Physicians on Social Media: Be Careful What You Wish For

It only takes one click. 

Your dopamine-thirsty mind projects into the future, thinking about how many likes will get generated, how many colleagues will think you’re fantastic. No amount of consequence, no matter how severe, can stop you now. And at this point, with your witty message articulated to perfection, complete with hashtags and a fun gif, your post is already stimulating your reward pathway; your poor, forgotten prefrontal cortex, the voice of reason, has been silenced. 

Too many times, a singular message, tweet, photo, or comment has brought heavy repercussions on its author. To make matters more difficult, the message from the poster can be seemingly innocuous. It only takes one person, over-sensitive or not, to get offended or find something “disrespectful,” and the author has a scar, a non-healing suppurative scar that can mar their reputation forever. 

And no one is immune: journalists, politicians, teachers, and police officers — people from all walks of life have had their careers ruined by one false social media move. A Google search for “careers ruined by social media” renders not just single examples, but multiple lists of the self-afflicted.

It seems like the solution is simple. Don’t publish anything that might be misconstrued as offensive by anyone. But, we see these missteps happen time and time again. 

Your Duty to Protect Patient Privacy

Irrespective of our own reputations, patients’ rights and safety stand above all else. As a health care provider, you are mandated by federal law to protect patients’ health information. HIPAA violations are common on social media. Even without identifiers, it is not permissible to share photos of patients without patient consent. A more subtle violation: the computer screen with patient names, or charts and files that you didn’t notice, in the background of the photograph. 

Just a few years ago, a Texas nurse was fired for posting a comment about a patient with a rare disease. While she didn’t use any patient identifiers, mentioning the disease, a general patient demographic (i.e., “young boy”), along with having her employer listed on her profile, gave enough information about the patient that he might have been able to be identified.

More egregious offenses can result in criminal charges. A Wisconsin nursing assistant was charged with a felony after she took and shared a video of her nearly-nude elderly patient with Alzheimer’s disease, claiming she wanted to show a supervisor how the patient was uncooperative with getting dressed.

Trouble Even Without Identifying a Patient

In 2014, when there were roughly one billion less users of social media worldwide, a New York City nurse was fired after posting a picture of an empty trauma bay after a patient resuscitation. There was nothing to identify any patient, nobody in the photo at all; simply a dirty trauma bay that was yet to be cleaned. And this photo led to her termination, as hospital administrators deemed it insensitive.

Remember, you only need offend one person, regardless of your intention, to be at risk for extreme ramifications. She was trying to capture the stresses and hard work of a well-functioning trauma team, and instead, was forced to find a new job, carrying a recent administrative termination in her history.

At-Risk Youth

In the words of Crosby, Stills, and Nash, “Teach your children well.” Teenagers are starving for social acceptance by their peers, are particularly vulnerable when it comes to writing something on the internet that they will grow to regret. And the medical community is certainly not immune, as evidenced by a recent Cleveland Clinic resident who had a history of repeated racist attacks before her entrance into the realm of medicine.

With great power, the power to say something that the entirety of the world can hear, comes great responsibility. And as smartphones and social media find themselves in children’s hands at younger and younger ages, the filter between thought and message-to-the-world grows thinner. 

Don’t Put It in Writing

Suppose you have the most brilliant and witty thing to say, and sharing it with others will elevate your social status immeasurably, but you’re not sure if it’s 100 percent acceptable. If you absolutely must, share it in real life and avoid potentially everlasting internet infamy. If you aren’t completely sure if it’ll fly, then someone out there can certainly find issue with it.

It sounds obvious, but I hope this painfully simplistic piece of advice saves someone out there from making a grave mistake. If you have any reservation about sharing something online, even in a small (and believed to be protected) group, just don’t do it. Impress those around you with your clinical acumen, your fund of knowledge, and your enjoyable company — not with an off-color message.

Brian Radvansky, MD is an Anesthesiology and Critical Care resident and blogs at Med School Tutors. He is also a 2018–2019 Doximity Author.

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