Key Takeaways
There are many risks with the use of social media. Chief among these is the risk to patient confidentiality and consent. Breaches in patient privacy not only cause patient harm but also put physicians at risk for liability under federal Health Insurance Portability and Accountability Act (HIPAA) and state laws.
Another important risk for physicians to consider with social media use is the consequence of posting content deemed unprofessional.
For physicians with personal or professional social media accounts, there are recommended tips to follow to protect their patients and themselves while engaging online.
Physicians who are new to social media can learn what to do and what to avoid from physicians already on these platforms.
Technology, including social media, continues to shape modern healthcare. According to the results of a survey of 4000 physicians in 2013, 65% reported using social media professionally and 90% were using it for personal reasons.1 With the expansion of social media over the past decade, medical practice in the modern healthcare system requires physicians to adopt and maintain safe social media practices.
The term “social media” has several definitions but typically refers to internet-based communication tools used by individuals, communities, or organizations to share content.1 Facebook, Twitter, LinkedIn, and YouTube are among the most widely known and used social media tools. Social media platforms are considered “Web 2.0” tools, which are online platforms on which users post their own content directly to the public.2
Social media platforms present physicians with a place to share information, educate patients, and discuss practice and public health policy issues with other healthcare professionals.1 However, it also presents significant risks, including potential patient privacy violations. This article will provide physicians with tools to minimize these risks and promote safe social media use.
Understanding the Risks
As with most internet-based tools, social media has its risks. Certain unique risks exist when social media is used professionally by physicians.1 Chief among these is the risk to patient confidentiality and consent. Breaches in patient privacy not only cause patient harm but also put physicians at risk for liability under federal Health Insurance Portability and Accountability Act (HIPAA) and state laws.
Importantly, HIPAA allows for sharing of de-identified medical information from which protected health information such as name, Social Security number, date of birth, and photographs have been removed.1 Still, patient privacy violations on social media are common.1,3 In a study of 271 medical blogs written by healthcare professionals, individual patients were mentioned in 42.1% of blog posts, with 16.6% of these mentions including enough information for patients to identify themselves or their physicians.4
Another important risk for physicians to consider with social media use is the consequence of posting content deemed unprofessional.1 Medical schools, residency programs, and employers may access social media accounts when making admission or hiring decisions. Content that is considered unprofessional could include patient confidentiality violations, profane or discriminatory language, or negative remarks toward patients, communities, employers, or other organizations.
Posting unprofessional content or sharing certain personal information can negatively affect a physician’s image with their patients, employers, and the public.1 Public trust in the medical profession can also be tarnished by these missteps.5
Physicians must also be aware of the ability for social media to affect their practice habits. In a 2022 survey of 206 physicians, 41% believed that social media influences prescribing practices, with 9% “frequently” modifying their prescribing based on social media and 32% doing so “occasionally.”6 Outside of prescribing, 57% of respondents also reported that their treatment perceptions change based on social media content.6
Although the influence of social media on medical practice is not inherently problematic, physicians should be mindful of the accuracy and reliability of content before integrating new information into their practice.
For physicians with personal or professional social media accounts, the following tips are recommended to protect their patients and themselves while engaging online.
Establish a Social Media Policy
Many large institutions, including hospitals and medical schools, have established social media policies.7 Medical students should be aware of their institutions’ social media policies, as should physicians practicing in hospitals or clinics.
For employers looking to create a new social media policy for their practice group, organization, or institution, the Society for Human Resource Management (SHRM) has shared general guidelines to aid in the process.8 These include:
- Bringing together a team of people from different departments to create the policy to ensure that all perspectives are considered;
- Differentiating employee roles on social media and reinforcing that employees can only speak on behalf of the group/company in a professional/official role, not on their personal accounts;
- Outlining what is and what is not acceptable social media activity and content;
- Reviewing state and federal legal restrictions to ensure that employees are aware of laws and regulations guiding social media practices;
- Providing employees with guidelines to handle policy violations or conflict; and
- Encouraging safe participation in social media and appropriate engagement with coworkers online.
