The Perils and Pitfalls of Social Networks

Désirée Lie, MD, MSEd


August 26, 2011

Professional Associations Respond

Recognizing the need for clinicians to debrief/vent in appropriate contexts, the Australian College of Critical Care Nurses recommends discussion of appropriate methods with trainees with the recognition of the absolute permanence of electronic communications.[14] The organization also recommends that institutions develop and publish clear institutional criteria for dismissible offenses.

The 2011 summer issue of the Journal of Clinical Ethics focused its attention on the American Medical Association's (AMA's) Council on Ethical and Judicial Affairs (CEJA) recent report on social media and the medical profession. The CEJA report was prepared in response to Policy D-478.985, Physicians and Electronic Social Networking, which was a request from the Medical Students Section that asked the AMA to address the issue of online professionalism. The report recognizes that use of social media can provide benefits, such as an online professional presence, and allows collegial support, fostering of positive relationships, and sharing of views in the public health interest. However, the report also urges physicians to honor the social contract expected of them. The underpinning of the recommendations for physician use of social media is derived from the AMA Code of Medical Ethics, which emphasizes that physicians in positions that do not directly involve patient care should not suspend their ethical obligations.[15]

The 2011 AMA guidelines for the use of social media provide a compass for physicians' online presence. They urge physicians to:

  1. Maintain patient confidentiality and privacy in all environments and refrain from posting identifiable patient information online;

  2. Use the highest privacy settings in social networking sites to protect personal information;

  3. Monitor their own Internet presence to ensure that information posted is accurate and up to date;

  4. Maintain appropriate boundaries with patients online;

  5. Separate personal and professional content online;

  6. Approach colleagues who post inappropriate content and report colleagues who persist in violations to the appropriate authorities if the content is not removed; and

  7. Recognize that online content and actions can impact careers and undermine public trust.[16]

Similar recommendations have been previously endorsed or suggested by others from disciplines that include surgery, psychiatry, internal medicine, and pediatrics.[1,5,10,17]

Some Practical Strategies to Maintain a Safe Online Presence

A number of practical suggestions for the social networking savvy professional can be found in the multitude of articles on this topic available in the literature. Some include:

  1. Conduct periodic Internet searches, akin to credit checking, to correct any online misinformation.[18]

  2. Maintain a healthy skepticism about privacy settings and assume that settings may be changed without notification or that privacy technology may be compromised or breached by hackers.[9]

  3. Recognize that the unintended audience for online postings is exponentially large and online content is permanent.[5]

  4. Avoid engaging in dual relationships with patients (such as "friending" patients on Facebook), which threaten the therapeutic dynamic of the patient-doctor relationship.[9,11,19,20]

  5. Obtain consent for use of all online patient images regardless of whether they are identifiable.[19] Include disclaimer language with all posts such as:
      All patient/s names and identifiable information have been changed to protect their privacy. Additionally, this content was viewed and approved for online use by the patient/s described or depicted.

  6. Involve regulatory agencies such as state boards as needed.

The majority of current expert opinion advises caution in the use of social media, emphasizing that the risks of interacting with patients in online social forums may outweigh potential benefits. In fact, some contend that absolute separation of personal and professional life is virtually impossible and recommend only a professional presence online.[21]


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