JDN_Social_media_white_paper_2012

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Social
Media
and
Medicine

Junior
Doctor
Network

Lawrence
Loh

Jean-‐Marc
Bourque

Daniel
Lee

Stewart
Morrison

Xaviour
Walker

Social
Media
and
Medicine

Junior
Doctor
Network

Lawrence
Loh,
MD,
MPH,
CCFP,
FRCPC1

Jean-‐Marc
Bourque,
MD2

Daniel
Lee,
MBBS,
MPH3

Stewart
Morrison,
MBBS
4

Xaviour
Walker,
MB
ChB5

Author
affiliations:

1
–
Dalla
Lana
School
of
Public
Health,
University
of
Toronto,
Toronto,
Ont.
Canada

2
–
London
Regional
Cancer
Program,
University
of
Western
Ontario,
London,
Ont.
Canada

3
–
Harvard
School
of
Public
Health,
Boston,
Mass.
USA

4
–
Western Health,
Melbourne,
Vic.
Australia
5
–
Mount
Auburn
Hospital,
Harvard
Medical
School,
Cambridge,
Mass.
USA

Montevideo,
Uruguay
2011

No
funding
was
received
in
the
preparation
of
this
document.

This
White
Paper
does
not
necessarily
reflect
the
opinion
of
the
WMA
or
the
institutions
of
the

authors.
It
is
not
a
policy
of
the
WMA.

©World
Medical
Association,
Inc.
2012

Ferney-‐Voltaire

13
chemin
du
Levant

01210
Ferney-‐Voltaire

France

wma@wma.net

3
Sections

1.0 Introduction
–
what
is
social
media?

2.0 Usage
and
statistics

3.0 Patients
and
social
media

4.0 Health
care
and
social
media

4.1 Health
Organisations

4.2 Public
Health

4.3 Health
Advocacy

5.0 Physicians
and
social
media

5.1 Patient
information
in
online
settings

5.2 Physician
and
patient
privacy
and
security
on
social
media
sites

5.3 Separating
personal
and
professional
boundaries
on
sites

5.4 Legal
aspects
of
online
postings,
ratings,
and
discussions

6.0 Ethical
issues
in
social
media

Summary

References
4
Executive
Summary

The
growth
of
social
media
platforms
on
the
internet
represents
both
opportunities
and
threats

to
the
way
medicine
is
practiced.
Greater
social
media
use
by
patients,
physicians,
health
care

institutions,
industry,
and
public
health
may
result
in
significant
positive
and
negative
impacts

both
for
individual
patient
care
and
at
a
population
health
level.

Social
media
refers
to
a
new
generation
of
platforms
and
applications
on
the
internet
that
make

it
easier
than
ever
for
individual
users
to
share
and
receive
information
on
the
web.
Once
the

exclusive
domains
of
blogs
and
wikis,
websites
like
Facebook,
Twitter,
and
YouTube
are

transforming
the
internet
landscape.
Today,
hundreds
of
millions
of
internet
users
are
involved

in
social
media
platforms,
presenting
a
tremendous
opportunity
and
challenge
in
controlling
the

veracity
and
flow
of
information
presented
in
intensely
personal
networks.

Doctor-‐patient
relationships
and
definitions
of
professionalism
have
undergone
notable

transformations,
and
the
distribution
of
medical
information
and
misinformation
now
occur
at

rapid
pace,
being
easily
archived
and
indexed
for
future
review.
In
this
context,
while
many
of

the
same
legal
and
ethical
responsibilities
for
physician
conduct,
privacy,
and
patient
well-‐being

remain
the
same,
the
logistics
behind
meeting
those
responsibilities
have
become
more
difficult

for
all
involved
in
an
increasingly
less
private
online
world.

Social
media
exists
in
several
different
categories.
Among
these,
those
causing
the
greatest

concern
to
health
care
and
health
care
professionals
are
blogs,
collaborative
projects,
content

communities,
and
social
networking
sites.
While
there
are
overarching
issues
with
their
use
by

patients,
physicians,
and
health
care
organisations,
each
individual
category
also
presents

unique
concerns
specifically
related
to
the
use
of
that
individual
platform.

For
patients,
social
media
represents
the
continued
increase
in
the
ease
by
which
patients
are

able
to
access
health
information
online.
The
greater
functionality
of
interaction
allows
the

development
of
online
support
groups,
which
can
improve
disease
outcomes
and
knowledge

but
are
vulnerable
to
abuse
by
unscrupulous
agents.
At
the
same
time,
the
increased
ease
by

which
information
(or
misinformation)
is
received
through
social
networking
sites
can
influence

various
aspects
of
the
doctor-‐patient
relationship,
related
to
diagnosis,
testing,
and
treatment.

For
health
organisations,
both
public
and
private,
there
is
potential
to
improve
health
literacy

and
knowledge
with
individual
patients
making
use
of
social
media.
However,
another
challenge

faced
by
these
organisations
is
both
the
protection
of
their
online
credibility
as
well
as
the
role

they
play
in
combatting
significant
misinformation
on
the
World
Wide
Web.

Public
health
organisations
benefit
from
decreased
investments
related
to
better
health

promotion
with
an
increased
ability
to
conduct
research.
However,
better
health
promotion

comes
with
the
challenge
of
misinformation
that
threatens
efforts,
and
the
increased
ability
to

conduct
research
brings
forward
significant
legal
and
ethical
concerns
that
must
be
carefully

considered
when
using
these
novel
technologies.

Finally,
the
use
of
social
media
by
physicians
presents
a
number
of
challenges.
There
is
a
blurring

of
professional
boundaries
when
physicians
choose
to
disclose
information
online
that
could,
by

5
the
nature
of
easy
transmission
of
social
media
platforms,
ultimately
be
seen
as
a
breach
of

privacy
or
unprofessional
behaviour.
The
protection
of
patient
privacy
and
confidentiality,
long
a

sacred
trust
held
in
the
doctor-‐patient
relationship,
is
threatened
by
an
increasingly
public

online
world.
At
the
same
time,
the
reputation
of
physicians
is
challenged
by
both
online
rating

websites
and
their
own
personal
postings
and
behaviours.

In
view
of
the
rise
in
use
of
social
media
among
physicians,
junior
doctors,
and
medical
students,

the
World
Medical
Association
(WMA)
has
passed
a
statement
on
the
professional
and
ethical

use
of
social
media.
Adopted
by
the
62nd
WMA
General
Assembly,
the
statement
highlights
that

the
boundaries
of
patient-‐physician
relationship
and
medical
ethics
remain
sacrosanct.
It

recommends
further
research
into
the
privacy
policies
of
websites,
and
encourages
education
of

both
medical
students
and
physicians
using
relevant
case
studies
to
protect
the
public

perception
of
the
profession.

