This page represents the personal thoughts, opinions, and musings of Jerad M Gardner, MD regarding the use of social media for medical doctors. Although much of my social media experience centers around my specialty of pathology (see: Social Media Guide for Pathologists), the ideas and issues discussed in here are intended to focus on the general social media needs of physicians and healthcare workers from any field of medicine. This page is based on my personal experiences and is by no means official or exhaustive, nor is it necessarily the correct way to do things. A lot of people ask me questions about this topic, and I often give presentations on it, so I am merely attempting to compile my answers and main talking points online in the hopes that some readers will find it useful. I'll try to continue to update this page as often as I have new things to share. - Jerad
For those who have limited past experience with social media, these websites might be useful to explain the basics of the major social media sites:
Specific examples of how I use social media on a professional level. The possibilities are endless, but this might spark some ideas that you can run with.
- I created discussion groups focused on dermatopathology and bone and soft tissue pathology on Facebook. I started these so that I could share interesting cases and teach others. But to my surprise the membership on both groups exploded and pathologists from around the world started sharing their own teaching cases with each other. Both groups have over 6000 members currently (April 2014) and are still growing rapidly.
- When I need to find a clinical photo or photomicrographs of a rare entity for a presentation, I post a request on my pathology-related Facebook groups. With thousands of members receiving the message, I am usually able to find even rare things within a day or so.
- Organize multicenter research projects, particularly when the project requires collecting a series of rare cases. IRB would still be needed, of course, but this is a great way to scout out other investigators who may be interested in collaboration remotely.
- Share links to recent journal publications and other articles or blog posts related to my field. Debate and discussion over new data and findings is robust and can be had in real time on Facebook, a situation I feel is far superior to the old style of writing a letter to the editor to debate a paper.
- I often share links to my soft tissue pathology Youtube teaching videos, links to my dermpath teaching cases on dermpedia.org, or my dermpath and soft tissue path tweets (Twitter: @JMGardnerMD ) on my Facebook feed. This allows me to share my new pathology-related content with a broader audience (not all of my friends use Twitter or are subscribed to my Youtube channel, but the majority of them use Facebook.
- Build personal relationships with other physicians in my specialty and other specialties from around the country and the world (networking)
- Colleagues may not know my email but they know how to message me on facebook. I get FB messages all the time about a variety of things from professional colleagues (research projects, consults [sans patient info of course], invitations to be a guest lecturer or to present a course, etc).
- Follow and interact with patient advocacy groups. This is an awesome experience and is very rewarding!
- Share dermpath and soft tissue teaching “pearls” with my followers
- Build recognition of my name and my areas of professional interest and experience
- Connect with other pathologists and clinical colleagues
- Follow and interact with patient advocacy groups. Again, very rewarding.
- Tweet to Senators and Representatives regarding pathology-related legislative issues
- LinkedIn is more of an online CV than an interactive social network. It is cool in that your colleagues can write recommendations and public reviews of your performance (you get to approve which are displayed on your profile) and can verify that you have experience in various knowledge areas.
- Overall, it is a good place to display where you work, what you are publishing, what committees you are on, etc. It does that much better than Facebook or Twitter.
- I think all doctors should create a LinkedIn profile. It doesn't take long to create, there is minimal upkeep, and it provides a way for other professionals to find you and contact you in the future. I've received many requests/invitations via LinkedIn.
- Post soft tissue pathology teaching videos
- I am on G+, but I don’t use it very much. The network of active users is much smaller and less robust at this point than Facebook or Twitter.
There are many potential benefits, and I feel they definitely outweigh the risks (see below).
- Help others in the field (It's the right thing to do, and it also builds political capital and goodwill)
- Teaching opportunities
- Build a huge professional network
- International name recognition
- Invitations/opportunities to speak, collaborate on research and other projects, travel as a visiting lecturer, and even give talks ABOUT social media (it's still a niche area that most doctors don't know much about)
We have all heard horror stories in the news of politicians, actors, and other famous people getting into minor or major trouble by something they posted on a social media site. While I certainly don’t think we should totally avoid social media or live in excessive fear of making a mistake, being aware of some examples of these mistakes and learning some general guidelines can help us avoid them. Obviously, the more famous and/or “important” one is, the more impact is likely to occur when that person makes a social media gaffe. So at least I feel relatively safe because of that.
Here is my main personal guideline: Be reasonable. Just don’t say ridiculous, hateful, inflammatory, or extremist things on your public social media page. If you wouldn’t want it in the newspaper, maybe you shouldn’t say it online. Remember that even if you have your Facebook set to private, your friends who you allow to see your posts can always take screen shots or copy and paste your posts out into the wide open internet (this has happened many times before). So just think before you post. And don’t post when you are not of sound mind. That means if you have had more to drink than you might have intended to, or when you are angry, or any other reason that might make you less inhibited.
