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Dear colleagues,
Most of us engage with social media, whether actively tweeting, following friends on Facebook, or discussing TikTok videos with family. Many gastroenterologists leverage social media to build their professional brand and to reach a wider audience. Others remain wary of committing a social media faux paux or worry about patient confidentiality. In this Perspectives column, Dr. Stephen Chris Pappas and Dr. Mohammad Bilal discuss the risks and benefits of social media for the practicing gastroenterologist. Dr. Pappas has a unique perspective as a gastroenterologist who is also trained as a lawyer, and Dr. Bilal speaks from a wealth of experience leading educational activities on social media. We look forward to hearing your thoughts on Twitter @AGA_GIHN and by email at [email protected].
Gyanprakash A. Ketwaroo, MD, MSc, an associate professor of medicine, Yale University, New Haven, Conn., and chief of endoscopy at West Haven (Conn.) VA Medical Center. He is an associate editor for GI & Hepatology News.
Carefully consider the plentiful risks, concerns
BY STEPHEN CHRIS PAPPAS, MD, JD, FAASLD, FACLM
Social media for gastroenterologists comes with benefits accompanied by pesky risks. The risks are pesky like a mosquito bite: An itching bite is annoying, but getting malaria is serious. Managing your unprofessional tweet to salvage your reputation is going to be annoying. Disclosing a patient's identity on social media is going to be serious; you could find yourself fired, fined, reprimanded, and without hospital privileges, as happened recently to a Rhode Island physician. I divide the risks of social media into legal risks (for example, disclosing patient identity or inadvertently creating a doctor-patient relationship), risks of compromising ethical standards (for example, impairing the doctor-patient relationship), and mixed legal/ethics risks (for example, inappropriate Twitter banter disparaging individuals, promotion of “fake news”). Fortunately, these risks are intuitive and can be mitigated by attention to some simple principles.
Disclosing a patient’s identity on social media is clearly in violation of privacy laws and other regulations. Since privacy compliance is drummed into us ad nauseum via annual compliance training, we could ask “how on earth could an inadvertent disclosure of identity occur?” We must remember that sites that are nominally termed “secure” may not be. As a general suggestion, I would regard social media of all types as open public forums with permanent postings. Even limited descriptions of a patient on social media may allow identification of the actual patient. The risk may be highest in smaller communities; in the past I assisted a small-town practitioner manage the fallout from inadvertently identifying a patient on his professional Facebook page by simply saying “I recently managed a 38-year-old pregnant woman with Crohn’s disease ...” That small amount of information allowed some members of his community to identify the specific patient. My suggestion would be to never talk about individual patients on social media. Phrase comments or questions generically; for example, “Crohn’s disease in pregnancy is managed with attention to ...”.
Another legal risk of social media engagement is to unknowingly create a patient-doctor relationship with a duty to treat, opening the door for exposure to malpractice litigation if something goes awry. A patient may interpret a social media interaction as establishing a patient-doctor relationship. While we think we know what defines a doctor-patient relationship, it’s not always clear and varies between jurisdictions. Indeed, a physician-patient relationship may not even be a necessary element of a claim for professional negligence (an issue shared with “curbside” consults). A recent court case in Minnesota ruled that a duty to care is established if “... it is reasonably foreseeable that the third party will rely on the physician’s acts and be harmed by a breach of the standard of care.” That case involved a telephone call, but you could see the standard easily morphing to apply to social media posts. Gastroenterologists should always talk about disease and treatment on social media in generic terms, preferably with appropriate caveats (for example, “Patients with cholestasis and intense itching may be treated with naloxone in selected cases after detailed assessment by a hepatologist”).
Impairing an established doctor-patient relationship by “friending” a patient on your personal Facebook risks a potential compromise of professional ethics, breaking the boundaries between profession and person for the gastroenterologist. The approach by most professional societies is that a “friend” on social media is equal to a friend in the real world; the same legal and ethical standards apply. Doctor-patient friendships may compromise objectivity, lead to preferential but not optimal therapy, and increase the risk of skirting around informed consent among other issues. Being friends on social media is discouraged, but not prohibited, by most professional societies and licensing bodies. In my opinion, that is sound advice. Over a career of more than 40 years, I have had patients who became friends, but only after I had transferred their care to another hepatologist.
