Doctors and Social Media: The Influencer Will See You Now?
There are currently 192 million daily active users on Twitter. Facebook enjoys a staggering 1.84 billion daily active users. It is no secret that social media platforms are widely used for both personal and professional purposes, and physicians are no exception. One 2014 survey found that more than 90% of physicians used social media for personal activities and 65% used these sites for professional reasons, numbers that have likely grown in the intervening years. In the professional realm, many physicians use social media to promote their practice, engage with colleagues, and provide trustworthy health education to patients and the general public. As benign as these activities are, some physicians have gotten into hot water with social media posts ranging from outright violations of the law, such as patient privacy violations, to more subjective issues such as “inappropriate” or “unprofessional” conduct.
Before a physician dons their scrubs and participates in the latest TikTok trend, MIEC recommends considering risk mitigation strategies:
- Follow AMA Ethics Opinion: Professionalism in the Use of Social Media (see Figure 2).
- Follow the Federation of State Medical Boards (FSMB) Social Media and Electronic Communications guidelines (2019). The guidelines specifically cite the following as grounds for disciplinary action:
- Inappropriate communication with patients online
- Online sexual misconduct
- Use of the Internet for unprofessional behavior
- Online misrepresentation of credentials
- Online violations of patient confidentiality (Note: the patient’s name does not have to be included to constitute a violation)
- Failure to reveal conflicts of interest online
- Online derogatory remarks regarding a patient or other physicians
- Online depiction of intoxication
- Discriminatory language or practices online
- Unethical marketing involving misrepresentations of potential outcomes of treatment
- Do not dispense medical advice. Give general medical information with the disclaimer that this is not to be construed as patient-specific medical advice or treatment.
- Enable privacy and security settings on your social media platforms.
- Maintain separate personal and professional social media accounts. Be mindful about how information shared publicly may be received. Remember that once posted to the Internet, information often cannot be completely deleted. That ill-advised tweet sent in a moment of rancor may already be screen-shotted before you have a chance to take it down.
- Do not “friend” or “follow” patients on your personal accounts.
- Develop a social media policy for employees and staff. Establish guidelines that include confidentiality and privacy expectations, and the consequences of failing to adhere to the policy. Caution staff against posting information to their personal accounts that could be damaging to the reputation of their employer or their profession. Have an attorney versed in employment law or an HR expert review the policy to ensure employee rights to free speech on personal time are balanced appropriately against the employer’s rights to dictate employee conduct.
- Do not participate in a war of words online. Refrain from responding to harassing, untrue or inflammatory comments written about you. In the case of a negative review on Yelp or other rating sites, physicians and administrators may respond in a general way, but should not provide any clinical information or even verify that the reviewer is a patient of the practice, as this would likely be considered a HIPAA violation. MIEC can assist in crafting an appropriate response.
- Avoid commenting on “sensitive” issues such as religion or politics (exceptions may be sensitive issues directly related to public health matters, such as the #ThisIsMyLane movement on Twitter.)
- Be a champion of accurate health information and be transparent about any sponsored/monetized content you are creating. According to one Slate article on the medical ethics of physician social media “influencers” or brand ambassadors (those with a large following who are often compensated for their posts and engagement): “a large contingent of health care professionals have pushed for transparency and self-regulation through the #VerifyHealthCare movement, which asks influencers to explicitly list out their credentials, conflicts of interests, and clarification that personal endorsements are not always professional ones.” If you are producing monetized content, be aware of the ethical implications of the products you promote in your role as a physician and follow FTC guidelines on appropriate advertising, as well as AMA ethics guidelines on advertising and publicity.
With respect to social media, perhaps the FSMB says it best: “Consider innovative ways in which social media can enhance your practice, career, or patient care that reflect sound ethical and professional principles.”
Association for Healthcare Social Media: https://ahsm.org/
MGMA Social Media Toolkit request form: online.mgma.com/social-media-toolkit
AMA Code of Medical Ethics Opinion 2.3.2: Professionalism in the Use of Social Media
Physicians should 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.
When using social medical for educational purposes or to exchange information professionally with other physicians, follow ethics guidance regarding confidentiality, privacy and informed consent.
When using the internet for social networking, physicians should 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.
If they interact with patients on the internet, physicians must maintain appropriate boundaries of the physician-patient relationship in accordance with professional ethics guidance just as they would in any other context.
To maintain appropriate professional boundaries physicians should consider separating personal and professional content online
When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, 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.
Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers and can undermine public trust in the medical profession.