There have been a couple of widely-publicized cases recently of physicians divulging patient information in social media. I’m sure the doctors involved did not intend to violate patient privacy.

While there are several excellent guidelines and policies on this topic, there isn’t a whole lot of practical advice, so here are my tips to help you avoid privacy violations (I hope this is the beginning of a conversation that will encourage more doctors to participate in social media).

1. Don’t talk about patients, even in general terms. It’s so difficult to anonymize patients; it’s not worth your time to attempt it.

For example, it’s pretty obvious no thinking person would post this: “Dave Ekrem was in the ER last night with alcohol-induced liver disease.”

But this could also identify your patient: “We had a fifty-year-old male in the ER last night with alcohol-induced liver disease.” (Somebody’s going to say “Really? In Boston? Hey—where was Dave last night? He’s fifty. Oh—I feel sorry for the kids.”)

And so could this: “Had a patient in the ER last night with alcohol-induced liver disease.” It takes only a couple of clues for the sleuths and wags to piece something together. As little as time frame OR geography, coupled with condition, could be enough.

2. Do talk about conditions, treatments, research. You can write about conditions, treatment options, research, or other topics in general terms.

Avoid: “I saw a patient last Tuesday with xyz condition …”
OK: “Children with xyz condition typically present with these symptoms …”

Here are a few great examples of physicians providing valuable content without talking about specific patients:

• Mama Doc 101: Introduction of Solids from Wendy Sue Swanson, MD
• Pediatric Injury Prevention: Obeying Pitch Counts by Howard J. Luks, MD
• Measles Q&A with Dr. Mark Pasternack, MD, chief, pediatric infectious disease at MassGeneral Hospital for Children

3. Don’t be anonymous. This has always been a warning sign in social media — even before Facebook and Twitter when we were using listserves and bulletin boards. Anonymity breds bad behavior. It encourages you to say things you shouldn’t. If you’re not familiar with the case of Dr. Flea, it wouldn’t be a bad idea to Google it.

4. If you wouldn’t say it in the elevator, don’t put it online. This is a famous test, probably repeated by compliance departments and trainers at hospitals all over the US. If you wouldn’t say it in the elevator, don’t put it online. You can try speaking your post out loud before hitting the enter key. Take particular care when replying to people in real-time venues like Twitter. You don’t have to respond right away and if you have any doubt at all, ask a friend or colleague for their reaction before you post.

5. Check the tone of your social media presence. Watch the tone of your posts/tweets: if you’re using social media to vent about work, you should pause and evaluate–too much complaining could be an early warning sign of trouble. Unfortunately, humor can be another warning sign. Any time you write something you think is funny, ask a friend to have a look before you post.

6. Don’t mix your personal and professional lives. Use separate accounts for your personal and professional lives. Don’t friend patients on Facebook, check your privacy settings monthly (they change from time to time) and assume that anything you put online could become public. If you want to have a professional presence on Facebook, create a page apart from your personal account.

7. Disregard your comp teachers’ advice. Writing teachers in colleges will advise you to “show don’t tell,” and “make it concrete and active.” They would prefer to have a story about a real person — Dave, with alcohol-induced liver disease — rather than general advice about the condition or treatment options or your response to recent research. They’d love to know Dave’s age, ethnic background, marital status, what brand of shirt he was wearing, that his loafers were scuffed. If you’ve ever had a composition course, you may have to unlearn a little doctrine.

But we need for you to write!

As a physician, you have a perspective on health topics that’s uniquely valuable to society. People need information from qualified healthcare professionals and sometimes information from healthcare pros is needed to balance other information being put out on the web (or the coffee shop, playground, etc.).

Dave Ekrem manages web development and social media for MassGeneral Hospital for Children and blogs at his self-titled site, Dave Ekrem.

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