Uncomfortable social media situations doctors should avoid

The situation could have been handled better, to say the least, when an attending noticed a striking case of genital warts while performing a pap smear. As recounted by Kristen Fuller, MD, the attending photographed the warts and posted the image on social media—without the patient’s knowledge.

The attending doctor’s intentions were good, the Family Medicine physician and Real Talk author explained. They wanted to present and discuss the case from a medical point of view. The execution, however, couldn’t have been worse.

The end result was a lesson that all healthcare professionals (HCPs) may learn from about the do’s and don’ts of social media.

A teachable moment

The attending had broken one of the cardinal rules of medical social media: Always ask the patient’s permission before sharing. In this case, the patient was furious when she found out her privacy had been violated.

“My attending was mortified and did not mean any harm by it, and discussed it with our residency program so we did not make the same mistake,” Fuller said.

The attending deleted the post from the site and photo from her phone, apologized to the patient, and described her error for the benefit of the entire residency program.

Now it also stands to benefit any HCP reading this article, too. Fuller said the attending’s error imparted several important lessons:

• Communicate. This goes beyond asking permission to take a photo, Fuller said. Ask and explain why you’re taking it. Then if the patient says no, respect their wishes.

• Maintain privacy. Show only the minimum amount of information necessary in the photograph. For example, a photo documenting a rash on someone’s face should only show the rash, not their face in an identifiable manner. Also withhold the patient’s name, date of birth, or any other identifying information.

• Get it in writing. Employed physicians should consult with their legal or marketing departments, which may have forms for this purpose. Patient consent should be given explicitly for sharing on social media for medical purposes, and it should be agreed that all identifying factors will be withheld. You may want to work with an attorney to draft a legal document.

Official guidance

The AMA also offers official guidance for medical social media in its Code of Medical Ethics.^[] In addition to a strict adherence to patient privacy, the AMA also suggests:

• Maintaining your own privacy. Use the privacy settings offered by each platform to your advantage, but know that they aren’t foolproof and that anything you post is likely permanent. Routinely audit what you’ve posted and what others have posted about you.

• Maintaining boundaries. If you engage with patients on social media platforms, all of the standard protocols of the provider-patient relationship still apply. Maintain the same ethics that you would in person. You may want to take the extra step of creating separate personal and professional accounts.

• Maintaining standards. According to the AMA, physicians have a responsibility to flag inappropriate posts by other doctors, giving colleagues the opportunity to delete or modify them. Egregious posts that go uncorrected should be reported to appropriate channels.

• Maintaining relationships. Social posts have the power to damage provider-patient relationships and partnerships with colleagues. They can also cause reputational damage for the entire profession.

In the case of Fuller’s colleague, familiarity with this guidance might have helped them avoid an unpleasant situation. The error also contains a few big-picture takeaways about medical social media use.

Taking the good with the bad

According to Fuller, social media is a powerful tool that physicians must wield responsibly. Spend some time viewing some of the excellent medical accounts on platforms like Instagram and TikTok and you’ll find HCPs who are bringing transparency to the challenges of working in healthcare, and sharing hard-earned medical pearls, or working to eliminate the stigmas surrounding mental health and addiction.

Some have even used social media to add medical context to current events, such as the ongoing COVID-19 pandemic or the overturning of Roe v. Wade. But social media still casts a long shadow—even in medicine.

“Unfortunately, some physicians are still shaming things such as body image, addiction, mental health, [while] supporting diet culture [the belief that physical appearance is more important than health],” Fuller said.

Perhaps the most egregious example of the former was the publication in 2020 of a now-retracted Journal of Vascular Surgery study.^[]

Researchers then weighed how “unprofessional or potentially unprofessional” the content was. Sixty-one unwitting study participants found themselves in this category because photos showed them drinking alcohol, wearing Halloween costumes, or wearing bikinis.

This sparked a viral social media backlash, #MedBikini, in which female physicians shared photos of themselves wearing bikinis to highlight gender discrimination. 

Separating work and private life

For better or worse, social media straddles the border between work life and private life.

She suggested keeping anything off social media that you wouldn’t want your supervisor to know about. This includes your opinions of others—especially colleagues and superiors—or your perceptions about your job itself.

Ultimately, using social media is an exercise in controlling perception, Fuller said. 

"Avoid talking about your alcohol or drug use, or anything that could potentially jeopardize your career or how your patients view you as their physician," she concluded.