I wonder how many physicians who used social media for the first time yesterday were aware of the risk they were taking? Did they realize that unprofessional behavior involving social media could actually threaten their license to practice medicine? These thoughts motivated me to blog about the risks of social media that are unique to physicians. My intent is not to cause Henny Penny alarmism and avoidance of social media. After all, I obviously engage in social media for leisure as a practicing physician myself and enjoy it very much. Instead, I want my colleagues to feel confident using social media, but with full awareness of the inherent risks, all of which are manageable including many that are avoidable.
I'm just sayin'...
Social Networking Risks
Social networking sites will often publically display personal identifying information unless one actively omits them from public view including home address, e-mail addresses, home phone number, mobile phone number, race, religious preferences, sexual orientation and political views. Also, when you associate with someone on a social networking site you provide them access to personal content that is not available to others on your public page. The personal content could include personal identifying information, pictures, personal messages and even messages posted to your page from other people.
A recent survey (JAMA. 2009;302(12):1309-1315) revealed that a significant number of medical students have personal Facebook accounts with personal identifying information available to the public. In addition to this privacy exposure, some had also posted unprofessional content on Facebook such as:
- Violations of patient confidentiality
- Pictures of illicit drug use or unethical behaviors
- Use of profanity
- Use of sexually-suggestive language
- Criticisms of other people or institutions
- Satirical or sarcastic material
Posting unprofessional content on a social media website could be judged by a credentialing body, such as the Texas Medical Board, as a reason for disciplinary action that could place the physician’s license to practice medicine at risk.
Social Networking Risk Management
“Unprofessional content” can be defined to be any content that shows, implies or suggests that a physician has failed to adhere to professional behavior. Content posted on a social media site that explicitly shows a physician engaged in illegal or unethical behavior is obviously unprofessional. But how can physicians distinguish the border that separates "acceptable" content from "unprofessional" content?
Consider the core curriculum on “Professionalism” that the Accreditation Council for Graduate Medical Education (ACGME) uses for physicians-in-training. This curriculum includes training on professional behavior in areas such as:
- Compassion, integrity, and respect for others
- Responsiveness to patient needs that supersedes self-interest
- Respect for patient privacy and autonomy
- Accountability to patients, society and the profession
- Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
The line that distinguishes sensitivity from insensitivity to human diversities is perhaps the most difficult one for physicians to discern when communicating on the Internet. Content that includes insensitive comments on gender or other human diversities falls into the category of unprofessional behavior. Unfortunately, the diverseness of individuals and cultures can sometimes make it very difficult to anticipate a perception of insensitivity. The best advice is to avoid comments that have even a remote possibility of offending someone.
Also, physicians who understand and adhere to patient confidentiality in their daily practice will be vulnerable to breaches of privacy when using social media if they fail to understand the lack of anonymity when using social media sites and the permanence of any content they post. In spite of using “alias” names, no one is really anonymous on the Internet. There are many examples of people (including doctors) who presumed anonymity but ended up with serious legal difficulties. The permanence of posted content is due to the nature of social media. Even if one deletes their entry, it is possible that other social media sites have already linked to that content and/or reposted it elsewhere.
The bottom line is that physicians should realize that whatever they write on the Internet not only is permanent, but is also traceable to their actual identity. Physicians are wise to gain more insights on social media risk management by discussing it with their personal lawyers and seeking information from their professional organizations and journals (such as these articles from the American Medical Association and New England Journal of Medicine).
I'm just sayin'.