Social media is ubiquitous in today’s society. It is a means of communication, education, entertainment, advertisement and networking. But the use of social media is not without risk, especially for psychiatrists.
As you consider what presence you want to have on any social media platform, you need to consider the pros and the cons of using this technology.
Let’s start with the positive aspects of psychiatrists’ use of social media.
Social media is a form “of electronic communication[s] (as Web sites for social networking and micro blogging) through which users create online communities to share information, ideas, personal messages, and other content (such as videos).”1 Popular social media sites such as Facebook, LinkedIn, Twitter and Instagram can be a means of communication among patients and with patients and also a means for patient engagement. Email as the “grandfather” of electronic communication is also a form of social networking. Email is becoming more and more widely used with patients and their parents/guardians, often for scheduling purposes.
Social media may provide a means to educate your patients, their parents/guardians, and the community on health-related topics, such as specific psychiatric diagnoses. Patients and their parents/guardians increasingly turn to the internet and social media to learn about their diagnoses, treatments and physicians.
While few psychiatrists use social media for direct marketing to patients and their parents/guardians, your presence on social media is an inexpensive means of describing the scope of your services to a large audience. Use your website to post positive patient comments, keeping the patient de-identified, to promote awards and accreditations received and to highlight your community service efforts. It is important to be aware that when treating minors and if using patients comments, to obtain legal consent from the appropriate person when indicated.
Social media is a valuable tool for communicating and collaborating with your colleagues on disease prevention, diagnosis and treatment. Social media provides the opportunity for you and other physicians to form groups with similar interests and to share resources with professional colleagues. Professional networking sites such as LinkedIn allow you to connect with providers in other fields for potential referrals. In addition, listservs can also be a method in which doctors communicate with colleagues about patients or particular diagnoses/interests. Social media is a useful tool for communication and collaboration with colleagues both near and far.
But we cannot fail to recognize the risks of using social media.
Patient Privacy and Confidentiality
Privacy, security and liability expectations for patient communication are grounded in HIPAA, state privacy laws, federal requirements and professional responsibility requirements. Even with privacy settings and encryption, you cannot assume that communications on social media are private. As we read on an almost daily basis, communications can be hacked and privacy violated.
Patients are entitled to confidentiality and privacy no matter the form of social media outlet you use.
Psychiatrists now have access to the personal lives of their patients, which include information not shared with them by their patients or information the patients do not want to reveal. Whether psychiatrists should interact with a patient through a social media forum such as Facebook or via a connection on LinkedIn is an ongoing debate. One school of thought is that social media may be a rich source of information about your patient’s behavior outside their communication in the office. Whether the postings of what the patient is feeling or thinking are always accurate is questionable, however.
Should you want to use the information you obtain via social media in treatment, its source would need to be disclosed; how the patient would respond to your having information they may consider “off-limits” to you may be difficult to anticipate.
Another school of thought is that accepting a “friend” request on Facebook or connection via LinkedIn is seen as a potential boundary crossing, impacting the privacy of both the patient and the physician. Accepting a patient “friend” or LinkedIn request also gives rise to ethical professional integrity concerns as well as the impact on the patient relationship if the communications or online activities are perceived as inappropriate.
Psychiatrists are being approached about their interest in setting up a business account on sites like Yelp. While you may consider this a source of marketing, giving your patients this vehicle for checking into your practice could potentially violate their privacy and confidentiality.
What you post on any social media site reflects your personal and professional reputation. Anything and everything you post online has the potential to go viral. Even if you or your staff consider venting about a patient online, thinking that the patient would remain anonymous, and you remove the post immediately, the damage has been done.
Online communication can give rise to potential libel and defamation claims. Online entries and social media communications are potentially discoverable and subject to e-discovery (electronic discovery) rules. In brief, the e-discovery rules require a duty to preserve relevant or potentially relevant information once litigation is pending or reasonably anticipated as long as it is in your custody or control.
Risk Management Strategies
When using social media, consider these risk management strategies.
- First and foremost, keep your professional and personal lives separate. Limit access to your Facebook page and Twitter account to just your family and very close friends. Set all of your communication to the highest privacy settings. Keep in mind that anything you say on Facebook or other social media may not be private and may be discoverable in litigation.It is also important for your friends and family to know that they should not post any information about you on their social networking sites.
