Article written by Drs. Carolyn Carman and Douglas Totten, Ethics and Values Committee
The use of social networking sites (SNS) and Internet-based capabilities (IBC) are increasingly utilized in both the business place and the private sector as patients and practitioners become more comfortable with Internet technology and tools. The ability to readily share information and quickly reach large numbers of people presents both advantages and challenges. James E. Paramore, O.D., former chair of the AOA Ethics and Values Committee states, "Optometrists need to be aware of how to uphold the same professional and ethical standards in their social media participation as they do in the rest of their practice. Failing to do so could hurt patients and possibly harm optometric careers."
Social media can be described as interactive platforms that enable individuals to share user-generated content. Social media can be presented in several formats including Internet forums, micro blogs, podcasts, wikis and other bookmarking applications. Sites such as Facebook and Twitter are among the most commonly used network websites.
To help preserve the doctor-patient relationship, maintain patient privacy, and ensure security of information, the following guidelines are recommended for optometrists who use SNS and IBC in their personal and professional lives.
1. Optometrists are discouraged from interacting with current or past patients on personal SNS such as Facebook and Twitter. As stated in the AOA Standards of Professional Conduct adopted in 2011, "Optometrists should avoid intimate relationships with patients as such relationships could compromise professional judgment or exploit the confidence and trust placed in the optometrist by the patient."
2. If doctors have online interactions with patients for the purpose of discussing medical treatment, these interactions should only occur when identity can be verified. All medical and/or personal identifiable information should be sent in an encrypted or secure manner.
3. SNS and IBC can be used as valuable tools for optometrists to gather online, share their experiences, and discuss topics in eye care and medical treatments. These types of professional interactions with colleagues provide a beneficial means for peer-to-peer education and discussion. It is the responsibility of the optometrist to try to ensure that professional networks they use are secure and accessible to registered users only. These websites should be password protected to safeguard against the general public from having access and considering the discussion as medical advice. Optometrists should also confirm that any medical information obtained from a professional online discussion is supported by current medical research before incorporating into a patient care regimen.
4. Patient confidentiality and privacy should be protected at all times, especially on SNS and IBC media. These sites have the potential to be viewed by the public and any breaches in confidentiality could be harmful to the patient as well as in violation of federal privacy laws, such as HIPAA. While optometrists may discuss their experiences, they should never provide any information such as names, code names, or pictures that could be used to identify a patient.
5. At times, optometrists may write online about their experiences as a health professional, or they may post comments on a website as a physician. When doing so, optometrists must reveal any existing conflicts of interest. They should also disclose their professional credentials.
6. Optometrists should be aware that any information posted on a SNS or IBC may be circulated, possibly unintended, to another audience, may be taken out of context, or may continue to be accessed online in perpetuity. They should consider they are representing the optometric community when posting online. Optometrists should always act professionally and take caution not to avoid posting statements that could be misinterpreted easily or are unclear.
7. Optometrists who allow employee Internet access should have a written policy about SNS and IBC use. Office policies should promote education, training and awareness for responsible use of social media and Internet use. Employees should be informed about any employer intention to edit, modify, delete, or review Internet communications. This should be tied into office HIPPA policies and training for employees.
8. It is recommended that optometrists use separate personal and professional SNS addresses. Although SNS security setting may be set to limit users' access, it may be beneficial to utilize different personal and professional accounts to ensure better separation. Also, optometrists should use a personal email address rather than a professional e-mail address for logging on to SNS for personal use. Users who view a professional e-mail address attached to a personal online profile may misinterpret the doctor's actions as representing the medical profession or a particular institution.
9. Doctors and staff should adhere to the same principles of professionalism online as they would offline. Harassment of any type, negative comments about competitors or former staff members, or any other unprofessional conduct should not be expressed.
In summary, optometrists who use SNS and IBC should limit personal interaction with patients, maintain professional doctor-patient boundaries, and comply with patient privacy and confidentiality standards. Employees should be well informed about office policies on SNS and IBC use, as well as HIPPA regulations. "Optometrists have acknowledged that professional standards guide the traditional optometrist-patient relationship in face-to-face interactions. The online relationship is no different," said Morris S. Berman, O.D., MS, chair of the AOA Ethics and Values Committee and vice president and dean of Academic Affairs at the Southern California College of Optometry. Optometrists should follow the AOA Standards of Professional Conduct and should apply them with any type of communication or media used.
Social Media Do's and Don'ts:
Should I accept Facebook friend requests from patients?
Not recommended. A better idea may be to use your office website to share general or eye health information, give directions, and promote your practice. If you choose to use Facebook for business purposes, consider creating a separate account for your personal profile to use with selected friends, family and colleagues only. It is not recommended to accept "friend requests" from patients on your personal Facebook page.
Should I respond to personal medical questions on Facebook or Twitter?
Not recommended. Those with online medical questions should be directed to contact their primary care providers. Ocular health care questions from your patients should be handled through an office visit, phone consultation, or encrypted e-mail exchange.
Should I post any information about my patients?
Never. This would constitute illegal and unethical practice.