Feature
Social Networking Savvy
Physicians need to be informed about how to use social media wisely.
By Colin M. Segovis and Melissa L. Rethlefsen
When we first wrote about social networking and social media in Minnesota Medicine in January 2009, they were still largely associated with students and technology buffs. During past two years, however, use of YouTube, Twitter, and Facebook has become mainstream even in health care.
Social media connect people and facilitate dialog between individuals and groups, allowing for the sharing of user-generated content. Want to share a picture? Post it. Want to tell the world what you are up to? Do a status update. Observe something interesting? Tweet about it. Social media are designed to be open, transparent, and easy to use, which makes them both extremely effective ways to communicate and a privacy nightmare.
For those reasons, physicians and other health care workers increasingly will need to know how these tools work and about the privacy issues they raise in order to counsel patients about using them safely, market their services and manage their reputations, and maintain their personal and professional relationships.
Practical Tips for Using Facebook
1. Create a Facebook Page for Your Practice • Distinguish between your personal and professional identities by creating a separate Facebook page for your practice. Use it to highlight news, photos, videos, and more. You can engage with patients and customers on these pages by allowing them to “like” the page. Make sure there is an appropriate disclaimer and discourage patients from posting personal information.
To find out more, go to www.facebook.com/pages.
2. Check Your Personal Account’s Privacy Settings • Facebook’s privacy settings are notoriously complicated; but there are a few things you can do to make your Facebook account more secure. In your account menu, go to “Privacy Settings.” Select “Friends Only,” or scale up your privacy settings by choosing the “Customize” settings option (this works best if you have lists of friends established—see next tip).
Next, go to “View Settings.” Here, you can change who can search for you in Facebook (we suggest “Friends of Friends,” or just “Friends”), who can see your Friends lists, who sees what you “like,” and more.
Finally, from the main “Privacy Settings” page, edit your settings under “Apps and Websites.” The key options to edit here are “Public Search” (so your Facebook profile doesn’t show up in Google), “Instant Personalization,” and, most importantly, “Info accessible through your friends.” We recommend disabling all three.
To find out more, go to www.facebook.com/settings/?tab=privacy.
3. Utilize Friends Lists • Want to share news with your medical school friends but spare your high school buddies? Friends lists help you sort your Facebook friends into groups. All information you share in Facebook, whether photos, status updates, education and work information, or links, can be shared with one or more lists (or even only with certain people, if you choose). You can customize which lists can see what in your privacy settings, or any time you post something new to your profile (look for the lock icon below the update box).
To create Friends lists, in the account menu, choose “Edit Friends.” Then click on “Create a List.”
4. Use Secret Groups • Facebook makes it easy to collaborate with small groups. You can create “secret” groups to help establish a private space for you and your friends. Groups allow you to create documents in the style of Google Docs, share materials, create events, and more. They are designed to be productivity tools for business but work equally well for any kind of small group.
Although they are not secure, they work well for support groups and other types of small-group communication. Click on “Create Group” from the Facebook home page to start a new group.
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Using Social Media in Health Care
The first step in using social media appropriately is to ask yourself: Who is my audience? If you are trying to deliver a message to a large number of people, then using social media is the way to go. For example, the Mayo Clinic uses YouTube, an online video-sharing community (www.youtube.com/user/mayoclinic), and Twitter, an information network that allows people to share brief messages in real time (http://twitter.com/mayoclinic), to inform the public about clinic developments, to share patient stories, and to the educate the public about medical conditions, procedures, and the clinic’s offerings. Mayo is also using Facebook to develop an online community it can communicate with patients and patients can share their own stories and respond to others’ stories of healing and hope (www.facebook.com/MayoClinic).
Social media also can be appropriate when your audience is fellow health care providers. The Cleveland Clinic uses Facebook to share information about continuing medical education (www.facebook.com/pages/Cleveland-Clinic-Center-for-Continuing-Education/78798950895?v=wall). Twitter can be like an extended group practice, where physicians all over the world share news, thoughts, and tips with other providers (see http://twitterdoctors.net/ for a list of physicians who are avid Twitter users).
As for connecting with patients, the Health Insurance Portability and Accountability Act of 1996 spells out how health care providers should communicate with patients using electronic means.1 Users of social media must adhere to these guidelines. You should not use social media tools to contact a patient regarding anything that could be considered confidential. You should not, for example, use the email tool in Facebook to send a note to a patient. Physicians also should be aware that their giving advice on social media sites may lead some patients to respond to them with questions and requests for prescription refills and even friendship.