More recently with escalating, aggressive, tones for social media communications, GI/hepatology practitioners must be aware of the serious risk of blurring their personal and professional online lives, particularly where Twitter is involved. The rapidity which people seem to want to reply to a tweet, the public and durable natures of a tweet, and the ability to significantly retweet and repost all spell potential disasters for the physician tweeting an inappropriate communication. Separation of personal and professional social media accounts is strongly encouraged but alone is not enough; you are never totally anonymous online. The reality is that a physician will be judged for an inappropriate communication whether it’s found on their professional or personal site. Either posting could result in reputation damage, reprimands, medical license restrictions or revocations, and litigation. Nationally, medical boards now regularly deal with disciplinary actions for inappropriate social media activity. The best preventive measures include pausing before you post, check the veracity of what you are posting, place your post in context, and assess the tone of your post and the tone of the site that you are posting to. A perfect storm for disaster is that the material is not clearly evidence based and could be construed as “fake,” you are personally emotionally charged, and the site you are posting to is a known cauldron of emotion and fake news.
In summary, social media affords benefits in a health care setting but it comes with some baggage. However, the risks of a social media presence are largely instinctive. An initial starting point is pausing to consider, “Would I say/do this in a public venue where everybody could hear/see me?” If there is any concern, don’t post. Subsequently, conduct yourself on social media with meticulous attention to protecting confidentiality, avoiding any impression of creating a doctor-patient relationship, avoiding doctor-friend relationships, being aware of key legal, institutional, and professional society guidance, separating personal and professional activities, and maintaining professionalism.
Dr. Pappas is in the GI and hepatology section of the department of medicine at Baylor College of Medicine, Houston. He has no relevant conflicts of interest to disclose.
References
Attai DJ et al. Semin Hematol. 2017 Oct; 54(4): 198-204.
Bal BS et al. Clin Orthop Relat Res. 2019 Oct; 477(10): 2204-6.
Ekrem, D et al. 20111 Jun 6. https://www.kevinmd.com/2011/06/7-tips-avoid-hipaa-violations-social-media.html
Hallenbeck J. Doctor and Friend. 2005 Jun. https://journalofethics.ama-assn.org/article/doctor-and-friend/2005-06
Moses RE et al. Am J Gastroenterol. 2014 Aug;109(8):1128-32.
Understand its multifaceted importance
BY MOHAMMAD BILAL, MD, FACP
Merriam-Webster’s dictionary defines social media as “forms of electronic communication (such as websites for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content.” Over the last few years, there has been an increase in use of social media by medical professionals. Whether we like it or not, social media is here to stay. Patients use social media to look up information regarding their doctors, medical practices use it to promote the services they offer, institutions share their programs and initiatives, and doctors use it for education, to engage with like-minded colleagues, collaborate, spread awareness, network, and combat medical misinformation. Social media is now rapidly being used by gastroenterologists and hepatologists, as well as majority of professional GI organizations, and hashtags such as “#MedTwitter”, “#GITwitter,” and “#LiverTwitter” have developed into popular academic forums.1 Therefore, the impact of social media in GI is multifaceted and includes its role in medical education, promoting your practice or division, finding collaborations, building your network and establishing mentors and peer-mentors, disseminating your work, and building your brand.2
What is your goal?
Gastroenterologists could have one or more of the goals mentioned above for using social media. Determining the goals for social media use a priori will allow for determining which social media platform will be appropriate for you. Therefore, it is important to understand the users of various social media platforms. In 2017, Facebook was the highest used social media platform in all age groups, whereas Instagram was most popular amongst ages 18-29 years, while Twitter was used more commonly in ages 30-59 years as compared with Instagram. If your goal is to share scientific knowledge and literature with like-minded physicians and interact with leaders in the field, then Twitter may be ideal. If you want to connect with a younger, more diverse audience, Instagram might be a good option. While many physicians may have a Facebook account, this is often reserved for personal use. Many have separated of personal and professional social media use, although they do not need to exist in silos. Defining your goal with social media use will direct you to the best platform to reach your audience.
Medical education
The use of social media especially Twitter for medical education is continuously increasing. Several leaders in the field use “Tweetorials” as a means to educate others. Tweetorials are a collective set of tweets that systematically cover a specialized topic.3 Other educational forums such as @ScopingSundays, @MondayNightIBD, @IBDClub and @GIJournal provide structured platforms for GI focused discussion.4 @MondayNightIBD is also a source for official continued medical education. Other social media educational platforms include “Liver Fellow Network” which has wide variety of educational materials pertaining to hepatology. In addition, there is continuous opportunity to engage with leaders in the field and authors of published studies and guidelines. Several endoscopy educators have dedicated YouTube channels which have endless supply of educational videos.
