Is Your Facebook Account a Privacy Breach?

December 18, 2010

A recent article in the Journal of Medical Ethics (there is a link to the paper at the bottom of the article) reviewed doctors’ current Facebook use and what this might imply in terms of the doctor/patient relationship.  The study is small (only 202 people) and only involved residents and fellows, thus limiting the conclusions that can be reached.  However, it provides a some insight into how physicians use social medial, and invites some useful questions and suggestions.

Most of the physicians interviewed (73%) used Facebook, and most provided enough information that they could easily be identified.  The majority of users used standard privacy settings, instead of applying tighter settings.  Most physicians stated they would decline a Facebook friend request from a patient.  Nearly 50% of the physicians in the study indicated that they felt their presence on Facebook could affect the doctor/patient relationship, but most thought this would only happen if patients had full access to the doctors’ profiles.

The fact that so many physicians provided personal information is important.  Facebook’s standard security settings allow anyone to see your status posts and your photos–meaning that patients could easily identify their physician, read their updates, and send a friend request whether or not the physician would want that to happen.

A few thoughts:

–More and more physicians are going to have a social media presence.  We need to determine how best to use it, and medical educators should be teaching students and residents how to use social media professionally and safely.

–New social media users should seek help or guidance from more-experienced users in order to ensure that patient/provider privacy is being protected, and experienced users should be willing to guide their less-experience peers.

–The best practice is likely to have a private Facebook page that has stringent privacy settings and is accessible only to those people you would really welcome seeing it.  One can then establish a professional Facebook page that can be used for professional and official contact with patients.

–My bias is to decline friend requests from patients interested in having access to your personal page.  I have a disclaimer on my Facebook page noting that I will decline friend requests from patients, explaining that I use Facebook as a private means of communication with friends and family.

Social media such as Facebook and Twitter are here to stay, and will become ever more relevant to medical care as younger physicians enter practice and younger patients become professionals and health care consumers.  Rather than avoiding this fact, we must learn to use social medial to enhance doctor/patient communication while continuing to protect privacy and demonstrate professional responsibility.  The open and personal nature of much Facebook activity opens the possibly of privacy breaches–we must take care to avoid harm.

Social Media ROI

December 3, 2010

Sharing a link to Howard Luks’s blog post where he discusses the return on investment (ROI) on physician involvement in social media (SM).  The post includes a brief video of Dr. Luks discussing his ROI from his active social media participation (he is @hjluks on Twitter, and runs his blog). 

Physicians and medical practices may be reluctant to engage in SM if they do not believe there is going to be a tangible result from their efforts.  Previous articles have suggested that the ROI from Twitter is likely to be very positive because of there is not much investment needed and hence any return would make the ROI look good.  But Dr. Luks’s experience–which admittedly might not be typical–would make the ROI incredibly positive. 

Dr. Luks notes that he had 14 patients in the last month who reported finding him via online resources.  If we conservatively expect that the patients only come once and had a standard evaluation (which I’ll conservatively estimate at around $150 for a new patient consultation), the charges from these visits would be $2,100.  If these patients end up requiring further care and additional visits (or if they require surgery or another procedure), then the return increases dramatically.

Maybe information of this sort will encourage health care providers and (maybe more importantly) medical practices and health care systems to consider engaging in SM.  I already believe it will benefit their public relations and their communities; Dr. Luks shows it might also benefit their bottom lines.

Using Mobile Technology to Improve Health Outcomes

December 1, 2010

It takes extending the definition of social media a little further than might seem obvious, but this study shows how mobile technology can be used to enhance health care.  The study used text messages to provide educational information about a medical problem and to help improve treatment adherence.  The results of the study were positive: better adherence, strong patient satisfaction scores, and a high proportion of patients willing to continue receiving the texts.


Admittedly this is a small study and lacked a control group, it presents interesting ideas for future study.  Participants in the study found the text messages to be useful and (presumably) non-intrusive, given how many would be willing to continue receiving messages in the future.  One could imagine a medical practice where a nurse or provider could send out such messages or reminders to patients who had difficult-to-control illnesses in order to educate and promote better outcomes.


The relevance to social media is this: as of right now, privacy concerns limit the ability to use social media for patient care.  The public nature of much of this communication means that personal health information cannot be shared in this setting.  However, posting educational information via Twitter or Facebook (which patients could chose to receive via SMS or text services) would be acceptable considering they are not targeted at any one person.  Similarly, medication reminders could be generally distributed through similar means.  Meanwhile, direct text or SMS messages sent to an individual could be used to actively target care more directly.  In this model, social media allows health care professionals to educate and promote health in a  general (but still interactive) way while not impinging on private matters.