While
such
resources
are
being
developed,
the
WMA
statement
goes
on
to
direct
physicians
and

medical
students
to
monitor
their
own
internet
presence.
It
recommends
separating

professional
and
personal
lives
as
much
as
possible
by
considering
their
intended
audience

when
posting
social
media
content
by
avoiding
overly
liberal
disclosure
of
personal
information,

and
reminding
physicians
and
medical
students
of
their
responsibility
to
provide
factual
and

concise
information
within
declared
conflicts
of
interest.
It
finally
calls
on
physicians
to
look
out

for
each
other,
speaking
to
colleagues
about
clearly
inappropriate
social
media
behaviour
and

reporting
such
behaviour
to
appropriate
authorities
as
needed

In
our
review,
we
hope
to
address
some
of
these
issues
in
depth,
and
highlight
both
the

tremendous
potential
that
exists
in
harnessing
social
media
and
the
equally
contentious
pitfalls

that
must
be
considered
as
social
media
grows,

ultimately
transforming
the
online
landscape.

6
Foreword

This
white
paper
examines
the
role
of
social
media
in
the
provision
of
health
care,
particularly
in

light
of
a
recently
adopted
World
Medical
Association
General
Assembly
Statement
on
the

Professional
and
Ethical
Use
of
Social
Media.
[1]

The
paper
begins
a
comprehensive
review
on
the
growing
phenomenon
of
social
media
by

reviewing
the
definition
of
“Web
2.0”
and
offering
a
classification
system
based
on
current

literature.
This
classification
system
provides
an
overview
of
the
different
types
of
social
media

in
use
by
internet
users
today.

The
paper
continues
by
reviewing
statistics
related
to
the
use
of
social
media
before
examining

considerations
for
the
use
of
social
media
from
the
perspective
of
patients
and
physicians.

It

closes
with
a
basic
introduction
to
the
specific
legal
and
ethical
considerations
regarding
the
use

of
social
media
in
the
provision
of
medical
services.

7
1.0
Introduction
–
social
media:
what
and
why

Social
media
refers
to
a
collection
of
Internet-‐based
entities
that
have
vastly
transformed
the

way
people
search
for
information,
interact
with
each
other
and
participate
in
their

communities.
[2]
It
encompasses
a
wide
variety
of
websites,
from
online
web
journals
(also

known
as
blogs),
social
networking
communities,
video
and
photo
sharing
platforms,
news
and

educational
sites,
and
information
websites
ranging
from
research
to
reviews.
Facebook,
Twitter,

YouTube,
and
Wikipedia
have
become
household
names.
Combined
with
exploding
worldwide

Internet
usage,
they
have
transformed
communication
as
shared
platforms
for
the
development

and
dissemination
of
information
created
by
millions
of
individual
users.

The
industry
term
“Web
2.0”,
which
arose
in
2004,
describes
a
new
generation
of
web
programs

and
applications
representing
a
shift
to
a
more
dynamic,
interconnected
virtual
world.
“Web

2.0”
represents
a
generation
of
websites
that
demonstrate
rapid
information
sharing
as
a
key

attribute.
Such
platforms
have
made
it
easier
than
ever
for
individuals
to
share
information
on

the
web.
Growing
from
simple
beginnings,
blogs,
wikis,
and
social
networking
sites
are
now

accessed
by
millions
of
Internet
users
on
a
daily
basis.
As
a
result,
these
platforms
facilitate

significant
information
flows
between
individuals,
among
online
communities
and
forums,
and

further
flows
from
individuals
to
larger
entities
such
as
governments,
corporations,
and

researchers.

This
flow
of
information
has
significant
implications
for
the
relationship
between
patients
and

the
medical
community.
Together
with
Web
2.0,
Eysenbach
has
suggested
a
definition
for
the

specific
term
“Medicine
2.0”
in
the
context
of
the
evolving
web:
[3]

“Medicine
2.0
applications,
services
and
tools
are
Web-‐based
services
for
[…]
caregivers,
patients,

health
professionals,
and
biomedical
researchers
who
use
Web
2.0
technologies,
and/or

semantic
web
and
virtual-‐reality
tools,
to
enable
and
facilitate
social
networking,
participation,

apomediation1
,
collaboration,
and
openness
within
and
between
these
user
groups.”

Standard
social
media
and
“Medicine
2.0”
web
services
present
opportunities
and
challenges
for

both
patients
and
the
broader
clinical
and
preventive
health
care
communities.
Used
carefully

and
judiciously,
such
websites
can
provide
rapid
access
to
accurate
medical
information,
and

offer
disease
sufferers
and
their
families
easy
connection
to
role
models
and
stories.
[4]

Interactive
tools
can
empower
patients
to
take
responsibility
for
their
own
health,
while
public

health
work
can
be
supported
in
their
efforts
to
conduct
disease
surveillance,
contact
tracing,

and
health
promotion
efforts.

Conversely,
the
potentially
rapid
spread
of
misinformation
also
threatens
efforts
to
protect
the

public’s
health.
A
group
of
cancer
patients
gathered
on
an
online
forum
might
turn
to
unproven

treatments
or
natural
therapy
put
forward
by
unscrupulous
agents
posing
as
peer
sufferers.

Newly
ubiquitous
“rating
sites”
provide
no
way
to
verify
contentious
reviews,
which
have
the

1

The
term
‘Apomediation’
characterizes
a
‘third
way’
for
users
to
identify
trustworthy
and
credible
information
and

services.
In
this
way
the
health
professional
gives
‘relevant’
information
to
a
patient,
by
filtering
what
is
credible

quality
information.
[2]

8
potential
to
destroy
a
physician’s
reputation.
Rapid
information
sharing
can
spread
panic
and

fear
about
diseases
and
treatments
across
media
such
as
Facebook
or
Twitter.

It
is
clear
that

the
immense
potential
presented
by
social
media
must
be
properly
tempered
by
an
awareness

of
the
risks
arising
from
the
ease
of
the
spread
and
longevity
of
digital
information.
Such
risks

must
be
properly
managed
by
physicians
and
physician
associations.
Several
national
medical

associations
now
provide
guidelines
on
social
media
use,
and
social
media
in
healthcare
is
a

growing
field
of
research
and
ethical
debate.
[5-‐7]

In
its
2011
statement,
the
World
Medical
Association
also
calls
on
its
members
associations
to

establish
comprehensive
guidelines
that
address
issues
pertaining
to
individual
physician

disclosures
and
behaviour,
training
and
education
on
proper
use
of
social
media,
and
privacy,

confidentiality,
professionalism
and
conflict
of
interest
considerations
in
using
such
technologies.

