Originally published April 2017
Social media is ubiquitous in enabling personal connections online, and medical-focused professional networks are similarly influential among physicians who want to share information and experiences with colleagues around the world.
These healthcare social networks provide a means for communication and collaboration that would otherwise not be possible, and offer the promise of improved health outcomes for patients. While many physicians and patients embrace the benefits of these online networks, they should also be aware of the potential risks and understand how to mitigate them.
Crowdsourcing diagnoses and treatment solutions
While some may consider healthcare social networks to be part of eHealth or telemedicine, there are notable differences compared to such practices as ePrescribing and eCommunication. The primary distinction is that healthcare social networks are, by definition, social and therefore open to other Internet users.
"Crowdsourcing" is a common objective in healthcare social networks. Crowdsourcing is "the practice of obtaining information or input into a task or project by enlisting the services of a large number of people, either paid or unpaid, typically via the Internet."1
In medical crowdsourcing, responders to a clinical query may be motivated by recognition, curiosity, or simply the satisfaction of collaborating. Financial rewards may also be a motivating factor.2 For patients, medical crowdsourcing offers access to a large pool of medical expertise to diagnose and treat rare or difficult conditions—though patients are generally advised to not act on crowdsourcing opinions or advice, and instead seek their own doctor’s professional judgment.
There are numerous different healthcare social network platforms, though many of their features overlap. Some platforms are targeted specifically at physicians to help diagnose and treat their existing patients. SERMO and Canadian-based Figure 1, for example, allow physicians to upload images and other clinical details of their cases, and other physicians provide responses to help arrive at diagnoses and propose treatments. Other platforms are targeted at patients who seek help with troubling medical conditions from the network’s members which include physicians and other healthcare experts. CrowdMed is a leading platform in this area.
When physicians offer a clinical comment or opinion via a social network, they might be considered to owe the patient a duty of care, even if they have never met the patient. While the law continues to evolve in this area, it is possible that discussing a case over a social network would be seen in the same light as a "corridor consult." Generally speaking, a physician owes a patient a duty of care only when a doctor-patient relationship exists. However, at least one Canadian court has suggested that a physician may owe a duty to provide advice that meets the relevant standard of care even in the absence of a doctor-patient relationship, such as when advice is given in a corridor consult.3
Physicians who offer medical advice on a social network that is likely to be used by patients living outside of Canada might consider including a note that the information being provided may be applicable only in Canada. This will help mitigate the risks of non-Canadians following medical advice that might not be appropriate or relevant. The CMPA will generally not provide assistance with medical-legal matters brought outside of Canada that arise from the publication of information to a non-medical audience.
When using a social network to help diagnose and treat their existing patients, physicians should be cautious about relying on an online opinion, particularly if the identity and reputation of the other individual are unknown. Physicians may want to document in the patient’s medical record an online recommendation that is relied upon, as well as the rationale for a rejection of a particular recommendation on a course of treatment.
While platforms such as CrowdMed reassure physicians they are not legally liable if their suggested diagnoses or treatment solutions turn out to be incorrect—owing to, among other factors, the aggregate nature of experts’ suggestions where no single individual has absolute influence4—such assurances are untested in Canadian courts and cannot be relied upon at the present time. The CMPA is not aware of any legal actions brought in Canada to date involving medical crowdsourcing.
Consent and confidentiality
Physicians who share information about their existing patients on social networks are obligated to protect patient confidentiality. This can be achieved by ensuring that the posted information is properly de-identified, that is, excludes any information or images that might identify a specific patient. While, for example, the Figure 1 platform informs users that, because their images "do not have identifying details about patients and are not attached to any patient information" and consequently are not subject to privacy regulations,5 physicians should nevertheless do their own due diligence to ensure their patients’ health information is not identifiable. Alternatively, physicians should obtain the patient’s express consent to share identifiable personal health information.
Some social networks provide an electronic consent form that patients can sign, and in these instances physicians should ensure the form has been tailored to the legal requirements of their jurisdiction. Canadian physicians may instead choose to use the CMPA’s photo and video consent form [PDF], available on the CMPA website, for this purpose. The consent agreement, which should include a discussion with the patient about the photos and their intended use, should be documented in the medical record. If you are working in a hospital or other institutional setting, you should also familiarize yourself with, and abide by, any relevant policies or procedures that restrict the taking of clinical photos.
Social media platforms typically provide ways to hide confidential information such as automatically detecting faces and blocking or blurring them in uploaded photos, as well as reviewing uploaded images and removing them when necessary. If a patient were to complain to a medical regulatory authority (College) or privacy commissioner, or bring a legal action in relation to a privacy breach, it is uncertain whether the physician’s reliance on the social network’s practices to identify potential confidentiality issues would be considered sufficient.
When a patient seeks medical advice through a crowdsourcing platform such as CrowdMed, it is the patient who initially posts his or her personal health information on the site and agrees to the platform’s terms and conditions. The physicians and other practitioners who offer advice in response to such requests need not seek additional consent from the patient to discuss that patient’s health information within the social platform.
Managing your professional reputation
When using professional social networks, like all social media, keep in mind that you are governed by the same legal and professional standards that would apply in any other professional setting. As the Canadian Medical Association notes, "having an online profile or identifiable presence on social media can have the same degree of positive or negative impact on a physician’s social reputation as being active in any other public venue."6 These standards apply whether or not you choose to be anonymous online and whether or not your identity has been "verified" (i.e. the social platform authenticates your identity by checking publicly available databases of licensed physicians and then displays your verification badge).
Forging a connected future
The CMPA, together with its healthcare partners, encourages physicians to explore innovative approaches to medical care, and to consider their use of professional social networks with prudence. Similarly, the CMPA supports efforts by governments, regulatory authorities, and medical associations/federations to establish the regulatory clarity governing the use of new health technologies, and thereby help physicians to better manage the associated medical-legal risks.
When all parties work together to develop a suitable approach to the appropriate use of emerging technologies, including healthcare social networks, providers can use such tools with the confidence that they are providing the best possible care for their patients and making a positive contribution in healthcare.
- Oxford Dictionaries, Dictionary, Thesaurus, & Grammar [Internet]. [cited 2017 Jan 13]. Available from: https://en.oxforddictionaries.com/
- McCartney P. Crowdsourcing in Healthcare. Am J Matern Child Nurs [Internet]. 2013;38(6):392. Available from: http://journals.lww.com/mcnjournal/Citation/2013/11000/Crowdsourcing_in_Healthcare.15.aspx
- Crawford v. Penney, 2003 CanLII 32636 (ON SC), aff’d 2004 CanLII 22314 (ON CA)
- CrowdMed. Medical Crowdsourcing, What is Crowdsourcing? [Intenet]. [cited 2017 Jan 19]. Available from: https://www.crowdmed.com/faqs
- Figure 1. Frequently Asked Questions [Internet]. [cited 2017 Jan 16]. Available from: https://figure1.com/sections/faq/index.html
- Canadian Medical Association. Social media and Canadian physicians: Issues and rules of engagement [Internet]. 2011;1–5. Available from: http://www.cma.ca/advocacy/social-media-canadian-physicians