Social Media Ethics for Medical Professionals

ethics

From Twitter to LinkedIn, every single one of us use social media every day. While using social media is not an obligation (obviously), imagine how you would be surprised by someone who has no social media account. Our posts on social media are meant to be there forever, carefully protected from deletion by Terms and Conditions of the social media site we used. Once you shared a post, it takes its place in the digital world as our footprint. “Who cares?”, you might ask. Well, the answer is EVERYBODY. Employers routinely check social media accounts of the individuals to grasp an opportunity to “reveal” their identities and and use this data in recruitment processes. Advertising companies are using our “share/like” data to select  “suitable” ad contents for us. States constantly monitor the soical media contents of their citizens.

In one sense, social media profiles are like the diaries of the past. However, there is a fundamental difference: While diaries are meant to be a confidante of the individual, social media “diaries” are notoriously verbose speakers ready to ruin us.

Statements

American Medical Association’s (AMA)  “Professionalism in the Use of Social Media” webpage emphasizes some basic (yet vital) rules. They can be summarized as follows:

  1. Physicians should be aware of patient privacy standards at all times, and must refrain from posting identifiable patient information online.
  2. When using social media for educational purposes or to exchange information professionally with other physicians, follow ethics guidance regarding confidentiality, privacy and informed consent.
  3. Physicians should use privacy settings to safeguard personal information and content to the extent possible, but should realize that once on the internet, content is likely there permanently. Thus, physicians should routinely monitor their own internet presence to ensure that the personal and professional information about them is accurate and appropriate.
  4. If physicians interact with patients on the internet, they must maintain appropriate boundaries of the patient-physician relationship.
  5. Physicians should consider separating personal and professional content online.
  6. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to advise against it. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.
  7. Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students) and can undermine public trust in the medical profession.

World Medical Association (WMA) issued a statement on the professional and ethical use of social media in 2011 which has some additions to the rules mentioned above:

  1. Physicians should study carefully and understand the privacy provisions of social networking sites, bearing in mind their limitations.
  2. Physicians should consider the intended audience and assess whether it is technically feasible to restrict access to the content to pre-defined individuals or groups.
  3. Physicians should adopt a conservative approach when disclosing personal information as patients can access the profile. The professional boundaries that should exist between the physician and the patient can thereby be blurred. Physicians should acknowledge the potential associated risks of social media and accept them, and carefully select the recipients and privacy settings.
  4. Physicians should provide factual and concise information, declare any conflicts of interest and adopt a sober tone when discussing professional matters.
  5. Physicians should draw the attention of medical students and physicians to the fact that online posting may contribute also to the public perception of the profession.
  6. Physicians should consider the inclusion of educational programs with relevant case studies and appropriate guidelines in medical curricula and continuing medical education.

British Medical Association’s (BMA) “Ethics of Social Media Use” page has detailed information on both benefits and risks of social media. Its “Social Media, Ethics and Professionalism Guidance” emphasizes the arguably most important reminder: “You are still a doctor or medical student on social media”. Touché!

Tips from Experts

The rules and codes are of course very important in theory. However, experts in this field will know best how to apply them in practice. For this article, we asked the leading names of the #FOAMed World the following question: “What is your FIRST RULE while using social media?”

Here are their answers:

Skin in The Game

“If you haven’t somehow got skin in the game, your opinion is probably worthless and/or unwanted.”

– Karim Brohi [*]

Stick to the Science

“Dr. Sapna Kudchadkar’s basic Twitter rules applies to all social media.

Always remember “a tweet is forever” it does not disappear.

Stick to the science and be collegial are my rules.”

-Yonca Bulut [*]

Dr. Sapna Kudchadkar’s Basic Twitter Rules

“Don’t ever give specific medical advice or try to diagnose online.

Don’t write about actual patients or cases.

Don’t ever sacrifice collegiality due to a difference of opinion.

Don’t forget to cite the source.

Don’t tweet slides of unpublished data.”

-Dr. Sapna Kudchadkar

No regrets!

“I never post anything I might regret in the future.”

-Shanta W. [*]

Vice Versa

“Don’t just try to project the best version of yourself on social media. Try to become more like the better version of yourself that you want to project on social media.”

