Art is not a mirror held up to reality but a hammer with which to shape it.
– Bertolt Brecht

In prior posts, I have discussed the issue of professionalism and social media.  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 or document that expressly discusses appropriate, positive use of social media in health care communications.

As a result, I am taking the liberty of making some suggestions as to what I think are important guiding principles for effective physician use of social media.  This will include some cautions that I feel are especially useful, but I would also like to explain how and why I think physicians can use social media in positive and useful ways.

Part of this task includes defining physician professionalism.  There are various definitions, but they share the common themes of respect for patients’ autonomy, individualism, and privacy; response to and concern for societal needs; embodiment of humanistic values of altruism, empathy, compassion, honesty, and integrity; focus on the scientific basis of medical knowledge; accountability to peers; and commitment to professional development and competence

With those guiding principles, here are my suggestions for how physicians can effectively use social media:

1. Do not discuss patient’s illnesses, medical conditions, or personal information online.  Unless you have a patient’s express permission to share their information, then do not discuss anything about them online.  The simple fact is that even if we believe we have made information anonymous, it is hard to do so completely (as this doctor discovered).  If a patient has given you their permission, make that clear in the post.  Otherwise, do not discuss real patients’ information via social media.  Rather than choosing to discuss a specific recent case that you might have seen, it would be better to offer a broader perspective or discussion on the issues at hand.  This is especially true in a smaller community, where even broad descriptions of patients and clinical situations might allow patients to be identified.
2. Use social media to share information that promote quality health care and up-to-date medical information.  There is a wealth of information available on Twitter, for example, that provides current information regarding medical research and treatments.  The New England Journal of Medicine, the Journal of the American Medical Association, the American Academy of Family Physicians, the National Institutes of Health, and the Centers for Disease Control (among many, many others including individual medical specialty organizations and journals) all have accounts that provide regular updates with a focus on basic science and clinical care.  By following these accounts and sharing relevant and actionable information, we promote its dissemination.
3. Address those societal needs that you think are most important, or that motivate you.  Social media use will undoubtedly be an added responsibility during your free time, and so using it to focus on issues that are relevant to you makes it easier to sustain the effort.  For example, I am a strong believer in the need to enhance our primary care workforce via family medicine and I support the Patient Protection and Affordable Care Act (PPACA) of 2010.  As a result, my Twitter feed focuses on these topics.  I share updates about how the PPACA will enhance patients’ access to health care and reform health insurance company practices, about the importance of family medicine (and primary care) and the need to reform our system to support and train more family physicians, etc.  Each of us will be motivated by our specific interests, but we should use social media as tool to call for necessary change to benefit society as a whole.
4. Recognize that you represent your profession, and help others recognize that they do, too.  When someone views your social media posts, they will likely see the post through the lens of your profession.  If they see my posts, it might not be seen as “Mark Ryan thinks such-and-such” but rather “Dr. Mark Ryan thinks such-and-such.”  It might then be tempting to presume that others in the same profession feel the same.  So, take care not to post updates that would violate the definition of professionalism identified above.  If you see someone else posting updates that seem unprofessional, I think it is appropriate to connect with them and discuss this issue–not in a punitive way, but rather to help promote the proper use of social media tools.
5. Promote the humanistic values identified as congruent with medical professionalism.  Be honest, forthright, helpful, and compassionate.  Offer help, answer questions, and suggest resources when you are able to do so.  Be open to contact from others, and participate in discussions when time allows.
6. I do not think it is necessary to separate personal and professional content online.  My social media presence is a reflection of who I am, and expresses my beliefs and my priorities.  These are what make me the person and the physician that I am, that define the societal needs that I seek to address, and determine my perspective on any number of issues.  To be personal, my social media presence must reflect my beliefs.  However, I do use a disclaimer to note that my opinions are mine alone (not those of my employer), and I understand that there are those who will disagree with me.  Social media is an opt-in phenomenon: if someone wants to read my opinions, they will have to come find my accounts … and they can choose to ignore me and any of my posts.
7. I do not think we must keep our social media content locked behind tight privacy restrictions.  My accounts’ privacy settings depend on my anticipated use: I keep my Twitter and Tumbr accounts public because I intend for the information to be public.  I keep my Facebook account private because I do not intend to use it for public information, but rather to keep up with friends and family.
8. Do not practice medicine via social media.  It seems self-evident, but it is worth making clear.  I do not provide any individual, specific medial care or medical advice via social media.  The most I have done is to provide links to already-available online resources for people to review and to help them make their own decisions as to how to proceed with any given medical issue.  I do not knowingly interact with any patients on Twitter but, if I did, I would interact with them the same way I interact with anyone in a public setting.  I do not friend patients on Facebook because of how I choose to use Facebook
9. Presume that everything said online can be found if someone looks hard enough, and is going to be available forever.  This might be an exaggeration, but it provides guidance when thinking about what information should be shared.  I assume that nothing is actually private, and so I do not post any information (even via direct messages) that I would be bothered if it were made public.  For the same reason, I choose not to use any anonymous accounts: I assume that someone out there could identify me if they tried hard enough.  This helps me edit what I put online and what stays in my head.

I hope that this post accomplishes its goal: to provide some suggestions and guidelines on how to use social media effectively and professionally as a physician.  Social media is not simply a way to reflect what is happening around us, but rather a way to play an active role in changing society for the better.

Mark Ryan is a family physician who blogs at Life in Underserved Medicine and Social Media Healthcare.

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