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Healthcare Social Media (#HCSM) Series: Keeping It Professional

Austin Chiang B&W

This article originally appeared on the blog of Austin Chiang, MD, internal medicine resident at New York-Presbyterian Hospital/Columbia University Medical Center in New York City. We’re so excited he’ll be moving to Boston this summer to start his Gastroenterology training at Brigham and Women’s Hospital, a Harvard Medical School-affiliated teaching hospital.

Connect with Dr. Chiang on Medstro, Twitter (@AustinChiangMD), Instagram (@AustinChiangMD), Facebook (AustinChiangMD), or his website!

This is the second entry of this 6-part blog series on Healthcare and Social Media!

  1. #HCSM Series: Listen Up Medical Providers
  2. #HCSM Series: Keeping It Professional
  3. #HCSM Series: For The Patients
  4. #HCSM Series: Impacting Public Health
  5. #HCSM Series: Industry and the FDA
  6. #HCSM Series: Shaping Medical Education

In addition to being informative and collaborative, social media can be a fun venue to chat, share photos, and exchange stories. That said, you may want to take note that what you say or post could potentially be used against you. Who defines the boundaries of professionalism in social media? What is considered acceptable? Beyond patient privacy, what are the other issues that are still heavily debated?

1. Inappropriate content is posted more often than you think

If you think tweets are simply forgotten with time, think again. Tweets are digitally archived by the Library of Congress, so it’s best to exercise some discretion before haphazardly posting information. Moreover, words can often be taken out of context, so beware of how the media can take certain liberties with the content you post online.

Patient privacy and HIPAA compliance are obvious concerns.  One study showed that out of 271 medical blogs, 42% had patient descriptions and 17% had sufficient information to identify patients and 3 blogs even posted recognizable photos of patients (presumably without noting informed consent).

There have been highly publicized instances in the not-so-distant past of physicians on a medical mission to Haiti posting inappropriate photos of themselves with nude patients on the operating table and posing in front of coffins. Medical students have been faulted for breaching confidentiality and “friending” patients on social networks.

Needless to say, these individuals were penalized, but less egregious violations may not be interpreted as such by everyone. While posing with nude, unconscious patients is an obvious no-no, photos exhibiting certain behaviors such as drinking alcohol have been considered inappropriate by some.

2. Who sets boundaries and are there set guidelines?

If anyone is restricting what and how you should be tweeting, it’s your employer, institution, or school. However, even as recently as 2010 (7 years after the outset of Facebook and 4 years after the creation of Twitter), only 13 out of 132 medical schools had published social media policies in their student handbooks.

Between schools and institutions, guidelines are hardly uniform. As expected policies are often developed by administrators, but the medical school at OSU (Ohio State) has policies put forth by their student council. Reviewing a number of institutions, some dedicate 3 to 4 sentences to warning against violating patient privacy or the general code of conduct. Other institutions outline a variety of scenarios and dedicate paragraphs to what should be shared online and how to find resources if there are areas of confusion. For an example of the latter, check out the policies at the Icahn School of Medicine at Mt. Sinai by clicking here.

Professional organizations also have released recommendations, but these too are inconsistent and the focus often differs greatly from one group to another. To illustrate this example, read on…

3. What other concerns are there besides patient privacy?

The AMA has highlighted a number of issues. How do we go about reporting colleagues if we observe something we might view as unprofessional or inappropriate? What is considered reportable? Do we draw the line at alcohol or at drugs? Should activity on private social media accounts be reported?

Furthermore, does an alias render a doctor exempt from these policies? How much should doctors disclose on social media outlets? For instance, do doctors need to disclose pharmaceutical affiliations if they are posting their opinions or information about certain medications?

The ACP and FSMB recommend separating personal and professional identities from the outset. Not everyone is in agreement with this proposition. Some argue that social media involvement is an extension of the “small town physician” identity. What about actual small town doctors where patients are often friends and members of their own tight-knit community?

Two Passports

Some experts recommend separating personal and professional identities, like having 2 passports. This was taken from the fall Massachusetts ACP meeting, Social Media: Keeping it Professional. Left: Andrew Zimolzak, MD, MMSc; Right: Bradley Crotty, MD

4. Some additional challenges that we face with keeping it professional

As social media and mobile health evolve, policies are sure to change as well. However, even if social media was to stay the same, the professional identity is a dynamic one. Doctors are expected to make an immediate transition from patient to doctor and consumer to provider upon graduation from medical school. With every stage of medical training, we take on different responsibilities and become more integrated in the medical system. Likewise, there are often more affiliations to disclose and much more at stake. These transitions make it difficult for physicians to adopt fixed policies.

Now that there is a growing number of physicians on social media platforms, will there come a point that it will become a patient expectation? At that point, can physicians opt out of social media without being viewed as potentially having something to hide?

As these questions are being sorted out, you may want to consult an expert or keep certain things offline if you have second thoughts about whether or not something is up to professional standards. Simply put, when ensuring conduct is in accordance with your institution’s regulations, common sense can go a long way.

Austin Chiang, MD

Austin Chiang, MD

    Dr. Chiang completed his medical education in 2011 at the Columbia University College of Physicians and Surgeons in New York, NY. He continued his training at New York-Presbyterian Hospital, Columbia University Medical Center in New York City where he is currently finishing a residency in Internal Medicine. Under the mentorship of Chief Health and Medical Editor Dr. Richard Besser and managing editor Dan Childs, he contributed briefly to medical stories as a resident member of the ABC News Medical Unit at the ABC News national headquarters in NYC. In the summer of 2014, he will begin his fellowship training in Gastroenterology at Brigham & Women's Hospital, a Harvard Medical School-affiliated teaching hospital in Boston, MA. He hopes to explore his role as a physician not only in the clinical and research settings but also in social media, mass media, and medical innovation.

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