Social media has great impact in sharing information with a community and engaging in general conversations.  Adding SMS or text messages to social media communication allows health care providers to target individual patients more effectively.  If this early report bears out, then the impact of social medial and mobile technology can be substantial.

Social Media in Healthcare is More Effective When It Drives Knowledge Not Marketing

December 1, 2010

Topic 1 for the Sunday nights #HCSM Chat: There’s been a lot of talk about physicians and patients in HCSM lately – but what about HC organizations?

Let’s define social media:

Wiki: ”Social media are media for social interaction, using highly accessible and scalable publishing techniques. Social media uses web-based technologies to turn communication into interactive dialogues.” This is what happen Sunday night during our #HCSM chats, in our Tweeter feeds and posts.

Wiki also identified:
Social Media Marketing “Social media marketing is a recent addition to organizations’ integrated marketing communications plans. Integrated marketing communications is a principle organizations follow to connect with their targeted markets. Integrated marketing communications coordinates the elements of the promotional mix; advertising, personal selling, public relations, publicity, direct marketing, and sales promotion.” This is using SM as part of business plan. It is the intersection of SM and marketing,

Many of the comments Sunday night captured the essence of these definitions.

nickdawson @bjoconnell agree. “Some still haven’t left the 1-way push and use the “we” voice non-stop.”

@RichmondDoc T1: “The only orgs I follow are those that provide me w/useful and consistently valuable info; I follow relatively few for that reason.”

@HealthSocMed “I’m not sure I *do* want to engage with the organization. I want to engage with people, maybe orgs should B blind?”

@jacquehealth: “Agree with @quality1 – Use SM to increase awareness, understanding, and health behaviors, not mktg.”

Brands and corporations realized that various SM platforms are valuable listening tools to identify trends, find loyal customers, drive brand messages into conversations, etc. And that is what SM became to these organizations, part of their marketing mix. Social media for brands is a way to use people/patients as extensions of marketing plans.

How active are HC organizations in SM? Ed Bennet continues to compile a frequently updated list of Hospital Social Networks. As of October 19, 2010 there are 2,259 Hospital Social Networking Sites. His page has it broken down by various media (e.g. YouTube, FB, Twitter, LinkedIn, and Blogs) and by state. This is a great resource worth monitoring.

Frequently SM in HC organizations takes on a single goal and strategy: business development. A HC organization might look at a SM strategy based on a narrowly focused set of objectives: increase awareness, improve image, change census, increase use of a new piece of equipment, etc. This is not 100% of the time, Mayo Clinic uses SM to drive knowledge and improve patient-care as do other HC organizations.

Consider the following segments of a marketing plan: Broadcast (print, radio, outdoor), Digital Marketing (banners, Web sites, e-mail, search, etc.) and Social Media (networks, communities, blogs, microblogs). Each segment serves a specific set of strategies within a marketing plan. These are not fixed. They are flexible but their power to achieve objectives is maximized when they are applied appropriately. Broadcast is passive and used to promote messages. It can be used to engage readers but engagement is less effective. SM offers higher engagement between participants but has a low broadcast potential.

I believe HC organizations may be short sighted when they use SM to drive a message that can be best achieved via Broadcast and to fail to use SM to achieve what it can do best, actively engage participants in knowledge seeking behaviors.

SM is all about dialogue, interactivity, spontaneity, people and technology. It offers HC organizations the chance to not only listen and market, but to position itself at the center of HC knowledge and information for a unique network, their patients’ current and future knowledge and behavior. I have advocated that we need to help patients and people who are seeking solutions to HC problems move beyond WebMD etc. as single sources of knowledge and have them learn instead from their MD, their hospital, specialty societies, and networks of friends who share similar HC concerns. Make no mistake that patients are reaching out for answers using all of these resources. HC organizations should step in and become the final resource for them. A place to focus what they want to solve and what they have solved. Who do patients trust more than their own physician and the hospital they are affiliated with? If they don’t, then HC organizations need to position themselves that way in the mind of the patient and caregiver community.

For example, there is no reason why an oncology department in a regional hospital cannot create a network for breast cancer patients. This network uses resources in and outside the hospital to improve and share knowledge. Bi-monthly the department can hold tweet chats to discuss issues in breast cancer. Results and reviews of the topics can be posted with references. This site becomes a resource for patients and the hospital. It is less about marketing and more about knowledge. It is a resource for patients seeking solutions to problems in HC. HC organizations are not pushing a message they are the message. The medium becomes the message.

HC organizations should consider SM as a tool to educate and improve patient care, not an extension of the marketing department. Ultimately patients will trust and respect where they find knowledge, understanding, and people they share common problems with. Success, if measured in marketing terms will follow.

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