Episode 056: The Permanence of Posting

Speaker 1: You are listening to Your Practice Made Perfect. Support, protection, and advice for practicing medical professionals. Brought to you by SVMIC.

Brian: Hello. Thanks for joining us. My name is Brian Fortenberry. On this episode of our podcast, we're going to be talking about something incredibly relevant to today's society as a whole, but certainly in the world of healthcare and the changing world of healthcare: social media and how we handle that and what its implications are in the healthcare arena. And to help us decipher this and go through this discussion, we have Dr. Katrina Hood. Dr. Hood, thanks for being with us today.

Dr. Hood: Thank you, Brian. Glad to be here.

Brian: I happen to know some of the roles that you play not only at SVMIC but other areas and arenas as well. But our listeners may not be familiar with that. Before we even get started into this social media conversation, tell us a little bit about yourself, about your background, and some of the things you do at SVMIC as well.

Dr. Hood: Certainly. I am a practicing pediatrician in the South and have been with my current group for about 18 years and have watched as the internet has really taken on such a big part of what we do. So I think mainly my expertise comes from just watching the expansion as we have seen this. I also happened to be involved with SVMIC on the board of directors and then also involved with the University of Kentucky here in the state as their community pediatrician representative. So, for all of those things, I'm hopeful that I can provide some insight into what we're going to discuss today.

Brian: Well, I guarantee you, you will, and on behalf of everyone at SVMIC and our policyholders, thank you for all you do and how you, along with that group of directors, keep your finger on the pulse of what's going on in the healthcare world. This is certainly one of those issues, as you said, it seems like social media and things that are all electronic now are moving at light speed compared to where they were just a few years ago. So, social media is something we're definitely having to talk about and be concerned within the healthcare arena now. So, how is social media used in medicine as we speak today?

Dr. Hood: So, we've definitely, as you're saying, seen the explosion on the internet of social media platforms, whether that's Twitter, Facebook, Instagram, and a whole host of others. It allows physicians and for that matter everybody that uses them including medical students and other healthcare professionals excellent ways for us to share information about ourselves and with each other and with patients as well. One study I was reviewing shows that about 88% of individuals less than 35 have at least one social media account. So, it's certainly prevalent in the younger age groups as well as into the older age groups.

So it allows physicians, residents, everyone to be creative somewhat outside of, perhaps, medicine but also within, and as we all know, definitely social networking, professional networking... The other big part of it, though, is the ease that we can disseminate public health information and discuss those issues amongst each other.

Brian: The ability to go out and get information, like you were saying, the dissemination of that information, it's easier to get that these days. Correct?

Dr. Hood: Exactly. And so patients often come in with a lot of information they've gleaned from the networks and from social media platforms as well. We also see residents and physicians using social platforms like these with educational opportunities as well.

Brian: When you talk about residents, the younger generation, most of them, I think you said like 80+ percent, have access to social media and use it regularly. That is something that has always been interesting to me as I've had opportunities to have conversations with doctors in training, whether it's students or residents or in fellowships. Often, I'm struck by how much they are on social media. So, to that extent, what are some specific recommendations that you might have for using social media when it comes to residents?

Dr. Hood: Certainly. At no point in any of our discussion do I think it's not the right thing to do, but there's certainly some guidelines we can all use because we all know there's challenges associated with social media. One of the biggest things is a gentle reminder to everybody that as much as we want our comments to be fleeting and just out there for a brief point in time, they are forever permanently on the web and at some point discernible to anybody that really knows how to look closely. So, that's one important thing.

Brian: Sure.

Dr. Hood: I also found it interesting as I was thinking about this question, I asked my daughter, she recently graduated from college as a college athlete, were there specific things they had been told as well as far as use of social media. She gave me some really good pointers that actually kind of go across even into all of our lives. So, it was interesting to me that it certainly applied.

Brian: That's great if you can share a few of those with us. That would be wonderful because I think that is something that's good not only for physicians in training but college students in general or all of us.

Dr. Hood: Correct. So one of them was not to link your website to someone else's website because you can't control the content, which I thought very interesting. They were also instructed as athletes not to directly link to a personal activity because, again, there's no control over that content, which made a lot of sense.

Brian: Right.

Dr. Hood: Certainly, as we all know and we'll repeat somewhat later in the conversation as well, never referencing controlled substances that should be not utilized in certain ways, profanity, you never want to talk badly about another individual. Then finally, just because they're athletes, they shouldn't promote any products in any way.