[1]

Classification

In
a
2010
paper,
Kaplan
and
Haenlein
[2]
categorise
social
media
platforms
in
a
two
dimensional

matrix
that
considers
the
intersection
between
self-‐presentation
and
self-‐disclosure
with
overall

social
presence,
with
each
dimension
ranked
from
high
to
low.
The
following
are
the
six
main

categories
discussed
in
their
paper:

Blogs
(high
self-‐disclosure,
low
overall
presence):
Some
of
the
earliest
forms
of
social
media,

blogs
are
online
journals
published
to
the
Internet
at
large
by
individual
users.
While
initial
blogs

were
personal
in
nature
and
published
under
pseudonyms,
the
development
of
specialty
and

expert
blogs
led
to
their
eventual
adoption
by
traditional
media
outlets
as
an
accepted
method

of
journalism.
The
end
result
has
been
the
development
of
a
wide
array
of
blogs,
from
simple

humour
sites
to
professional
blogs.
Blogs
have
even
grown
popular
with
the
medical
community,

often
written
by
trainees
or
practicing
physicians
on
topics
ranging
from
clinical
practice
and

healthy
living
tips
to
the
“human
side”
of
medicine.
[8]
While
this
has
increased
the
ease
by

which
patients
access
expert
opinions,
this
presents
threats
to
the
traditional
doctor-‐patient

relationship
and
also
makes
blogs
potentially
negative
influences
on
the
public
perception
of

physicians.
Notably,
blogs
serve
as
potential
flashpoints
for
ethical
issues
such
as
breaches
of

patient
confidentiality.
[9]

Collaborative
projects
(e.g.
Wikipedia)
(low
self-‐disclosure,
low
overall
presence):

Collaborative
projects
represent
the
joint
development
of
content
for
publication
on
the

website.
They
can
often
be
divided
into
two
general
types
–
websites
that
permit
users
to
fully

participate
in
adding,
removing
and
changing
web
content,
and
websites
that
collate

information
(such
as
ratings,
comments,
or
opinions.)
In
either
case,
the
online
community
often

agrees
on
a
set
of
“rules
and
tools”
to
facilitate
discussion
between
differing
viewpoints
and

maintain
the
accuracy
of
the
information.
As
a
prime
example
of
a
fully
participative
online

community,
Wikipedia
bills
itself
as
“the
free
encyclopedia
that
anyone
can
edit”.
[10]

In
the

same
way,
websites
like
Yelp
[11]
allow
participants
to
rate
experiences,
products,
and
services

on
everything
from
restaurants
to
grocery
stores,
while
other
websites
Urbanspoon
[12]

and

RateMDs
focus
on
being
more
in-‐depth,
subject-‐specific
community
barometers.
Specific
health

care
considerations
relate
to
the
open
nature
of
these
projects
–
while
they
disseminate

information
more
easily
to
patients
and
can
even
be
tailored
to
specific
communities
of
patients,

9
that
same
ease
makes
them
vulnerable
to
spreading
misinformation,
distorting
facts,
or

breaching
privacy.

Content
communities
(e.g.
YouTube)
(low
self-‐disclosure,
medium
overall
presence):
Sharing

photographs
and
other
media
has
been
a
staple
since
the
formation
of
the
Internet.
However,

content
communities
represent
innovative
central
repositories
of
such
media.
YouTube,
for

example,
is
a
video-‐sharing
website
that
allows
anyone
to
register
and
post
video-‐based
media

content.
Since
its
inception
it
has
now
grown
to
become
the
biggest
video
sharing
site
in
the

world,
with
over
100
million
videos
watched
daily
on
an
unlimited
range
of
topics,
with
a

number
of
imitation
video-‐sharing
sites
attempting
to
emulate
its
success.
Other
content

communities
exist
for
other
forms
of
media,
such
as
Flickr
for
photos,
[13]
TED
for
educational

videos,
[14]
and
Slideshare
for
presentations.
[15]
All
of
these
communities
contain
medical

content
in
their
libraries,
which
arises
from
numerous
sources
of
varying
repute.
While
many

well-‐renowned
health
care
organisations
have
made
use
of
these
content
communities,
many

other
interest
groups
have
taken
the
opportunity
to
spread
misinformation
and
fear.

Social
networking
sites
(e.g.
Facebook)
(high
self-‐disclosure,
medium
overall
presence):
The

earliest
incarnation
of
social
networking
sites
were
forums
and
bulletin
boards,
which
today
are

ubiquitous
and
cover
a
range
of
topics.
From
these
initial
communities
of
conversation
and

discussion,
Facebook,
Myspace
and
Twitter
emerged.
These
websites
provide
an
opportunity
for

their
members
to
connect
with
one
another
electronically,
combining
elements
from
content

communities,
collaborative
projects,
and
blogs
to
allow
users
to
share
photos,
stories,
and

personal
opinions.
[16-‐18]
Due
to
their
extremely
personal
nature
and
focus
on
human

relationships,
social
networking
sites
represent
some
of
the
most
behaviour-‐changing
and
risky

online
activities
that
physicians
and
patients
partake
in.
The
World
Medical
Association’s

guidelines
call
on
physicians
using
social
media
to
take
care
to
review
the
privacy
policies
of
the

platforms
they
use
in
order
to
judiciously
separate
their
personal
and
professional
lives.
This

matters
most
in
social
networking,
where
patients
can
“connect”
directly
to
physicians
and

monitor
their
personal
online
presence
and
data,
and
where
physicians
may
be
apt
to
disclose

more
private
information
under
the
mistaken
assumption
that
it
is
only
being
published
to
their

immediate
connections
(without
considering
the
potential
for
onward
transmission.)
[1]

Virtual
gaming
worlds
(e.g.
World
of
Warcraft)
(high
self-‐disclosure,
low
overall
presence):

Virtual
worlds
provide
an
immersive
environment
in
which
users
often
take
on
‘character’
roles,

participating
in
various
challenges
and
interacting
with
other
players.
The
most
famous
of
these

is
World
of
Warcraft,
[19]
which
is
a
fantasy-‐themed
multiplayer
game
and
growing
online

community.
Despite
enforced
limitations
on
self-‐disclosure,
studies
have
shown
that
the

character
traits
of
regular
participants
in
these
online
games
are
often
reflected
in
their
online

persona.
[20]
Such
gaming
worlds
have
little
relation
to
health
care
practice.

Virtual
social
worlds
(e.g.
Second
Life)
(high
self-‐disclosure,
high
overall
presence):
Similar
to

virtual
worlds
for
gaming,
social
worlds
are
a
means
for
people
to
live
a
“virtual
life”
in
parallel

to
their
real
life,
though
the
popularity
of
such
social
worlds
is
waning.

[21]
Similar
to
virtual

gaming
worlds,
virtual
social
worlds
have
limited
impact
on
physicians,
patients,
and
health
care

organisations.