Networking
As mentioned above, platforms such as #GITwitter and #LiverTwitter have become popular forums for engaging and connecting with like minded colleagues. Social media provides a space to share ideas and build collaborations with colleagues working on similar projects. The concept “#Twitter2Paper” has been proposed which signifies an idea that generated on Twitter and was eventually converted to a manuscript.5
Institutional, divisional, and practice promotion
Social media is a great tool to showcase the clinical, educational and scholarship services and efforts by programs, practices or divisions. During the COVID-19 pandemic, recruitment efforts at all stages were mainly shifted to virtual platforms, and social media was an instrumental way for programs to highlight their culture and initiatives. Prospective applicants can often refer to social media to get a better understanding of what the program offers. Similarly, if a new clinical service is being provided, targeted efforts can be made to ensure that patients are aware of the available services.
Patient education and combating misinformation
Several gastroenterologists also use social media to spread awareness regarding GI diseases. Instagram, Facebook, and TikTok are effective mediums where one can reach a wider audience. It is important for gastroenterologists to provide accurate information since there is a sea of misinformation available on the internet as well. Posts regarding colonoscopy and colon cancer awareness can help alleviate myths regarding role of colonoscopy. In addition, patient advocates use social media to provide peer support to others who deal with challenges related to chronic illnesses such as inflammatory bowel disease.
Sharing your work
Sharing your work on social media can help your work reach a broader audience. Studies have shown that work shared on social media has higher altmetric scores and can also lead to increased citations.
Diversity, equity, and inclusion
Social media offers a platform where one can promote or showcase their support for causes they believe in. The hashtag “#DiversityinGI” has been instrumental in promoting causes pertaining to diversity and inclusion in GI.
Pitfalls
As gastroenterologists continue to use social media, it is important to be mindful of potential pitfalls. The most critical aspect is to always remember that no post should intentionally or unintentionally violate HIPAA. It is advisable to know your institutional and state social media policies.
Social media is beaming with knowledge, education, science and inspiration. There are endless opportunities for professional and personal growth with effective and responsible use of social media. Its never to late to join the conversation.
Dr. Bilal is an assistant professor of medicine at the University of Minnesota, Minneapolis and an advanced endoscopist in the division of gastroenterology at Minneapolis VA Medical Center. He has no relevant conflicts of interest to disclose.
References
1. Mikolajczyk AE et al. Hepatol Commun. 2020 Jul 5;4(8):1229-33.
2. Bilal M and Oxentenko AS. Am J Gastroenterol. 2020 Oct;115(10):1549-52.
3. Breu AC. N Engl J Med. 2019 Sep 19;381(12):1097-8.
4. Bilal M et al. Nat Rev Gastroenterol Hepatol. 2021 Aug;18(8):519-20.
5. Pawlak KM et al. United European Gastroenterol J. 2021 Feb;9(1):129-32.
Dear colleagues,
Most of us engage with social media, whether actively tweeting, following friends on Facebook, or discussing TikTok videos with family. Many gastroenterologists leverage social media to build their professional brand and to reach a wider audience. Others remain wary of committing a social media faux paux or worry about patient confidentiality. In this Perspectives column, Dr. Stephen Chris Pappas and Dr. Mohammad Bilal discuss the risks and benefits of social media for the practicing gastroenterologist. Dr. Pappas has a unique perspective as a gastroenterologist who is also trained as a lawyer, and Dr. Bilal speaks from a wealth of experience leading educational activities on social media. We look forward to hearing your thoughts on Twitter @AGA_GIHN and by email at [email protected].
Gyanprakash A. Ketwaroo, MD, MSc, an associate professor of medicine, Yale University, New Haven, Conn., and chief of endoscopy at West Haven (Conn.) VA Medical Center. He is an associate editor for GI & Hepatology News.
Carefully consider the plentiful risks, concerns
BY STEPHEN CHRIS PAPPAS, MD, JD, FAASLD, FACLM
Social media for gastroenterologists comes with benefits accompanied by pesky risks. The risks are pesky like a mosquito bite: An itching bite is annoying, but getting malaria is serious. Managing your unprofessional tweet to salvage your reputation is going to be annoying. Disclosing a patient's identity on social media is going to be serious; you could find yourself fired, fined, reprimanded, and without hospital privileges, as happened recently to a Rhode Island physician. I divide the risks of social media into legal risks (for example, disclosing patient identity or inadvertently creating a doctor-patient relationship), risks of compromising ethical standards (for example, impairing the doctor-patient relationship), and mixed legal/ethics risks (for example, inappropriate Twitter banter disparaging individuals, promotion of “fake news”). Fortunately, these risks are intuitive and can be mitigated by attention to some simple principles.
