More Social Media Guidlines for Physicians. Should We Care?

Late last year, the American Medical Association published guidelines to guide how physicians use social media.  Once the recommendations were made public, I posted that I did not think the guidelines were very helpful.  My overall sense was that the guidelines were designed more to discourage or limit physicians’ participation in social media…or at least highlight the risks of using social media.

Now, two other sets of guidelines have been released.  The Massachusetts Medical Society (MMS) released their guidelines about two months ago, and the British Medical Association recently made their guidelines public.

I’ve been meaning to review the guidelines in detail, but have not had the time to do so.  So I thought I would try and give an overview of where the guidelines are similar and where they differ.

Highlights of the MMS guidelines include:

  • Patient privacy is of the utmost importance.
  • Physicians should maximize privacy settings, but should not assume these settings are absolute.
  • Physicians must maintain professional boundaries if interacting with patients online.
  • Physicians should separate personal/private and professional information online, and should not connect with patients in public social media settings.
  • Physicians should be responsible for monitoring others’ use of social media: “when physicians see content posted by colleagues that appears unprofessional, they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.”
  • Physicians should disclose any relationships they have with any services or products that they review or discuss online.
  • Physicians must realize that any information posted online may affect how the public views physicians and the medical profession, might impact individual physicians’ reputations, and may have career consequences (especially for trainees).

I do not believe that these guidelines differ very much from the AMA guidelines I mentioned earlier.

Meanwhile, the BMA guidelines largely tread the same paths: protect patient privacy, disclose conflicts of interest when they exist, be aware of how your online posts and comments might reflect upon yourself and the medical profession, etc.  The BMA also specifically notes that “It would be inappropriate to post informal, personal or derogatory comments about patients or colleagues on public internet forums.” Of note, the BMA does not suggest that physicians should be responsible for policing each others’ online posts.

As was the case with the AMA guidelines, the BMA guidelines also emphasize the potential harms and risks of physician involvement in social media.

Maybe this is the nature of guidelines: to highlight how potential risks without focusing on the potential benefits.  But none of the guidlines–AMA, MMS, or BMA–discuss how to use social media effectively and successfully.  If physicians are only provided with cautions and warnings about social media, and are not given guidance on how social media can be used to enhance the health of individuals and communities, then physicians are hearing an unbalanced perspective.

In fact, some physicians have argued that health care professionals have an obligation to engage in social media: read Brian Vartbedian (@Doctor_V)’s perspective here, and watch a video of Dr. Wendy Sue Swanson (@SeattleMamaDoc)’s thoughts here.

So: on the one hand, physicians are called to engage with patients via social media.  On the other hand, professional organizations continue to urge physicians to exercise caution and care without discussing possible benefits and values of engaging with patients via social media.  So what do we do?

My thoughts: I put very little weight on these guidelines.  The AMA, MMS and BMA guidelines all tend lack specifics, and many of the cautions seem to be self-evident.  Responsible, professional physicians should not disclose patients’ private information while using social media, and responsible, professional physicians should be aware of the limitations of online privacy.  So long as a physician is using their common sense, then these guidelines offer little guidance.

So: I will continue using social media and I will continue encouraging fellow physicians to use social media.  I believe the value outweighs the potential risks, and that reasonable caution provides sufficient protection.  I will continue to look for guidelines that offer guidance an insight in the positive sense (how to get the best results and value from using social media) as opposed to only offering warnings and cautions.  Until those guidelines are released, I will continue to put very little weight on social media guidelines for physicians.


8 Responses to More Social Media Guidlines for Physicians. Should We Care?

  1. richmonddoc says:

    During tonight’s #hcsm chat, someone mentioned the CDC’s social media tookit:

    Looking it over, it has a great deal of info on the tools used for social media engagement, and some good guiding principles.

    But I still think there is a gap to be filled in terms of how and *why* docs should be using social media.

  2. […] of professionalism and social media.  These two posts can be found here and here.  I have also taken issue with medical organizations’ extant social media guidelines.  In some of these posts’ comments, it has been noted that there is no corresponding […]

  3. […] “How to maintain physician professionalism in social media.”  Dr Ryan has been one of a number of critics of the social media guidelines adopted recently by some professional medical organizations, such as […]

  4. […] posts can be found here (professionalism) and here (physician online behavior).  I have also taken issue with medical organizations’ extant social media guidelines.  In some of these posts’ comments, it has been noted that there is no corresponding guideline […]

  5. rdjfraser says:

    I like your critic that the guidelines do not offer a whole lot of useful guidance on how physicians can use social media. I don’t think any regulatory or governing body will be be able to really do that.

    Personally, I’ve been grateful for any healthcare organization beginning to lay down some guidelines or boundaries. The lack of them makes it worse, and even more paralyzing for the majority of providers to begin to experiment to find the benefits. I’m hoping that from this there is a bit more comfort knowing what the boundaries lay, and there is continuing consideration of where me might push and move these original guidelines. Hopefully now more providers (being a nurse I think outside physicians) can now begin to develop evidence and experience that can be translated more broadly.

    At the very least I hope these guidelines at least reduce, if not stop, the valuable professionals who lose their ability to practice due to a lack of clarity and education on how to protect themselves and their patients online.


  6. KPHubert says:

    Has there been discussion anywhere about physicians interacting with a patient’s (or caregiver of a patient’s) blog? Is this considered OK practice when you consider that essentially anything on the Internet is public? Or is this crossing a professional boundary?

    • richmonddoc says:

      My general thought in this is that docs need to be careful. HIPAA prevents doctors from revealing their patients’ personal health information. Even commenting about a patient’s post about their own health issues could be seen as confirming/validating that personal health information.

      • KPHubert says:

        I agree. The issues of interacting on a patient blog are very similar to interacting with a patient on Facebook.

        What would you say to a colleague if you found out they were searching out a patient’s blog or Facebook page? There was no interaction online, but they did discuss the information they found there with the patient.

        I’m aware of a colleague doing this and it feels “icky” to me. His rational is that the blog is public. Even so, it feels like he crossed a privacy line with this patient since she did not specifically ask him to read it.

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