Despite its potential to improve healthy behaviors, connect sick patients with resources to learn about treatment, enable authorities to respond to public health emergencies and increase reporting time of healthcare-related complications, irresponsible use of social media can cause enormous problems for healthcare professionals.
"The use of social media in the healthcare setting raises a number of professionalism issues including concerns related to privacy and confidentiality; professional boundaries; recruitment; the integrity, accountability and trustworthiness of healthcare professionals; and the line between professional and personal identity," wrote the authors of an AMA Journal of Ethics article.
The Chicago-based Loyola University researchers highlight five use cases throughout the article that illustrate how easily physicians and other healthcare professionals can run into snags when engaging in social media. Something as seemingly innocent as a political opinion, a shared photo, or using a search engine could cross an ethical or legal line, they wrote.
The researchers provide the following five scenarios to illustrate conundrums healthcare professionals might run into when using social media:
1. The Global Health Student: A medical student is on an immersion trip to the Dominican Republic during the summer after her first year. She wishes to document her experience with the patients she encounters by photographing them in the clinical setting. She speaks fluent Spanish and asks for verbal consent from a patient to take her picture before doing so. She does not tell the patient what she plans to do with it. She uploads the photo to her Facebook account, describing the patient's clinical issues.
2. The Tweeting Physician: A physician who works in a private practice is openly critical of healthcare reform. He tweets: "I don't support Obamacare or Obama; patients who voted for him can seek care elsewhere." His colleagues are concerned his political views may hurt their practice; moreover, they wonder if it's ethical for a physician to refuse to see someone because of his or her political views.
3. The Googling Program Director: A residency program director is overwhelmed with resident applications. He has started to search applicants on Google to learn about their online identities. He discovers a few of the applicants have photos on their Facebook profiles that show them in an unflattering light. One is holding a drink at a party, appearing to be inebriated. Most disturbing is one set of photos in which the students (and even some physicians) are brandishing weapons on what appears to be an international immersion trip.
4. Connecting on LinkedIn: A young pediatrician has recently finished his training and is now a newly minted attending physician. He is building his practice and has active accounts with Facebook and LinkedIn. A mother of one of his patients has recently sent a request to be his "friend" on Facebook. He declines this friend request, believing this may impair his clinical judgment. He wonders, however, if it would be appropriate to connect with this patient's mother through LinkedIn, since it is a site for professional networking as opposed to personal friendships.
5. Patient Targeted Googling: A physician treating an elderly woman for shortness of breath began looking for the cause of her worsening condition. He sent for a drug screen, on which she tested positive for cocaine. She told him she had no idea how cocaine could be in her system, which made him concerned she might be a victim of abuse. One of the nurses involved in her care Googled her and discovered that she had a previous police record for cocaine possession.
In addition to providing case-by-case insight on the five instances they outline, the authors include general guidelines to have in place that will help mitigate any potential problematic social media uses:
1. Have a clear understanding of local, state and national laws concerning privacy.
2. Have a working knowledge of professional society guidelines.
3. Know your institutional culture.
4. Be prepared to make changes to stay current with the rapid developments in technology.
5. Circulate policies, including updates, in writing to all who are required to abide by them.
6. Differentiate between guidelines for education and guidelines for practice, if appropriate.
7. Educate all (students, staff and faculty) about the policies.
"As healthcare professionals, we all need to accept, adapt and amend policies, practices and professional obligations to use social media with good outcomes and avoid the bad or even the ugly," the authors wrote.