Brian: Those are really good guidelines not only for athletes but I'm sitting here and thinking, you know, that's not a bad perspective to take for anybody really involved in social media.

Dr. Hood: Exactly. The AMA actually came out with professional guidelines for social media use, a starting point and this was in the May 2015 writings. So, they had several things that I thought were really important. So, first is the key for all of us, whatever position we are on medicine is ensuring privacy. Then when you're with your group, residents, attendings, we all have to just make sure that we're being professional about what we're sharing so that at no point are we divulging any of our patient privacy information. And this will come out later as well in our discussions.

The second is keeping those contacts of your professional life and your social life separate. Because those two personas sometimes gray as we're making comments on our social media websites. We have to be so careful. We've all seen it on the news media multiple times where people have utilized their social media inappropriately and it comes out in very bad ways. So, professionalism is critical.

Brian: Yes.

Dr. Hood: There's a couple more.

Brian: Sure.

Dr. Hood: The third one is, when you're directly communicating about information with a patient, it really should be in that patient-physician role and not that you're going to be giving diagnoses or advice to somebody on your social media platform that actually isn't a patient. Because medical, legally, that certainly can become a problem.

Brian: Right.

Dr. Hood: Then the final one, as we discussed earlier, is remember that anything we put out there is certainly permanent. So, one of the things that came across quite evident is that many residency directors have started looking for these sort of things. So, as they ask their residents about jobs they're looking for, they find these posts on social media that may or may not be in the best light for that individual. So, the question of making sure what you put out there is something you want your future employers to see.

Brian: You're exactly right when it comes to that, Dr. Hood, because I personally have had conversations with people that have talked about, prior to having a resident join a program or even credentialing and hospitals and other places, that part of the process was to go out and check their social media profile just to see what was out there and how professional they were. So, that could really affect you negatively in your career and professionally, correct?

Dr. Hood: And for many years to come, exactly. So, I do think the other part of this is that the older generation that's going to potentially be doing some of the hiring of these younger folks is also, remember, that many of us change over time. And so those things that got documented on our personal social media websites may have been part of our youthful years. Many of us that grew up before social media, none of that's documented because it's all forgotten and there's nowhere that we see proof of it. So, I think being accepting of these new challenges that we see with social media with our young people is important.

Brian: I totally agree with you. I have had conversations before with residents and training, and I'm always telling them, “Listen, what you do now more so than me,” or as you said, the earlier generations, “what you do now affects you a lot more because there is proof of it. There's pictures, there's documentation of it, and you're going to be held to that standard. And  there are going to be people out there that part of the process is to go through social media profiles to check the professional side of people.” Wouldn't you agree with that?

Dr. Hood: Yes. Very much so. There was one really critical piece that I think, if you remember, just like we talked about surgical timeouts...

Brian: Yes.

Dr. Hood: I found one online as well, Pause Before Posting. So, I thought that was a good way to remember this.

Brian: That is fantastic because in the moment you're not necessarily thinking about all the implications of what you're about to put out there for everyone to see, but I think that's a great idea. If you pause, think about it, you might decide not to hit that send button. You know, we've kind of hit on this already, Dr. Hood. Some of the pitfalls of social media both professionally and personally. Do you have anything to add to that at this point?

Dr. Hood: Yeah. I think where it really comes down to is affecting your reputation and then diminishing the trust that the public has put in healthcare. So, I think when we in our posts, even if they're just on our personal sides, are profane comments, political rants, use of alcohol, illicit drugs, those sort of things. those are just not going to be good for your reputation. So, I think an easy place to start is to recognize those as a difficult thing to put out there forever. Then as far as the trust, if a healthcare provider divulges someone's personal information, then those patients pass on to others how much of a problem we have caused. Not only for them but just as a HIPAA breach as well as that huge medical liability risk when we put things we shouldn't.

Brian: Absolutely. And it can cause business issues. Like you're saying, I mean, that would really affect your business model if the PR gets bad because of HIPAA violations or other things like that. We've talked so far a lot about the negative side of social media, but there's a positive side too. A lot of times people focus on that negative aspect out there. But can you tell us how could it be used effectively and positively?

