LegalMD Newsletter Feb 2018

09 February, 2018

Medico-Legal Newsletter
February 2018, New Delhi
As social media use in the country continues to grow, physicians are realizing how valuable a tool. For healthcare professionals, social media is like a double-edged sword as it is an opportunity to connect with potential and existing patients, disseminate general health information, advertise their services, seek professional advice and professional opportunities.
The term ‘social media’ generally refers to Internet-based tools that allow individuals and communities to gather and communicate; to share information, ideas, personal messages, images, and other content; and, in some cases, to collaborate with other users in real time. It can be used for both personal and professional purposes.
They may include blogs, social networks, video- and photo-sharing sites, wikis, or a myriad of other media, which can be grouped by purpose, serving functions such as:
  • Social networking
  • Professional networking
  • Media sharing
  • Content blogs
  • Knowledge/information aggregation
  • Virtual reality and gaming environments
There is growing debate about whether the medical profession should play a role in using social media to communicate more effectively with individual patients and the patient community at large. The reality is that individual doctors and medical organizations have to consciously decide if, why and how to use the various social media platforms. While use of social media could potentially increase the exposure of physicians to disciplinary and medico-legal issues, those physicians who choose to use social media can help shape how these tools can improve health care in the future.
Exact numbers vary, but most studies indicate that Internet usage by physicians now exceeds 80%. Physicians use social media for personal interactions as well as professional communication and research.
Approximately 1% of healthcare professionals using social media are creating blogs, forums, and information-sharing websites that provide information to
ePatients and other healthcare professionals.
Another 9% engage with others on social media by commenting on posts and participating in group discussions or online chats and sharing useful information or links with followers or other members of an online community.
Finally, 90% of physicians are social media consumers who use the Internet and social media to find and read relevant information related to their patients and practice.
It is undeniable that the internet and social media platforms have become an integral part of how patients and members of the public seek information about health and increase the sense of engagement patients have in their own care. Through a variety of websites and fuelled by the growing availability of electronic patient health records, patients are increasingly sharing information with other patients about their health conditions and their health care providers.


Social media pose a challenge for physicians (and other professionals) in terms of separating one’s personal and professional lives. While such a separation is a fundamental tenet of the medical profession, social media blur such boundaries in ways that can enrich communications, but can also put physicians at risk.
Other reasons include:
  • Most physicians have joined the conversation online at some level. Nonetheless, concerns remain in the healthcare community and the foremost among these concerns are the physician’s ethical and legal obligations
  • Because a misstatement on social media can spread quickly through social sharing, some physicians are reluctant to share information or opinions online. They may also avoid statements that appear to provide a diagnosis due to professional ethics standards
  • Additionally, privacy rules loom particularly large as a reason why physicians are cautious about engaging with individual patients
Social media is unique in that it allows for two-way communication online between creators and consumers of information. Thus, social media may be an ideal platform for mass health communication as well as the potential for addressing specific queries by individuals.
A systematic review identified seven key uses of social media for health communication:
  • Provide health information on a range of conditions
  • provide answers to medical questions
  • facilitate dialogue patient-to-patient and patient-to-health professional
  • collect data on patient experiences and opinions
  • health intervention, health promotion and health education
  • reduce illness stigma
  • provide online consultations
While engaging in social media, it is recommended that physicians:
  • Comply with all legal and professional obligations to maintain patient privacy and confidentiality
  • Maintain appropriate professional boundaries with patients and those close to them
  • Maintain professional and respectful relationships with patients, colleagues, and other members of the health-care team
  • Comply with relevant legislation with respect to physician advertising
  • Comply with the law related to defamation, copyright, and plagiarism when posting content online
  • Avoid conflicts of interest
The following guidelines are recommended for physicians who use social media and social networking in their personal and professional lives.
  1. Interacting with Patients
  • Physicians are discouraged from interacting with current or past patients on personal social networking sites such as Facebook
  • They should only have online interaction with patients when discussing the patient’s medical treatment within the physician-patient relationship, and these interactions should never occur on personal social networking or social media websites
  • In addition, physicians need to be mindful that while advanced technologies may facilitate the physician-patient relationship, they can also be a distracter which may lessen the quality of the interactions they have with patients. Such distractions should be minimized whenever possible
  1. Discussion of Medicine Online
  • Social networking websites may be useful places for physicians to gather and share their experiences, as well as to discuss areas of medicine and particular treatments. These types of professional interactions with other physicians represent an ancillary and convenient means for peer-to-peer education and dialogue
  • While such networks may be useful, it is the responsibility of the physician to ensure, to the best of his or her ability, that professional networks for physicians are secure and that only verified and registered users have access to the information
  • These websites should be password protected so that non-physicians do not gain access and view discussions as implying medical advice, which may be counter to the physicians’ intent in such discussions
  • Physicians should also confirm that any medical information from an online discussion that they plan to incorporate into their medical practice is corroborated and supported by current medical research
  1. Privacy/Confidentiality
  • Just as in the hospital or ambulatory setting, patient privacy and confidentiality must be protected at all times, especially on social media and social networking websites. These sites have the potential to be viewed by many people and any breaches in confidentiality could be harmful to the patient and in violation of the prevailing laws of the country
  • While physicians may discuss their experiences in nonclinical settings, they should never provide any information that could be used to identify patients. Physicians should never mention patients’ room numbers, refer to them by code names, or post their picture
  1. Disclosure At times, physicians may be asked or may choose to write online about their experiences as a health professional, or they may post comments on a website as a physician. When doing so, physicians must reveal any existing conflicts of interest and they should be honest about their credentials as a physician.
  2. Posting Content
  • Physicians should be aware that any information they post on a social networking site may be disseminated (whether intended or not) to a larger audience, and that what they say may be taken out of context or remain publicly available online in perpetuity
  • When posting content online, they should always remember that they are representing the medical community. Physicians should always act professionally and take caution not to post information that is ambiguous or that could be misconstrued or taken out of context
  • When moderating any website, physicians should delete inaccurate information or other’s posts that violate the privacy and confidentiality of patients or that are of an unprofessional nature
  1. Professionalism: To use social media and social networking sites professionally, physicians should also strive to adhere to the following general suggestions:
  • Use separate personal and professional social networking sites. For example, use a personal rather than professional e-mail address for logging on to social networking websites for personal use. Others who view a professional e-mail attached to an online profile may misinterpret the physician’s actions as representing the medical profession or a particular institution.
  • Report any unprofessional behaviour that is witnessed to supervisory and/or regulatory authorities
  • Always adhere to the same principles of professionalism online as they would offline
  • Cyber-bullying by a physician towards any individual is inappropriate and unprofessional
  • Refer, as appropriate, to an employer’s social media or social networking policy for direction on the proper use of social media and social networking in relation to their employment


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

  • Inappropriate communication with patients online
  • Use of the Internet for unprofessional behaviour
  • Online misrepresentation of credentials 
  • Online violations of patient confidentiality
  • Failure to reveal conflicts of interest online
  • Online derogatory remarks regarding a patient
  • Online depiction of intoxication
  • Discriminatory language or practices online State medical boards have the option to discipline physicians for inappropriate or unprofessional conduct while using social media or social networking websites with actions that range from a letter of reprimand to the revocation of a license
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