Disclosing a patient’s identity on social media is clearly in violation of privacy laws and other regulations. Since privacy compliance is drummed into us ad nauseum via annual compliance training, we could ask “how on earth could an inadvertent disclosure of identity occur?” We must remember that sites that are nominally termed “secure” may not be. As a general suggestion, I would regard social media of all types as open public forums with permanent postings. Even limited descriptions of a patient on social media may allow identification of the actual patient. The risk may be highest in smaller communities; in the past I assisted a small-town practitioner manage the fallout from inadvertently identifying a patient on his professional Facebook page by simply saying “I recently managed a 38-year-old pregnant woman with Crohn’s disease ...” That small amount of information allowed some members of his community to identify the specific patient. My suggestion would be to never talk about individual patients on social media. Phrase comments or questions generically; for example, “Crohn’s disease in pregnancy is managed with attention to ...”.
Another legal risk of social media engagement is to unknowingly create a patient-doctor relationship with a duty to treat, opening the door for exposure to malpractice litigation if something goes awry. A patient may interpret a social media interaction as establishing a patient-doctor relationship. While we think we know what defines a doctor-patient relationship, it’s not always clear and varies between jurisdictions. Indeed, a physician-patient relationship may not even be a necessary element of a claim for professional negligence (an issue shared with “curbside” consults). A recent court case in Minnesota ruled that a duty to care is established if “... it is reasonably foreseeable that the third party will rely on the physician’s acts and be harmed by a breach of the standard of care.” That case involved a telephone call, but you could see the standard easily morphing to apply to social media posts. Gastroenterologists should always talk about disease and treatment on social media in generic terms, preferably with appropriate caveats (for example, “Patients with cholestasis and intense itching may be treated with naloxone in selected cases after detailed assessment by a hepatologist”).
Impairing an established doctor-patient relationship by “friending” a patient on your personal Facebook risks a potential compromise of professional ethics, breaking the boundaries between profession and person for the gastroenterologist. The approach by most professional societies is that a “friend” on social media is equal to a friend in the real world; the same legal and ethical standards apply. Doctor-patient friendships may compromise objectivity, lead to preferential but not optimal therapy, and increase the risk of skirting around informed consent among other issues. Being friends on social media is discouraged, but not prohibited, by most professional societies and licensing bodies. In my opinion, that is sound advice. Over a career of more than 40 years, I have had patients who became friends, but only after I had transferred their care to another hepatologist.
More recently with escalating, aggressive, tones for social media communications, GI/hepatology practitioners must be aware of the serious risk of blurring their personal and professional online lives, particularly where Twitter is involved. The rapidity which people seem to want to reply to a tweet, the public and durable natures of a tweet, and the ability to significantly retweet and repost all spell potential disasters for the physician tweeting an inappropriate communication. Separation of personal and professional social media accounts is strongly encouraged but alone is not enough; you are never totally anonymous online. The reality is that a physician will be judged for an inappropriate communication whether it’s found on their professional or personal site. Either posting could result in reputation damage, reprimands, medical license restrictions or revocations, and litigation. Nationally, medical boards now regularly deal with disciplinary actions for inappropriate social media activity. The best preventive measures include pausing before you post, check the veracity of what you are posting, place your post in context, and assess the tone of your post and the tone of the site that you are posting to. A perfect storm for disaster is that the material is not clearly evidence based and could be construed as “fake,” you are personally emotionally charged, and the site you are posting to is a known cauldron of emotion and fake news.
In summary, social media affords benefits in a health care setting but it comes with some baggage. However, the risks of a social media presence are largely instinctive. An initial starting point is pausing to consider, “Would I say/do this in a public venue where everybody could hear/see me?” If there is any concern, don’t post. Subsequently, conduct yourself on social media with meticulous attention to protecting confidentiality, avoiding any impression of creating a doctor-patient relationship, avoiding doctor-friend relationships, being aware of key legal, institutional, and professional society guidance, separating personal and professional activities, and maintaining professionalism.
Dr. Pappas is in the GI and hepatology section of the department of medicine at Baylor College of Medicine, Houston. He has no relevant conflicts of interest to disclose.
