Introduction
The unprecedented development and adoption of social networks raise a series of questions concerning ethical behavior and responsibility of social media users. Social media, web and mobile technologies are being utilized in the healthcare sector to support patient-centered care. Patients benefit from self-management tools, maintaining regular contact with health care providers, and close monitoring. Researchers in health care also take advantage of social media to easily recruit participants for health-related studies. The purpose of this research paper is to summarize the ethical issues to consider when using social media in a healthcare setting.
Ethical Issues
Before exploring the ethical issues associated with social media; it is essential to define the key terms. According to Taylor et al. (2014), social media is a series of online applications developed on web 2.0 technology to allow the creation and exchange of information. Social media covers a wide range of communication channels, but most of them are internet-based. Social media enables the user to create a profile and share personal information. Social media has become the primary form of communication in the modern society such that it has been adopted in the healthcare system.
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The discipline of ethics deals with what is right and wrong. Professional ethics determine the rules, regulations and practices to guide interactions with clients. Medical ethics is concerned with the relationship between patient and physician, and the relationship should be guided by the ethics of autonomy, justice, beneficence, and non-maleficence.
As social media took over, many individuals in the healthcare sector also signed up for social media. Some individuals do not know how to differentiate between appropriate content to post on social media or not. George et al. (2013) give extreme cases of medical students/ professionals who have crossed ethical boundaries on social media, for example, a nursing student was expelled for posting pictures of a human placenta on Facebook. Some medical professionals take pictures of their patients without their consent for social media, and this proves that social media can be hazardous for health professions. Parsi & Elster (2015) also give the example of the infamous Yoder case where a student inappropriately blogged about a patient given details that could be used to identify the patient. Another salacious news headline on social media use was, “US ‘Penis Photo Doctor’ Loses Job.” The BBC News headline was about a doctor who took pictures of his patients’ private parts. History has shown that health professionals can cross ethical boundaries when using social media.
Health professionals are starting to adopt social media into their activities. Ventola (2014) gives an example of medical social media sites such as Semo and Doximity. Sermo is a “physician-only” social network where physicians discuss treatment options and seek expert advice. Similar social sites such as Doximity and Medical Directors Forum bring physicians together. Physicians also use social media for patient care. For example, Georgia Health Sciences created WebView, a social media platform to enable patients to reach their doctors. Other physicians are using mainstream social media sites such as Facebook and Twitter to enhance patient communication. Social media is a new channel of communication, and there are bound to be ethical challenges concerning patient privacy and trust. Aside from improving communication, social media enhances professional development. Medical institutions use social media for training workshops on essential skills such as communication, medical humanities, and ethics (Daniel et al., 2013). There are groups on social media dedicated to professional development and keeping up with trends in medicine. Social media can also strengthen mentor-mentee relationships by enabling professionals to connect with each other on a simple platform.
Chretien & Kind (2013) explore the risks of using social media in healthcare. The first risk is poor information quality. Patients tap into various “health subcultures” on social media including weight loss communities and communities for individuals suffering from different conditions. Patients with chronic diseases can take advantage of peer-to-peer health care and support from other patients and caregivers from social media. Patients have to be aware that information on social media and other online sources lack quality and reliability. Physicians and other health professionals who share information on social media share limited information. The medical information online is often unreferenced, incomplete or informal. Health information on social media emphasize on anecdotal reports and rely on individual patient’s stories that do not reflect on collective medical knowledge. Social media users can take health information seriously thinking that individuals sharing them on social media are qualified or that they are well aware of all the facts.
Parsi & Elster (2015) state that the most prominent ethical concern is about privacy and confidentiality. Privacy and confidentiality are two related terms; privacy is concerned with how an individual shares information about himself or herself. Alternatively, confidentiality focuses on the information shared by another person in a relationship of trust. In the healthcare setting, privacy is patient-controlled, whereas confidentiality is physician controlled. Physicians have the ethical obligation to maintain confidentiality to preserve patient trust. Without a commitment to confidentiality, patients will no longer share intimate information about their health. The Health Insurance Portability and Accountability Act (HIPAA) of 2003 states that physicians can only share patient information to facilitate treatment, payment, and healthcare operations. However, in the age of social media, physicians and other healthcare professionals are sharing patient information online, thus breaking their commitment to uphold confidentiality.
When patients use social media to consult with their physicians, there is a risk that their health information is not safe (George et al., 2013). A breach of privacy will cause more harm when it occurs online as information on social media can be accessed by millions of people. Physicians who communicate with their patients on social media should make patients aware of privacy risks, seek consent and put in place the right privacy protections to safeguard patient information. Physicians planning to communicate with patients directly must use closed and secure systems with data encryption. Physicians should also pay attention to external security threats. Facebook and Twitter are unsecured open sites, and security breaches are known to occur regularly on the sites.
