Carefully consider the plentiful risks, concerns
BY STEPHEN CHRIS PAPPAS, MD, JD, FAASLD, FACLM
Social media for gastroenterologists comes with benefits accompanied by pesky risks. The risks are pesky like a mosquito bite: An itching bite is annoying, but getting malaria is serious. Managing your unprofessional tweet to salvage your reputation is going to be annoying. Disclosing a patient's identity on social media is going to be serious; you could find yourself fired, fined, reprimanded, and without hospital privileges, as happened recently to a Rhode Island physician. I divide the risks of social media into legal risks (for example, disclosing patient identity or inadvertently creating a doctor-patient relationship), risks of compromising ethical standards (for example, impairing the doctor-patient relationship), and mixed legal/ethics risks (for example, inappropriate Twitter banter disparaging individuals, promotion of “fake news”). Fortunately, these risks are intuitive and can be mitigated by attention to some simple principles.
Dr. Stephen Chris Pappas
Disclosing a patient’s identity on social media is clearly in violation of privacy laws and other regulations. Since privacy compliance is drummed into us ad nauseum via annual compliance training, we could ask “how on earth could an inadvertent disclosure of identity occur?” We must remember that sites that are nominally termed “secure” may not be. As a general suggestion, I would regard social media of all types as open public forums with permanent postings. Even limited descriptions of a patient on social media may allow identification of the actual patient. The risk may be highest in smaller communities; in the past I assisted a small-town practitioner manage the fallout from inadvertently identifying a patient on his professional Facebook page by simply saying “I recently managed a 38-year-old pregnant woman with Crohn’s disease ...” That small amount of information allowed some members of his community to identify the specific patient. My suggestion would be to never talk about individual patients on social media. Phrase comments or questions generically; for example, “Crohn’s disease in pregnancy is managed with attention to ...”.
Another legal risk of social media engagement is to unknowingly create a patient-doctor relationship with a duty to treat, opening the door for exposure to malpractice litigation if something goes awry. A patient may interpret a social media interaction as establishing a patient-doctor relationship. While we think we know what defines a doctor-patient relationship, it’s not always clear and varies between jurisdictions. Indeed, a physician-patient relationship may not even be a necessary element of a claim for professional negligence (an issue shared with “curbside” consults). A recent court case in Minnesota ruled that a duty to care is established if “... it is reasonably foreseeable that the third party will rely on the physician’s acts and be harmed by a breach of the standard of care.” That case involved a telephone call, but you could see the standard easily morphing to apply to social media posts. Gastroenterologists should always talk about disease and treatment on social media in generic terms, preferably with appropriate caveats (for example, “Patients with cholestasis and intense itching may be treated with naloxone in selected cases after detailed assessment by a hepatologist”).
Impairing an established doctor-patient relationship by “friending” a patient on your personal Facebook risks a potential compromise of professional ethics, breaking the boundaries between profession and person for the gastroenterologist. The approach by most professional societies is that a “friend” on social media is equal to a friend in the real world; the same legal and ethical standards apply. Doctor-patient friendships may compromise objectivity, lead to preferential but not optimal therapy, and increase the risk of skirting around informed consent among other issues. Being friends on social media is discouraged, but not prohibited, by most professional societies and licensing bodies. In my opinion, that is sound advice. Over a career of more than 40 years, I have had patients who became friends, but only after I had transferred their care to another hepatologist.
More recently with escalating, aggressive, tones for social media communications, GI/hepatology practitioners must be aware of the serious risk of blurring their personal and professional online lives, particularly where Twitter is involved. The rapidity which people seem to want to reply to a tweet, the public and durable natures of a tweet, and the ability to significantly retweet and repost all spell potential disasters for the physician tweeting an inappropriate communication. Separation of personal and professional social media accounts is strongly encouraged but alone is not enough; you are never totally anonymous online. The reality is that a physician will be judged for an inappropriate communication whether it’s found on their professional or personal site. Either posting could result in reputation damage, reprimands, medical license restrictions or revocations, and litigation. Nationally, medical boards now regularly deal with disciplinary actions for inappropriate social media activity. The best preventive measures include pausing before you post, check the veracity of what you are posting, place your post in context, and assess the tone of your post and the tone of the site that you are posting to. A perfect storm for disaster is that the material is not clearly evidence based and could be construed as “fake,” you are personally emotionally charged, and the site you are posting to is a known cauldron of emotion and fake news.
In summary, social media affords benefits in a health care setting but it comes with some baggage. However, the risks of a social media presence are largely instinctive. An initial starting point is pausing to consider, “Would I say/do this in a public venue where everybody could hear/see me?” If there is any concern, don’t post. Subsequently, conduct yourself on social media with meticulous attention to protecting confidentiality, avoiding any impression of creating a doctor-patient relationship, avoiding doctor-friend relationships, being aware of key legal, institutional, and professional society guidance, separating personal and professional activities, and maintaining professionalism.
Dr. Pappas is in the GI and hepatology section of the department of medicine at Baylor College of Medicine, Houston. He has no relevant conflicts of interest to disclose.
References
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