Could Facebook Get Me in Trouble?

Question:

Like many of my friends, I enjoy using Facebook, Twitter, and YouTube. How can I keep my online presence professional and in accord with patient privacy rules?

Response from Megan L. Fix, MD Associate Residency Director, Emergency Medicine, University of Utah, Salt Lake City

Facebook, Twitter, and other social networking Websites are fun, and your online identity can be informative to future employers, patients, or colleagues. But involvement in social media can also get you into trouble if you aren't careful. Here are some suggestions for safeguarding hospital and patient privacy and your perceived professionalism online, both as a student applying for residency and as a medical professional.

Hospital and Patient Privacy

Privacy is paramount to good patient care. At some point in your medical training, you will learn about the Health Insurance Portability and Accountability Act (HIPAA), which prohibits you from giving out "individually identifiable health information” without it being medically necessary -- and without the patient's permission.^[1,2] Let's pretend you are a patient who has a rash in a vulnerable area. You go see a physician and get treated, and that's the end of it, right? Well, it should be, but I have heard stories of providers posting pictures of rashes, fractures, and accidents on Facebook without the patient's permission. This is a violation of HIPAA, and in many of these cases, the provider was fired. Your safest bet is to never post anything online that is directly related to a specific patient.

Unfortunately, unsanctioned posting is common among medical students. About 60% of US medical school deans report that their students have posted unprofessional content online, and 13% of those deans also report that their students have violated patient confidentiality, according to a 2009 study in JAMA.^[3] These violations are grounds for expulsion.

If you have questions about what is acceptable to post, read your school's social media policy. If your school does not have a rule -- only about 10% of US medical schools have guidelines explicitly mentioning social media^[4] -- I suggest that you work with your dean and a focus group to create one. (It would be a great addition to your medical school and to your future residency applications.) Start by looking at examples such as Vanderbilt University Medical Center's "Social Media Toolkit," which spells out rules and provides helpful hints.

Residency Applications

You have probably seen compromising pictures of someone online. Perhaps it was a person you know, like a friend you partied with in college. The problem with Facebook is that any picture or story attached to you can be permanently associated with you.

As you may know, residency directors and employers frequently look up their applicants online. The JAMA survey of medical deans found numerous cases of students posting damaging information about themselves. For example, 52% of deans reported student use of profanity, 48% use of frankly discriminatory language, 39% depiction of intoxication, and 38% use of sexually suggestive material. Of 45 respondent schools that reported an incident, 30 (67%) gave an informal warning and 3 (7%) reported a student dismissal.

Don't be that student! You have spent too much money and effort to get to medical school to risk getting dismissed or disciplined. Remember, any disciplinary action will be reported on your residency applications, so think before you post.

Separation of Professional and Personal Life

Part of being a physician is holding yourself to a higher standard. That means you have to keep your personal and professional lives separate. Facebook can make this difficult. Some institutions such as Vanderbilt are developing policies stating that whenever you identify yourself as part of the university (for instance, using your university email address or joining a university group), you should add the following disclaimer:

The views and opinions expressed here are not necessarily those of X University Medical Center, and they may not be used for advertising or product endorsement purposes.

Another example of blurring the professional-personal boundary involves providers "friending" patients. There is an inherent imbalance of power between patient and provider, just as there is between student and teacher. Do you want your patients to know what you did last weekend? This might create a loss of trust and admiration. In the same vein, do you want to know what your patients did last weekend? This may create subconscious biases that could interfere with patient care. Although others might have different views (see "Just Between Friends," I personally do not think it's a good idea to friend your patients.

An article in The New Physician, published by the American Medical Student Association, offers social networking do's and don'ts that will help you safeguard your professional reputation.^[5] For example, before posting about an interesting case you saw that day, it's important to remember that the information you give can potentially identify a patient. In addition, run the "dean test" on whatever you post online: If it's embarrassing to have your dean see it, don't post it.

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