Should Physicians Friend or Unfriend Social Media? 'It's Complicated'

Julie Song, MPH, CPHRM, Patient Safety Risk Manager, The Doctors Company
Published: Tuesday, Nov 11, 2014
Julie Song, MPH, CPHRM

Julie Song, MPH, CPHRM

Compared to other industries, the medical profession has been late in recognizing the many benefits of social media. In the past few years, it has entered into an uneasy relationship with the new medium.

On the one hand, social media can be a tool to motivate patients to be more active participants in their healthcare. In specialties like oncology, where having a strong support group is sometimes as important to recovery as treatment, social media has created invaluable communities for information and encouragement.

However, because of confidentiality rules in the Health Insurance Portability and Accountability Act (HIPAA) and potential medical-legal repercussions, the medical community must be cautious when engaging with social media. Healthcare is a profession that is dependent on establishing trust and credibility—and social media has the potential to undermine a strong reputation built over years with one careless post or tweet.

Social media is broadly defined and includes many forms of electronic communication through which users create content for public dissemination. Beyond direct interaction with patients, physicians use social media to collaborate with other physicians and for marketing purposes. Physicians in many of the more elective specialties have embraced social media marketing to set themselves apart in the competitive market.

Physician-to-Patient Engagement

With the plethora of social media platforms available, it is easier than ever to communicate with patients. If a patient sends a friend request to his or her physician through Facebook, the physician may feel pressured to accept the request. But by doing so, the physician is potentially giving the patient access to personal posts, contacts, and pictures—despite privacy controls, it takes constant vigilance to completely separate one’s professional and personal life online.

Those who advocate for physicians interacting with patients through social media are quick to point out that social media is bringing back the days when patients had a personal relationship with their doctor. With the limited time that physicians have to spend with patients in the exam room, interacting with patients through social media might be seen as a way of strengthening the physician-patient relationship. However, liability can result from blurring professional and personal boundaries. In a profession where objectivity is paramount, having a personal relationship with the patient may compromise professional judgment.

Communication with patients either directly or en masse through social media also may lead to HIPAA violations if protected health information (PHI) is revealed online. Penalties for data breaches were increased under the American Recovery and Reinvestment Act. PHI in electronic form must be encrypted to ensure security, but the majority of social media platforms are not capable of encryption. Although the patient may identify himself or herself on social media as a patient of the practice, the physician is held to a different standard. The physician does not have to disclose the patient’s name to violate HIPAA—posting just a few distinguishing characteristics, which might enable another person to figure out the identity of the patient, could be enough to be a violation in itself.

The Federation of State Medical Boards specifically discourages physicians from “interacting with current or past patients on personal social networking sites such as Facebook.”1 The American Medical Association strongly suggests that physicians distinguish their public and professional digital identities.

Even if the physician is aware of the privacy and security concerns with social media, staff training is important.  A physician’s staff could incur liability on behalf of the practice through unprofessional social media activities that portray patients or the practice in a poor light. Because employees are representatives of the practice, their actions could undermine the patient-physician relationship. Ensure that there is a social media policy that is reviewed with all staff members on an annual basis. The social media policy should discourage employees from engaging with patients on social media and should require that employees not mention patient-related matters on their personal social media sites.

Practicing Medicine Across State Lines

In addition to blurring professional and personal boundaries, social media also can create confusion about when the patient-physician relationship is established. Traditionally, the relationship did not begin until the patient presented for an office visit and a full examination occurred.

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