Chretien & Kind (2013) also evaluate the ethical dilemma of the patient-physician social boundary. When physicians and patients interact on social media, there is a confusion on the boundaries and limits of the relationships. Social media is an informal channel of communication; patients and physicians can start investigating each other’s private lives on social media. A physician who uses sites such as Facebook or Twitter can view the patient profile and get to know more about the patient. Physicians who are not afraid to break boundaries can even reach out to their patients even when it does not concern their health issues. Von Muhlen & Ohno-Machado (2012) advises physicians to preserve professional boundaries online. The professional boundary is essential to the integrity of the patient-physician relationship. When the lines are broken, cases of problematic self-disclosures can occur. When physicians consult with their patients online, the sanctity of the patient-physician relationship is broken. The physicians will find themselves receiving friend requests from the patients, and it will be hard to maintain the professional relationship. Patients will be asking physicians about their health issues through social media, and physicians will have no choice but to respond because they are online friends.
Healthcare professionals also use social media as a forum for discussion and debates on medical matters. The freedom to voice opinion on the internet forum is not absolute, and health professionals should be guided by the need to prevent harm and damage to the reputation of others. Grobler & Dhai (2016) state that health professionals should exercise sound judgment when posting online and avoid unsubstantiated or negative comments about others. Grobler & Dhai (2016) explore the ethical issue of the public image of the profession. Professionalism is a social contract between practitioners and the society. Health professionals have the privilege of caring for patients, a privilege that comes with status and respect. The society expects physicians to be professional and empathetic. The intimate relationship between physicians and patients demands high ethical behavior from physicians. Society expects physicians to behave professionally, even in their daily activities outside of work. Poor judgment reflects poorly on the physician, the profession, and the healthcare organization. Physicians should be careful about what they post on social media as their online brands should uphold professionalism and good reputation.
George et al. (2013) emphasize the importance of maintaining ethics when using social media to minimize cases of liability, litigation, and compensation. Health professionals who break ethical boundaries on social media expose themselves and the health organization to lawsuits and liability. If a patient finds out that his/her information is shared online, the patient is likely to sue the physician and the healthcare facility. Cases of defamation and damage to reputation will also arise due to wrongful or derogatory posts. Contents that break privacy, attack a person’s moral character or expose someone to ridicule can result in legal action against the individual who made the comments and the organization. Health organizations have the responsibility to come up with policies to guide social media use. The policies should educate professionals on the dangers of social media, the kind of information to share online and how to uphold professionalism.
George et al. (2013) also discusses the widespread use of social media for clinical research as a benefit of social media. Millions of social media users share their information online on a daily basis. The information is relevant to public health as it is concerned with social norms, imitative behavior, and social reinforcement. An individual’s social network (friends) on social media can influence one’s health behaviors. Medical professionals should use social media to improve communication and outcomes. CDC uses social media to track information on flu outbreaks and other diseases that threaten public health. On a small scale level, health researchers use social media for their studies. Using social media to conduct medical and healthcare-related research has ethical implications. According to McKee (2013), social media is known for its anonymity and inability to trace sources, thus utilizing social media for medical research can lead to credibility issues. Social media participants are less likely to take the study seriously, and yet the researcher does not have a way of verifying the information provided.
Denecke et al. (2015) further explores the concept of privacy and patient confidentiality. Social media exposes a wide variety of information. Patients can be the ones sharing information, or the physicians can be the ones sharing information. Grajales et al. (2014) state that when physicians are sharing patient information; it is crucial to seek patient consent, even when they are not using patient details that can be used to identify a patient. A patient will feel betrayed if he/she is going through social media to find his/her physician sharing a narrative on patient experiences without seeking consent. Patients and physicians should also trust each other for them to communicate and share information through social media.
Conclusion
Social media has transformed communication, and it is in the process of transforming communication in healthcare. Physicians have adopted social media to connect with their peers, carry out research and to communicate with patients. Social media has the potential to improve healthcare through improved communication. Social media facilitates the patient-physician network, discussion and information sharing. While social media has transformed communication in health care, physicians must be aware of the ethical implications of social media use on professionalism and patient-doctor relationships. Physicians should abide by the ethical and professional commitments when interacting with patients on social media. Physicians should also put in the right measures to uphold privacy, confidentiality, and trust when communicating with patients through social media.
References
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