The Perils and Pitfalls of Social Networks

Désirée Lie, MD, MSEd

Disclosures

August 26, 2011

A Primer for Responsible Social Networking

What Are Social Networks?

Online social networks are locations on the Internet where one can create a personal profile and connect to others to create a personal network, among the most popular of which are Facebook, Twitter, Friendster, and LinkedIn. Other tools that permit interaction and spread of information include blogs, wikis, and file-sharing sites. Examples of some healthcare-seeking sites used by patients include Medhelp and DailyStrength. Physician rating sites such as 123people use a meta search engine to categorize findings from publicly available records and sites (such as licensing agencies and property tax records) into information clusters that include email addresses, phone numbers, and social network profiles. The use of such networks and sites has exploded in recent years to include a substantial proportion of patients and practicing clinicians.[1]

How Do Physicians Use Social Networks?

A recent study of physician use of Twitter examined the self-identified profiles of 260 physician users and reported that 30% posted 20 tweets within 1 day or less.[2] An analysis found that 3% of tweets were unprofessional; 0.7% violated patient privacy, 0.6% contained profanities, 0.3% included sexually explicit material, and 0.1% included discriminatory statements. The public profiles posted by physicians in this study included their names in 78% of cases, a photograph of themselves in 78%, and a link to a Website in 92% of cases.

A national, randomly stratified survey conducted earlier in 2011 found that 93.5% of medical students, 79.4% of residents, and 41.6% of practicing physicians used online social networks.[3] Practicing physicians were most likely among the 3 groups to have visited the profile of a patient or their family member (15.5%). However, a sizeable majority of respondents, 68.3%, indicated that interacting socially with patients was unethical. The survey also found that patient-doctor interactions within social networks were typically initiated by patients.

A 2009 survey conducted in France found that 73% of residents and fellows had Facebook profiles, with over 90% displaying real names, birth dates, and personal photographs.[4] Among the respondents, 85% reported that they would automatically decline a request by a patient to "friend" them and 15% would decide on an individual basis. Moreover, 76% believed that the patient-doctor relationship would be altered by patients having open access to their doctor's Facebook page.

Landman and colleagues reported that 64% of residents and 22% of faculty in surgical specialties at 1 institution had Facebook accounts, of which half were publicly accessible.[5] A cross-sectional study conducted in New Zealand of 338 recent medical school graduates revealed that 63% had active Facebook accounts. While a majority, 63%, had activated privacy options, among those with publicly available information, 37% revealed the user's sexual orientation, 16% noted religious views, and 43% indicated their relationship status.[6] Almost equal numbers displayed photographs of themselves using alcohol (46%) as included photographs of themselves demonstrating healthy behaviors (45%).

One university in the United States reported 44.5% of residents and medical students using Facebook, with over three quarters including at least 1 personally identifiable piece of information and only a third availing themselves of privacy settings.[7] A significant proportion showed potentially unprofessional behaviors (photographs of intoxication, overt sexuality, and foul language). A 2009 survey of deans at US medical schools found that 60% had experienced incidents of students posting unprofessional content and 13% had found violations of patient confidentiality occurring as a result of online postings by students within the past year.[8]

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