Social media can be a valuable learning tool for clinicians. In healthcare-oriented Twitter chats, Matthew S. Katz, MD, has learned how to listen more attentively to his own patients, and to ask them better questions.
“But social media has the potential for both harm and good. Social media does shift some of the dynamics of the patient-doctor relationship, but working together we can find ways to make social media use less likely to be harmful,” Katz says.
Healthcare providers may unintentionally share too much patient-related information. For example, in May 2018, #ShareAStoryInOneTweet led to viral sharing of health stories, with more than 650 professionals swapping anecdotes disclosing information about others.1 Among the stories about potentially living patients, 46% appeared to contain identifiable information, should the patients see the posts. “We need to develop an ethics-centered, evidence-based framework that helps provide guidance on how to ensure that doctors going online do not undermine the trust patients already have in them offline,” says Katz, a radiation oncologist at Lowell General Hospital.
“Sometimes, however, even despite one’s best intentions, social media use can cause harm,” says Jonathan M. Marron, MD, MPH, a clinical ethicist at Boston Children’s Hospital.
Well-meaning clinicians post interesting or challenging cases online. Some of those cases might be anonymized enough to not violate patient privacy regulations. However, if a patient could recognize themselves in the post, it could be an ethically problematic harm to their trust in the healthcare team if that person never agreed to information-sharing.
“Clinicians should be aware of such worst-case scenarios when using social media,” warns Marron, part of the teaching faculty at Harvard Medical School’s Center for Bioethics.
As patients increasingly access information online, “it gives more autonomy to patients, but requires doctors to ensure that people make informed decisions based upon accurate information, rather than the first hit on Google,” Katz says.
Many clinicians see their social media presence as quite distinct from their clinical role. “While this is somewhat true, it is important to remember that we are still clinicians when we post things online. Once something is put online, we cannot control who sees it or how it’s interpreted,” Marron says.
Marron, Katz, and colleagues recently wrote a paper to assist oncologists in developing standards for ethically informed social media use.2
“This is a necessary next step given the rapid growth of online conversations between patients, doctors, and the general public. As a resident, guidelines would help me learn responsible online behavior as I advance to the next steps of my career,” says Utkarsh Shukla, MD, the paper’s lead author and a radiology oncology resident at Tufts Medical Center.
Ethical concerns over physicians’ social media use recently came to the forefront involving the need to delineate between facts and misinformation surrounding COVID-19.
“Drawing the line between the promotion of healthy skepticism in science and truly unprofessional or unscientific content is no easy matter,” says Matthew DeCamp, MD, PhD, director of the research ethics program at the Colorado Clinical and Translational Sciences Institute.
Healthcare providers are obligated to promote accurate information, whether in the exam room or on social media. However, the potential of social media to amplify content has led some licensing bodies and institutions to consider when content crosses the line to the realm of unprofessional.3
Conflict of interest is another area that social media guidelines fail to adequately address.4,5 “We aren’t necessarily better at the disclosure of financial conflicts of interest online than we were a decade ago. The best way to ensure disclosure happens and remains visible still hasn’t been determined,” DeCamp notes.
Ethicists can help address these issues by creating institutional policies that balance issues of free speech and the promotion of honest and open scientific dialogue.
“Ethicists uniquely understand the important role these values play in society, and that what we hold as ‘fact’ is often changing,” DeCamp says.
REFERENCES
1. Ahmed W, Jagsi R, Gutheil TG, Katz MS. Public disclosure on social media of identifiable patient information by health professionals: Content analysis of Twitter data. J Med Internet Res 2020;22:e19746.
2. Shukla UC, Jimenez RB, Jagsi R, et al. Ethics-centered guidelines for social media use by oncology professionals: A call to action. JCO Oncol Pract 2022 May 4;OP2100765. doi: 10.1200/OP.21.00765. [Online ahead of print].
3. Rubin R. When physicians spread unscientific information about COVID-19. JAMA 2022;327:904-906.
4. Decamp M. Physicians, social media, and conflict of interest. J Gen Intern Med 2013;28:299-303.
5. McCarthy CP, DeCamp M, McEvoy JW. Social media and physician conflict of interest. Am J Med 2018;131:859-860.
Many clinicians see their social media presence as distinct from their clinical role. While this is somewhat true, it is important to remember once something is put online, one cannot control who sees it or how it is interpreted.
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