Social media have blurred the distinction between personal and professional identities, challenging health care professionals to redefine professionalism in the digital age. The professional standards expected of health care professionals do not change because you are communicating through social media. Rather social media presents you with new circumstances to which the established principles still apply.
A personal Facebook profile seems to cause the most blurring of private and professional boundary lines. According to a recent survey by Pennsylvania State College of Medicine, the social media savvy of many incoming medical students may be leading to unintended medical privacy and confidentiality breaches. The survey found that overall students seemed to be mindful of the potential dangers of social media use and had a good understanding of how it could be used or misused in a professional context. However, when faced with a professional dilemma, there was a disconnect between what the students said they would do versus what they thought they should do.
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Though 39 percent of students said that they should tell a hypothetical peer to remove drunken pictures and foul language from Facebook, 41 percent said they would actually do nothing. Doctors and medical students should always be wary of the digital legacy they leave on the internet. Anything that has once been posted and immortalized on the internet can always resurface. There may be images or personal views that could surface at any time and could have serious implications for your professional career, particularly for future employers (previous research has found that more than half of the residency programs in the country would reject applicants based on unprofessional Facebook content, such as the inappropriate pictures in the previous scenario).
Anything you post online may be seen by an unintended audience, and once it is online, it creates a lasting digital footprint.
Aside from not posting compromising content, what else can you do to protect your professional reputation on Facebook?
Review Your Facebook Privacy Settings
Over the next few weeks, Facebook will roll out a new and expanded privacy checkup tool. It will take users through steps to review who they’re posting to, which apps they use, and the privacy of key pieces of information on their profile. When new people join Facebook, the default audience of their first post will be set to Friends (previously it was set to Public).
While you are waiting for the roll-out why not check your current privacy settings and make sure they are set to the highest level. Do bear in mind however, that you should never rely on such settings to be absolute, as there is always the possibility that these can be breached. Therefore, you should always consider the potential professional implications of the content that you post. This also applies to content others may post on your behalf. On Facebook your friends can “tag” you in a photo that you may not wish to have in the public domain. Change your privacy settings so that you cannot be tagged in this way by others. Regardless of intention, social networks such as Facebook are made for sharing information so you should know the security settings that are required to ensure your information is kept safe, and if in doubt always take a conservative approach.
Don’t Accept Facebook Friend Requests From Patients
To maintain appropriate professional boundaries consider separating personal and professional content online. In an op ed for USA Today in 2010, Katherine Chretien, assistant professor of medicine at George Washington University, wrote “if you add me as your friend on Facebook, I will have to politely decline. Because I like you. Because I love being your doctor. And, because some lines shouldn’t be crossed.”
“Having a so-called dual relationship with a patient — that is, a financial, social or professional relationship in addition to the therapeutic relationship — can lead to serious ethical issues and potentially impair professional judgment. We need professional boundaries to do our job well.”
So what should you do if a patient wants to friend you on Facebook?
You can politely refuse the request and explain the reasons why it is not your policy to do so. You can then direct the person to your business page on Facebook. And if you don’t have a business page – then set one up.
Don’t Offer Medical Advice on Facebook
Even with a Facebook business page, you may still be faced with some ethical hurdles to cross. What should you do if a patient asks a clinically significant question there and expects an answer in the same venue?
You are strongly advised not to offer direct clinical advice to a patient on any social media platform. That doesn’t mean that you should ignore the request, but rather politely and firmly direct the person to where they can seek help.
Familiarize Yourself With Defamation Law
Defamation is the act of making an unjustified statement about a person or organisation that is considered to harm their reputation. Defamation law can extend to any comments posted on the web, irrespective of whether they are made in a personal or professional capacity. People can often feel less inhibited when posting comments online and as a result may say things they would not express in other circumstances. Make it clear that you moderate Facebook comments for defamatory material.
Never Breach Patient Confidentiality on Facebook
Most improper disclosures of patient information are unintentional. Although individual pieces of information may not alone breach patient confidentiality, the sum of published information online could be sufficient to identify a patient or someone close to them. Avoid posting content regarding patients. Even if they, their case, symptoms etc have been anonymised, there is still the chance of identification. No content on social networking sites should ever reference patients or their specific case.
Help Colleagues on Facebook Maintain Professional Standards
If you see content posted by colleagues on Facebook that appears unprofessional you 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 action to resolve the situation, you should report the matter to the appropriate authorities.
Google Yourself
Routinely check your own internet presence to ensure that you are satisfied that the information about you is accurate and appropriate, particularly if that information is not posted directly by you.
Conclusion
Facebook and other social media are dynamic and constantly evolving dimensions in modern society, inextricably linking both professional and personal lives. It is easy to disassociate the online environment from being a public arena, particularly while it may just be you using your PC, smartphone or tablet. However, you should always be mindful that the content you generate online can reach a public domain regardless of your intention for the information to be public or private.
Healthcare professionals have a unique standing in the community that is built on trust with patients. Always be aware of your actions and take appropriate measures to ensure your own privacy and that of your patients at all times.