Social Media’s Long Arm
Keep in mind that social media have taken office water cooler chat and opened it up to the world. Both practicing health care providers and those in training need to be extremely careful when using them to connect not only with patients but also with colleagues, friends, and family members.
Health care providers and others who have been less-than-careful with what they post on social networking sites have learned that there can be major professional consequences. Students have been expelled, teachers have been fired, and one woman with depression even claims she lost her mental health benefits because she looked happy in her Facebook photos.2 In several cases, physicians have been disciplined by their employers for what they’ve done online: posting photos showing themselves posing with guns while providing earthquake relief in Haiti, blogging about a malpractice case, posting patient photos, and playing Facebook’s “lying down” game using hospital equipment. More examples of bad behavior and innocent mistakes gone awry are illustrated in the series “Friday Faux Pas,” offered by Mayo Clinic’s Center for Social Media.3
You also need to remember that once information is posted to one social media site, it can be distributed elsewhere easily and quickly—this is especially true with Twitter, Flickr, and YouTube, which have less strict privacy settings than Facebook. Furthermore, there are servers devoted to backing up the Internet (www.archive.org/). The Internet Archive doesn’t back up content from Facebook.
But the Library of Congress has archived tweets since the inception of Twitter, and any blogs that mention you may well be backed up in many places. Erasing a photo or video from the Internet is extremely difficult, if not impossible. Therefore, one should be extremely careful when considering posting information online (see p. 31).
The Personal Meets The Professional
Social media can blur the line between one’s personal and professional life. Some social media advocates say that having only one online persona, where work and home interact, can help build camaraderie in the work place. But introducing colleagues to your inner sanctum of politics, jokes, musical taste, and even your friends can be risky, especially for those seeking employment or positions in training programs. Letting your colleagues see pictures of your Halloween costume on your Facebook page may merely be embarrassing. Letting a potential employer do the same may have real consequences.
In some ways, the trickiest audience for physicians to deal with is their friends. Even if a physician doesn’t use social media, a friend might. And they may be posting photos or videos of you or quotes from a recent talk without your knowledge. Social media makes everyone a journalist, and even with the most stringent privacy settings, information shared online can be reshared across the web—all without your permission. The doctors posing with guns in Haiti did not mean to share their photos with the general populace; yet a simple Google search elicits a selection of the questionable photos. By using social media, you place a lot of trust in your connections.
Using social media can have a number of unintended consequences. If a patient stumbles across information about a physician engaging in risky behavior, that may erode the patient’s respect for the physician and limit his or her effectiveness in counseling that patient about that same behavior.
This issue is especially relevant for younger physicians and medical students. Educational institutions and potential employers may look up candidates’ online profiles. Some disciplines, such as pharmacy, are now viewing applicants’ Facebook pages during their residency selection process.4 This will likely become common practice.
Concern about the implications of social media use for students and physicians has led organizations such as the American Medical Association, the New Zealand Medical Association, the Australian Medical Student Association, and the New Zealand Medical Student Association to develop policies on social media and guidelines for online professionalism.5,6 Despite such policies and warnings, data suggest that medical students still post unprofessional content.7
Physicians can no longer ignore social media or use them cavalierly. They need to understand that these communication tools can enhance their ability to help patients and the public. But they also need to be vigilant about protecting the privacy of their patients and guarding their own reputations. MM
Colin Segovis is an M.D./Ph.D. student and Melissa Rethlefsen is an assistant professor of medical education at the Mayo Clinic College of Medicine.
References
1. U.S. Department of Health and Human Services. Summary of the HIPAA Privacy Rule. Available at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html. Accessed March 9, 2011.
2. Cashmore P. Depressed woman loses health benefits for happy pics on Facebook. Mashable. Available at: http://mashable.com/2009/11/22/facebook-health-benefits/).
3. Fleming A. Friday Faux Pas: “Rogue” tweet via hootsuite. Mayo Center for Social Media. February 8, 2011. Available at: http://socialmedia.mayoclinic.org/category/friday-faux-pas/). Accessed March 9, 2011.
4. Cain J. Use of social media by residency program directors for resident selection. Am J Health Syst Pharm. 2010;67:1635-39.
5. American Medical Association Policy: Professionalism in the Use of Social Media. Available at: http://www.ama-assn.org/ama/pub/meeting/professionalism-social-media.shtml. Accessed on March 9, 2011.
6. Australian Medical Association. Social Media and the Medical Profession. Available at: http://ama.com.au/socialmedia. Accessed March 9, 2011.
7. Chretien KC, Greysen SR, Chretien JP, Kind T. Online posting of unprofessional content by medical students. JAMA. 2009;302(12):1309-15.