For starters, physicians should know that in 2011, the American Medical Association issued guidelines in its Code of Ethics for physicians using social media:
• Physicians must safeguard patient privacy and confidentiality online and through text messages, and must refrain from posting identifiable patient information;
• Clinicians need to realize that privacy settings are not absolute and that once on the Internet, content is likely to remain there permanently.
• When interacting with patients online, physicians must maintain the same professional and ethical boundaries as in any other setting.
• Physicians are strongly encouraged to separate personal and professional content online.
• Physicians must uphold the profession and must take action if colleagues post unprofessional or unethical content.
• Physicians must recognize that online actions and posted content can negatively affect their reputation among patients and colleagues, can have consequences for their medical careers, and can undermine public confidence in the medical profession.
Interactions with other doctors
Connecting with other doctors through social media is a great way to share information and improve the profession. However, most of the time texting and using social media to work with other doctors is not appropriate.
Physician-to-physician messages for the purpose of treating an individual must be promptly and properly documented in the patient’s medical record. Right now, that’s terribly difficult to achieve successfully and consistently.
There are at least a few popular social media platforms that are exclusive to doctors only. Some of them say they allow anonymous posts and interactions. However, doctors need to realize that almost nothing on the Internet is anonymous. Physicians must ensure that they uphold the ethics and obligations of the practice of medicine when posting anything on any site, whether their names are available or not. HIPAA doesn’t just subsidize because a doctor’s name is not directly related to a post. It also does not subsidize because a patient’s name is not mentioned in a publication.
It is good practice for a doctor to walk away from the post or text before sending it, to consider what purpose it will serve and whether it preserves the confidentiality and ethical obligations that are necessary for the situation.
Additionally, physicians’ interactions with other physicians on pure social media, especially with their superiors at work, can blur the lines between professional and personal lives. Supervising physicians (employers, assistants, professors, etc.) should not attempt to connect with their subordinates through social media and subordinate physicians should think twice before requesting to connect with supervising physicians.
Interactions with patients
First, prior to any interaction with a patient via social media, text messaging, video conferencing, or similar transmission, physicians must comply with any and all applicable telemedicine statutes in the states where they practice. Telemedicine laws are constantly evolving to keep up with changes in the area of communications, and physicians are well informed to familiarize themselves with the laws.
The AMA Code of Medical Ethics contains an opinion on the use of email to communicate with a patient. Perhaps most importantly, the Code states that email correspondence should supplement a doctor’s personal encounters with a patient. Also, a doctor is held to the same professional and ethical standards over email as they are in person. Medical advice or patient-specific information should not be transmitted over an unsecured connection without prior authorization from the patient.
Although the AMA has not published guidance regarding text message communications with patients, physicians are encouraged to consider using the same guidelines. For example, text messages containing patient-specific data should not be sent over a public or unsecured connection. Copies of the text message should be kept in the patient’s file to ensure continuity of care. And doctors need to realize that they are held to the same standard of care over texting that they are in their office encounters. A single text message delivered without a complete image could expose the physician to the same liability as an inaccurate evaluation performed in the office. Appropriateness of care cannot be sacrificed for the sake of ease of communication.
Messages sent to patients via social media are even more problematic. Patient privacy laws generally prevent providing specific patient information in this manner. Furthermore, even if patient-specific information is not transmitted via social media, a physician’s failure to maintain proper professional boundaries with his or her patients can tarnish the reputation of the profession and subject the physician to disciplinary action.
