10 Ways Doctors Lose Patients and Respect on Social Media

Michael Woo-Ming, MD, MPH

January 07, 2020

Editor’s Note: This article is adapted from the Medscape Physician Business Academy course, Doctors and the Internet: Boost Your Reputation and Career.

Some doctors stay away from social media because they see numerous potential risks.

Physicians in particular are vulnerable on social media. They face strict restrictions on patient privacy, the need to present absolutely correct medical information, and pressure to present a public image that is above reproach.

However, these concerns don't mean you have to give up on social media. They just mean that you need to understand the specific risks and take measures against them.

With social media, more than ever, people need to exercise discretion. You can surmise most of the precautions you should take by using common sense. Always take a moment to think about the implications of what you are about to do.

Here are some of the common social media pitfalls for doctors:

1. Not Recognizing the Viral Nature of Social Media

Social media operates like a megaphone. It can amplify a stray comment across many channels, go viral, and suddenly reach tens of thousands of people.

Any mistake or misstatement you make can be very hard to erase. You can take down an ill-conceived post, but it may already be too late. It may have been passed along in screenshots and other means.

For example, a St. Louis ob-gyn complained on Facebook about a particular patient's tardiness with appointments. Someone posted a screenshot of the physician's post to her hospital's Facebook page, and many patients reacted. The hospital determined that her comments did not violate the patient's privacy and she kept her job, but her very public comments made her look bad.

2. Violating Patients' Privacy

Social media's emphasis on being transparent and personal provides many opportunities for a patient's privacy to be violated. Risky situations include crowdsourcing the diagnosis of a patient with colleagues, highlighting patients' cases on a practice website, and posting photos where a patient's face or patient information inadvertently shows up in the background.

Potential violations happen fairly often. In a study of 271 medical blogs written by doctors and nurses, 45 (16.6%) gave sufficient information for patients to identify their doctors or themselves. Three of the blogs showed recognizable images of patients.

You can violate privacy without making any obvious identification, such as a patient's name or face. Patients can be identified when connected to an unusual accident, a rare condition, or admission to a certain hospital or unit. In addition to violating the Health Insurance Portability and Accountability Act (HIPAA) or a state privacy law, these breaches can prompt an action by the state medical board and even result in the loss of your job.

Several years ago, a doctor posted her frustrations with a trauma patient. Although she did not name him, she gave enough information to identify him. As a result, she was fired from the hospital, reprimanded by the state medical board, and fined $500.

It's a good idea not to refer to a particular patient at all, but if you must do so, eliminate such specifics as the patient's age, the name of the hospital, or the circumstances of an accident. If you are concerned that the person's identity could still be revealed, such as with a rare condition, don't use social media; instead, send the information directly to a specific colleague.

When physicians share radiologic images or dermatologic samples of patients, they must remove all identification from them, including written remarks, birthmarks, scars, tattoos, jewelry, and unique surroundings.

If you want to identify your patients for marketing or other purposes, you'll need their written consent. The consent form should include the purpose of the identification, who is authorized to make it and when, information on patient's right to revoke the authorization, and the patient's signature. Have an attorney approve the wording.

3. Responding to Patients' "Friend" Requests

Patients occasionally send Facebook friend requests to their doctors, and doctors may regret having to turn them down. After all, having a positive relationship with your physician promotes confidence, encourages compliance with treatment, and may even aid healing.

In one study about doctors receiving friend requests, 42% said they would not always reject them. But having a patient on your personal Facebook page is never a good idea. On your page, they could reach anyone in your network of friends, view your personal photographs, or read your personal blog.

These patients could also begin asking you for medical advice, which could lead to a HIPAA violation. Or perhaps they might seek a romantic relationship, which, if not stopped, could prompt disciplinary action by your medical board.

The solution is to set up two Facebook pages: one that is private for your family and friends, and one that is professional for your patients and the general public. You can take similar steps on other social media such as Twitter and Instagram.

4. Giving Specific Medical Advice to Patients

When people respond to your posts providing general advice on treatment, they often ask about their own specific case. It's never wise to respond to these questions. Your reply and subsequent back-and-forth messaging could become a HIPAA violation.

It's also possible that your reply could form the legal basis of a physician–patient relationship. If the patient thinks your advice led to some injury, you might be sued for malpractice.

When patients ask for specific advice, suggest that they come in for an office visit. You can also add a boilerplate statement to your blog that you won't address specific patient care issues through social media.

5. Posting Unprofessional Behavior

On their Facebook pages, some doctors leave comments and photos that show them in an unprofessional light, without thinking about the consequences. They don't seem to realize that patients, employers, and potential employers could view these posts.

In a study of Facebook pages of newly minted urologists, 40% had potentially objectionable content, including profanity, drunkenness, unprofessional behavior at work or meetings, and sexually suggestive poses or clothing.

