Medical Professionals and Social Networking: The Opportunities, Challenges, and Risks

Due to the remarkable expansion of the Internet over the past decade, the world of medicine has undergone a revolution in the realm of communication. Today, many hospitals and physician practices have their own Web sites, which advertise their services and ultimately make the patient’s experience more favorable. For example, online registration is increasingly common, thereby reducing the administrative burdens encountered by patients when they arrive at a new facility or healthcare provider’s office.

Physicians and their staff s frequently use e-mail rather than the telephone to communicate test results or instructions, and patients can use it to inform their doctors about any new symptoms or treatment-related side effects. With e-mail, it is now possible for patients to send inquiries 24 hours a day and potentially receive a response outside of normal business hours. This strategy is particularly attractive for busy clinicians who can use their non-office hours to respond to patient concerns and questions.

Perhaps even more dramatic than how electronic communication has changed the traditional interactions between physicians and their patients is the ever-expanding quantity of medical information that is accessed directly by patients. The Web sites established by existing health-related organizations, patient advocacy initiatives, and private companies currently provide millions of pages of informational content dealing with individual conditions and patient experiences. Of course, to be complete, it is essential to note that the interpretation of what is being stated on a particular site, its usefulness, and its validity are very diff erent issues from mere availability.

Social Networking and Organized Medicine

Recently added to this explosion of Internet-based communication between healthcare providers and their patients is the complex and evolving world of social networking. With sites such as Facebook and Twitter, the expansion of strategies to rapidly and easily communicate with 1 or many “friends” in cyberspace has been nothing short of spectacular.

Important questions need to be asked in regard to social networking. For instance, how has social networking impacted medicine, and how might this evolve in the future? Are there particular concerns associated with this unique form of communication that healthcare providers, including students and those in training, should fully understand before they elect to participate in 1 or more of these forms of social networking? How can the potential risks be mitigated to help ensure safe and appropriate communication? +

Opportunities for Social Networking

Social networking can benefit physicians, patients, professional groups, and medical students/trainees. The following are a few examples.

Physician-to-physician communication

Physicians can quickly and easily share opinions with peers regarding a specific medical topic. For example, a new paper on a novel treatment of an uncommon cancer may be published in a peer-reviewed journal or an abstract presented at a national or regional scientific meeting. Is the information truly important? Are there serious flaws in the study design? What are the implications for patients currently under the physician’s care or those who will become patients in the near future?

Add to these issues the fact that the media may publish information (that may or may not be accurate) on the study results, and patient-associated Internet sites may similarly announce the findings (which, again, may not be accurate). How should physicians respond if asked by patients how the study results will affect their own care? Rapid communication between a community of interested and knowledgeable physicians may help an individual physician to effectively interpret and subsequently discuss with others (including patients) the implications of this new report. Physicians may use social networking to discuss practice management and other issues not directly related to individual patient care, including healthcare reform or payment for covered Medicare services.

Physician-to-patient communication

Physicians may elect to use social networking to directly communicate with their patients regarding how they personally interpret study results. This ensures that the information quickly reaches the patients. In addition, helpful patient education resources can be shared via the social networking sites.

Professional groups

A growing network of people living with cancer and their families are using social networking for information, support, lobbying, and fund-raising.¹ In one Facebook search in 2008, more than 500 such groups were found. Cancer organizations could band together to provide a type of central clearinghouse for up-to-the-minute information about cancer prevention and control, and to communicate effectively and efficiently with their own members and other organizations.¹

Trainees/students

Trainees or students in professional schools may eff ectively use social networking strategies to share common events or to suggest strategies to survive the rigors of particular experiences (eg, specialty or subspecialty boards, internship year).

Potential Dangers of Social Networking

Unfortunately, it is not difficult to provide examples of the dangers associated with social networking that are relevant to everyone, including all members of the healthcare team (ie,

physicians, nurses, and other support staff ), trainees, and students in health-related professional schools. Two such examples, while not medically related, could just as easily involve medical professionals. In 2009, a 12-year-old boy in California was assaulted by as many as 14 of his middleschool classmates after a Facebook group urged students to beat up redheads.² Anonymous gossip sites on college campuses have targeted individuals with claims (true or not) regarding sexual orientation, detailed descriptions of sexual encounters, and the presence of a sexually transmitted disease.³ The horrific impact on an individual’s life associated with such pronouncements cannot be overstated, regardless of their accuracy.

