Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
Social media can be a powerful tool for patient education and advocacy, but it can also lead to risky behavior and damage a professional reputation. New guidance from the American Academy of Pediatrics offers insight on how to ethically use it.
Social media platforms have become an increasingly popular tool for information and communication during the coronavirus disease 2019 (COVID-19) pandemic. As parents were forced to keep their children home from school and avoid appointments of all kinds, social media became a lifeline for some to get advice and ideas to keep their children healthy and enriched at home.
The use of social media in the clinical environment poses unique problems, though, particularly when it comes to professionalism and ethical issues. New guidance from the American Academy of Pediatrics (AAP) aims to help pediatricians harness the benefits of social media use and avoid risky behaviors.1
“Pediatricians need to recognize that social media can be an incredibly useful communication tool with their patients and families but there a number of potential professional, ethical, and legal pitfalls to avoid as well,” says Jonathan Fanaroff, MD, JD, a neonatologist, professor of pediatrics and director of the Rainbow Center for Pediatric Ethics at University Hospitals Rainbow Babies and Children’s Hospital and Case Western Reserve University in Cleveland, Ohio. “During the COVID pandemic when there was so much confusion and rapidly changing information social media was a very important to keep patients and families up to date.”
Fanaroff was one of the authors of the new guide, along with Robert Macauley, MD, FAAP, FAAHPM, a pediatrics professor and practitioner at Oregon Health & Science University in Portland.
“Social media offers many opportunities for pediatricians to promote the health of individuals and populations, and also experience greater fulfillment and a stronger sense of community. At the same time, there are also risks involved in terms of boundaries and professionalism,” Maccauley adds. “A thoughtful approach is necessary to take advantage of the opportunities while avoiding the pitfalls.”
In a new clinical report published in Pediatrics, a number of recommendations are made to help pediatricians navigate the ethical and legal risks involved when it comes to using digital communication tools like social media networking sites. Social media can offer pediatricians a powerful tool for communicating important health information, advocacy, and education—as well as correcting misinformation spread by non-clinicians.
“The pandemic has definitely accelerated the implementation of ‘virtual visits.’ This doesn’t fall in the category of social media, but the shift away from in-person interactions has probably increased patients’ and parents’ expectations on being able to access information and guidance remotely,” Macauley says. “Questions about preventing COVID-19 transmission and—more recently—vaccine safety and availability are particularly important for pediatricians to address, given the prevalence of misinformation on the Internet.”
According to the report, more and more people are turning to the Internet for the bulk of their communication. A favorite digital tool for many age groups is social media, with 72% of Americans—including 90% of teenagers—engaged on some social media platform. As people increasingly use social media in their personal lives, the desire to use it to communicate with their health care providers has grown, too. According to the AAP, 54% of millennials and 42% of adults would like to connect with or follow their health care providers on social media channels. Even people who don’t use social media already would be willing to sign on to improve communication with their health care providers. This trend is only expected to grow as today’s children—dubbed digital natives due to their comfort in using digital communication—grow into adult patients.
The range of comfort in using social media varies among pediatricians, though, and reports of violations or complaints of unprofessionalism online have only increased hesitation to engage with patients online.
The question then becomes how can pediatricians navigate the pitfalls of social media without losing an important tool in education and advocacy? There are many loud voices on the Internet when it comes to issues affecting children, and pediatricians have to be a part of that discussion.
Some of the many benefits of a pediatric presence on social media include:
Still, the drawbacks that can come with social media use at a professional level can outweigh the benefits for some.
It can be very easy to cross the line of professionalism on social media, especially when some level of anonymity is falsely assumed. Even simple comments or photos can cause problems when taken out of context, or providing too self-disclosure about the pediatricians own political or personal habits.
“In terms of sharing important information, the most important things to avoid are inappropriate disclosure and failure to identify conflicts of interest,” Macauley explains. “Focusing on providing accurate health information—while separating one’s personal online presence from the professional—will address the first. In terms of the second, it is important to disclose any potential conflicts of interest, such as consultant fees or any other financial incentives, if promoting a relevant product or service.”
These risks aren’t only limited to what pediatricians themselves post, but also posts that they may be tagged in by others unknowingly. Too much self-disclosure or blurred boundaries can damage a professional reputation, compromise patient confidentiality, or create a conflict of interest.
“The clinical report recommends a number of ways to provide information in an ethical manner, including having separate personal and professional social media accounts, following state and federal privacy and confidentiality laws, and 'pausing before posting', meaning considering the impact of any particular post,” Fanaroff says.
Fanaroff explains the problematic nature of the Internet, and that postings can be forever. Any posting can be saved or a screen shot taken, meaning that it can be shared or reposted even after it has been deleted.
It’s important to draw a clear line between professional and personal beliefs, as well as boundaries with patients when it comes to privacy and relationships, adds Macauley.
“It is important to separate one’s personal from professional profile, to avoid inappropriate self-disclosure. Offering patient-specific health advice raises concerns both for Health Insurance Portability and Accountability Act (HIPAA) compliance, as well as potentially inadvertently entering into a physician-patient relationship,” Macauley warns. “Caution needs to be used in responding to ‘friend’ requests from current patients, which the AAP discourages. This also applies to parents of patients, if that is the sole basis of that person’s relationship with the pediatrician. Although not technically ‘social media,’ so-called ‘patient-targeted googling’ or seeking information about a patient without that patient’s knowledge is problematic, as such information may be unreliable and raises questions about how or whether to reveal knowledge of that information to the patient.”
Some recommendations for pediatricians who want to engage in social media professionally, but who also want to minimize their risk include:
1. Macauley R, Elster N, Fanaroff JM, Committee on Bioethics, Committee on Medical Liability and Risk Management. Ethical considerations in pediatricians’ use of social media.Pediatrics. 2021;147(3):e2020049685. doi:10.1542/peds.2020-049685