The Perils and Pitfalls of Social Networks

Désirée Lie, MD, MSEd


August 26, 2011

Back to the Cases

So what would you do if confronted with one of the 2 situations hypothesized at the beginning of this article? A review of available literature suggests the following responses would be most appropriate:

Case A. The recently published AMA policy titled Professionalism in the Use of Social Media recommends against befriending patients online. The dual role creates the potential for harm in the therapeutic relationship and excessive self-disclosure. Ignoring a patient's friend request may appear to be discourteous to the patient. Therefore, a clinician may choose to explain in person why the online social relationship would be inappropriate. Googling the patient, as was done in this hypothetical case, in order to find out more is outside the boundary of the patient-provider contract, not relevant to the decision to not "friend" the patient, and could be interpreted as an infringement of patient privacy.

Case B. The AMA, as well as other experts, recommends that clinicians monitor themselves and one another for inappropriate online presence or materials. If one finds content that violates patient protection or privacy, he or she should approach the offending individual. Failure to remove the content should prompt a report to an accountability agency. In the case proposed earlier, highly sensitive patient information was shared through an online forum without the patient's consent. The physician who posted the information may have felt that the urgency of the situation justified the online call for expert opinion. He should be asked to refrain from similar future privacy violations -- and advised to use traditional confidential communication channels to seek expert opinion regarding the patient's management.

A recent report found that 100% of US medical schools had Websites, 95% had a Facebook presence, and 10.6% had Twitter accounts.[22] Only 38% of schools had developed explicit written policy about online behaviors and postings; over half encouraged thoughtful and responsible social media use. Example of such policies, including one from the Indiana University School of Medicine can be found online.

The creation of policies that demand accountability from professionals and place limits and consequences on their use of social media beginning during training is a trend that is likely to continue.


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