References
Attai DJ et al. Semin Hematol. 2017 Oct; 54(4): 198-204.
Bal BS et al. Clin Orthop Relat Res. 2019 Oct; 477(10): 2204-6.
Ekrem, D et al. 20111 Jun 6. https://www.kevinmd.com/2011/06/7-tips-avoid-hipaa-violations-social-media.html
Hallenbeck J. Doctor and Friend. 2005 Jun. https://journalofethics.ama-assn.org/article/doctor-and-friend/2005-06
Moses RE et al. Am J Gastroenterol. 2014 Aug;109(8):1128-32.
Understand its multifaceted importance
BY MOHAMMAD BILAL, MD, FACP
Merriam-Webster’s dictionary defines social media as “forms of electronic communication (such as websites for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content.” Over the last few years, there has been an increase in use of social media by medical professionals. Whether we like it or not, social media is here to stay. Patients use social media to look up information regarding their doctors, medical practices use it to promote the services they offer, institutions share their programs and initiatives, and doctors use it for education, to engage with like-minded colleagues, collaborate, spread awareness, network, and combat medical misinformation. Social media is now rapidly being used by gastroenterologists and hepatologists, as well as majority of professional GI organizations, and hashtags such as “#MedTwitter”, “#GITwitter,” and “#LiverTwitter” have developed into popular academic forums.1 Therefore, the impact of social media in GI is multifaceted and includes its role in medical education, promoting your practice or division, finding collaborations, building your network and establishing mentors and peer-mentors, disseminating your work, and building your brand.2
What is your goal?
Gastroenterologists could have one or more of the goals mentioned above for using social media. Determining the goals for social media use a priori will allow for determining which social media platform will be appropriate for you. Therefore, it is important to understand the users of various social media platforms. In 2017, Facebook was the highest used social media platform in all age groups, whereas Instagram was most popular amongst ages 18-29 years, while Twitter was used more commonly in ages 30-59 years as compared with Instagram. If your goal is to share scientific knowledge and literature with like-minded physicians and interact with leaders in the field, then Twitter may be ideal. If you want to connect with a younger, more diverse audience, Instagram might be a good option. While many physicians may have a Facebook account, this is often reserved for personal use. Many have separated of personal and professional social media use, although they do not need to exist in silos. Defining your goal with social media use will direct you to the best platform to reach your audience.
Medical education
The use of social media especially Twitter for medical education is continuously increasing. Several leaders in the field use “Tweetorials” as a means to educate others. Tweetorials are a collective set of tweets that systematically cover a specialized topic.3 Other educational forums such as @ScopingSundays, @MondayNightIBD, @IBDClub and @GIJournal provide structured platforms for GI focused discussion.4 @MondayNightIBD is also a source for official continued medical education. Other social media educational platforms include “Liver Fellow Network” which has wide variety of educational materials pertaining to hepatology. In addition, there is continuous opportunity to engage with leaders in the field and authors of published studies and guidelines. Several endoscopy educators have dedicated YouTube channels which have endless supply of educational videos.
Networking
As mentioned above, platforms such as #GITwitter and #LiverTwitter have become popular forums for engaging and connecting with like minded colleagues. Social media provides a space to share ideas and build collaborations with colleagues working on similar projects. The concept “#Twitter2Paper” has been proposed which signifies an idea that generated on Twitter and was eventually converted to a manuscript.5
Institutional, divisional, and practice promotion
Social media is a great tool to showcase the clinical, educational and scholarship services and efforts by programs, practices or divisions. During the COVID-19 pandemic, recruitment efforts at all stages were mainly shifted to virtual platforms, and social media was an instrumental way for programs to highlight their culture and initiatives. Prospective applicants can often refer to social media to get a better understanding of what the program offers. Similarly, if a new clinical service is being provided, targeted efforts can be made to ensure that patients are aware of the available services.
Patient education and combating misinformation
Several gastroenterologists also use social media to spread awareness regarding GI diseases. Instagram, Facebook, and TikTok are effective mediums where one can reach a wider audience. It is important for gastroenterologists to provide accurate information since there is a sea of misinformation available on the internet as well. Posts regarding colonoscopy and colon cancer awareness can help alleviate myths regarding role of colonoscopy. In addition, patient advocates use social media to provide peer support to others who deal with challenges related to chronic illnesses such as inflammatory bowel disease.
