1. Where are the lines?: Social
media and the regulators
Presentation to the Alberta Digital Professionalism Collaborative
Meeting
SEPT. 26, 2017
PAT RICH @PAT_HEALTH

2. Who I am
Pat Rich –
 Medical writer, editor and social
media commentator
 Worked with and on social media
daily for past decade
 Helped develop first secure
private online social network for
Canadian physicians
 Wrote first balanced social media
guidelines for Canadian doctors

3. Hosted discussions on social media
and regulation

4. The new reality
 Professional use of social media a fact of life for many health
care professionals
 “Off label” use of social media and digital tools, emails and
texting rampant among health care professionals
 Privacy and confidentiality being redefined by activist patients
 Growing number of patients and the public want and expect
interactions with health care professionals on social media

5. Regulatory issues
 Should social media be treated any differently than any other
communications channels?
 Is professional behavior on social media different than face to
face conduct?
 Do individual health care professionals have greater rights of
self-expression on social media?
 Does ubiquity of social media change the nature of patient
privacy and confidentiality?
 How should regulatory bodies respond to new digital tools
and social media platforms?

6. The new digital era
“Today’s medical professionals must be masters
of different skills that are related to using digital
devices or online solutions” and mastering those
skills “is now a crucial skill set that all medical
professionals require.”
Dr. Bertalan Mesko
,

7. Being a digital health professional
 Shape an idea in under 400
words
 Share an idea in a few hundred
characters
 Put an idea on a short video clip
 Understand the limitations of
patient-specific dialogue on
public networks
 Manage input and consumption
of information
Dr. Bryan Vartabedian

8. Googling patients – the new reality
 “In searching for their patients online, clinicians may be unwittingly
setting legal precedents for mental healthcare. As more and more
providers Google to guide their decisions, they may be shifting the
clinical standards to which all practitioners are held.”
 “If a patient leaves a suicidal message on Facebook, and the
clinician misses it, there’s a future—seemingly more plausible by the
day—in which that clinician could be sued for malpractice if the
patient then attempts suicide. ”
Getting Googled By Your Doctor: Erene Stergeopolus

9. What are/is social media
Extension of every day interaction
Conversations & exchange
Communities of shared interest
THE SAME AS OTHER
COMMUNICATIONS CHANNELS … BUT
DIFFERENT

10. The power of social media

11. Prevalence of social media in medicine
- Ontario
“In my now nearly 40 years as an Ontario physician I
have never witnessed such passionate engagement
with OMA affairs or the political process. (It) was
directly fuelled by the use of social media and the
enhanced connectivity between different regions and
specialties.”
Dr. Alan Drummond
(@alandrummond2)

12. Some health care discussions initiated
on social media

13. Why consider using social media
 To stay informed
 As a learning tool in medical education
 Communicate (engage) with peers and patients
 Disseminate information
 Advocate for/against something
 To help get a job
 To deliver clinical care
 Because if you decide not to use social media, your decision
should be based on sound knowledge about what you are
choosing not to use

14. The challenges
 Impact on patients
 Liability
 Privacy
 Ethics
 Boundaries
 Time theft
 Reputation
 Compensation

15. Regulatory – then …. and now
The Council has recently become aware that some
physicians have posted information on
Facebook … such that specific patients have
been inadvertently identified…Council does
not believe there is ever a need, or a point, to
posting any information regarding a
physician’s professional or clinical activity in
such a fashion, considering the many risks and
no discernable benefits.
College of Physicians and Surgeons of New Brunswick
… the College (of Physicians and Surgeons of
Ontario recognizes that social media
platforms may present important
opportunities to enhance patient care,
medical education, professional competence,
and collegiality, among other potential
benefits.
College of Physicians and Surgeons of Ontario

16. Why?
“Whether physicians are active on social media
or not, an understanding of social media and its
potential implications on their professional lives
is essential.”
Dr. Hartley Stern, CEO, Canadian Medical
Protective Association

17. Social media use n hospitals
“For the most part, hospitals have
figured out that they need to be
there communicating with their
customers. Some have found out the
hard way that you have to have a
good social media policy, you have
to set up guidelines for people who
are doing the posting, you have to
train and educate people and you
have to hold people accountable.”
Christina Thielst

18. Social media use in hospitals
“I think there is a still a bit of a
stigma about using social media at
work... So I think there is still room
for people to understand how useful
it can be as a part of a work tool, and
as part of a staff engagement tool,
and as part of a sharing ideas and
knowledge internally between co-
workers or with external partners..”
Ann Fuller - CHEO
RECOMMENDATUONS
Lakeridge Health should develop a
strategic plan for integrating social media
where appropriate into hospital activities
The Lakeridge social media policy for
employees should be revised to
encourage employees to be more
proactive in using social media to
support hospital initiatives. The policy
should also continue to provide guidance
on what is not appropriate.
Ongoing educational activities should be
offered to Lakeridge staff and physicians
by the Communications department to
encourage their use of social media
where appropriate.

19. Social media and academia
 Social media is a new space for academic
medicine that has enormous possibilities for
research, education, clinical care, and
dissemination of health care science.
 Institutions are starting to recognize social
media scholarship as significant and
meritorious and to include it when an
academic is being considered for promotion
and tenure.
More Than Likes and Tweets: Creating Social Media
Portfolios for Academic Promotion and Tenure: JGME, Aug.
2017

20. The rules (summarized)
Respect patient privacy and
confidentiality
Be professional

21. “Don’t Lie, Don’t Pry
Don’t Cheat, Can’t
Delete
Don’t Steal. Don’t
Reveal”
Dr. Farris Timimi, medical director,
Mayo Clinic Center for Social Media,
April 5, 2012

22. Social media and health care: New challenges

23. Medical politics aren’t
for the faint of heart
Former Ontario deputy health minister
Michael Decter quoted by Theresa Boyle
in The Toronto Star, Feb. 27, 2017

24. … and so it goes

25. Outcomes of Ontario physician
situation
 Canadian Medical Association hosted session on intra-
professionalism with focus on incivility on social media –
developing new Code of Ethics and Professionalism
 Some physicians reported to the CPSO for inappropriate
behavior
 Some physicians criticized OMA and other doctors for
reporting doctors to CPSO

26. Tweetchats on regulation

27. “
”
Rather than eliminating boundaries and
“suggesting anything goes,” physicians should
just ask themselves whether what they are
posting on social media is appropriate for a
physician in a public space – with the issue of the
content being professional or personal being
irrelevant.
Social Media and Physicians’ Online Identity Crisis” published in JAMA, Aug. 14 , 2013
(v.310, no: 6, 581-582).

28. What needs to be done
 Better education for all health care providers of the risks and benefits of
using social media in health care
 Codes of conduct and ethics that acknowledge realities of practising in a
digital health environment
 Updated guidelines
 Close monitoring of changing social mores with respect to
communications in the health care sector between patients and providers

29. Thank you!
Questions?