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How to Stay Out of Trouble on Social Media

In this edition of “The Wired Practice,” Ron Harman King, MS, of the healthcare consulting firm Vanguard Communications, offers guidelines on safe use of social media for patient education and recruitment.

See an earlier segment for more on this topic: What Happened When a Doctor Cried on Social Media.

A transcript of his remarks follows:

With all the controversy surrounding the American president and Twitter, and the Russians and Facebook, I’m sure quite a few healthcare providers have been asking themselves this question lately: Shouldn’t I just stay the heck away from social media?

Well, maybe. But let’s not overlook good reasons aplenty for healthcare providers to engage with and educate healthcare consumers through social media. More on that later. Let’s first talk about what can go wrong. Typically, the worst social media experiences concern HIPAA and privacy issues. Earlier this year, for example, a Texas nurse with anti-vaccination views took to Facebook to describe her encounter with a young measles patient.1

While on the surface the nurse’s post didn’t share any identifying patient information, her Facebook profile included the name of the hospital where she worked, and her post was to a geographically specific Facebook group. Further, the post referenced the patient’s recent travels. It didn’t take long for the nurse’s employer to decide that some Facebook users might be able to connect the dots and identify the patient. For the hospital, this would be a violation of privacy laws, and therefore the nurse lost her job.

In a more flagrant example, three employees of an assisted living home in Georgia posted a video to Snapchat depicting them goofing off and ignoring a patient. Although the patient was not shown in the video, a coworker alerted management. Not only were all three fired, but local authorities also arrested and charged the trio with exploiting an elderly and disabled person.2

In addition to privacy concerns, politics and personal opinions can ignite social media firestorms and attract unwanted attention. Sometimes you don’t even have to post something yourself. For an issue of the Dallas Medical Journal a couple of months ago, 7,500 physicians responded to a survey on the gender pay gap in medicine. The journal published comments from eight. One, a local internist, remarked that “female physicians do not work as hard and do not see as many patients as male physicians. This is because they choose to, or they simply don’t want to be rushed, or they don’t want to work the long hours.”

Comments from the other seven providers were publicly ignored. But the internist’s remarks inspired Twitter users to hunt down his personal account before he had the chance to delete it and uncover other inflammatory Tweets. This drew national media coverage, which in turn led to the doctor’s resignation from leadership positions at a local hospital.

Why does it seem that healthcare providers wind up in social media hot water more often than other professionals? My hypothesis is that society entrusts them with the safety and health of the public, thereby granting doctors in particular special elevated status. With that, of course, comes greater scrutiny.

With all this extra attention, how do you stay off the hot seat? Really, two rules of thumb can save your bacon most of the time. First, avoid online comments on political and social topics, absent overwhelmingly compelling public health factors. For example, I would not be bashful about taking a scientific and evidence-based stand on behalf of childhood vaccinations. But otherwise, in today’s climate of extreme polarization, wading into political and social discussions online could undermine your professional credibility on healthcare topics.

Second, beware the regulatory gods. Do not discuss any individual case anywhere on social media even if you don’t name the patient or if you change some personal details — remember, in certain instances, revealing just a smidgen of an individual’s health information can inadvertently identify even an unnamed person and invite privacy-law troubles galore from the U.S. Office of Civil Rights or other enforcement agencies. Of course, you can and should certainly speak broadly about diseases, conditions, and treatments in your posts; just be extra-careful to steer clear of any personal details — as well as providing individualized healthcare advice to any online follower, of course.

None of this is to argue against use of social media in healthcare whatsoever. To the contrary, social media has become a universally effective tool for hospitals, health systems, provider groups, and individual providers for patient education as well as brand building and new patient recruitment. After all, social media is where people are these days — and where opinions and decisions are influenced. Consider: In a recent survey of consumers, 78% of respondents said social media affected their buying decisions.3

And in a survey of healthcare consumers, the consulting firm PricewaterhouseCoopers found that 41% said social media would influence how they coped with a chronic condition, their approach to diet and exercise, choosing a specific hospital, or choosing a specific physician; 61% said they were likely to trust information posted by doctors, and more than three-quarters said they expected provider groups to respond to appointment requests within a day.4

Today, 69% of all U.S. adults — and 93% of American teens and young adults — use social media.5 Its global reach and gargantuan opportunities for patient education is why the Mayo Clinic employs a social media team of 10 members, including a physician,6 and why the Cleveland Clinic social media staff posts six times each day on Facebook,7 where it has attracted about two million followers.8

For more practical guidance, the National Institutes of Health offers an excellent peer-reviewed journal article online on social media risks, benefits, and guidelines for healthcare professionals.9

In my experience, the benefits far outweigh the risks. Besides, do we really want the Russians to hog the spotlight all for themselves?

1. Camila Domonoske “Texas nurse loses job after apparently posting about patient in anti-vaxxer group” NPR; August 29, 2018.

2. David Boroff “Three employees of assisted living facility make Snapchat video of dying woman called ‘The End,’ cops say,” Daily News; July 9, 2018.

3. Steve Olenski “Are brands wielding more influence in social media than we thought?” Forbes; May 7, 2012.

4. Molly Gamble “41% of consumers say social media affects their hospital choice” Becker’s Hospital Review; April 17, 2012.

5. Susannah Fox “Tech adoption climbs among older adults” Pew Research Center; May 17, 2017.

6. Mayo Clinic Social & Digital Innovation Team

7. Marianne Aiello “Secret to Cleveland Clinic’s social media success: Content” Health Leaders Media; June 11, 2014.

8. Mark Brohan “How Cleveland Clinic connects with patients via social media,” Internet Health Management; May 4, 2017.

9. C. Lee Ventola “Social media and health care professionals: Benefits, risks and best practices” Pharmacy and Therapeutics; July 2014, 491-499, 520.