreach, patient care and, of course, personal use, it’s easy to understand the impetus. Many potential pitfalls exist, from jeopardizing doctor-patient relationships to damaging doctors’ reputations and an entire profession’s authority. To combat these dangers, most researchers’ conclusions call for a dynamic, collaborative approach to developing social media policy that works for all doctors, patients, students and institutions. Most of all, maintaining focus on the main intent for using online services provides a great safeguard against challenges to professionalism. As Juan Enriquez of Harvard reminded listeners in his TED presentation, “Just remember the purpose,” and content creators will be far more likely to maintain their professional standards.
Klee D, Covey C, Zhong L. (2015). Social media beliefs and usage among family medicine residents and practicing family physicians. Journal of Family Medicine 47(3):222-6. Retrieved May 29, 2015,www.ncbi.nlm.nih.gov/pubmed/25853534.
Carlowe J. (2014). Social media blurs doctor patient relationship, warn experts. OnMedica. Wilmington Healthcare Limited. Retrieved May 29, 2015, www.onmedica.com/newsarticle. aspx?id=63c764ca-8275-4289-88e4-9830fb7a2a81.
The Health Communicator’s Social Media Toolkit. (2011). CDC Social Media Tools, Guidelines & Best Practices. Centers for Disease Control and Prevention. Retrieved May 29, 2015,www.cdc.gov/socialmedia/tools/guidelines/index.html.
Professionalism in the Use of Social Media. (2011). AMA Code of Medical Ethics. American Medical Association. Retrieved May 27, 2015, www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page.
Social Media. ACA Public Policies. American Chiropractic Association. Retrieved May 29, 2015,www.acatoday.org/level2_css.cfm?T1ID=10&T2ID=117#135.
Thompson LA, Dawson K, Ferdig R. (2008). The Intersection of Online Social Networking with Medical Professionalism.Journal of General Internal Medicine 23(7): 954–957. Retrieved May 29, 2015,www.ncbi.nlm.nih.gov/pmc/articles/PMC2517936.
Greysen SR, Kind T, Chretien KC. (2010). Online Professionalism and the Mirror of Social Media. Journal of General Internal Medicine 25(11): 1227–1229. Retrieved May 29, 2015,www.ncbi.nlm.nih.gov.ezproxy.nycc.edu:2048/pmc/articles/PMC2947638/#CR15.
- How are Pages different from personal profiles? (2014). Facebook Help Center. Facebook. Retrieved May 29, 2015,www.facebook.com/help/217671661585622.