Dr. Hood: Sure. So, one that I think is interesting is actually a physician that goes by Dr. Mike on Instagram and he shares his life kind of all throughout the day. Going to the gym, walking his dog and doing healthy lifestyle activities and has thousands and thousands of followers. There's another physician, Dr. Pho, P-H-O, who's named social media's leading voice for healthcare, essentially. He gives insights for doctors, medical students–

Brian: It's great to have people out there that are doing it right that you can kind of focus on and you can even lead people that want to have a social media presence to these types of individuals and say, these are the type of people that are doing it correctly. If you're going to model someone's behavior, social media-wise, this might be a good way to do it. Was that fair to say?

Dr. Hood: That's fair to say. And then, in addition, I think those are just two more of celebrity-type ways to use social media has a Facebook page as does I know many, many practices. We found an incredibly effective way to post flu shots, we post anniversaries of staff and physician, employment dates, which just is celebration and connecting with the patient. We're also able to remind, you know, “it's time for your school physical.” So, a lot of great things come from our Facebook page. Sometimes we have occasional negative things that are a challenge. But in general, it's a very big positive.

Brian: As we said early on in this podcast, there are so many people utilizing social media today that that often might be the best way to communicate with someone or as a way to, as you said, remind them of upcoming appointments or things of that nature, correct?

Dr. Hood: Correct. Then another one that I think is for both patients and for those in healthcare, the CDC tweets on a regular basis about health messages that might affect hundreds or thousands of patients. So, another very effective way that Twitter has been used.

Brian: There is a lot of information to be gleaned out there. Are there differences of opinion, though, on how it can or should be used when it comes to this information?

Dr. Hood: Sure. So, I think a big part of the differences is very subjective and has a lot to do with generations. Where the younger generation may feel like this topic is very benign and not going to be an issue, somebody that's a bit older may see this as unprofessional or feel like the public may see it as unprofessional. My feeling is it's really more of a generational difference.

Brian: Even small children are more comfortable dealing with iPhones and computers and iPads and just the logistics of it more so than say our mothers or grandmothers, so that does stand to reason. Earlier you were talking about different articles that you had read and studies that you had seen. Have you read a study on objective evaluation of social media as it has to do with the residency programs? What can we learn from that? What can we pass on from the study?

Dr. Hood: Sure. It was a study done in 2015 where they queried Facebook and identify 281 recent urology resident graduates and found their specific Facebook pages. It was interesting, not specifically just about urology residents, but that of these young people, 40% had some form of unprofessional behavior on their Facebook page. It was interesting kind of how that played out in the study. Eight percent of those 281 showed some way that intoxication with alcohol was an issue. There were 13% that had profanity in their posts. Three percent, which is small but it's still for someone who's a physician, unfortunate, unlawful behavior. Then the final one was about 5% had given out some way confidential patient information.

Brian: That's eye-opening. Some of those numbers are very big and whenever you're thinking 5% give out confidential information, which could be HIPAA violations, you think well 5% is not that big until you understand what the implications are of just one person doing that. That's a big problem.

Dr. Hood: Correct. And to take it one step further, in 2009 there was a survey of US medical schools that reported 60% of their residency directors had had instances of unprofessional behavior that had to result in warnings and/or dismissals from the program. So, that's a big number of all the medical schools, but still, 60% had in some way had to deal with social media difficulties.

Brian: That's a lot going on there. And like you said, that is something that is a today problem and a future problem that wasn't necessarily there 10, 15, 20 years ago that professionals were having to deal with. As we get ready to wrap up our conversation, Dr. Hood, what would you say would be just a couple of the key takeaways that we've discussed today for residents in particular, but really anyone when it comes to social media? What are some good takeaways of things we should be aware of, good and bad?

Dr. Hood: I think the biggest takeaway is to keep ourselves out of trouble is keep patient information private. That should only be in the established doctor-patient relationship. So, you can be safeguarding that information to the highest extent possible. Then, by all means, we want social media to be used because it will be, no matter what we want or don't want. But see the benefits that we can get from it such as the creativity and the sharing of ideas, our educational benefits from it, the public health benefits and all of the good social aspects, and definitely the camaraderie that I've definitely experienced myself with using social media.

Brian: As you said, there is a lot of good to be had with social media, but there's also definitely these pitfalls that we have talked about as well. Thank you so much for taking the time to have a discussion with us to help us kind of navigate some of this tricky water, doctor. Thanks for being here.

Dr. Hood: I appreciate it, thank you. And always remember, pause before posting.

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect with your host, Brian Fortenberry. Listen to more episodes, subscribe to the podcast and find show notes at svmic.com/podcast.

The contents of this podcast are intended for informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and change over time. All names in the case have been changed to protect privacy.