Just my two cents

Musings on social media and the world as I see it


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Physicians are not your (Facebook) friends

Doctors on Facebook -- is it a good idea? (photo by j.reed)

When you’re sick, hopefully the first person you call is your physician. In that sense, he or she IS your friend. But unless you’ve got a standing relationship with your physician outside the exam room, that’s where the “friendship” should end.

But in today’s socially connected world, physicians who are on Facebook with personal accounts may find themselves receiving “friend” requests from patients. While there are policies in the works from several agencies like the American Medical Association, nothing has yet to be formalized. While there are several sources for guiding physicians, like this article from FiercePracticeManagement, many physicians are still left in a quandary. As a result, several of our physicians have asked us what they should do. We worked with our legal department to develop some guidelines for our doctors to consider if and when they receive these request

Although this goes against the social media “be social!” mantra, first and foremost, we have recommended that they not accept the friend request, based on a few simple facts. The first is obvious: physicians must maintain patient privacy and confidentiality at all times, and while that’s easy to do in a hospital or office setting, the lines can become a bit blurred when it comes to the world of Facebook. It’s not out of the realm of possibility for a patient to initiate a conversation on a Facebook wall that could cross the line, thereby eroding the boundaries of the physician-patient relationship, and possibly even threatening ethical standards because of the casual nature of communication on the social network.

We also have asked physicians to keep in mind that accepting friend requests from patients will allow those patients to see personal information and have a glimpse into the private lives of the physicians. Unless the privacy settings are tweaked carefully, patients who are now Facebook friends would be privy to the doctor’s conversations with friends, or see the photos of dinner and cocktails last weekend. It could change the professional image and reputation of a physician if a patient can see into the private and/or social life of a physician.

I recognize that this may go against the grain, but we felt it was in our physicians’ best interests to keep their personal and professional lives separate. On the other hand, if they were to establish a Facebook account for their practice, I believe that would involve a totally different set of guidelines.

I’m very interested to hear how other hospital marketers and social media managers are advising their physicians. Share your thoughts!

This post was written for an originally appeared on www.hospitalimpact.org.


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Why is it so hard for hospital staff to follow HIPAA rules in social media?

HIPAA is a common term in hospitals. If your hospital or health system is like ours, you spend a lot of time training, reminding and testing all employees on what is covered by HIPAA laws. For the most part, I believe employees understand the law and what they need to do to protect our patients and their privacy. Hospital employees sign agreements and promise to uphold their end of the deal, realizing there will be consequences if there are violations.

But for some strange reason, when it comes to social networks, employees seem to forget they are bound by those same regulations.

There have been numerous reports of breaches of patient privacy through social media outlets lately. Just this week, the LA Times storyreported that staff members were fired from St. Mary Medical Center in California, and another three were disciplined after posting photos of a dying man on Facebook rather than treating him.

In June, Tri-City Medical Center, also in California, terminated five employees and disciplined another after discovering they used “social media to post their personal discussions concerning hospital patients.” The hospital issued a statement on their website apologizing for the breach and how they were addressing it. (Applause for the transparency!)

As disturbing as they are, stories like these and others are popping up in the national news and it’s unsettling for everyone. There is something to learn from this though, and it is not that we need to ban social media from our hospitals. Social media is a powerful, evolving medium that allows us to communicate vital information and to hear from, and engage with, members of our communities. It should not be ignored. In fact, I strongly believe it should be embraced by hospitals as another way to reach out to their communities.

The stories of these breaches simply underscore the vital need for having strong policies in place that address the use of social media within and outside of the hospital. Employees need to know and understand that they are accountable for upholding the HIPAA laws even when they leave the hospital. That includes when they enter chat rooms, social networking sites or even their own blogs. In addition, human resources departments must be on board in recognizing that HIPAA laws extend to the use of social networks and any breaches of patient confidentiality through these means will result in disciplinary action.

Ed Bennett is the director of Web strategy for the University of Maryland Medical System. He also manages a blog which provides a wealth of information on hospitals and social media. The site provides a nice list of publicly published policies. It’s a great resource for hospitals, and can help in developing a new policy or tweaking an existing one to address social media specifically.

I am still confused as to why hospital staff members would ever think it was okay to reveal privileged patient information through any means, especially one as public as social media. Perhaps these changes in the way we communicate call for not only new and revised policies but also for additional training and signed agreements for staff to further understand the ramifications of violating HIPAA through social networks. What are your thoughts?

This post was originally writtten for and appeared on www.hospitalimpact.org.


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Patient complaints: To delete or not to delete, that is the question

When we decided to add social media to our arsenal of healthcare marketing tools, we knew there was an inherent risk in doing so. We understood the potential of negative comments appearing on a Facebook wall, or a disgruntled patient tweeting about how many hours they’ve spent in our busy emergency department. But when it actually happens, it’s unsettling nonetheless.

In my own experience, we sailed along happily on our hospital Facebook pages for quite a while until one day we found a post that identified a doctor by name, and not in a flattering way. Thus began a series of many meetings and discussions and ultimately, the development of a protocol to address such negative postings.

As the hospital’s representative in the social media world, I understand that we need to expect these posts, and part of me feels that deleting a post is simply censorship. Deleting a post goes against the grain of social media, where people expect to have their say and be heard. Another part of me, however, understands that a doctor’s reputation is being called into question by one unhappy patient. And that is exactly why you need a policy for what is acceptable and what is not. But just having a policy isn’t everything. Let me explain.

Our policy contains some very straightforward information that nearly anyone can understand, followed by the more formal, legal jargon. Included is a section that indicates a user should not post anything that is “abusive, harassing, embarrassing, tortuous, defamatory, obscene, libelous,” etc. Seems clear, right? Well, we learned those words are very subjective. In my opinion, the post was none of those. In the doctor’s opinion, however, it was, and the doctor also questioned whether there was a legal avenue to investigate if the comment remained online.

So, what did I do? I listened to our department’s leader, of course, but I also listened to the doctor. Was it right that her name was being smeared on a public social site? Of course not, but the same could be done by a patient writing on a personal blog, writing on his or her own Facebook page, or going to the news with a sexy story about how he or she did not get the care that she felt was required.

In any case, it opened our eyes to the subjective nature of the policy, and it also led to a protocol being developed so that in the future, if a member of the hospital staff is identified by name in a way that COULD be considered as “abusive, defamatory, embarrassing…”, then the post would be removed and the user would be notified that the post was deleted because it went against the policy. The protocol, however, does allow for negative posts about the hospital in general or a particular department to remain online.

It was an interesting experience, and one that happened again just a few weeks later on another of our Facebook pages. This time it was a lot easier to recognize that it wasn’t censorship, but protecting the reputation of an individual physician. And I am quite happy that if I were on vacation, any member of the team who was covering for me would know exactly how to handle negative postings because of the protocol we developed.

But I’d be very interested to hear what other hospitals are doing. So what say you: To delete or not to delete? Do you agree with our approach?

(Written for and originally posted on www.hospitalimpact.org)