E-Professionalism and Online Professional Boundaries: Considerations for Healthcare Professionals on Social Media

With social media tools come new opportunities in healthcare, but also challenges.

Social media tools provide a unique set of opportunities in healthcare, but with these new opportunities come a number of potential challenges. As health professionals navigate the world of social media, concerns have arisen regarding questions of ethics and professionalism and how the use of social media fits within the social contract between the medical profession and society.

In today’s world of widespread social media use, it is important for healthcare institutions to establish guidelines for the professional use of social media. This can help to maximize the positive effects of social media in healthcare, such as improved communication with patients and the promotion of health-related information, while minimizing the negative effects, such as the risk of the unauthorized disclosure of patient information or the spread of misinformation.

This will become even more important as a generation of individuals who grew up sharing their lives online enters the workforce. Some medical students may view social media as irrelevant to the workplace and may not see it as a factor in evaluating professional abilities.

Organizational worries about social media come from a variety of perspectives, but they may generally be divided into three categories: reputation, privacy, and boundaries. Policies and training for social media can be developed in these connected, yet separate sectors.

Reputation

The ethical standards expected of healthcare professionals do not change because they are communicating through social media rather than face-to-face. However, using social media creates new circumstances in which the established principles apply. Healthcare professionals have a responsibility to uphold the values of their profession and to maintain a professional online presence. They should be mindful of the public nature of social media and avoid inappropriate or unprofessional behavior.

Inappropriate or unprofessional behavior on social media can damage the reputation of both the individual and the organization, and may undermine public trust in the profession. Social media conversations can last indefinitely and reach a potentially large and unknown audience. What may be intended as a private joke or a way to decompress by complaining about the workplace or coworkers can be misconstrued when published on social media. This can have negative consequences for both the individual and the organization, as it may be perceived as indicating a lack of professionalism or care for patients.

Privacy

Healthcare professionals have a duty to protect the privacy of their patients and must be careful to not disclose any personal or medical information about patients on social media or other online platforms. This includes avoiding the use of social media for communication about patient care or treatment.

Discussing patient situations on social media, even if the patient cannot be clearly identified, carries a high risk of unauthorized disclosure of patient information. One instance to illustrate this occurred at a Kansas nursing school. Four nursing students were dismissed from their program after one student shared a picture of a patient’s placenta on her Facebook page. Even though the picture did not include any identifying information about the patient, the school regarded this behavior as unprofessional and took disciplinary action.[1]

To protect their own privacy, medical professionals should be aware of their own privacy settings and limit how much information they share on social media. The creation of separate identities for personal and professional purposes on social media platforms has been recommended by some commentators. However, it is nearly impossible to completely separate professional and personal identities. Social media is ultimately a public space.

It is important to note that privacy settings on personal accounts are not absolute. Postings on social networking sites can be disseminated (whether intended or not) to a larger audience, taken out of context, and remain publicly accessible.

Boundaries

Online interactions can present challenges when it comes to maintaining professional boundaries. The line between personal and professional content can be blurry on social media, and it can be difficult to determine what constitutes appropriate professional behavior.

It is not uncommon for healthcare professionals to receive friend requests from patients on social media. This can present a challenge in terms of maintaining appropriate professional boundaries while also using social media to improve the patient-provider relationship.

One way to address this issue is for healthcare professionals to consider the nature of their relationship with the patient and the potential risks or benefits of accepting the friend request. For example, if the relationship with the patient is primarily professional, it may be more appropriate to decline the friend request in order to maintain clear boundaries. On the other hand, if the relationship is more personal and the healthcare professional feels comfortable accepting the friend request, it may be a way to build trust and improve the patient-provider relationship.

Professionalism is the foundation for the social contract between the medical profession and society. Healthcare professionals will need to apply principles of professionalism to new settings to establish guidelines and policies for ethical conduct. Ongoing discussion regarding the role of social media in healthcare is necessary as both the technology and our understanding of it continue to evolve and increasingly influence the healthcare landscape.

Notes

[1] Miller LA. Social media: friend and foe. J Perinat Neonatal Nurs. 2011;25(4):307–309