A Physician’s Guide to Social Media

Published on: February 6, 2012

Originally Published February 2012 in The Exchange – Issue 1

The Internet and social media have become a primary source for health information. National Research Corp. recently surveyed more than 22,000 Americans and concluded that 16% use social media sites as a source for health care information. Of those, nearly all respondents named Facebook as their preferred source; YouTube was second with 32% usage followed by Twitter’s 18% usage. Similarly, a 2010 telephone study conducted by Pew Research Center concluded that nearly three quarters of adults surveyed have used the Internet to acquire health information. Online ranking or review sites also serve as a source for information about physicians.2 Physicians, like their patients, also are avid users of social media sites. According to research and consulting firm Frost & Sullivan, physicians’ personal use of social media has surpassed that of the general population while their professional use of social media has increased at a much slower pace. Time constraints, concerns over liability and privacy issues are leading reasons why physicians are slower to embrace the professional use of social media. As the use of social media for health information becomes more frequent, it requires close scrutiny and awareness of associated liability exposure. While social media encourages non-clinical communication with patients, the professional boundaries of the physician/patient relationship remain in effect regardless of the method of communication.

Considering a social network page?

With over 500 million Facebook users and 75 million Twitter users, social networking offers an opportunity for physicians to build an online presence and reputation. Although Facebook and Twitter are the dominant sites for social networking, there are other sites that focus on specific services. The following information offers a cursory review of the most popular social networking sites.

• Facebook: prohibits businesses from creating profiles (which are intended for people), but allows fan pages as a way for businesses to digitally connect with the public. The differences between the two Facebook pages include, but are not limited to, the number of allowable friends, and fans, accepting fans and friends, privacy settings, email limitations, and access to others’ profiles. A Facebook fan page is similar to joining a group; it allows users who share a common interest (i.e., your practice, a medical disease or condition) to connect with you without having access to other fans’ profiles and limits the information publicly available.
• Twitter: allows dissemination of small doses of information that are posted to the author’s profile or blog, sent to other users and indexed for future Internet searches
• LinkedIn: focuses on finding, developing and maintaining professional connections.
• Yelp: an online guide that helps users find people, places and things of interest through user reviews.n
• Professional blogs: an opportunity for physicians to update patients and users about professional growth (e.g., Board-certification designation, sharing a published report or study in which a practice physician has participated); to discuss changes in the standard of care; or to review health advancing studies with colleagues.

If you have, or are considering a social network page for your practice, a social media policy will protect you from the ethical dilemmas and challenges of social networking and their impact on the physician-patient relationship (see Figure 1). The AMA has developed a social media policy to assist physicians in maintaining professionalism when digitally connecting with patients (see Figure2).

Using Social Networks

Benefits	Dangers
Provide updated practice information (e.g., summer hours, holiday schedule etc.)	No governing body to regulate content;
Provide links to information specialty and practice (e.g., changes in the standard of care, vaccine availability, medication recall);	Anonymity of authors
Provide patient education information (e.g., disease management workshops, how to take medication properly);	Limited recourse to address negative comments;
Encourages personal improvement (practice- spon-sored fitness contests or activities, patient and staff recognition contests); and	Physician/patient relationship boundaries blurred;
Advertising new medical procedures or equipment.	Promotes nonclinical communication between physicians and patients;
	Privacy and security defaults set by site owner;
	Uncontrolled access to personal information; and
	All content is public and retrievable, even when deleted.

When social media sites are not your “friend”

A Pew Research Center study reported, among other things, that younger patients are heavy Facebook and Twitter users and older patients are the fastest growing category of Facebook users. Physicians with social media sites receive “friend” requests from patients daily; however, becoming a patient’s online friend increases your liability exposure the possibility of a confidentiality breach of protected health information. Patients’ willingness to rely on social media for information on a medical condition, the reputation of a health care provider, and to discuss the medical care of a family member or relative is startling. Regardless of your patient population, the Internet is becoming a part of patients’ daily lives and you should position yourself to take advantage of this trend remaining mindful of the limitations of social media applications.

Social media legislation

Social media sites and personal and professional blogs remain largely unregulated. In 1996 Congress enacted legislation which essentially gave immunity to publishers and speakers of an interactive computer service. With very few limitations, this legislation has no effect on criminal, state or intellectual property laws, leaving limited legal recourse for physicians whose patients post negative or inflammatory comments about them or their practice on social network sites. America Online, Inc. has prevailed in lawsuits involving liability for defamatory statements contained in a user’s post and for statements made by an AOL subscriber in a chatroom. It is unlikely those patients’ negative comments will be removed or that physicians’ rebuttals are published by a site owner.

Reputation management

A 2009 article published in the New England Journal of Medicine’s Practicing Medicine in the Age of Facebook notes that the potential size of the online community and the still-evolving rules of etiquette differs greatly from how physicians and patients interacted in the past. At the end of the day, physicians have no control over what is written about them online. This lack of control makes it easy for physicians’ online reputations to become impugned without advance notice. Physicians are encouraged to periodically monitor online conversations about them and their practices by searching (in at least three search engines) the physician and practice names, specialty-specific keywords, geographic locations and more.When a physician’s professional acumen is questioned, it is not unusual for the physician to become defensive and attempt to elucidate negative comments. A recent Google search for “physician rating websites” revealed an alarming number of patient-friendly resources in less than 10 seconds, of which, more than 20 sites are dedicated exclusively to rating physicians. There are companies that specialize in assisting physicians to monitor and control their digital reputations. An online search for “reputation management service” or a similar phrase provides links to free and paid online assistance to monitor your online reputation (see Figure 3).