10
2.0
Usage
and
statistics

In
2012,
Facebook
emerged
as
the
largest
social
media
network
in
use
worldwide,
and

represents
the
enormous
growth
of
social
media
usage
among
the
general
public.
With
nearly

750
million
unique
users,
of
whom
50%
log
in
on
any
given
day,
Facebook
allows
internet
users

to
interact
with
community
pages,
events,
groups
and
personal
posts
from
their
friends.
[16]
In

the
same
vein,
Twitter
is
a
platform
that
allows
users
to
share
ideas
in
posts
lengthening

140-‐
character.
Using
“hashtags”
(a
reference
to
the
keystroke
#)
allows
users
to
categorise
their

posts
by
topic,
which
can
often
lead
to
news
and
current
events
becoming
popularly
“tagged”
in

posts.
[17]

Many
celebrities,
entertainers,
and
politicians
have
made
use
of
Twitter
to
reach
out

to
members
of
the
public.
[22]

These
platforms
for
social
media
are
also
increasingly
used
by
medical
professionals,
trainees,

and
students.
A
2010
study
[23]
demonstrated
that
65%
of
students
at
the
University
of
Otago,

New
Zealand,
had
a
Facebook
account.
A
comparative
study
carried
out
by
Universal
McCann
in

April
2008
[24]
showed
that
the
respondents
in
over
29
countries
had
overwhelmingly
read
and

had
their
own
blogs,
uploaded
or
viewed
video
clips
online,
and
continuously
participate
in

social
networks.

Despite
the
growth
of
such
platforms,
and
their
adoption
by
physicians
and
trainees
alike,
the

health
care
industry
in
the
U.S.
has
a
low
social
media
presence.
A
survey
conducted
by
Deloitte

found
that
only
700
of
5000
major
U.S.
hospitals
had
but
a
minimal
social
media
presence.
[25]

This
has
not
stopped
the
proliferation
of
various
health-‐related
social
media
websites
across
all

the
categories
discussed
by
Kaplan
and
Haenlein.
For
example,
RateMDs
has
caused
controversy

as
a
rating
site
for
physicians,
where
patients
can
freely
and
anonymously
post
comments
and

ratings
on
a
physician’s
knowledge,
punctuality
and
helpfulness.
[26]
Even
beyond
this,

physician
networking
sites
(such
as
Sermo),
health-‐focused
search
engines
(such
as
Kosmix),
and

even
online
“eGames”
focused
on
health
(such
as
Exergames)
have
all
arisen
in
the
last
few

years
and
represent
a
growing
source
of
health
information
and
interaction
for
patients
and

physicians.

11
3.0
Patients
and
social
media

People
search
for
information
and
resources
in
a
variety
of
settings.

The
simplicity
and
ease
of

the
Internet
has
made
it
a
source
of
health
information
from
its
very
inception.
Surveys
indicate

that
eight
out
of
ten
American
internet
users
have
searched
for
health-‐related
information,
[27]

and
in
this
new
era
of
Web
2.0,
a
large
proportion
of
patients
share
their
experiences
and

receive
information
and
support
through
social
media.

In
2010,
the
Pew
Internet
and
American
Life
Project
documented
that
66%
of
Americans
had

access
to
broadband
Internet,
[28]
compared
with
5%
in
2000.
[29]
Over
the
same
time,
the

percentage
of
Americans
looking
for
health
information
online
had
increased
from
25%
to
61%.

[30]

A
2010
U.S.-‐based
survey
conducted
by
Deloitte
found
that
patients
commonly
look
for

information
regarding
their
diagnoses
and
treatment
options,

but
also
seek
out
quality
of
care

data
(such
as
doctor
reviews)
and
hospital
comparison
data.
[25]
The
same
survey
suggested

that
this
implies
that
having
information
about
traditional
medicine
sharing
the
same
space
as

recent
medical
trends,
such
as
medical
tourism
and
alternative
health
care;
patients
are
now

more
likely
to
ignore
traditional
medical
advice
in
favour
of
information
from
peers
and/or

similar
patients.

Beyond
just
information
retrieval,
however,
patient
information
exchange
has
also
been
altered

by
social
media.
The
Internet
has
provided
a
venue
for
support
groups
from
as
early
on
as
1982.

Early
computer-‐mediated
communication
via
online
support
groups
permitted
anonymous,

frank
discussions
of
sensitive
personal
issues.
[31]
Social
media
sites
today
host
the
successors

of
many
disease-‐specific
information
exchanges;
these
present
both
potential
benefits
and
risks.

A
study
examined
15
Facebook
groups
focused
on
diabetes
management
and
the
content
of

their
wall
posts.
[32]
Two-‐thirds
of
the
posts
reviewed
included
sharing
of
diabetes
management

strategies,
while
others
were
related
to
feedback
and
emotional
support.
Of
concern,
a
quarter

of
posts
were
related
to
non-‐FDA
approved,
‘natural’
products,
and
13%
of
posts
contained

requests
for
personal
information
from
Facebook
participants.
These
results
highlight
the

usefulness
of
social
media
as
a
platform
for
health
and
disease
specific
social
interaction
and

support,
but
also
the
potential
for
misuse
by
parties
attempting
to
leverage
the
interaction
for

some
sort
of
secondary
gain.

Understanding
these
benefits
and
risks
is
important
in
the
face
of
rapidly
evolving
health-‐
specific
social
media
utilisation.
Literature
already
notes
cohort
as
well
as
longitudinal

differences
in
platform
usage
and
preference.
A
survey
of
asthma
patients
aged
between
12
and

40
years
old
named
email
as
the
most
preferred
method
of
electronic
health
information

communication,
with
some
interest
also
expressed
in
text
messaging
and
Facebook.

Communication
via
Myspace
and
Twitter
elicited
minimal
interest.
[33]

Some
potential
practice
standards
may
arise
related
to
chronic
disease
and
social
media.
Social

networks
have
fostered
the
creation
of
communities
of
patients
with
the
same
conditions;

12
sophisticated
virtual
communities
facilitate
information
sharing
on
coping
with
a
common

disease
condition,
with
the
added
benefit
of
a
personal
network
of
friends
who
understand.

Online
peer
support
services
have
been
shown
to
improve
cancer
patients’
outlook,
helping

them
feel
more
in
control
of
their
health
and
strengthening
their
coping
skills.
This
finding
was

consistent
across
age
groups
and
was
even
more
pronounced
for
older
patients.
[34]

Scheduled
online
support
groups,
moderated
by
a
professional,
can
augment
these
efforts.
A

‘virtual
coach’
can
provide
individualized
guidance
and
support
based
on
readily
available

analyses
of
each
patient’s
characteristics
and
performance.
In
addition,
a
clinician
can

communicate
frequently
and
efficiently,
offering
personalized
email
support
to
each
patient

without
requiring
in-‐person
meetings.
Such
professionals
can
monitor
these
‘virtual
support

groups’,
participating
in
patient
discussions
via
informational
chat
rooms
and
blogs.
[35]
An

example
includes
online
cancer
support
groups,
which
might
facilitate
people
coming
together

to
explore
medical
concerns
while
responding
to
emotional
needs.
[36]

The
balance
of
power
in
the
physician-‐patient
relationship
is
heavily
influenced
by
these
new

sources
of
information
and
interaction
that
are
now
readily
accessible
by
physicians
and

patients.
Patients
now
often
arrive
at
appointments
with
information
that
may
or
may
not
be

relevant
to
the
investigation
and
management
of
their
conditions.
However,
this
does
not

obviate
the
legal
and
ethical
need
for
physicians
to
conduct
assessments
and
work-‐up
according

to
established
standards
of
care.