Sharing your work
Sharing your work on social media can help your work reach a broader audience. Studies have shown that work shared on social media has higher altmetric scores and can also lead to increased citations.
Diversity, equity, and inclusion
Social media offers a platform where one can promote or showcase their support for causes they believe in. The hashtag “#DiversityinGI” has been instrumental in promoting causes pertaining to diversity and inclusion in GI.
Pitfalls
As gastroenterologists continue to use social media, it is important to be mindful of potential pitfalls. The most critical aspect is to always remember that no post should intentionally or unintentionally violate HIPAA. It is advisable to know your institutional and state social media policies.
Social media is beaming with knowledge, education, science and inspiration. There are endless opportunities for professional and personal growth with effective and responsible use of social media. Its never to late to join the conversation.
Dr. Bilal is an assistant professor of medicine at the University of Minnesota, Minneapolis and an advanced endoscopist in the division of gastroenterology at Minneapolis VA Medical Center. He has no relevant conflicts of interest to disclose.
References
1. Mikolajczyk AE et al. Hepatol Commun. 2020 Jul 5;4(8):1229-33.
2. Bilal M and Oxentenko AS. Am J Gastroenterol. 2020 Oct;115(10):1549-52.
3. Breu AC. N Engl J Med. 2019 Sep 19;381(12):1097-8.
4. Bilal M et al. Nat Rev Gastroenterol Hepatol. 2021 Aug;18(8):519-20.
5. Pawlak KM et al. United European Gastroenterol J. 2021 Feb;9(1):129-32.
Dear colleagues,
Most of us engage with social media, whether actively tweeting, following friends on Facebook, or discussing TikTok videos with family. Many gastroenterologists leverage social media to build their professional brand and to reach a wider audience. Others remain wary of committing a social media faux paux or worry about patient confidentiality. In this Perspectives column, Dr. Stephen Chris Pappas and Dr. Mohammad Bilal discuss the risks and benefits of social media for the practicing gastroenterologist. Dr. Pappas has a unique perspective as a gastroenterologist who is also trained as a lawyer, and Dr. Bilal speaks from a wealth of experience leading educational activities on social media. We look forward to hearing your thoughts on Twitter @AGA_GIHN and by email at [email protected].
Gyanprakash A. Ketwaroo, MD, MSc, an associate professor of medicine, Yale University, New Haven, Conn., and chief of endoscopy at West Haven (Conn.) VA Medical Center. He is an associate editor for GI & Hepatology News.
Carefully consider the plentiful risks, concerns
BY STEPHEN CHRIS PAPPAS, MD, JD, FAASLD, FACLM
Social media for gastroenterologists comes with benefits accompanied by pesky risks. The risks are pesky like a mosquito bite: An itching bite is annoying, but getting malaria is serious. Managing your unprofessional tweet to salvage your reputation is going to be annoying. Disclosing a patient's identity on social media is going to be serious; you could find yourself fired, fined, reprimanded, and without hospital privileges, as happened recently to a Rhode Island physician. I divide the risks of social media into legal risks (for example, disclosing patient identity or inadvertently creating a doctor-patient relationship), risks of compromising ethical standards (for example, impairing the doctor-patient relationship), and mixed legal/ethics risks (for example, inappropriate Twitter banter disparaging individuals, promotion of “fake news”). Fortunately, these risks are intuitive and can be mitigated by attention to some simple principles.
Disclosing a patient’s identity on social media is clearly in violation of privacy laws and other regulations. Since privacy compliance is drummed into us ad nauseum via annual compliance training, we could ask “how on earth could an inadvertent disclosure of identity occur?” We must remember that sites that are nominally termed “secure” may not be. As a general suggestion, I would regard social media of all types as open public forums with permanent postings. Even limited descriptions of a patient on social media may allow identification of the actual patient. The risk may be highest in smaller communities; in the past I assisted a small-town practitioner manage the fallout from inadvertently identifying a patient on his professional Facebook page by simply saying “I recently managed a 38-year-old pregnant woman with Crohn’s disease ...” That small amount of information allowed some members of his community to identify the specific patient. My suggestion would be to never talk about individual patients on social media. Phrase comments or questions generically; for example, “Crohn’s disease in pregnancy is managed with attention to ...”.