-Elias Jaffa [*]

THINK

“One word: THINK. T: Is it true? H: Is it helpful? I: Is it inspiring? N: Is it necessary? K: Is it kind?”

-Manrique Umana McDermott [*]

Know the Rules

“So many important things to consider….one of the bigger ones is know your institution’s rules and guidelines… Most have them—some are strict and some aren’t. But know the rules. Many institutions literally have someone assigned to watch social media output among employees.”

-Rob Rogers [*]

A Force for Good

“Be a force for good in the world. Don’t say anything you wouldnt say in front of my mother & chair.”

-Seth Trueger [*]

Once You Write…

“Every single letter is a long lasting prey of the web.”

-Nicolas Peschanski [*]

Not an Online Hospital

“1- Patient privacy rules are also valid here.

2- Social media is not an online hospital.

3- Social media is not a scientific journal.

4- Social media is not a suitable platform to debate with colleagues.”

-Fatih Beşer

Think Before You Speak

“The best tweets are the ones you don’t ever send. You should consider not sending the vast majority of tweets.”

-Bruce Lambert [*]

Conclusion

“What should I be known for?” A social media account that you have shaped around this simple question will undoubtedly lead to incredible opportunities. In any case, there is no escape from using social media.

By carefully reading and implementing the rules mentioned in this post, you can prevent social media from doing you more harm than good.

Cite this article as: Ibrahim Sarbay, Turkey, "Social Media Ethics for Medical Professionals," in International Emergency Medicine Education Project, April 26, 2021, https://iem-student.org/2021/04/26/social-media-ethics-for-medical-professionals/, date accessed: December 7, 2022

Professionalism and social media

Some reflections by Dr. Amila Punyadasa

It seems like nearly everyone, certainly from the Generations Y and Z, is using Facebook or Twitter these days for one reason or another. Although not a fan myself, I do concede that when used with prudence, social media and the Internet is an invaluable resource for teaching and learning. It can support physicians’ personal expression, improve camaraderie and improve the dissemination of public health messages. Equally, it risks broadcasting unprofessional content online that reflects poorly on individuals, their affiliated institutions, and the medical profession alike.

Just saw an 18-year-old unmarried G5P0, with Chlamydia, herpes, and gonorrhea. Disgusting!

Hypothetical tweet

Physicians' SOCIAL MEDIA USE

 physicians must be cognizant of patient confidentiality and privacy and monitor their Internet presence

For example, let us consider a hypothetical tweet from a female doctor to her colleague describing a recent patient: ‘Just saw an 18-year-old unmarried G5P0, with Chlamydia, herpes, and gonorrhea. Disgusting!’ This tweet would have contravened a few of Wilkinsons (2009) so-called ‘behaviors inherent to good medical professionalism.’ This doctor should have had “respect for her patients’ diversity” and shouldn’t have been so judgmental (in this case, about the patients alleged sexual promiscuity and lifestyle). She also should have upheld patient confidentiality (as although the patient’s name wasn’t tweeted, the descriptors used about her obstetric and sexual histories would surely have made her easily identifiable amongst her friends and family who might have come across this tweet). The doctor should have, in my opinion, had better regard for professional boundaries and exercised greater judgment and discretion.

Defining unprofessionalism online and policing it has been challenging. However, with the increase in awareness of such occurrences, regulatory bodies have published various documents in an attempt to regulate physician’s activities on social media sites. The General Medical Council (GMC) has attempted to do exactly this with its paper. It warns against the blurring of boundaries between ones public and private lives and advices that privacy on these sites cannot be guaranteed. Furthermore, it stresses that physicians must be careful with regards to patient confidentiality, elaborating that although one piece of information may not breach confidentiality by itself, together, a few may certainly do so.

In summary, physicians must be cognizant of patient confidentiality and privacy and monitor their Internet presence to ensure that information posted is both accurate and appropriate. With regards to interaction with patients through social media, again, this interaction should fall within the boundaries of established professional norms. If a physician feels that such an interaction transgresses such norms, he/she should report the matter to the relevant authorities. Finally, it is imperative that physicians realize that inappropriate online interactions may have a negative impact on their reputations and that of their institutions, career advancements, and, perhaps most damning, may serve to undermine public trust in the medical profession as a whole.

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References