As a nurse, I have often struggled with the issue of how to best use social media as a healthcare professional. What is appropriate to share? Can I give health advice over social media? Should I use my real name? Considering the large number of physicians that I see using pseudonyms on Facebook, I feel pretty confident assuming this isn’t just a nursing problem. Back in nursing school there seemed to be a great deal of rhetoric surrounding the perils of social media. Some people advised us not to use it, and some hospitals even blocked social media websites.
How we’ve historically viewed the patient-provider relationship is problematic within the digital age. Traditionally there has been a social contract between healthcare professionals and the general public that maintains a certain degree of separation.1 Basically we try to compartmentalize our personal and professional lives. However, the foundation of this contract is beginning to crack as our personal and professional lives become less distinct.1,2 This was less complicated when the blurring of professional and personal worlds consisted of running into a patient at Costco. However, sharing our personal lives through social media is making it increasingly difficult for healthcare professionals to uphold this social contract.1
Easy and instant access to social media – thanks to handheld devices – makes it easier than ever for us to screw up (and quite publicly). Social media tools can be incredibly useful or disastrous; for example, it is impossible to stop the spread of a tweet once it has been retweeted.3 A thoughtless tweet could be seen as endorsing a medication. Blogging about an interesting case could potentially violate patient confidentiality. Unbecoming photos of what you did last weekend could tarnish your reputation. These considerations go beyond basic netiquette and traditional concepts of professionalism; we call this digital professionalism, or eProfessionalism.4
The approach to educating students regarding social media and eProfessionalism shouldn’t be centered around surveillance and punishment; it should involve constructive guidance.1 Merely punishing students won’t teach them proper behaviour, and having someone professionally creep their social media accounts is, well, creepy. I believe it is vital to teach health professions students social accountability5 and how to be professional online.2
Guseh and colleagues (2009) published a really interesting article on eProfessionalism and social media within the health professions. Based on this (and a few other articles), I’ve come up with some practical tips for using social media:
- Be aware of your privacy settings. From my readings it appears that when privacy is discussed in regards to social media usage in healthcare, it most commonly refers to patient privacy. I agree that this is a substantial concern, and you obviously shouldn’t be posting information about your patients. However, the privacy of healthcare professionals also needs to be discussed. Not only should you be aware of your privacy settings,6 you should also consider whether they’re appropriate for how you intend on using your social media account. For example, your personal Facebook page shouldn’t be public, but you may want to have a public LinkedIn account that you use for professional purposes.
- Show restraint in what you post. Even with the strictest of privacy settings, you should still be cautious of what you post about yourself and others. For example, Steve may have his Facebook set to private, but that picture of him doing a keg stand in his scrubs is now out there in the digital universe. With a click of a button that picture could be shared or saved. Privacy settings can also be breached by hackers, so it’s best to be conservative in what you’re sharing (and change your password often!) Also ensure you aren’t violating patient privacy in what you share.6,7 The Registered Nurses Association of Ontario recommends not posting anything when you’re in doubt.8 You can always think about it, and come back to it later.
- Thoughtfully consider friend requests. Over the course of your career you may receive friend requests from patients or patients’ family members. For example, in one study 34.5% of doctors reported receiving friend requests from patients and members of a patient’s family.4 Although some authors recommend taking time to consider how accepting or declining a friend request may effect the therapeutic relationship,6 most of our Colleges and professional associations discourage friending patients on social media.9-11 This crosses a professional boundary and could be misinterpreted as a romantic advance, may damage the patient-provider relationship, and could increase the provider’s scope of professional responsibility and thus liability.9,11 Additionally, personal information and pictures you share may be taken out of context by patients.9 I believe it is also important to consider the nature of your social media account.12 It likely isn’t appropriate to accept a patient’s friend request on your personal Facebook account, but it may be entirely appropriate on a professional Facebook page that contains information on your practice. Likewise, the Canadian Medical Association recommends having separate personal and professional social media accounts.12
- Don’t send friend requests to patients.6 Just don’t do it!
Still not sure how to use social media in a professional manner? Consult your regulatory College, professional associations, or your place of work. Many of them provide clear guidelines on how to use social media in an effective and professional manner.
- Ellaway RH, Coral J, Topps D, et al. Exploring digital professionalism. Med Teach. 2015;37(9):844-849.
- Hillman T, Sherbino J. Social media in medical education: a new pedagogical paradigm? Postgrad Med J. 2015;91(1080):544-545.
- Coons S. Communication through social media: its potential and pitfalls. Res Pract. 2012;13(2):44-50.
- Kaczmarcyzk JM, Chuang A, Dugoff L et al. E-Professionalism: a new frontier for medical education. Teach Learn Med. 2013;25(2),165-170.
- Royal College of Physicians and Surgeons of Canada. Social media for physicians: what’s the value and how to get started. YouTube. 2013. https://www.youtube.com/watch?v=0yuqxtQ8GOM&feature=youtu.be. Accessed November 30, 2016.
- Guseh JS, Brendel RW, Brendel DH. Medical professionalism in the age of online social networking. J Med Ethics. 2009;25:584-586.
- Fraser R. The nurse’s social media advantage. Indianapolis, IN: Sigma Theta Tau International; 2011.
- Registered Nurses Association of Ontario. Social media guidelines for nurses. http://rnao.ca/news/socialmediaguideline. Retrieved October 27, 2016.
- Canadian Nurses Association (CNA). When private becomes public: the ethical challenges and opportunities of social media. Ethics Pract Regist Nurses. 2012:1-15. https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/ethics_in_practice_feb_2012_e.pdf?la=en
- College of Nurses of Ontario. Communicating with clients online. Last updated March 26, 2015. http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/ask-practice/communicating-with-clients-online. Accessed October 27, 2016.
- Nurses Association of New Brunswick. Practice guideline: ethical and responsible use of social media technologies. October 2012. http://www.nanb.nb.ca/media/resource/NANB-PracticeGuideline-SocialMedia-E.pdf. Accessed November 30, 2016.
- Canadian Medical Association. Social media and Canadian physicians: issues and rules of engagement. 2011. https://www.cma.ca/En/Pages/social-media-use.aspx. Retrieved October 27, 2016.