- Think before you post, especially if venting about a patient or posting other confidential information, then think again and pause before you act. Failure to use professional judgment in online forums leads to doubts in the public about the privacy of their communications with you, raises the public’s level of reluctance to speak frankly with their healthcare providers, and shakes patients’ trust in the medical system.
- Assume any pictures, videos, or comments you share with colleagues will reach other eyes and ears. Ensure that the electronic systems for authorized disclosure and sharing are secure for both the sender and the recipient. However, even with secure systems, once an image or recording has been sent from one person to another, you may no longer control where it might go next, or where it will end up.
If you do not have permission, or if what you are sharing is not about a patient’s clinical issues, then do not post it on a networking site. After all, given the technical capabilities available, such as face recognition and triangulation, it is best to assume that all patients are identifiable, even if you keep names and information anonymous.
- Determine the clinical reason to check out your patient’s use of social media and obtain his consent before you do so. The patient may not wish for you to have access to information about them outside the therapeutic relationship. Your searching social media sites for patient information may be perceived as curiosity, self-interest or even stalking. Be aware of the rules on when it may be necessary to break confidentiality, know when you may be able to address with the patient’s parents/guardian if you see something concerning on the patient’s social media page.
- Ensure that your email system is encrypted for patient communication. Obtain informed consent regarding the potential risks with the use of email, including potential violation of patient confidentiality, the need for use of the patient’s personal, not work, account, and that all email communication will be retained as part of the patient’s medical record.
- Decline your patients’ request to become a “friend” on Facebook or a connection on LinkedIn to preserve the appropriate patient-physician boundaries. The reasons for refusing to accept these offers should be discussed and declined in person during your session. The face-to-face discussion is a means of educating the patient on the boundary concerns and reduces the risk of the patient feelings of abandonment by a “virtual” rejection.
- Implement a social media policy for your office practice, including that no member of the staff: 1) is allowed to post any patient’s personal health information on their personal social media sites; 2) is authorized to post any proprietary or confidential information about the practice on their personal website; 3) may cyber bully or harass a fellow employee via their personal social media site. Explicit policies can easily be created to guide employees on the dos and don’ts when using social media. Be sure that employees understand and acknowledge that they are not speaking on behalf of your practice when posting on their personal site.
Having the policy that no member of the staff is allowed to “friend” a patient or member of his family will establish boundaries for the staff and provide a uniform response for the staff that they are not allowed to do so when a patient makes the request.
- Consider adding a broad disclaimer statement that the information posted on your social media site should not be considered medical advice and the users seeking specific medical advice should contact their physician or call 911 in case of an emergency.
- Do not respond directly to patients or their parents/guardians who post negative comments about you on their social media sites. Under HIPAA you are not allowed to acknowledge the patient is in your practice. Consider developing a response to negative comments, such as “we encourage patients with a concern or complaint to contact us so we can address their issues privately.”
However, you should contact legal counsel or the police if a patient threatens an individual or breaks other laws when posting information on social media sites.
- Review and implement the guidelines on online medical professionalism issued by the professional associations such as the American College of Physicians and the Federation of State Medical Boards in April 2013.
Use of social media brings to mind the words from The Tale of Two Cities: “It was the best of times. It was the worst of times.” Make your use of social media the best of your time, reputation and your professional career.
2 American College of Physicians Ethics, Professionalism and Human Rights Committee; American College of Physicians Council of Associates; Federation of State Medical Boards Special Committee on Ethics and Professionalism. Online Medical Professionalism: Patient and Public Relationships: Policy Statement from the American College of Physicians and the Federation of State Medical Boards. Ann Intern Med. 2013; 158:620-627. http://annals.org/article.aspx?articleid=1675927
3 American Medical Association. Opinion 9.124. Professionalism in the Use of Social Media. Code of Medical Ethics. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page
4 APA Principles of Medical Ethics, Section 4, article 3: http://www.psych.org/MainMenu/PsychiatricPractice/Ethics/ResourcesStandards.
5 Mayo Clinic Center for Social Media: http://socialmedia.mayoclinic.org