Advice for Doctors on Social Media:
This site also has some useful guidelines:
Here are some enlightening (and entertaining) links that might be relevant:
Is it ok to post de-identified histologic/endoscopic/radiologic/clinical pictures on Facebook or Twitter?
This gets asked about a lot. The short answer is: YES. Below is the long answer. I'm not a lawyer, but here are my personal views:
1. Posting de-identified images does not in any way violate HIPAA. People who have argued with me about this usually either don't understand HIPAA, don't understand medicine, or more likely, both. I'm not a lawyer, but HIPAA makes it pretty clear what patient identifiers are: http://cphs.berkeley.edu/hipaa/hipaa18.html. Please note #17 on the list: "Full face photographic images and any comparable images". Consider de-identified images, even from exceedingly rare cases or cases where n=1, are published in print and posted online in medical journals every month. True, most lay public don't read these journals, but medical journals are PUBLIC not private and can be accessed by anyone willing to pay or use a library. From an ethics/privacy/HIPAA perspective, posting de-identified pics on Facebook for educational purposes is no different from publishing them in a journal in my opinion.
2. Do opinions given on Facebook, Twitter, or anywhere online count as official consults and put the poster at legal risk? I'm not a lawyer. Perhaps there has been some legal precedent in this area but I am not aware of it (if anyone knows, please send me a link). I feel online comments are just opinions not true medical advice. No doctor-patient relationship or consultant-contributor relationship is created. If the person who posts the images chooses to use comments from a forum to guide their clinical diagnosis, that is their prerogative as a trained and qualified physician. The rules of my Facebook forums at least clearly state that the purpose is educational and that all comments are unofficial and not consults. I think it would be unethical (and foolish) for anyone to quote or cite any comment from a Facebook group in an official medical report or anywhere else in a patient's chart.
Here are some tips I use to stay out of trouble:
1. I never say "today I saw a case of disease X" or "yesterday I had this really sad case of (specific type of rare cancer here)". I never use dates. I might say "I recently saw" but I try to always be vague. Remember, a date is a patient identifier.
2. I usually modify the patient history to varying extents when I post an unknown. If I say "this is a left leg mass from a 20 year old woman" there is a high likelihood that the true age is different by a couple of years, the sex might not really be female, and maybe the anatomic site is not really correct either. I try to always do this as a further layer of protection from any accusation of privacy violation. Fibbing on the details to add a further layer of protection to patient confidentiality is a reasonable thing to do in my view.
3. Food for thought: I have a variety of clinical, radiographic, and histologic images in my teaching files, some of which are from colleagues in other countries and also from the USA in years prior to HIPAA. How can anyone know if the image I'm posting is from this week in my hospital, 20 years ago in New York City, or 5 years ago in Budapest? It's impossible, because I make sure my images are always de-identified.
Personal privacy issues (protecting your privacy as a physician)
This is a complex topic. Everyone has different comfort levels regarding social media and privacy settings. I tend to be a pretty open person and will friend someone on Facebook after just meeting them once. But I am also pretty careful about what I post on Facebook and try to avoid saying things that I wouldn’t want to have repeated in public. Some people are very concerned that others not be able to access their FB page. Fortunately, most social media platforms provide multiple adjustable privacy settings. You should read up on this carefully and decide what setting is right for you, especially if you are very concerned about privacy.
How do I maintain boundaries between me and my patients on Facebook?
As a pathologist, I don't often run into this issue. I work with patient biopsies all day long, but patients rarely get to know me or meet me. But if you work directly with patients face to face in clinic and are concerned about getting unwanted Facebook friend requests from your patients, here's what you should do:
Essentially, you should have a hidden/invisible personal Facebook account that you use for friends and family. You should also have a public professional Facebook page (not a separate account) for youself and/or for your practice or group (if you have a small/solo practice, your practice page may represent you as a physician, but if you are one member of a large group or clinic, then you may want an individual professional page with your name and a separate page with your practice's name). This will allow patients to find your public page when they search for you but not find your personal profile. You patients can "like" your page, post comments about what a wonderful doc you are, see content you post on your page that would be of interest to patients, etc, but patients won't be able to see your personal account, pics of your kids and/or dogs/cats, or anything else you prefer to keep private.
Here's exactly how you do it step by step:
The use of social media like Facebook and Twitter by doctors and other medical professionals is attracting a lot of attention. There are numerous articles on this topic. I'll try to post good ones here.
- Physician use of Twitter (discussion of a JAMA article)
- Why doctors should embrace social media (the author, John Madrola, MD, is a great person to follow on twitter: @DrJohnM)