Welcome to the Ethics Forum! The optometric profession has long recognized its ethical responsibilities to patients, colleagues, other health care professionals and the public. This forum provides an opportunity to review a hypothetical case study containing potential ethical challenges and includes suggestions on how one might handle the situation based upon the American Optometric Association Standards of Professional Conduct and Code of Ethics.

Feedback
If you have any questions on ethics, please submit them to EthicsQuestion@aoa.org. The AOA Ethics and Values Committee will respond to your questions as soon as possible. If you have an ethical challenge you wish to share, please feel free to submit a case description to ethics@aoa.org. The case description will be reviewed by the AOA Ethics and Values Committee and may be featured in a future Ethics Forum.

Social Networking

By Adrienne Ari, O.D.

Case Study #6

You have a moderately robust practice in a suburban area. You want to continue to grow your practice and decide to update your practice's webpage and venture into social media by creating a Facebook presence. You actively manage your webpage and it has all of the typical practice information such as your location, services offered, and staff biographies. Your new Facebook page for your practice takes off! You get hundreds of "likes" and now some of your patients even send you "friend requests". Your patients also post clinical questions on your page. You'd like to answer their questions but are concerned that you will be sharing confidential patient information. Also you don't necessarily want to accept these requests, but you don't want to appear to snub your patients. What do you do?

Discussion:

Social media sites such as Facebook, Twitter, and YouTube are online applications that foster social interactions and collaboration. Health professionals have begun using social media to benefit patients, enhance professional networks, and advance understanding of individual and contextual factors influencing public health.1 In contrast to standard forms of engagement and education, social media has advantages to include profound reach, immediate availability, and archived presence and broad accessibility.2 As of 2010, the world spends over 110 billion minutes per day on social networks and blogging sites, translating into 22 percent of all time spent online.2 In 2012, Facebook surpassed a billion users worldwide, or nearly 1/7th of humanity.1 Clinicians can certainly use this to their advantage, providing information on common diseases and disorders. By participating in social media, clinicians can communicate with their patients in a format that patients can relate to and understand, potentially improving the doctor/patient communication. However, caution needs to be taken not to reveal any personally identifiable information or HIPAA protected health information (PHI). Additionally, 61 percent of patients are now seeking both support and medical information on line and looking for health care information is now the third most popular online activity, after internet search and email. 2

According to the AOA's Code of Ethics, optometrists should ensure confidentiality and privacy of patients' protected health and other personal information.3 But is engaging with patients online acceptable? Additionally in the AOA's Standards of Professional Conduct of "Confidentiality," optometrists and their staff should hold in confidence all protected health and other personal information, an essential element of the doctor-patient relationship that is necessary to build and maintain trust.4

In the above scenario, you must consider the following before coming to a conclusion:

Privacy/Confidentiality

If doctors have online interactions with patients for the purpose of discussing medical treatment, these interactions should only occur when identity can be verified.5 Clinicians must be aware that social networking 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 state and federal privacy laws, such as HIPAA.5

Friendship versus doctor/patient relationship

What happens if you cross professional boundaries by "friending" a patient? Optometrists should follow the AOA Standards of Professional Conduct and should apply them with any type of communication or media used. 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."4 A potential solution may be establishing separate business and personal Facebook accounts.

Reputation

What content can you post? Optometrists should be aware that any information posted on a social networking site may be circulated, possibly unintended, to another audience, may be taken out of context, or may continue to be accessed online in perpetuity.5 Optometrists should always act professionally.

Whatever course of action is taken, it is important for the optometrist to seriously weigh all of the options available. Social media can be an asset to the clinician if used appropriately.

References:

1. George DR, Rovniak LS, Kraschnewski JL. Dangers and opportunities for social media in medicine, Clin Obstet Gynecol. 2013 Sep; 56(3):

2. Medicine, morality, and health care social media, BMC Medicine 2012; 10:83, [cited 2016 Jan 25]. Available from URL: http://bmcmedicine.biomedcentral.com/articles/10.1186/1741- 7015-10-83

3. AOA Code of Ethics, www.aoa.org, About the AOA, Ethics and Values

4. AOA Standards of Professional Conduct, www.aoa.org, About the AOA, Ethics and Values

5. AOA Social Media Recommendations, www.aoa.org, About the AOA, Ethics and Values