Social Media 101

Social Media 101: Choose Your Friends Carefully

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Social networking can provide you with an online presence, foster camaraderie within the profession, strengthen your professional networks, and provide an opportunity to widely disseminate public health messages and other health communication. However, this “brave new world” also presents new ethical dilemmas and challenges to the patient-provider relationship.

There is a profound change sweeping the world of medicine. Technology is the driver, but it has nothing to do with a new drug, device, or procedure. Rather it is about the change in clinician behavior and mindset that the Internet—and social media more specifically—has unleashed. By any estimation, the population of healthcare providers online is growing rapidly. According to recent statistics, 89% of U.S. physicians use the Internet to access pharmaceutical, biotech, and medical device information in the early part of 2009[1] while 41% of physicians conduct all their medical and library research online—a percentage that is likely to double by the end of 2010.

Social media has been defined as “The various activities that integrate technology, social interaction, and the construction of words, pictures, videos and audio—and the community it involves.” In general, clinicians use social media sites such as Twitter, Facebook, and online medical communities to a) seek out clinical information and opinions and discuss medical points of view with their peers, b) increase their professional exposure among colleagues and the general community, c) inform the public of ongoing public health issues, and d) for purely social reasons, such as staying in touch with family and friends.[2]

Opportunities for social networking are broadly grouped based on the content provided as well as the level of available interactivity, sponsorship, and intended audience. Each type of opportunity has its own set of pros and cons and requires different levels of scrutiny and mindfulness.

Clinician-only Social Networking. There are a number of dedicated sites such as Sermo and Ozmosis that offer clinicians the chance to connect with their peers for knowledge sharing, networking, and support. These sites do tend to have some overlap, but present walled (and safe) communities for clinicians to share opinions and interact in a guarded environment.

Linked-In. Linked-In is a broader form of social networking used primarily for developing employment and marketing contacts within a common professional network. According to its Web site, Linked-In has more than 1.5 million healthcare professionals connected across more than 200 countries worldwide. The Linked-In groups feature is very popular as a place where like-minded peers can discuss topics of the day, share professional resources, and recruit/apply for new professional opportunities.

How does it work? First, you create a profile that includes your CV, academic training, and other pertinent information, then you gradually build a contact network consisting of people you know and trust (direct connections), their connections (second-degree connections), and the connections of second-degree connections (third-degree connections). Thus, you can gain an introduction to someone you’d like to know through a mutual, trusted contact within your contact network. The key to making and keeping good contacts here is to make sure that you link only to people you know and whose work and values you trust before adding them to your network.

Journal & CME Sites.Social media is taking a larger role in the information offered by print journals. Virtually all journals have a robust online presence offering an interactive opportunity for you to engage with their content. Other sites, such as our own Primary Issues, provide continuing medical education activities alongside interactive content and community-based forums.

Blogs.The past year has seen the emergence of a number of blogs, or online journals, that offer a clinician’s perspective on a wide range of issues related to healthcare, but generally in a tone and language that is more approachable by consumers. As a result, they are unlocking some of the mystery behind medical decisions and helping to humanize the industry—a powerful social force! In those blogs that present case histories or vignettes, the patient is typically anonymized and key details, such as gender or age, are altered to protect patient privacy.

Microblogs. The most famous microblogging site is Twitter, which enables users to send and read messages called tweets. Tweets are text-based posts of up to 140 characters displayed on the user’s profile page that can be sent to an unlimited number of “followers.” Since its launch in July 2006, Twitter has gained popularity with best guesstimates of more than 175 million users worldwide.[3] Clinicians typically use Twitter as an extension of their Web presence, a patient communication site, a marketing tool, or a virtual “water cooler.” Hospitals are using Twitter to post emergency department wait times, to tweet details about upcoming vaccination clinics, and to update family members on the status of their loved ones during surgery. Much of the Twitter buzz among clinicians focuses on medical news or the business of medicine rather than medicine itself, due in part to the privacy issues and the limited dialogue opportunity provided by 140 characters.[4]

Experts advise that you be very careful about what thoughts you spin off into cyberspace via Twitter. Your tweet can be retweeted as well as indexed for searching at a later date. Before you tweet, consider whether you would want the same information broadcast in not only your local paper, but also a national—or international—newspaper.

Facebook. Facebook is a photo-sharing, social networking Web site with a membership exceeding 500 million active users.[5] Its considerable following and easy accessibility to online personal information are creating complex ethical issues for patients and their healthcare providers; some even predict that Facebook will change how we approach medical practice.[2]

Facebook allows users to share personal information and photos with an unlimited number of “friends” within the site, who request access via a “friend request.” Users can choose to post personal data such as birthdate, address, relationship status, and sexual orientation, as well as more innocuous information like a favorite movie or a social event attended. Several levels of privacy can be selected, and many users choose to make their information available only to those they’ve personally selected as friends. However, if you choose a less stringent privacy setting—willfully or accidentally—all of your information becomes available to the entire Facebook community. While it seems unlikely that any healthcare professional would choose that option, a recent study reveals that 63% of U.S. medical students and residents chose to keep their Facebook profiles open to all.[6]

Tools like Twitter, Facebook, and blogging can potentially help clinicians better educate and interact with patients, perhaps even humanizing themselves in the process. But mishandling that powerful online megaphone can potentially risk, or at the very least blur, the clinician-patient relationship. In particular, Facebook poses a distinct challenge for the patient-clinician relationship. Up to 40% of practicing physicians have been friended by a patient. Many physicians choose not to accept the request, opting instead to deal with the request at the patient’s next office visit. Ed Carver, a Boston-based physician, considers a patient’s friending request as a privacy breach, akin to “asking for my home phone number or whether I’m married.”

