Tips for social media users

Physicians who want to use social networking sites have a few things to consider.

In 2015, 65% of Americans used social networking sites. If you're a physician who wants to be one of them, there are a few things to consider, according to Katherine Chretien, MD, associate professor of medicine and assistant dean for student affairs at George Washington University in Washington, D.C.

Dr. Chretien, who both uses and researches social media, offered Hospital Medicine 2016 attendees some tips for going on Facebook, Twitter, and the like while protecting, and maybe even enhancing, your professionalism, legal obligations, and patient relationships.

“You can think of using social media for clinical care as a hierarchy of needs,” she said. The first need is security for both your patients and your career. For example, if you're going to post a patient anecdote, keep in mind the requirements of Health Insurance Portability and Accountability Act (HIPAA), which lists 18 potential patient identifiers that must be removed.

“Clearly you wouldn't have a name and you wouldn't have an address, but all elements of dates are identifiers. If you said, ‘I saw this patient today,’ that is actually identifying the date of the encounter,” said Dr. Chretien. “Per a HIPAA-compliance lawyer, the trouble that most people run into is the date element.”

Also remember the other potential legal consequences of social media postings. “All of that information shared on private or public sites is discoverable and can be used in court proceedings, including judging your character,” Dr. Chretien said.

Keep in mind that even when you're within the law, patients might have additional concerns about their data being shared online, according to some research Dr. Chretien and colleagues conducted. “We asked 491 primary care patients at academic medical centers, ‘Would you allow your doctor to post a de-identified picture of you, such as a rash on your back, if it would help diagnose you?’” Only 20% said no, but the majority of those who said yes wanted to be asked for permission first.

Physicians trying to avoid these pitfalls can find plenty of expert guidance. “There are lots of guidelines out there and recommendations, but there are also guiding principles that people that are in that space and have navigated for a while have come up with,” said Dr. Chretien.

She and her colleagues gathered some of those principles in a study of Twitter “superusers” (medical students who regularly tweeted about medical education and their own professional development) and published the results in the November 2015 Journal of General Internal Medicine. “They were mindful of online professionalism, which meant to them avoiding mentioning specific patients, to think twice and tweet once, to avoid venting at all costs, to avoid inflammatory statements, and be aware of their public image,” said Dr. Chretien.

The students had also thought about the purpose behind their use of social media, which is 1 of the points in a mnemonic, PRIP, developed by pediatrician and tech expert Bryan Vartabedian, MD. The first P is for privacy (the patient's), and the R is for respect (speak in a respectful manner about patients). The I represents intent. “Is it to share knowledge, is it to gain empathy or understanding, or is to make fun of someone or vent?” Dr. Chretien asked. The final concept is Perception, for example, whether your readers will perceive that you're providing real patient details if you've changed them without explicitly saying so.

Those who've mastered these basics, such as the Twitter superusers, move on to more complex concerns, such as how to reflect their personalities. “They said, ‘We need to be authentic. We're not going to be robots and just post very boring things,’” said Dr. Chretien. She noted that that the Twitter superusers her research team talked to had all identified faculty role models who were successfully using Twitter.

Finally, once you have all your own priorities resolved, think about what your social media is doing for others. Dr. Chretien described the top level of the social media in medicine hierarchy of needs as discovery: “How can I use social media for good? How can I improve patients' health and enhance my career, mentor others, and innovate?”