To Tweet or Not To Tweet – Using Social Media in Your Medical Practice

By Laura A. Petersen

Social media is the primary source of communication for some individuals. Many healthcare providers are using Twitter, Facebook, and blogs to educate and interact with their patients. In fact, one study revealed that physicians’ use of social medical grew 50% last year, with usage by doctors ages 45-54 tripling. While using social media can help grow your practice, it can also cause problems. Social media can blur the line between a professional and social relationship, and it can negatively impact society’s view of physicians as they are expected to embody altruism, integrity, and trustworthiness. Healthcare providers accordingly must use social media cautiously.

In 2010, the American Medical Association created a policy to help guide physicians’ use of social media. The guidelines are as follows:

• Physicians must always remember patient privacy and confidentiality requirements and refrain from posting identifiable patient information online;
• When using the internet for social networking, physicians should use privacy settings to safeguard personal information but also recognize that privacy settings are not absolute. Moreover, they need to recognize that because content on the internet is permanent, they should routinely monitor their internet presence;
• If physicians interact with patients on the internet, they must maintain appropriate boundaries of the physician-patient relationship;
• Physicians should consider separating personal and professional content online;
• When physicians see content posted by colleagues that appears unprofessional they must bring that content to the attention of that colleague so he/she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the colleague does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities; and
• Physicians must recognize that online actions can negatively affect their reputation among patients and colleagues and that their actions can undermine public trust in the medical profession.

Many commentators criticize the AMA policy’s lack of usefulness. Most of the guidelines are not practical or concrete enough to provide any real assistance, and they do not provide any sort of “safe harbor” criteria for those who use social media. Moreover, the policing responsibility alienates physicians from using social media.

Common sense dictates healthcare professionals’ use of social media. Many physicians receive Facebook “friend” requests from patients. While the AMA guidelines do not prohibit it, risk management and ethical principles dictate that those requests should be declined. There are several reasons for this. First of all, you do not want patients to view you in an unprofessional light. Some photos or comments posted on a wall may be appropriate for family members but not for patients. Additionally, your friends and family members do not know that they need to edit a wall post, and they may leave comments that patients should not see. Additionally, Facebook friendships may last longer than a physician-patient relationship.

Accordingly, physicians should create two Facebook pages: one for the professional practice and one for personal use. The professional page can be used to communicate with patients while ensuring that no private information is disseminated. This also provides an opportunity for patients to “like” your practice without being identified as a patient, instead of being a “friend.” Keep in mind that you must also have rules and guidelines with your patients and medical staff regarding social media. One of these rules is that you not respond to personal medical questions on Facebook or Twitter. Questions should be referred to the patient’s physician. If a question comes from your patient, handle it through an office visit, phone consultation, or an encrypted email exchange.

It is also important to remember HIPAA considerations with social media. Even if you use a physician-only discussion board like SERMO, you should not be able to identify a patient by the information posted. Additionally, such “curbside consults” should be taken with a grain of salt since you do not definitively know who is replying to your inquiry. HIPAA concerns apply not only to the healthcare provider’s posts and tweets, but also information posted by a patient. For example a patient might be too open on a wall post and blame or sue the physician for making his own information public. Once a patient posts something, he has essentially consented that it’s public information; however, many patients would not view it that way. Accordingly, in addition to blocking patient access to personal Facebook pages there should be clear warnings on any public sites against posting medical information.

If you use social media, you must monitor your social networking. If you do not monitor it, you run the risk of missing urgent messages or a patient’s medical history, details, or possibly facing a malpractice action for failing to respond. Most professionals would agree that social media is not a reliable means of clinical communication with a physician; however, jurors might not see it that way. If a healthcare provider starts using social media as means of regular communication or an element of communication with patients, the provider must look at it on a reasonably regular basis to be aware of information that was sent that way.

It’s also important to remember that you’re never going to be truly anonymous on the web. Anything that you write on Twitter or on a blog is indexed by Google and permanently retained. Internet service providers, websites, and social networking companies are under no obligation to resist subpoenas in a civil lawsuit. Additionally, you must consider copyright, slander, and libel laws. As one physician who uses social media says, “Think before you hit the update button.” The online world facilitates “disinhibition;” make sure you are comfortable with a patient reading that post. Consider that information can instantly be passed along from a friend to a friend to a friend. Especially when using Twitter, make sure your tweet could not be misinterpreted. Given the 140-character space constraints, you may inadvertently compress your comments that could lead to misunderstanding. Taking time to review information before updating can prevent such problems.

When used well, social media can bolster the physician-patient relationship by providing a means of communication which extends beyond the exam room door. Physicians who use blogs and have Facebook pages are viewed positively by patients. Social media is a way of creating a more personal experience with technology. It certainly makes physicians more accessible, especially among younger patients that rely heavily upon social media. Even when it is not used as a marketing tool, many patients appreciate that a physician is web savvy. So, to tweet or not to tweet is up to you – just make sure you do it carefully.

Originally published in the Fall 2011 edition of Quinn Quarterly.