Doctors debate the social-media dilemma

On Facebook and Twitter, Dr. Evan Adams regularly shares links to health news stories and alerts about disease outbreaks. The deputy provincial health officer, who is responsible for aboriginal health in British Columbia, says he’s had both positive and negative experiences with social media.

On one hand, these online platforms allow Adams to interact with people around the province and spread important health information. On the other hand, some people try to use social-networking sites to seek medical advice or start personal relationships with him. That’s inappropriate, Adams told the Georgia Straight.

“I really think of using the Internet for group care and not individual care,” Adams said by phone from Victoria. “I can’t be looking after one person’s sore tooth when there are, literally, millions of people in very dire situations who are needing care. And I think, for some patients, that’s hard to understand.”

Although Adams has embraced using social media, many medical doctors are opting to stay away when it comes to their work.

In November 2013, the Canadian Medical Association surveyed 885 practising and retired physicians, residents, and students about their use of social media. Fewer than five percent of respondents were using Facebook for professional purposes. Meanwhile, 19 percent were using LinkedIn and nine percent were using Twitter for such purposes.

Almost 90 percent of respondents said they think the use of social media in health care presents professional and legal risks. About 40 percent believe these tools are of little or no use in daily practice.

“Social media is just another distraction from real patient care,” one respondent commented. “Do not waste our time.”

According to the CMA’s “rules of engagement” for social media, issued in 2011, these platforms may increase doctors’ exposure to disciplinary and legal risks, but they also could be used to improve health care in the future. The CMA instructs physicians to “be transparent” and suggests they establish separate professional pages on social-networking sites.

The College of Physicians and Surgeons of B.C. tells doctors to treat social media as “virtual public spaces”. The college’s social-media guidelines, approved in 2010, say physicians should not send friend requests to patients. The guidelines also advise doctors to use the strictest privacy settings, remove “unprofessional” content proactively, “exercise restraint” when disclosing personal information, and ask permission when it’s necessary to view patients’ profiles.

“I think one of the things is it’s truly untried, but it’s also governed by the same ethical and professional standards that would apply to a face-to-face physician-patient encounter,” Dr. William Cunningham, president of Doctors of B.C. (formerly the B.C. Medical Association), told the Straight by phone from his Vancouver office. “I think that’s the big challenge. Using social media, it just makes it very difficult to separate the personal and professional lives of doctors.”

According to a September 2013 article in the medical journal Clinical Obstetrics and Gynecology, discussion of the dangers of social media has “largely overwhelmed” talk of the potential benefits to medicine. Its authors, three Pennsylvania State University professors, suggest that improved privacy controls on Facebook and Google+ could lead doctors to feel more comfortable about accepting patients into their networks. The article notes that social media offers opportunities to improve physician-patient communication, enhance doctors’ professional development, and facilitate health research.

Dr. Kendall Ho told the Straight that physicians need to inject their expertise into the health conversations that patients are having on social media or others will fill the void. But doctor-patient confidentiality must always be preserved, according to Ho, a professor in the faculty of medicine and the director of the eHealth Strategy Office at the University of British Columbia.

“Why are we using social media?” Ho said by phone from his Vancouver office. “I think the ‘why’ is because we want to build up that relationship with our patients and also to make sure that it doesn’t do harm.”

On February 3, Ho was a panellist at a public forum called “Connecting for Quality: Social Media and Health Care” at Vancouver General Hospital, where he also works as an emergency physician. Although social media is being used today for “knowledge exchange”, Ho believes “co-creation” is the future.

“I think it’s vitally important for us to be in social media now—both patients and health professionals—so that we can create the next generation of communication through the Internet,” Ho said.

UBC medical student Connor Forbes already has personal Facebook and Twitter profiles but he anticipates setting up separate professional pages on those sites after he graduates. Forbes told the Straight that he’s looking forward to seeing how social media will be used in medicine in the coming years.

“Because it’s uncharted waters right now, people are a bit hesitant to jump in until we see what happens and if there are any consequences,” Forbes said by phone from the William A. Webber Medical Student & Alumni Centre. “As we start to see that it’s okay to maintain a professional online presence separate from your personal presence, then we’ll see more doctors involved in social media.”