Social media is a collection of Internet-based platforms which allow people to connect and interact.

A 2011 survey found that 93.5% of medical students, 79.4% of residents, and 41.6% of practicing physicians use online social networks. Another recent study showed nearly 87% of physicians use social media for personal use and 67% use these services professionally.

Although it seems self-evident, it is occasionally forgotten that physicians must protect the privacy and confidentiality of their patients and maintain a standard of professionalism in all social networking interactions at all times.

Failure to do so can have devastating ramifications in the life of a medical professional.

A social network describes a group of people. Social media are the tools people use. The major kinds of social medial include:

Blogs: These are websites or sections of a website where an author can post articles encouraging reader feedback. It provides for open-ended interaction between the author and the reader in the form of comments and replies.

Micro blogs: These are similar to blogs, except they come with a restriction on length. An example is Twitter, which limits posts to 140 characters.

File-sharing Sites: These emphasize sharing files of various media. An example is YouTube. This site invites user feedback by way of comments and offers tools so users can recommend or share files.

Integrated Social Media: These sites integrate many kinds of social elements. For example, Facebook combines micro blogging, full blogging, and file sharing. LinkedIn is similar but organized around professional relationships.

There are potential benefits to social networking. It provides a forum for collegial discussion and exchange of knowledge. It can be used to educate the public on health-related matters. YouTube can be used for physician or patient teaching as a supplement to traditional face-to-face education. Because micro blogs are almost in real time, they have become a popular way for connecting with other colleagues at medical conferences. Professional networks such as LinkedIn have converted the business card into an interactive and living resume.

It is evident that when used appropriately, social networking has many possible benefits. However, there can be unintended consequences from its use, especially when work experiences are shared.

One meta-analysis of physician blogs found that nearly 17% included enough patient information for patient identification. Remember, these sites have the potential to be viewed by many people and any breach in confidentiality could be harmful to the patient and in violation of federal privacy laws (HIPAA).

A study of physicians using Twitter found that 3% of Tweets were unprofessional and 0.7% violated patient privacy. 0.6% contained profanities, 0.3% included sexually explicit material, and 0.1% included discriminatory statements. In 2011 an emergency department physician posted information online about a trauma patient. The posting did not include any patient identifiable information; however enough detail was included that others in the community could identify the patient.

The physician was fired from the hospital and reprimanded by the state medical board.

State medical boards have the authority to discipline physicians for unprofessional behavior relating to inappropriate use of social networking media, such as:

• Inappropriate communication with patients online.
• Use of the Internet for unprofessional behavior.
• Online misrepresentation of credentials.
• Online violations of patient confidentiality.
• Online derogatory remarks regarding a patient.
• Online depiction of intoxication.

Actions can range from a letter of reprimand to revocation of a license. Improper use of social media may violate state and federal laws established to protect privacy and confidentiality, which could include both civil and criminal penalties, including fines and possible jail time. The physician could be sued for defamation, invasion of privacy, or harassment.

Information created or shared via social media could be subject to e-discovery in the course of litigation.

The American Medical Association and Federation of State Medical Boards have developed guidelines for the appropriate use of social networking in medical practice. By following these guidelines, physicians may limit their risk exposure. Some of the recommendations include the following:

• Interaction with current or past patients on personal social networking sites is discouraged.
• When using sites for discussion of medicine online, it is the responsibility of the physician to ensure to the best of their ability, that the professional site for physicians is secure and that only verified and registered users have access to the information. The website should be password protected so that non-physicians do not gain access and view discussions.
• Patient privacy and confidentiality must be protected at all times. Be aware that information you post on a social networking site may be distributed (whether intended or not) to a larger audience, and could be misconstrued. What you say may be taken out of context and remain publicly available forever online. A blog leaves a permanent imprint on the Internet because most blogs are searchable by date, name, or keywords, and an entry from long ago can be quickly accessed.
• You are representing the medical community, so always act professionally. Adhere to the same principles of professionalism online as offline.
• Use separate personal and professional social networking sites.

Dr. Olivier is an emergency physician at Opelousas General Health System in Opelousas, La., a member of the ACEP Medical-Legal Committee, and President of the Louisiana Chapter of ACEP.

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