I remember the day about 15 years ago when my doctor tentatively gave me his email address, telling me he trusted that I wouldn’t abuse it. (For the record, I’ve used that address maybe five times.)
What place do social media have in a physician or nurse’s career? And where do the boundaries lie?
Risks, and also benefits
“The technology came available before anyone had time to consider the ramifications of physicians’ use of it on their practice,” says Jennifer Kesselheim, MD, a hematologist-oncologist at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center who studies professionalism in clinical training, and has written about perceptions of appropriate social media use among hospital residents. “A lot of the early literature seemed to focus mostly on how to restrict physicians’ use of social media so as to avoid lapses in professionalism. Immediately our eyes went to the risks, not the benefits.”
The medical field’s thinking about social media is evolving. Kesselheim points to an opinion piece in the journal Academic Medicine that argues for moving past concerns about patient privacy and security.
“We need to ensure professionalism and restrict unprofessional behaviors online, but we also need to think about how to integrate social media into medical practice,” she says. “It’s part of the fabric of the lives of our patients and their families. And it could be an avenue to a new realization of the physicians’ professional role and how we can exist with our patients online in ways that build therapeutic alliances and enhance their care.”
“Doctors can be a very powerful force on social media,” adds physician, writer and tweeter Natalie Stavas, MD, a resident at Boston Children’s Hospital. “It’s a way to disseminate important information to a large number of people. But every physician who engages in social media needs to assume a certain level of risk and learn what they are comfortable with.”
Physician, not “friend”
Social media isn’t just about blasting information far and wide. It’s about making connections, about friending and following. Who is it ok for a doctor or nurse to friend or follow? Real-world friends and family? Colleagues? Mentors? What about patients?
With regards to the latter, Stavas is adamant: “If I met a patient in the hospital, and only knew them because I was their doctor, it would be wrong to friend them on Facebook,” she says. “And while there are families of patients who have sought me out and followed me on Twitter, I would never follow a family or tweet direct medical advice to a family.”
Her response echoes Boston Children’s social media policy: No initiating contact with patients or families. Staff are also discouraged from accepting “friend” requests or other invitations from families.
But what if someone you know socially shows up in your clinic?
“I know people from the community who have sick children admitted to the hospital,” says Stavas. “What if, by chance, I actually am responsible for their care? What if that family posts updates on Facebook all the time and even mentions me in a post? Should I de-friend them?”
Owning the conversation
Doctors are largely still wary when it comes to social media, and while medical institutions, state societies and even the American Medical Association have guidelines available for medical professionals, everyone is still figuring the ground rules out. Stavas admits that even she has made mistakes in deciding what to tweet.
“Everything I say on online is seen by many, many people,” she says. “I take this very seriously, because one wrong word or opinion can cause harm. And I have messed up. But I keep trying to learn from my mistakes.”
Overall, though, Stavas feels social media has the potential to do great good as a tool for teaching and dispelling myths. “Public policy and behavior can be changed just because things trend on Twitter. It’s such a powerful tool! If I had as many followers Kim Kardashian I could change the world, or at least get people to accept that vaccines don’t cause autism.”
Kesselheim concurs. “We’re not just physicians, we’re also educators and the voice of science. And I think it’s appropriate for us to be the voice of science online, so that patients get the right kind of information.”