Social media in health care creates risks, benefits

An increasing number of doctors are talking to their patients about medical concerns on social networks. Physicians are adding patients as friends on Facebook and discussing their private health issues in the open.

And while getting a wall post on Facebook from your doctor may seem innocuous, such acts can lead to awkward situations, privacy violations or wrong information, experts say.

“A lot of stuff is people sharing too much information that should either be left confidential, or in some cases information that shouldn't be shared because it's not true,” said Ryan Greysen, assistant clinical professor of medicine at the University of California, San Francisco.

In a recent study of 48 state medical boards, which license and discipline doctors, Greysen found that 44 of them have received reports of violations of online professionalism. Violations included improper contact with patients, inappropriately giving diagnoses and misrepresentation of one's credentials.

Disciplinary measures have ranged from limiting or suspending physicians' licenses to revoking them, the UCSF study found.

In one instance, a physician asked one of his patients for a date through an online dating website.

Another physician, on his blog, called a patient “lazy” and “ignorant” because she had made several visits to the emergency room after failing to monitor her sugar levels. In yet another case, a medical student filmed a doctor inserting a chest tube into a patient, whose face was clearly visible, and posted the footage on YouTube.

The federal Health Insurance Portability and Accountability Act sets boundaries on the ways health care providers use and disclose information that identifies patients. That includes a patient's health condition, birth date and even the existence of enrollment with a provider.

In California, a pair of laws since 2009 has authorized the state to investigate and fine medical facilities for health information privacy breaches. Those laws resulted from a string of widely publicized security violations at the University of California, Los Angeles, where employees looked at celebrities' medical records.

So far, the California Department of Public Health has issued 18 fines worth $2.2 million to medical facilities. The agency received reports of about 2,500 violations last year. The department does not separately track online violations.

Nearly 90 percent of physicians use a social-media website for personal use, and 67 percent use it professionally, according to a survey of 4,000 physicians by QuantiaMD, an online forum for doctors.

“My hunch is that in the majority of cases, people had a lapse in judgment about something, but because it's online, the reach of these online behaviors is so much greater,” said Greysen, who maintains a professional Facebook page and tweets about social media and medicine. “The impact can be a lot broader and faster because of the speed at which information travels.”

Health care providers need to be especially aware of the risk as they turn to keeping patients' records on electronic databases, said Anthony Wright, executive director of Health Access California, a patient advocacy group.

“We are entering into a world where we need to have a balance between a legitimate desire for seamlessness and sharing of information and data collection,” he said, “with strong privacy guarantees and guidelines.”

This spring, the Federation of State Medical Boards, which oversees the groups that license doctors, established guidelines for physicians' use of social-networking sites. The group recommends that doctors interact with patients online only when discussing medical treatment in a professional context, and avoid doing so on personal social-media sites. In fact, doctors are encouraged to set up separate professional and private accounts.

In addition, the group said, physicians may write online about their experiences as health professionals, but should also reveal their conflicts of interest and credentials.

For doctors who want to chat about work online, they may find an outlet in Doximity, a new social-networking site in San Mateo.

Begun in spring 2011, the site is a confidential forum that allows verified physicians to discuss research and talk about medical cases, which the law permits as long as the conversation is confined to health professionals. So far, Doximity has drawn more than 567,000 physicians from 87 specialties nationwide.

“We think there's a need for someone to be the hospital, the place where doctors and health care professionals can have their discussions,” said Jeff Tangney, Doximity's chief executive officer. “Unfortunately, that can't be LinkedIn and Facebook for patient privacy reasons.”

That said, more discussions lead to more problems solved, Tangney said. “We see cases solved all the time on the network,” he said.