Guidelines for Social Media Use Released by ACOG

Ken Terry

January 30, 2015

The American Congress of Obstetricians and Gynecologists (ACOG) has become one of the first medical specialty societies to issue guidelines on physicians' use of social media. Other guidelines are available from state medical boards, and the American Medical Association released a statement on the topic in 2010.

The ACOG report, published in the February issue of Obstetrics & Gynecology, was written by the society's committee on professional liability. Unsurprisingly, the legal risks for online activities are a prominent feature of the guidelines.

The report points out that some physicians may give medical advice on Facebook to people who are not their patients. Although they might feel comfortable about doing that in a face-to-face conversation with an acquaintance, providing medical advice online might establish a physician–patient relationship, the report notes. Therefore, ACOG recommends that physicians not give medical advice online to nonpatients.

All online and digital communications between physicians and patients, the report says, should conform with the Health Insurance Portability and Accountability Act (HIPAA) and the standards of professional behavior. ACOG reminds physicians that such communications may be included in the patient's electronic record and would therefore be discoverable in a lawsuit.

How about communications with patients on Facebook, Twitter, or other social media sites? Nathaniel DeNicola, MD, an obstetrician/gynecologist in the University of Pennsylvania Health System, who encouraged ACOG to formulate its social media policy, noted that the HIPAA rules prohibit physicians from disclosing protected health information on a social media site. However, there is nothing to prevent physicians from directing patients to an educational site or a forum that might be able to answer their questions, Dr DeNicola said in an interview with Medscape Medical News.

For example, if a 25-year-old woman wanted to know whether she ought to get a Papanicolaou smear, a physician could direct her to an informational site. "That wouldn't be a HIPAA violation," he said. "It's not medical advice, but medical information."

Clinicians should avoid social media posts about patients or clinical events, even if the patients are not identified by name, the report says. "When scrutinized in the context of an identified practitioner or hospital, the event can be traced back through public statistics data to a specific patient or hospital. Therefore, posting or blogging about specific events or cases is strongly discouraged."

This is a serious enough problem, Dr DeNicola pointed out, that many healthcare systems have barred all work-related posts on social media.

Although several professional societies have recommended that physicians not "friend" their patients on Facebook or other social media sites, ACOG did not take that step because many obstetrician/gynecologists opposed it, Dr DeNicola said.

"In some practices, doctors are friends with their patients outside the doctor–patient relationship," he explained. "So it's perfectly natural for them to be Facebook friends, and even social acquaintances. You don't want to make guidelines too prescriptive; you want to give doctors autonomy to make their own decisions."

Michelle Leiker, JD, senior counsel and vice president of legal affairs for the Wisconsin Medical Society, agrees that the decision on whether to friend patients "is ultimately a decision that the physician needs to make. But if they're going to friend a patient, they need to consider the risks and do what they need to do to manage those," she told Medscape Medical News.

In addition, she cautioned, physicians should not become too friendly with patients on social media, because to do so might lessen their ability to offer good medical advice offline.

She also cited the reputational harm that careless use of social media can wreak. For example, she said, "When physicians post pictures on their social media personal page, they may appear to show themselves drinking or celebrating something. That may lead people to wonder about their capability [as physicians]."

The ACOG report makes a distinction between professional and personal social media profiles. It observes that for some practices, Facebook or Twitter "may serve as a substitute for a professional web page or as an auxiliary platform for other original content, such as a blog." In that case, ACOG says, the physician can adjust security settings to prevent undesired content from being posted on the site and to prevent a professional profile from being "tagged" by other users. This is more difficult to control in the context of a personal profile, which can expose personal information to a larger audience, the report points out.

Twitter is less of a challenge in this respect, noted Dr DeNicola. Physicians can have both social "handles" for their personal interactions and professional handles that they use in their practices. This professional aspect can sometimes be valuable. When one practice temporarily lost its telephone service, he recalled, it sent out tweets to all of the patients who "followed" the practice to let them know the office was still open.

Medical societies, including the American Medical Association and the Wisconsin Medical Society, encourage physicians to maintain separate professional and personal identities to minimize the risks for social media. Nevertheless, Leiker warned physicians to use the privacy settings available on personal Facebook pages.

"Also, think carefully about what you post and what kind of reaction might occur," she said. Because at the end of the day, anything you post on the Internet may be public, and it could paint you in a bad light."

Obstet Gynecol. 2015;125:516-520. Full text

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