It
remains
the
responsibility
of
physicians
to
ensure
that
the
patient
receives
the
best
possible

care,
avoiding
unnecessary
or
frivolous
testing
and
protecting
patients
from
the
potential

mental
and
personal
harm
related
to
self-‐diagnosis
resulting
from
misinformation
from
the

Internet.

13
4.0
Health
care
and
social
media

4.1
Health
Organisations

The
importance
of
social
media
for
health
organisations
relates
to
their
need
to
manage
their

online
reputation
while
combatting
the
spread
of
misinformation
and
opinions
based
on
fallacy.

While
a
growing
body
of
scholarly
evidence
links
online
heath
information
to
positive
health-‐
related
behaviors,
the
growth
and
ease
of
social
media
platforms
has
also
resulted
in
concerns

about
the
quality
and
reliability
of
information
provided
through
this
medium.
[37]
For
example,

one
study
examining
urinary
incontinence
resources
on
Facebook,
Twitter,
and
YouTube
found

that
the
majority
of
information
provided
was
not
useful,
consisting
of
advertisements
for

commercial
products.
These
were
in
head
to
head
competition
with
the
fewer
evidence-‐based

YouTube
videos
from
reputed
health-‐care
professionals
and
professional
organisations.
[38]

The
previous
example
is
one
of
many
which
highlight
the
importance
for
organisations
and

societies
engaging
patients
through
effective
social
media
use.
In
all
cases,
organisations
must

strive
to
differentiate
themselves
from
non-‐credible
sources.
Successful
efforts
will
provide
both

credible
information
and
extensive
reach.
The
factors
in
their
success
should
be
the
focus
of

rigorous
evaluation
to
better
understand
how
they
were
effective.
Such
findings
should
then
be

widely
disseminated
to
inform
on-‐going
efforts
by
the
medical
community
to
engage
their

communities
through
social
media.

There
are
many
existing
examples
of
successful
health
organisation
efforts
in
both
the
public

and
private
sectors.
Private
health-‐care
organisations,
such
as
the
Mayo
Clinic,
[39]
government

public
health
agencies,
such
as
the
United
States
Centers
for
Disease
Control
(CDC),
[40]
and

internationally,
notably
the
World
Health
Organisation
(WHO)
have
all
developed
successful

social
media
programs
which
continue
to
grow.

[41]

The
Mayo
Clinic
Center
for
Social
Media
offers
podcasts
and
YouTube
videos
on
everything
from

disease
overviews
to
health-‐care
reform.
Their
social
media
website
counts
more
than
175,000

followers
on
Twitter,
as
well
as
an
active
Facebook
page
with
over
50,000
followers,
while
an

active
blog
on
the
website
presents
both
op-‐ed
and
research-‐based
pieces
on
the
growth
of

social
media
and
its
significance
to
health-‐care
delivery.
[39]

The
CDC
represents
an
example
of
successful
public
sector
marketing
through
social
media,

having
disseminated
information
through
numerous
internet
and
health
campaigns.
During

influenza
season,
the
CDC
uses
Facebook,
Twitter,
YouTube
educational
videos,
and
podcasts
to

increase
community
awareness
of
hand
hygiene
and
immunization.

They
also
team
up
with

other
partners,
such
as
Whyville,
to
create
virtual
world
vaccinations
for
younger
adolescents.

[40]
Related
to
their
success,
the
CDC
has
published
a
toolkit
for
health
promoters
to
facilitate

effective
use
of
social
media
in
health
promotion.
[42]

14
4.2
Public
Health

Similar
to
clinical
practice,
public
health
and
preventive
medicine
stands
to
gain
potential

benefit
from
the
use
of
social
media
in
health
promotion
efforts.
Successful
campaigns
have

made
use
of
websites
to
inform
and
reinforce
health-‐related
behaviours
among
specific
target

audiences.
At
the
same
time,
public
health
is
challenged
by
the
same
misinformation
that

interferes
with
clinical
practice,
which
poses
even
greater
difficulty
due
to
the
already
relatively

lower
profile
public
health
and
prevention
has
in
the
mind
of
patients
and
the
public.

Health
promotion
uses

Social
media
has
been
used
as
an
adjunct
to
traditional
media
sources
(e.g.
radio,
television,

print
media),
for
communicating
with
target
audiences.
Digital
media
lowers
barriers
and
offers

new
and
easy
opportunities
for
those
who
seek
health
information.
[43]

Web-‐based
learning
and
support
technology
benefits
both
clinicians
and
patients.
Patients
learn

to
overcome
barriers
and
to
self-‐document
activities
and
interactions
thereby
permitting

clinician
review
and
feedback
at
any
time.
[35]
Finally,
the
potential
exists
for
social
media
to

improve
public
understanding
and
appreciation
for
medical
sciences.
If
used
properly,
this
can

drive
quality
improvement
efforts
in
health
care.
For
example,
social
media
can
be
used
to

recruit
appropriate
patients
for
more
effective
clinical
trials.
[44]

Health
promotion
can
benefit
from
the
marketing
principles
espoused
by
social
media.
Today,

health
concepts
can
be
easily
and
effectively
distributed
according
to
consumer
marketing

principles
through
the
use
of
social
media.
Such
strategies
individualize
health
promotion

concepts
in
ways
that
traditional
media
has
failed,
allowing
word
of
mouth
promotion
of
ideas,

issues,
and
practices
to
create
awareness,
change
attitudes,
intentions,
and
behaviours

regarding
social
and
personal
health
issues.
This
concept
of
“social
marketing”,
used

appropriately,
represents
an
opportunity
to
promote
healthy
attitudes
and
behaviors.
[45]

Social
marketing
interventions
have
been
shown
to
both
promote
and
change
health-‐related

behaviors
and
issues.
For
example,
a
systematic
review
by
Wei
and
others
(2011)
shows
that

there
is
some
evidence
that
multi-‐media
social
marketing
campaigns
can
promote
HIV
testing

among
men
who
have
sex
with
men
in
developed
countries.
[46]
Another
example
is
virtual

health
fairs.
Health
fairs,
traditionally
used
in
worksite
and
community
health
promotion

programs,
have
now
developed
cyber-‐versions
that
have
demonstrated
the
potential
to
educate

patients
and
enhance
behavior
change.
[47]

Incident,
Disaster,
and
Epidemic
Management

Information
exchange
(dissemination
and
collection)
is
a
hallmark
of
social
media.
Most

significant
in
this
role
is
the
use
of
social
media
by
public
health
officials
in
disasters
and

emergency
situations.
Using
crowd-‐sourcing
technologies
and
electronic
communications
tools

allows
quicker,
more
coordinated,
effective
emergency
management.
[48]

During
the
2010
Haiti
earthquake,
social
media
was
used
to
locate
missing
people,
while
during

the
oil
spill
in
the
Gulf
of
Mexico,
social
media
helped
to
identify
areas
most
in
need
of
clean-‐up

efforts.
[49]
The
most
pertinent
example
arises
from
the
2009
H1N1
influenza
pandemic.
Public

15
health
officials
used
YouTube
broadcasts
to
update
the
public
[50]
arming
them
with
tips
on

what
to
expect
and
how
to
prevent
the
spread
of
the
disease.
Health
departments
also
drew

people
quickly
to
immunization
sites
by
texting
and
posting
announcements
on
Twitter
about

vaccine
availability.