One report about this sort of situation in medical schools noted a disturbing number of instances in which disciplinary action had been required against medical students due to inappropriate and unprofessional online content that included sexually suggestive material, discriminatory language, and scenes of intoxification.⁴ While the essential principle of freedom of expression must not be forgotten in this discussion, it is critical to acknowledge the fundamental responsibility to society of a medical professional, including students and those in training positions.

This concern also relates to patient privacy. It is one thing to discuss “friends” (hopefully, with their consent) on a Facebook page or during a Twitter exchange, but it is something very different (and unacceptable) to discuss a patient encounter, even if it is believed that the patient will not be able to be identified. Again, the issue here is professional responsibility. Once something is posted on a social networking site, it is simply and permanently in the public domain, a place where private patient-related information does not belong.

Mitigating the Risks of Social Networking

There are ways to guard against the pitfalls of social networking. The following are some methods to consider.

The medical school curriculum

Teaching how to lessen the risks associated with social networking can become part of the curriculum in medical schools. These lessons could include information about such risks, the proper way to use networks, setting privacy controls, and employing patient data.⁵

Regular monitoring

Always be aware of what others can find out about you through Internet searches. In addition, physicians should regularly monitor their own sites or pages to ensure that they do not miss important messages. Those who use their sites to communicate with patients run the risk of missing important information sent from a patient. This could then make them the target of a malpractice suit for not responding.⁶

The line between patients and ‘friends’

Physicians should avoid accepting Facebook “friend” requests from patients and they should also maintain strict privacy settings. Their personal pages should be separate from pages representing their practices so as to not blur the line between patients and friends.⁶

Discussion boards/forums

Be wary of taking advice from physicians on discussion boards, forums, and other such open—and often casual—vehicles of communication. Their suggestions may be outside the standard of care, and it is often difficult to verify that users are who they say they are.⁶

Lack of anonymity

Remember that you should never be anonymous in your postings. And never write negative things about your facility, other physicians, patients, or anyone else who could possibly be identified. Copyright, slander, and libel laws very definitely apply to the Internet.⁶

Conclusion

Social networking has the potential to be a valuable component of medical communication, both from physician to physician and between physicians and their patients. However, it is critical to appreciate the very public nature of such communication strategies, and the fact that being a medical professional requires one to understand the essential obligations of both confidentiality and propriety.

References

1. Briceño AC, Gospodarowicz M, Jadad AR. Fighting cancer with the internet and social networking. Lancet Oncol. 2008;9(11):1037-1038. Available at: www.thelancet.com/journals/lanonc/article/PIIS1470-2045(08)70275-4/fulltext?version. Accessed September 28, 2010.

2. Gorman A. Facebook group suspected in ‘ginger’ assault. Los Angeles Times. November 22, 2009. Available at: http://www.chron.com/disp/story.mpl/nation/6733480.html.

3. Yan S. Colleges fight back against anonymous gossip sites. Time. December 7, 2009. Available at: www.time.com/time/magazine/article/0,9171,1942971,00.html. Accessed September 28, 2010.

4. Chretien KC, Greysen SR, Chretien JP, Kind T. Online posting of unprofessional content by medical students. JAMA. 2009;302(12):1309-1315. Available at: www.ncbi.nlm.nih.gov/sites/entrez/19773566. Accessed September 28, 2010.

5. Harris G. Physicians-in-training should beware the potential impact of social networking site posts on professionalism. American Academy of Family Physicians Web site. Available at: www.aafp.org/online/en/home/publications/news/news-now/opinion/20100407socialnetworkingimpact.html. Accessed September 28, 2010.

6. Berkman ET. Social networking 101 for physicians: managing the risks of Facebook, Twitter, and other social media. Mass Medical Law Report. October 19, 2009. Available at: http://mamedicallaw.com/blog/2009/10/19/social-networking-101-for-physicians. Accessed September 28, 2010.

Maurie Markman, MD, is vice president for clinical research at the University of Texas MD Anderson Cancer Center in Houston.

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