Safety of care

Improving patient safety and reducing risks

Social media: The opportunities, the realities

Originally published October 2014
P1404-1-E

Virtual interactions and exchanges have never been more frequent. Individuals in most parts of the world can now exchange information instantaneously, to one person or a million. The ability to learn and share is vast — largely driven by social media.

For the medical professional, social media offer opportunities and innovative options for sharing information. Along with the innovation, however, comes risks such as online content that is inaccurate, is unmoderated, attributed to the wrong author, violates privacy, blurs professional and personal activities, and hurts reputations.

Physicians should recognize the impact of social media, and consider how much they want to engage and how to mitigate any potential risks.

Learning and sharing

Medical trainees and faculties are increasingly leveraging several social media sites to enrich trainees' medical education. Students are looking for opportunities to exchange and learn beyond the formal education setting, often using mobile devices to capture and share clinical learnings on social media sites. Facebook, Twitter, LinkedIn, YouTube, SlideShare, Flickr, and blogs are among the most popular sites.1

Students and faculty have an obligation to protect the privacy of patients and must refrain from sharing identifiable patient cases through social media, unless the patient has consented. This principle applies regardless of whether the platform's privacy setting is public or private. Some medical regulatory authorities (Colleges) remind physicians that confidentiality may be breached if patients, while not expressly named, can still be identified in an online case example.2

It is recognized that generic case examples or other learning material that does not contain identifiable patient information can help students learn. As physicians strive to keep current and abreast of medical findings, social media can prove invaluable.3

Patient engagement with social media

Patients are also participating in social media to keep current on health matters.4 Some join online patient groups to exchange information with others experiencing similar health conditions. Hungry for information, treatment options, and hope, patients may be acquiring knowledge that is inaccurate or inappropriate for their medical condition. However, it is comforting to know patients continue to view physicians as the most valuable source of information for their medical condition.5

As patients seek to share their clinical experience with others, they may wish to capture the physician-patient encounter or procedure for social media sharing. Physicians will want to consider how to manage these situations, recognizing the broad reach of social media and the beneficial impact this may have. Physicians who decline to participate should explain why so the patient understands the decision.

Most hospitals and facilities have policies governing the use of photographs or videos during doctor-patient exchanges. If in private practice, physicians may wish to develop policies or guidelines to help manage such requests.

Professional social media engagement

Physicians have long recognized and applied professional behaviour in all facets of care and private life. This behaviour extends to social media, where society's expectations of doctors remain the same as in "real life."

The consequences of unprofessional behaviour over social media are often more significant because of its reach and permanency. Once posted or recorded, the ability to retract a comment is very limited.

At times, social media content gives a false sense of detachment. Because of this, users may post responses or interact in ways that would be considered inappropriate in face-to-face encounters. Doctors should always ask themselves:

  • Is this how I would frame my response, if the individual or group was in my office, or if I was in direct contact?
  • Is my response typical of how I interact?
  • Will I feel the same way tomorrow, or 2 months from now, or 1 year from now, when my comment or contribution remains publicly available?
  • Will my response respect my professional obligations?

Know the obligations

Physicians have a duty to protect the personal health information of their patients, including on social media. Both physicians and patients should be aware of the risks and agree to certain conditions before engaging in electronic communications.

False or incorrect information can spread quickly and broadly through social media. This introduces a risk for both patients and their doctors. Imagine having a discussion with a patient about a recommended treatment which has been portrayed as dangerous on social media. Patients may be conflicted and may decline the treatment, based on false information.

Physicians are well-positioned to correct misinformation with patients. While physicians don't have an obligation to monitor everything that is stated on social media, they may want to contribute to the exchange with a view of providing factual information that will benefit others. When it comes to a physician's own social media platform, it is important to monitor what is said and be prepared to correct or interject when necessary.

Leverage social media

The value of social media in public health is well recognized. It broadens the opportunity to alert a community of outbreaks, vaccination centres, and measures that can be taken to mitigate exposure to contagious diseases.

Choosing the appropriate social media site is important. Weblogs, instant messaging platforms, video chat, and social networks can all be valuable platforms with benefits such as:

  • reaching large numbers of professionals for public health and policy exchanges
  • connecting with professionals at the national and international level to advance research, treatment, and care options
  • disseminating timely health information to trigger action

Physicians who use blogs or other social media sites to discuss health-related issues may want to include a reference to the Canadian context in which the information is provided. This will help mitigate the risks of non-Canadians heeding advice that may not be appropriate or relevant.

Publishing information on blogs or other social media platforms could result in legal actions being brought outside of Canada. The CMPA will not generally provide assistance to members who encounter medico-legal difficulty arising from the publication of information to a non-medical audience, when the matter is brought outside of Canada.

Consider the level of engagement

Whether doctors choose to engage in social media or not, they cannot ignore the implications.

If you are not active on social media, you should consider:

  • Learning enough about it to understand the implications for your patients, colleagues, and other members of the healthcare team.
  • Making an assessment of the potential benefits and risks, and being prepared to explain your decision to not participate to patients, colleagues, and others.
  • Recognizing that even if you're not participating, what you say or do can still be shared online.
  • Developing a social media policy for your practice and sharing it with your staff and patients. Stating that you're not engaging may help manage the expectations of staff and patients.
  • Determining if it is worthwhile to monitor what is said online about you and your practice.