Public
Health
Challenges

Public
health’s
key
reason
for
social
media
involvement
is
less
about
the
potential
benefits
and

more
about
the
need
to
combat
misinformation
and
incorrect
evidence.
While
traditional
media

limits
the
opportunity
for
fringe
ideas
and
non-‐evidence
based
viewpoints
to
reach
audiences,

the
rapidity
of
information
transfer
and
ease
of
access
has
made
social
media
a
haven
for
the

spread
of
uninformed
perceptions
and
opinions
that
threaten
public
health
efforts.

The
most
common
example
cited
is
the
rise
of
anti-‐immunization
sentiment
among
patients.
A

single
celebrity
opinion
or
view
is
replicated
en
masse
through
Twitter;
YouTube
videos
spread

conspiracy
theories
or
cling
on
to
already
discredited
studies
and
evidence.
Without
proper

safeguards,
such
use
of
social
media
threatens
efforts
to
control
and
eliminate
vaccine

preventable
disease,
and
underscores
the
importance
of
public
health
learning
on
how
to

effectively
advocate
and
respond
to
unfounded
allegations.

4.3
Patient
advocacy

Social
Media
has
been
used
by
health
professionals
as
a
mechanism
for
health
advocacy
and

inciting
change.
[51,
52]
The
group
Doctors
for
Obama
used
Facebook
in
the
2008
presidential

campaign
to
rapidly
mobilize
thousands
of
doctors
to
communicate
their
views
on
health
policy

to
the
Obama
headquarters.
This
group
of
physicians
continues
to
have
a
voice
in
the
Obama

administration.
[52]

In
response
to
the
state
of
emergency
rooms
in
Taiwan,
on
Feb
8,
2011,
an
emergency
medicine

physician
created
a
Facebook
group
called
“Rescue
the
Emergency
Room”.
Within
a
week

approximately
1500
people,
mostly
emergency
department
staff
around
Taiwan
became

members
and
started
actively
discussing
and
sharing
their
experiences.
The
group
soon

expressed
their
concerns
on
the
Facebook
profile
of
the
Taiwanese
Minister
of
Health
and

subsequently
invited
the
Minister
to
join
the
group.
Upon
his
engagement
in
the
discussion,
the

Minister
was
quick
to
visit
emergency
departments.
The
Government
in
turn
soon
committed
to

improving
resources
for
hospitals
and
emergency-‐room
overcrowding.
[51]

16
5.0
Physicians
and
Social
Media

5.1
Patient
information
in
online
settings

The
online
setting
presents
a
different
set
of
security
and
privacy
risks
when
compared
to

traditional
face-‐to-‐face
appointments.
The
inadvertent
disclosure
of
patient
information
in
a

social
media
setting
may
result
in
a
far
more
egregious
breach.
[53]
Specifically,
the
concept
of

“digital
footprints”
refers
to
the
potential
permanence
of
information
in
cyberspace.

The

aftermath
of
a
misplaced
post
in
the
social
media
arena
may
often
extend
far
into
the
future.

[54]

If
there
is
a
need
to
communicate
with
patients
electronically,
physicians
should
first
obtain
the

patient’s
consent.

Physician
offices
must
also
ensure
that
any
communication
systems
used
are

secure
and
should
avoid
direct
communication
with
patients
via
third-‐party
platforms.
[55]

5.2
Patient
Privacy
and
Security
on
Social
Media
Sites

Physician
use
of
social
media
technologies,
as
with
all
physician
conduct,
is
subject
to
the
ethical

and
legal
responsibilities
determined
as
best
practice
by
the
profession.
Ethically,
the
principle

of
non-‐maleficence
(being
“primum
non
nocere”
–
first,
do
no
harm)
is
directly
linked
to
the

patient’s
fundamental
right
to
privacy
and
confidentiality,
and
as
such,
must
be
carefully

considered
and
protected.
[56]

A
person’s
health
information
is
acknowledged
to
be
the
most

sensitive
of
all
personal
information,
[57]
and
the
ease
with
which
social
media
retains
and

spreads
information
makes
it
particularly
vulnerable
to
privacy
breaches
and
liability
concerns

for
health-‐care
providers
and
facilities
alike.
[58]

Privacy
has
been
defined
as
‘freedom
from
the
intrusion
of
others
in
one´s
private
life
or
affairs’,

and
is
a
fundamental
human
right,
protected
by
law.
[59,
60]
In
the
context
of
the
internet,

privacy
is
more
abstract,
and
often
misunderstood,
relating
not
only
to
the
underlying

architectural
solution
being
employed,
but
to
the
individual’s
level
of
comfort
and
degree
of

control
over
personal
data
contained
therein.
In
essence,
privacy
is
about
the
ability
to
make

choices.

A
speech
by
Boyd
at
the
2010
World
Wide
Web
conference
highlighted
this
concept:

“Privacy
is
not
about
control
over
data
nor
is
it
a
property
of
data.

It’s

about
a
collective
understanding
of
a
social
situation’s
boundaries
and

knowing
how
to
operate
within
them.

In
other
words,
it’s
about
having

control
over
a
situation.
It’s
about
understanding
the
audience
and

knowing
how
far
information
will
flow.

It’s
about
trusting
the
people,
the

situation,
and
the
context.”
[61]

Much
of
the
discussion
surrounding
private
health
information
and
social
media
focuses
on
the

potential
for
privacy
breaches;
the
consequences
of
such
breaches
can
be
severe.
Concerning

results
from
a
2009
paper
by
Chretien
and
co-‐authors
found
13%
of
interviewed
medical
school

17
Deans
had
noted
an
online
breach
or
violation
of
patient
confidentiality
by
a
medical
student.

[62]

These
breaches
can
arise
directly
from
social
media-‐based
interaction
specifically
related
to

health
care
(e.g.
a
doctor
and
patient
communicating
online),
or
indirectly
through
other
social

media-‐based
interaction
not
specifically
related
to
the
provision
of
health
care
(e.g.
a
physician

communicating
with
another
physician
about
weekend
plans
on
a
forum
or
blog.)