Make the connection

As social media continues to evolve, it is unlikely that patients will accept telephone or face-to-face communication as the sole method of communicating with their health care providers. How your patients respond to your online presence is completely within your control. Social media should not be feared, but respected. With the proper policies and procedures in place, you can use the Internet and social media to connect with patients in ways that improve the professional relationships and communication between physicians/patients and physicians/physicians without increasing your liability exposure.

Resources:

Guidelines for an organizational social media policy:

To maintain patients’ privacy and online professionalism of physicians and staff

• Do not post identifiable information online. Maintain your professional obligation to secure patients’ protected health information by not posting any content that can be associated with a specific patient. (e.g., photos of a birthmark, a tattoo, or a piercing; how an injury occurred; their nickname). Likewise, personal identifying information about a colleague or other health care provider should be avoided. Avoid dispensing online medical advice. Offering patient-specific medical advice online should be avoided.
• Physicians may give general medical advice, with a disclaimer stating there is no doctor/patient relationship established, and without the benefit of a good faith examination, specific medical questions can not be answered. Suggest patients visit their family physician or other healthcare provider to properly address their concerns.
• Use privacy and security settings. The Internet is a public domain whose contacts change frequently. Physicians should enable strict privacy settings on their social network pages to maintain control of what is posted and by whom. Regular monitoring of your name and your practice’s name to ensure the social media page and any personal and/or professional information posted about them is appropriate accurate. Regular monitoring should also be conducted to ensure site owners do not change your privacy settings to a public default during an upgrade or improvement to the site. (See Reputation monitoring)
• Maintain separate personal and professional social network accounts online. Social media eliminates face-to-face communication; however, a physician’s professional responsibility remains just as if the encounter is in person.
• Do not encourage patients to “friend” to or “follow” your personal social network page. Likewise, do not “friend” or “follow” your patients. Educate patients to the fact that the physician/patient relationship is most effective when the boundaries remain in tact. It is acceptable to invite patients to become a “fan” of your Facebook page.
• Be mindful of what you post. Information on the Internet is rarely permanently deleted; all tweets are immediately indexed and available through Google. Even if deleted, a permanent record of the tweet remains online. Physicians assume all liability for social network content published online. Consider designating the office manager or practice administrator as the point person for approval for social media content before the information is published and made available to the public.
• Develop an online compliance policy for staff. Establish guidelines that include confidentiality and privacy expectations, and the consequences of failing to adhere to the social media policy. Staff members who have a personal social network page should be prohibited from posting any content about the physician employer, the practice or other organizational information. If staff members are responsible for maintaining the practice’s social network page, specifics regarding acceptable content should be reviewed regularly. Controversial or potentially inflammatory content should be prohibited.
• Do not participate in war of words online. The anonymity of Internet posting makes it difficult to effectively respond to negative comments posted about you or your practice. Refrain from responding to harassing, untrue or inflammatory comments written about you.
• Do not comment on “sensitive” issues. Religion and politics are can be divisive subjects and are rarely appropriate as part of your social network communications.
• Be familiar with state and federal regulations. Physicians who have an Internet presence are best protected by having a social media policy regarding who can add or remove content, what may be posted, and risks associated with disclosure of protected health information Laws that apply in person also govern your online conduct. Some examples include:
  • Title VII of the Civil Rights Acts-prohibits discrimination based on race, color, sex, national origin or religion.
  • To maintain patients’ privacy and online professionalism of physicians and staff:

Figure 1

The AMA’s Professionalism in the Use of Social Media policy

• Be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online.
• Use privacy settings to safeguard personal information and content to the extent possible, but should realize that privacy settings are not absolute and that once on the Internet, content is likely there permanently. Thus, physicians should routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate.
• Maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context.
• Maintain appropriate professional boundaries by separating personal and professional content online.
• Address online content posted by colleagues that appears unprofessional. All physicians have a responsibility to bring inappropriate content to the attention of the author, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.
• Recognize that actions online and content posted may negatively affect their reputations among patients and col-leagues, may have consequences for their medical careers (particularly for physicians-in-training andmedical students), and can undermine public trust in the medical profession.

Figure 2

Social Media Policy Resources

Not endorsed by or affiliated with MIEC

• Mayo Clinic Center for Social Media – an interactive site with links to articles, videos and other social media information.
• Hootsuite – provides examples of social media policies and how to write them.
• The American Medical Association Social Networking Policy

Reputation Monitoring Resources

Not endorsed by or affiliated with MIEC

• Reputation Defender – a paid reputation monitoring service
• Reputation.com – offers online reputation management tips for physicians
• Google Alerts – Track new articles and web pages that mention your name or practice
• Social Mentions – Track Social Media mentions