Engaging on social media — on a personal basis

  • Recognize that delineating your personal and professional life on social media is often difficult, but you will want to separate the two as much as possible.
  • Act on social media as you would in your personal and professional life (virtual behaviour should mirror real-life behaviour).6 Compassion, respect, and integrity also belong on social media.
  • Do not "friend" patients on social media sites, as it becomes difficult to separate professional activities from personal ones. Just as with in-person consultations, remember that professional boundaries also apply to social media.
  • Recognize that irrespective of privacy settings, most of what is shared on social media is accessible broadly.
  • Appreciate the implications of what you share, albeit personal, to your professional life, as the two are often blurred.
  • Recognize the permanency of what is shared on social media and the difficulty in retracting or removing content.
  • Monitor what is said on social media about you and be prepared to correct or interject when and if appropriate.
  • Review and comply with your College guidance on the use of social media.

Engaging on social media — on a professional basis

  • Assess and determine which social media sites align with your objectives (e.g. blogs for sharing healthy lifestyle tips; Twitter to provide timely updates; Facebook to network; YouTube to post educational videos).
  • Establish guidelines on the use of social media, including the expectations for your staff. Make your guidelines known to patients, colleagues, and other healthcare providers.
  • Determine if you are the only contributor or if others will support your social media activities. Establish protocols for passwords and renew them often, to avoid misappropriation of your social media identity.
  • Recognize that your activities on social media are an extension of your professional activities.
  • Establish measures to ensure that patients' personal health information remains private and confidential, unless patients have provided consent.
  • Maintain appropriate professional boundaries and ensure that medical information posted is not seen as establishing a therapeutic relationship with online users.7 Information should remain general and geared to broad-based issues (e.g. vaccination).
  • Media are often leveraging social media to identify opinion leaders or experts on specific topics — determining ahead of time your interest, preparedness, and availability for media interviews will be helpful.
  • Recognize the permanency of what is shared on social media and the difficulty in retracting or removing content.
  • Monitor what is said on your social media site and be prepared to correct or interject when and if appropriate.
  • Review and comply with your College's policies or guidelines on the use of social media.

The value remains

Social media can be a powerful platform to improve healthcare decisions, share knowledge, and promote adherence to healthy lifestyles. When managed effectively, it can contribute to beneficial exchanges of information. Its full potential has yet to be realized and despite its well-recognized pitfalls, the value of social media remains.

Suggestions to help you get started on social media8:

  1. Learn about the various sites and determine which one will help you reach your intended audience. Different platforms serve different purposes. Set social media objectives for yourself and select the appropriate platform(s) to achieve them.
  2. Become familiar with the security settings and policies. Before benefiting from the information you'll find on social media, educate yourself on the security settings for each platform and the social media policies that pertain to your organization.
  3. Join, listen, learn. Before engaging, create a profile on Twitter and Facebook, for instance, and observe the conversations.
  4. Learn to manage your social media time. The amount of information shared on social media can be overwhelming. Learn how to filter what is relevant to you to make it more manageable.



References

  1. Pearson Learning Solutions. "Teaching, Learning, and Sharing: How Today's Higher Education Faculty Use Social Media," 2011. Accessed on May 24, 2014 from: http://files.eric.ed.gov/fulltext/ED535130.pdf
  2. College of Physicians and Surgeons of British Columbia, Professional Standards and Guidelines, Social Media and Online Networking Forums, September 2010. Accessed on June 5, 2014 from: https://www.cpsbc.ca/files/pdf/PSG-Social-Media-and-Online-Networking-Forums.pdf
  3. Bahner, David, Adkins, Eric, Patel, Nilesh, Donley, Chad, Nagel, Rolllin, Kman, Nicholas, "How we use social media to supplement novel curriculum in medical education," Medical Teacher, (2012) Vol. 34 No.6. Accessed on May 23, 2014, from: http://informahealthcare.com/doi/abs/10.3109/0142159X.2012.668245
  4. Chen, Xueyu, Siu, Lillian, "Impact of the Media and Internet on Oncology: Survey of Cancer Patients and Oncologists in Canada," Journal of Clinical Oncology, (December 1, 2001) Vol. 19 No.23. Accessed on May 23, 2014 from: http://jco.ascopubs.org/content/19/23/4291.short
  5. Ibid, Accessed on May 23, 2014 from: http://jco.ascopubs.org/content/19/23/4291.short
  6. Canadian Medical Association, "Social media and Canadian physicians – issues and rules of engagement." Accessed on May 23, 2014 from: http://www.cma.ca/advocacy/social-media-canadian-physicians
  7. College of Physicians and Surgeons of British Columbia, Professional Standards and Guidelines, Social Media and Online Networking Forums, September 2010. Accessed on June 5, 2014 from: https://www.cpsbc.ca/files/pdf/PSG-Social-Media-and-Online-Networking-Forums.pdf
  8. Royal College of Physicians and Surgeons of Canada. "Is your practice social media savvy? Four tips to get you started!," Dialogue, (January 2014) Vol. 14, No.1. Accessed on April 30, 2014 from: http://www.royalcollege.ca/portal/page/portal/rc/resources/publications/dialogue/vol14_1/social_media

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.