Irrespective

of
the
nature
of
the
breach,
the
broad
accessibility
of
social
media
requires
continued

physicians’
vigilance
in
ensuring
they
do
not
divulge
personal
health
information
(even
if
the

patient’s
identity
is
withheld)
without
the
informed
consent
of
the
patient.

A
potential
knowledge
disparity
exists
in
online
physician
-‐patient
relationships.
Physicians

benefit
from
numerous
guidelines
and
codes
of
conduct,
but
patients
are
less
well
equipped
and

may
not
fully
appreciate
the
privacy
implications
of
discussing,
sharing
or
interacting
with
health

information
online.
Specific
to
social
media,
patients
may
not
consider
the
full
scope
of
the

audience
who
may
be
exposed
inadvertently
(friends,
co-‐workers,
family),
or
indeed
seek
out

intentionally
(potential
employers,
health
insurers)
the
personal
health
information
they
are

sharing.
Encouraging
patient
engagement
in
social
media
requires
physicians
to
help
them
make

informed
privacy
choices.

Another
threat
to
privacy
comes
from
the
greater
shift
by
health
professionals
towards
a
more

contemporaneous
and
dynamic
method
of
information
sharing
and
research
collaboration.
In

the
past,
traditional
medical
journals
and
textbooks
had
a
limited
audience,
most
often
those

within
the
medical
profession.
These
journals
and
the
professionals
reading
them
are
bound
by

their
own
codes
of
conduct
in
safeguarding
case
reports
and
other
aspects
of
research
study

privacy
and
confidentiality.
In
contrast,
information
broadcast
on
the
Internet
or
via
social

media
is
not
only
potentially
accessible,
and
more
easily
searchable,
by
a
far
wider
audience,
but

the
audience
itself
is
not
be
bound
by
any
formal
ethical
standards
or
codes
of
conduct.

Disclosure
of
confidential
information
on
social
media
platforms
may
have
professional

consequences.
The
Medical
Board
of
New
South
Wales,
Australia
issued
a
general
warning
to

physician
about
disclosing
confidential
information
on
social
networking
sites,
[63]
and
at
least

one
physician
has
lost
her
job
after
being
seen
to
have
breached
patient
privacy.
[64]
Hader
&

Brown
(2010)
succinctly
highlighted
a
basis
for
appropriate
social
media
use:

“We
are
not
suggesting
that
health-‐care
providers
shy
away

from
common
online
networking
applications.
These
new

media
tools
and
technology
serve
important
social
and

professional
purposes
in
today’s
society.
But
please,
for
your

sake
and
the
sake
of
the
profession,
stop
and
think
before
you

post.”
[58]

The
paradigm
of
“thinking
before
posting”
is
in-‐line
with
wider
ethical
and
legal

responsibilities,
which
still
apply
in
the
social
media
realm
as
in
day-‐to-‐day
interactions.

Ultimately,
physicians
must
still
act
professionally
and
in
the
best
interest
of
their
patients.

Literature
suggests
that
physicians
intending
to
use
social
media
should:

18
1. Ensure
that,
if
engaging
with
patients
or
potential
patients
by
use
of
social
media,
they
are

not
inadvertently
making
their
patients
vulnerable
to
privacy
breaches.

2. Ensure
that,
if
intending
to
communicate
with
patients
using
social
media,
they
educate

their
patients
in
order
to
empower
them
to
manage
their
data
and
hence
achieve
privacy.

3. Ensure
that
professional
interactions
between
health-‐care
professionals,
including
the

transmission
of
any
health
data,
satisfy
any
local
policy
or
legislation.

4. Ensure
that
consent
is
obtained
for
the
disclosure
of
any
personally
identifiable
information

on
social
media
forums.

5.3
Separating
Personal
and
Professional
Boundaries

Professional
boundaries
protect
the
unique
dynamic
of
the
physician-‐patient
relationship,

ensuring
that
interactions
ultimately
benefit
the
patient.
[65]
Self-‐disclosure
of
personal

information
by
physicians
to
patient
is
rare,
and
often
seen
as
inappropriate.
Physicians
may

occasionally
share
information
with
individual
patients
to
establish
or
maintain
a
positive

physician-‐patient
relationship.
Such
disclosures
are
in
confidence,
tailored
to
individual
patients,

and
are
usually
relevant
to
the
context
of
an
interaction.
[66]

In
contrast,
inadvertent
social
media
“disclosures”
release
unrelated
personal
information
about

a
physician
that
may
influence
patients’
perceptions
or
trust,
which
may
extend
to
perception

and
trust
of
the
medical
profession.
In
a
commentary
on
medical
trainees
by
Farnan
(2009)
[67]

the
dilemma
presented
questioned
whether
an
individual
trainee’s
usage
of
social
media
is

within
their
capacity
as
a
trainee
or
as
an
individual
who
also
happens
to
be
a
medical
trainee.

Similarly,
physicians
commenting
on
social
media
sites
are
encouraged
to
identify
themselves
by

including
a
disclaimer
and
making
it
clear
that
they
are
not
speaking
on
behalf
of
their

institution.
Restrictions
dictate
that
any
disclaimers
should
not
include
the
logo
or
trademark
of

the
physician’s
relevant
institution
without
permission,
and
that
this
physician
should
also
be

careful
to
respect
copyright,
privacy,
fair
use
and
financial
disclosure,
as
well
as
other
applicable

laws.

These
issues
arise
from
the
availability,
archivability,
and
indexability
of
social
media.
Use
of

social
media
permits
greater
sharing
of
personal
lives,
extending
the
“professionalism”
required

of
physicians
within
the
framework
of
their
profession
into
their
personal
lives.
It
should
be

noted
that
sentiments
expressed
as
an
individual
may
be
perceived
differently
once
they
are

identified
to
be
coming
from
a
medical
professional.
Digital
posts
may
be
seen
out
of
context
by

any
number
of
people,
archived
and
indexed
for
future
reference.
Furthermore,
while
one
may

attempt
to
appropriately
tailor
postings,
Boyd
(2010)
points
out
that
other
social
media
users

may
refer
to,
comment
on,
or
reply
to
postings
that
portray
the
original
posting
in
a
more

negative
light.
In
essence
“participants
do
not
have
complete
control
over
their
self-‐
representation”.
[68]

In
order
to
establish
appropriate
personal/professional
boundaries
when
using
social
media,

medical
professionals
should:

1. Ensure
that
any
interaction
with
patients
occurs
in
a
professional
capacity,
and
that
is

made
clear
to
the
patient,
physician,
and
any
third
parties
involved.

19
2. Ensure
that
online
a
professional
identity
is
delineated
from
a
personal
identity,
and
this

delineation
is
clear
to
any
potential
audience.