Specific policy considerations for healthcare institutions/organizations include1:
- Addressing patient consent and how to safely post patient information on social media;
- Ensuring that employees disclose conflicts of interest;
- Establishing who may access social media while at work and for what purpose;
- Addressing employer expectations of employees when they are not working; and
- Requiring employees and students to sign a HIPAA authorization before allowing them to share patient-related information on social media.
Ensure Account Security
To maintain patient and personal privacy, physicians should take steps to maintain personal and professional account security. Useful methods for physicians to ensure account security include9:
- Using a strong password, typically including 3 random words, and having different passwords for each platform;
- Utilizing 2-factor authentication;
- Setting personal accounts to private and checking account privacy settings to determine who can see their content;
- Logging off when not using their accounts;
- Blocking spam accounts or unknown followers;
- Not clicking on unknown links in posts, tweets, or direct messages to avoid phishing scams;
- Monitoring their social media platforms and overall internet presence regularly to ensure that all information is accurate and appropriate.
In their guidelines for social media use, the American Medical Association (AMA) emphasizes that social media privacy settings are not foolproof and physicians should be aware that what they post online is typically permanent.5
Maintain Boundaries with Patients
Patient-physician boundaries can easily be blurred on social media. To prevent this blurring, the AMA recommends that physicians follow general ethical guidelines as they would in other contexts.5 The AMA Code of Medical Ethics can be found here.10
Separating personal and professional accounts is another effective strategy for maintaining boundaries with patients.5 However, physicians should also be prepared for situations when they interact with patients online. To navigate these interactions, guidelines recommend that physicians avoid giving medical advice online or inviting patients to join their social network.1 Instead, they should direct patients who want to connect on social media to official and secure communication platforms.
Ensuring patient privacy is another aspect of maintaining appropriate patient boundaries. In order to mitigate privacy violation risk, physicians should obtain consent from patients upfront before sharing their medical stories online.1 If consent cannot be obtained, patient information must be de-identified.3 In all cases, physicians are expected to write about patients in a respectful manner without the intent of self-promotion.
Share Appropriate and Informative Content
Physicians should take special care to post mindful, accurate content on their professional social media accounts. To that end, guidelines recommend that physicians share information from credible sources only and that they contextualize medical research appropriately.1,3 These principles extend beyond a physician’s own account. The AMA expects physicians to report and refute inaccurate or unprofessional content that they encounter from other health professionals on social media, as well.
Recognize When to Disconnect
When engaging with social media professionally, physicians must be aware of the potential for burnout. Although some physicians report using social media to help with work-related burnout, social media burnout has been acknowledged as its own entity in the past decade and is connected to anxiety and stress disorders.11,12
Signs of burnout associated with social media are similar to work-related burnout and include emotional exhaustion, depersonalization secondary to exhaustion, and indifference to social media outcomes.12 Physicians who experience social media burnout should be encouraged to seek emotional support and counseling, as well as consider taking an extended social media break, as needed.
Physicians who are new to social media can learn what to do and what to avoid from physicians already on these platforms. Mikhail Varshavski, known as “Doctor Mike,” is a family physician in New Jersey who has amassed a large social media following and who is mindful of his enormous responsibility.13 He uses his platform to combat misinformation and to encourage other well-intentioned physicians to share quality information online, among other important topics.
Another physician using their social media platform responsibly is Austin Chiang, a gastroenterologist and Chief Medical Social Media Officer at Jefferson Health in Philadelphia.13 Sparked by the pandemic, Dr Chiang began sharing posts on TikTok in response to COVID-19 misinformation. He continues to post on social media with an awareness of maintaining public trust and avoiding commercialization of his platform.
There are unfortunately many examples of actions for physicians to avoid on social media. Katharine Grawe, known as “Dr Roxy,” recently lost her state medical license due to live-streaming plastic surgeries on TikTok.14 Her medical license was revoked due to concerns about consent, patient privacy, and surgical complications related to her social media presence. Dr Grawe’s experience reinforces the importance of understanding boundaries and implementing ethical practices when engaging with social media.
Physicians who use social media may have reasonable concerns about minimizing their risks while also sharing useful information with the public. If you are a physician looking to create a professional or personal social media presence, finding other physicians on your chosen platforms is a great place to start. A supportive community of physicians on social media can help hold each other accountable and ensure safe information sharing.
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