Think about all the people who might view these posts, and what their reactions might be. In a survey of job recruiters, 55% had reconsidered job candidates on the basis of their social media profiles, usually in an unfavorable way.

The best solution is to simply stop posting such material. However, even fairly innocent photos of a doctor holding a beer can at a professional meeting or hanging out on the beach during a vacation might prompt unfavorable reactions from some patients.

The answer, again, is to have a personal page that is separate from your professional page. On Facebook, you can also adjust your privacy settings, which allow sharing with just a small group of friends. But keep in mind that privacy settings can often be porous.

6. Making Unprofessional Statements on Social Media

Social media is bristling with strong opinions on everything from politics and race to electronic health records. Some people think they are protected by a pseudonym, but it can be fairly easy to detect their identity.

Comments about race or gender, in particular, can go viral and lead to firings or resignations. When a Texas doctor commented that "female physicians do not work as hard," he was forced to give up his leadership positions at a large practice. And when a Colorado anesthesiologist posted racist comments about Michelle Obama, she was forced to resign from her health system.

Some physicians think public posts are an appropriate place to dump on patients. In the study of 271 doctors' blogs, 48 portrayed patients negatively, including one that stated, "She was a stupid, lazy, selfish woman all of which characteristics are personal problems, not medical issues or barriers to care."

Patients don't like negative comments in general, even if they're not directed at them. A recent study found that healthcare professionals who posted even one negative comment on Facebook seemed to have lost credibility among potential patients.

The obvious solution is to stop using social media as your private diary. Keep animosities to yourself. And if you come across a post that is abusive of you, be polite and civil. In many cases, others will come to your defense, and the abusive commenter will drop out of the conversation.

If you find yourself writing a post in anger, set it aside before sending it. Review it after you have calmed down, or have a colleague review it.

7. Violating Employers' Restrictions on Social Media Use

Practices, hospitals, and health systems have all kinds of restrictions on use of social media, and it would be useful for you to know about them before you go to work there. These restrictions may be too onerous if you are a heavy social media user.

Many organizations ban use of social media on workplace computers, and they may actually block access to it on their computers. But they can't block access through your smartphone or laptop, so they set down rules about social media use in general.

Some employers go further and retain the right to take control of your social media activities. The Cleveland Clinic's social media policy, for example, states that it "reserves the right to monitor, prohibit, restrict, block, suspend, terminate, delete, or discontinue your access to any Social Media Site, at any time, without notice and for any reason and in its sole discretion."

Some organizations want you to present material in a certain manner. Massachusetts General Hospital states that although you can post views that are inconsistent with hospital policy, you should not at the same time reveal that you work for the hospital. The hospital also advises to write in the first person and indicate that your statements are your personal opinion.

8. Not Revealing Conflicts of Interest on Social Media

Blog writers rarely disclose conflicts of interest. In a study of blogs written by health professionals, 11% contained endorsement of specific healthcare products, and none of those provided disclosures.

State medical boards see this as a problem. When writing about a product or procedure, "physicians must reveal any existing conflicts of interest and they should be honest about their credentials as a physician," according to the Federation of State Medical Boards.

The Federal Trade Commission also requires disclosure of material connections between advertisers and endorsers, which can take the form of payments or free products.

9. Behavior That Blunts Your Impact

The following social media behavior won't lead to fines or firings, but they can create negative impressions about yourself.

Making it all about you. Some people use social media to talk about themselves — how they felt today and what they had for lunch — and they wonder why no one visits their page.

Social media is about sharing. Remember to post, tag, like, comment, and share your friends' content. Showing interest in others is a good way to get others to show interest in you.

LinkedIn is a great place to give recommendations and endorsements of colleagues. To endorse someone, click on one of the skills that colleagues list on their profiles. Recommendations are long-form endorsements of one's quality of work. In this way, you can create an economy of favors.

Be sure to update your profile. Your profile is an important resource for prospective patients. Outdated practice profiles may create the impression that you're out of touch and may not be worth keeping up with. If your practice has added new doctors and new locations, it's time to update your profile.

Also, make sure all your profiles across social media are consistent. Conflicting information could make your practice look a little sketchy. Potential patients are looking for a practice they can trust.

10. Posting Too Much.

Many busy doctors post too little and don't get a strong following, but there are also people who post too much. If your followers are getting too many posts, they don't have a chance to enjoy each post, and they may begin to ignore your content. Two to three posts a week usually suffices.

Social media presents a variety of considerations that prompt many physicians to steer clear of it. But this new modality has become too important to ignore, and physicians can learn how to avoid its potential pitfalls.

Michael Woo-Ming, MD, MPH, is the CEO of BootstrapMD, a business consultancy for physicians, specializing in digital marketing; and owner of Executive Medical in San Diego, California.

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