Another legal risk of social media engagement is to unknowingly create a patient-doctor relationship with a duty to treat, opening the door for exposure to malpractice litigation if something goes awry. A patient may interpret a social media interaction as establishing a patient-doctor relationship. While we think we know what defines a doctor-patient relationship, it’s not always clear and varies between jurisdictions. Indeed, a physician-patient relationship may not even be a necessary element of a claim for professional negligence (an issue shared with “curbside” consults). A recent court case in Minnesota ruled that a duty to care is established if “... it is reasonably foreseeable that the third party will rely on the physician’s acts and be harmed by a breach of the standard of care.” That case involved a telephone call, but you could see the standard easily morphing to apply to social media posts. Gastroenterologists should always talk about disease and treatment on social media in generic terms, preferably with appropriate caveats (for example, “Patients with cholestasis and intense itching may be treated with naloxone in selected cases after detailed assessment by a hepatologist”).
Impairing an established doctor-patient relationship by “friending” a patient on your personal Facebook risks a potential compromise of professional ethics, breaking the boundaries between profession and person for the gastroenterologist. The approach by most professional societies is that a “friend” on social media is equal to a friend in the real world; the same legal and ethical standards apply. Doctor-patient friendships may compromise objectivity, lead to preferential but not optimal therapy, and increase the risk of skirting around informed consent among other issues. Being friends on social media is discouraged, but not prohibited, by most professional societies and licensing bodies. In my opinion, that is sound advice. Over a career of more than 40 years, I have had patients who became friends, but only after I had transferred their care to another hepatologist.
More recently with escalating, aggressive, tones for social media communications, GI/hepatology practitioners must be aware of the serious risk of blurring their personal and professional online lives, particularly where Twitter is involved. The rapidity which people seem to want to reply to a tweet, the public and durable natures of a tweet, and the ability to significantly retweet and repost all spell potential disasters for the physician tweeting an inappropriate communication. Separation of personal and professional social media accounts is strongly encouraged but alone is not enough; you are never totally anonymous online. The reality is that a physician will be judged for an inappropriate communication whether it’s found on their professional or personal site. Either posting could result in reputation damage, reprimands, medical license restrictions or revocations, and litigation. Nationally, medical boards now regularly deal with disciplinary actions for inappropriate social media activity. The best preventive measures include pausing before you post, check the veracity of what you are posting, place your post in context, and assess the tone of your post and the tone of the site that you are posting to. A perfect storm for disaster is that the material is not clearly evidence based and could be construed as “fake,” you are personally emotionally charged, and the site you are posting to is a known cauldron of emotion and fake news.
In summary, social media affords benefits in a health care setting but it comes with some baggage. However, the risks of a social media presence are largely instinctive. An initial starting point is pausing to consider, “Would I say/do this in a public venue where everybody could hear/see me?” If there is any concern, don’t post. Subsequently, conduct yourself on social media with meticulous attention to protecting confidentiality, avoiding any impression of creating a doctor-patient relationship, avoiding doctor-friend relationships, being aware of key legal, institutional, and professional society guidance, separating personal and professional activities, and maintaining professionalism.
Dr. Pappas is in the GI and hepatology section of the department of medicine at Baylor College of Medicine, Houston. He has no relevant conflicts of interest to disclose.
References
Attai DJ et al. Semin Hematol. 2017 Oct; 54(4): 198-204.
Bal BS et al. Clin Orthop Relat Res. 2019 Oct; 477(10): 2204-6.
Ekrem, D et al. 20111 Jun 6. https://www.kevinmd.com/2011/06/7-tips-avoid-hipaa-violations-social-media.html
Hallenbeck J. Doctor and Friend. 2005 Jun. https://journalofethics.ama-assn.org/article/doctor-and-friend/2005-06
Moses RE et al. Am J Gastroenterol. 2014 Aug;109(8):1128-32.
Understand its multifaceted importance
BY MOHAMMAD BILAL, MD, FACP
Merriam-Webster’s dictionary defines social media as “forms of electronic communication (such as websites for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content.” Over the last few years, there has been an increase in use of social media by medical professionals. Whether we like it or not, social media is here to stay. Patients use social media to look up information regarding their doctors, medical practices use it to promote the services they offer, institutions share their programs and initiatives, and doctors use it for education, to engage with like-minded colleagues, collaborate, spread awareness, network, and combat medical misinformation. Social media is now rapidly being used by gastroenterologists and hepatologists, as well as majority of professional GI organizations, and hashtags such as “#MedTwitter”, “#GITwitter,” and “#LiverTwitter” have developed into popular academic forums.1 Therefore, the impact of social media in GI is multifaceted and includes its role in medical education, promoting your practice or division, finding collaborations, building your network and establishing mentors and peer-mentors, disseminating your work, and building your brand.2
What is your goal?