In addition to the privacy issues, engaging in any type of friendships with patients (other than in an informal, bumping-into-at-the-supermarket sort of way) is not a generally accepted component of the clinician-patient relationship. Aside from opening the door to inappropriate interactions, online friendships are also likely to lead to over-disclosure by the clinician, which can eventually prove disruptive to the professional relationship.[7]

If you should accept a patient’s friend request, his information is also available to you. What if the patient has published compromising photographs, or has posted information that contradicts medical statements he’s made to you in the past? What are your responsibilities in dealing with this information? Do you bring it up at your next visit? Do you document the information in the patient’s chart? Note that most medical ethicists believe that information you obtain about a patient from social networking sites should not be entered into the medical record without the patient’s knowledge.[2]

Should I? Or Should I Not?

Some of you may be leery of participating in social media because of time constraints or discomfort with the tools to navigate the various social media opportunities. Or maybe you have no desire to broadcast your opinions or look for a new professional opportunity. The commitment necessary to cultivate a following of your blog or Twitter feed is not trivial—in most cases at least one to two hours per day. The Twitter commitment is so onerous that most don’t stick with it for long; a 2009 Nielsen report cites that only 40% of users were actively using their Tweeter accounts one month after creating an account.[8]

You may also have concerns about patient privacy, a fear of violating HIPAA rules, or lack clarity about protocol on the various sites. For some of you there may be another, more profound issue: the “white coat” syndrome. As a healthcare provider, you’re trained to maintain a certain personal distance with patients; as such, you may feel uncomfortable exposing yourself to such a broad and undefined audience.

However, social media and virtual communication is here to stay. If you’ve been reluctant to hop onto the social media bandwagon, it might be time to consider it. Patients are increasingly turning to the Internet for healthcare information. A recent Pew Research Center study found that 61% of adults look online for health information. Of these—

  • 41% of e-patients have read someone else’s commentary or experience about health or medical issues on an online news group, Web site, or blog.
  • 24% of e-patients have consulted rankings or reviews online of doctors or other providers.
  • 19% of e-patients have signed up to receive updates about health or medical issues.
  • 13% of e-patients have listened to a podcast about health or medical issues.[9]

But not all medical content on the Internet is credible. If this is where patients are turning for health and provider information, perhaps it’s where you should be as well to provide education and reach out to new patients. Given the many digital and mobile tools already available to healthcare professionals, many of you are likely to become more “social” with each other and with patients over the next few years. Kevin Pho, MD, a primary care physician in Nashua, New Hampshire, who blogs at, has the following advice for clinicians who are ambivalent about using social media:

“Doctors who are not active online risk being increasingly marginalized. Facebook and Twitter users, half of whom are under the age of 34, rely on the web for most of their information. As this demographic ages, it’s conceivable that they will consult social media first to answer their health questions. Social media presents a compelling opportunity for doctors to better interact with patients.” [10]

When handled responsibly, social media can bolster the doctor-patient bond by providing a bridge that extends beyond the examination room door and makes you seem more accessible and human. To help ease your entry into the social media waters, The American Medical Association recently released its own guidance on the topic. The new policy urges you to—

  • Use privacy settings to safeguard personal information and content to the fullest extent possible on social networking sites.
  • Routinely monitor your own Internet presence to ensure that the personal and professional information on your own sites and content posted about you and others is accurate and appropriate.
  • Maintain appropriate boundaries of the patient-physician relationship when interacting with patients online and ensure patient privacy and confidentiality is maintained.
  • Consider separating personal and professional content online.
  • Recognize that actions online and content posted can negatively affect your reputation among patients and colleagues, and may even have consequences for your career.[11]

Jill Shuman, MS, ELS
Published on January 4, 2011


  1. What percentage of physicians say the Internet is essential to their professional practice? iHealthBeat. Posted May 21, 2009. Accessed December 20, 2010.
  2. Guseh JS II, Brendel RW, Brendel DH. Medical professionalism in the age of online social networking. J Med Ethics. 2009;35(9):584-586.
  3. Murphy D. Twitter: on-track for 200 million users by year’s end. Web site.,2817,2371826,00.asp. Posted October 31, 2010. Accessed December 21, 2010.
  4. Dolan PL. Should doctors use Twitter? Web site. Posted June 29, 2009. Accessed December 20, 2010.
  5. Press Room: Statistics. Facebook Web site.!/press/info.php?statistics. Accessed December 21, 2010.
  6. Thompson LA, Dawson K, Ferdig R, et al. The intersection of online social networking with medical professionalism. J Gen Intern Med. 2008:23(7):954-957.
  7. Morse DS, McDaniel SH, Candib LM, Beach MC. “Enough about me, let’s get back to you”: physician self-disclosure during primary care encounters. Ann Intern Med. 2008;149(11):835-837.
  8. Martin D. Twitter quitters post roadblock to long-term growth. Nielsenwire Web site. Posted April 28, 2009. Accessed December 21, 2010.
  9. Fox S, Jones S. The Social Life of Health Information. Pew Internet and American Life Project. June 2009.
  10. Pho K. Op-ed: social media can enhance the doctor-patient relationship. Web site. Posted January 2010. Accessed December 21, 2010.
  11. AMA policy: professionalism in the use of social media. American Medical Association Web site. 2010. Accessed December 20, 2010.