3. Exercise
restraint
when
divulging
any
information
online,
in
either
a
personal
or

professional
context,
bearing
in
mind
any
future
implications
this
may
have

5.4
Legal
aspects
of
social
media
use

Physician
posting
of
inappropriate
material
may
lead
to
legal
sanctions,
threatening
the

credibility
of
the
physician
and
medical
profession.
To
prevent
inappropriate
use
of
social
media,

professionals
and
institutions
must
be
proactive
in
developing
standards
on
“online

professionalism”.
[53]However,
it
should
be
noted
that
the
monitoring
of
physicians’
online

activities
by
institutions
can
slip
into
legal
grey
areas
regarding
the
right
of
privacy
and
the
duty

to
care.
[69]

A
difference
may
exist
in
perception
between
physicians
and
the
public
regarding
what
is

appropriate
to
share
on
social
media
in
contrast
to
what
may
be
appropriate
in
medical

literature.

Information
that
might
not
contravene
medical
professionalism
may
be

misinterpreted
or
distorted,
and
thus
may
potentially
have
legal
implications.
Therefore,

alongside
ethical
and
professional
dictates,
physicians
must
consider
possible
legal
ramifications

related
to
their
interactions
in
social
media
environments.
[53]

While
physicians
are
entitled
to
freedom
of
speech,
legal
considerations
arise
from
limitations

imposed
by
professional
codes
of
conduct.
These
commonly
suggest
physicians
should
not

disclose
information
that
could
cause
disturbance
or
“substantial
interference”
with
a
health-‐
care
institution’s
operation
or
in
a
patient’s
life.

Further,
there
should
not
be
any
use
of
“vulgar,

defamatory,
and
plainly
offensive
medical-‐related
speech.”
[69]
Guidelines
from
National

Medical
Associations
on
Social
Media
may
be
a
helpful
resource.
[5-‐7]
For
example,
before

posting
about
an
institution
on
a
social
media
platform,
professionals
should
first
obtain
the

institution’s
consent.
Physicians
should
also
consider
the
permanence
of
digital
content

transmitted
online.
Other
limitations
apply
to:

1. Any
abusive,
personal,
malicious
or
off-‐topic
comments,
as
well
as
redundancy;

2. Hate
speech,
especially
discriminatory
comments
based
on
race,
ethnicity
or

gender;

3. Attempts
to
promote
or
endorse
products,
private
events
or
groups,
including

endorsements
of
pharmaceutical
companies;

4. Comments
that
are
likely
to
violate
the
confidentiality
or
privacy
of
patients
and

their
families;
and

5. Comments
that
are
likely
to
infringe
on
the
rights
of
any
third
party.

20
6.0
Ethical
Issues

As
patients
and
physicians
use
social
media,
there
are
social,
cultural,
or
individual
factors

related
to
such
use.
Examples
include
different
abilities
to
access
the
internet
between
groups

of
patients,
as
well
as
differences
in
the
comfort
level
of
patients
and
physicians
in
engaging
in
a

social
media
environment.
Like
access
to
electronic
health
records,
we
must
consider
potential

“health-‐care
gaps”
in
the
access
and
use
of
social
media,
such
as
poor
access
among
non-‐native

speakers
of
a
national
language,
or
patients
from
lower
socioeconomic
status.
[70]

Notably,
while
social
media
has
demonstrated
decreased
feelings
of
isolation
and
social

exclusion,
the
opposite
also
occurs:
concepts
such
as
“status
anxiety”,
related
to
anxiety
or

depression
related
to
social
media
information
shared
by
friends
or
colleagues,
have
indeed

been
described.
[71]
Further
research
is
needed
to
better
understand
both
how
this
influences

physician–patient
social
media
interactions,
as
well
as
the
potentially
maladaptive
behaviours

patients
may
develop.
Also,
as
stated
earlier,
physician
well-‐being
depends
on
better

understanding
the
additional
burden
of
maintaining
professional
appearances
in
their
online

presence
and
interactions.

There
is
a
demonstrated
ease
and
benefit
of
using
data
from
social
media
for
research,
public

health,
and
geographic
targeting
of
health
care
delivery.
Such
“secondary
data
usage”
presents

further
ethical
considerations,
and
despite
the
relative
ease
by
which
such
data
can
be
obtained,

physicians
are
still
bound
to
protect
patient
privacy
and
confidentiality.
Any
use
of
such
data
is

therefore
subject
to
standard
research
ethics
and
must
ensure
that
mechanisms
exist
to
provide

informed
consent
and
to
protect
patient
privacy
through
data
deidentification.
[72]

Beyond
our
focus
on
physician
and
public
health
use
on
social
media,
there
is
also
“patient-‐
generated
problematic
content”.
In
particular,
Boyd
and
co-‐authors
(2011)
explored
the
aspects

of
the
social
media
affecting
the
youth
population,
particularly
social
media
disclosures
of

mental
health
disorders
(e.g.
self-‐harm
and
eating
disorders).
Social
media
may
represent
a

source
of
support
and
encouragement
for
these
patients.
However,
there
is
the
potential
that

such
interactions
may
encourage
participation
in
negative
practices.
Currently,
there
is
no
easy

“legal,
technical,
or
social
solution”
and
further
research
will
be
required.
[73]
Thankfully,
the

relative
ease
of
access
to
such
information
through
social
media
will
assist
research
efforts.
The

article
succinctly
states:

“…while
the
Internet
does
not
provide
a
magic
bullet,
it
does
introduce

new
possibilities
for
leveraging
visibility
to
learn
from
and
reach
out
to

those
engaged
in
self-‐harm…”

It
is
apparent
that
many
of
the
ethical
considerations
in
the
use
of
social
media
reflect
those

standards
and
codes
set
out
by
physicians,
researchers,
and
societal
ethical
codes.
It
is
the
ease

and
simplicity
by
which
information
moves
that
challenges
tradition.
It
is
important
for

policymakers
and
stakeholders
involved
to
work
together
to
address
and
develop
ethical

standards
for
social
media
usage.
Emerging
standards
will
ensure
that
the
benefits
of
social

media
can
be
realized
by
patients,
researchers,
health
professionals,
and
public
health
officials,

without
succumbing
to
the
potential
ethical
pitfalls
of
social
media
usage.

21

22
Conclusion

This
white
paper
has
sought
to
provide
a
broad
overview
and
analysis
of
social
media
in
how
it

relates
to
patients,
the
medical
profession
and
health
care
overall.
The
potential
opportunities

presented
by
social
media
in
improving
health
care
must
be
weighed
carefully
against
the

significant
drawbacks
of
its
use.
Any
benefits
to
patients
will
only
be
realized
if
implementation

and
evaluation
is
carried
out
with
the
same
caution,
ingenuity,
and
scientific
rigor
dictated
by

our
professional
calling
and
responsibilities.
Physicians
are
called
to
be
proactive
in
shaping
the

social
media
environment
and
remain
vigilant
in
ensuring
that
the
use
of
such
technology

ultimately
benefits
the
patients
we
serve.

23
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