Gastroenterologists could have one or more of the goals mentioned above for using social media. Determining the goals for social media use a priori will allow for determining which social media platform will be appropriate for you. Therefore, it is important to understand the users of various social media platforms. In 2017, Facebook was the highest used social media platform in all age groups, whereas Instagram was most popular amongst ages 18-29 years, while Twitter was used more commonly in ages 30-59 years as compared with Instagram. If your goal is to share scientific knowledge and literature with like-minded physicians and interact with leaders in the field, then Twitter may be ideal. If you want to connect with a younger, more diverse audience, Instagram might be a good option. While many physicians may have a Facebook account, this is often reserved for personal use. Many have separated of personal and professional social media use, although they do not need to exist in silos. Defining your goal with social media use will direct you to the best platform to reach your audience.
Medical education
The use of social media especially Twitter for medical education is continuously increasing. Several leaders in the field use “Tweetorials” as a means to educate others. Tweetorials are a collective set of tweets that systematically cover a specialized topic.3 Other educational forums such as @ScopingSundays, @MondayNightIBD, @IBDClub and @GIJournal provide structured platforms for GI focused discussion.4 @MondayNightIBD is also a source for official continued medical education. Other social media educational platforms include “Liver Fellow Network” which has wide variety of educational materials pertaining to hepatology. In addition, there is continuous opportunity to engage with leaders in the field and authors of published studies and guidelines. Several endoscopy educators have dedicated YouTube channels which have endless supply of educational videos.
Networking
As mentioned above, platforms such as #GITwitter and #LiverTwitter have become popular forums for engaging and connecting with like minded colleagues. Social media provides a space to share ideas and build collaborations with colleagues working on similar projects. The concept “#Twitter2Paper” has been proposed which signifies an idea that generated on Twitter and was eventually converted to a manuscript.5
Institutional, divisional, and practice promotion
Social media is a great tool to showcase the clinical, educational and scholarship services and efforts by programs, practices or divisions. During the COVID-19 pandemic, recruitment efforts at all stages were mainly shifted to virtual platforms, and social media was an instrumental way for programs to highlight their culture and initiatives. Prospective applicants can often refer to social media to get a better understanding of what the program offers. Similarly, if a new clinical service is being provided, targeted efforts can be made to ensure that patients are aware of the available services.
Patient education and combating misinformation
Several gastroenterologists also use social media to spread awareness regarding GI diseases. Instagram, Facebook, and TikTok are effective mediums where one can reach a wider audience. It is important for gastroenterologists to provide accurate information since there is a sea of misinformation available on the internet as well. Posts regarding colonoscopy and colon cancer awareness can help alleviate myths regarding role of colonoscopy. In addition, patient advocates use social media to provide peer support to others who deal with challenges related to chronic illnesses such as inflammatory bowel disease.
Sharing your work
Sharing your work on social media can help your work reach a broader audience. Studies have shown that work shared on social media has higher altmetric scores and can also lead to increased citations.
Diversity, equity, and inclusion
Social media offers a platform where one can promote or showcase their support for causes they believe in. The hashtag “#DiversityinGI” has been instrumental in promoting causes pertaining to diversity and inclusion in GI.
Pitfalls
As gastroenterologists continue to use social media, it is important to be mindful of potential pitfalls. The most critical aspect is to always remember that no post should intentionally or unintentionally violate HIPAA. It is advisable to know your institutional and state social media policies.
Social media is beaming with knowledge, education, science and inspiration. There are endless opportunities for professional and personal growth with effective and responsible use of social media. Its never to late to join the conversation.
Dr. Bilal is an assistant professor of medicine at the University of Minnesota, Minneapolis and an advanced endoscopist in the division of gastroenterology at Minneapolis VA Medical Center. He has no relevant conflicts of interest to disclose.
References
1. Mikolajczyk AE et al. Hepatol Commun. 2020 Jul 5;4(8):1229-33.
2. Bilal M and Oxentenko AS. Am J Gastroenterol. 2020 Oct;115(10):1549-52.
3. Breu AC. N Engl J Med. 2019 Sep 19;381(12):1097-8.
4. Bilal M et al. Nat Rev Gastroenterol Hepatol. 2021 Aug;18(8):519-20.
5. Pawlak KM et al. United European Gastroenterol J. 2021 Feb;9(1):129-32.