On Twitter, 10,000 people are listening to Jen Gunter. Sexual health, shoes and ?The Hunger Games? are the subjects of just a few of the 36,500 tweets crafted by the obstetrician-gynecologist at Kaiser Permanente in San Francisco.
Gunter?s social-media presence also includes a blog, which she uses to write about birth control and weight loss; a professional Facebook page; another Facebook account for friends; Instagram; and Tumblr.
Gunter has plenty to say and plenty of ways to say it, but when patients she?s never met ask for medical advice online, she has just one thing to say: ?No.?
?You can?t have any kind of dialogue that way,? said Gunter, who is also director of pelvic pain and vulvovaginal disorders for Kaiser in San Francisco. ?You don?t know what you?re getting into.?
Gunter is firm on this policy, but the lines appear less clear for the increasing number of doctors who are talking to their patients about medical concerns on social networks. Physicians are adding patients as friends on Facebook and discussing their private health issues in the open. And while getting a wall post on Facebook from your doctor may seem innocuous, such acts can lead to awkward situations, privacy violations or wrong information, say experts.
?A lot of stuff is people sharing too much information that should either be left confidential, or in some cases information that shouldn?t be shared because it?s not true,? said Ryan Greysen, assistant clinical professor of medicine at UCSF.
Improper behavior
In a recent study of 48 state medical boards, which license and discipline doctors, Greysen found that 44 of them have received reports of violations of online professionalism. Violations included improper contact with patients, inappropriately giving diagnoses and misrepresentation of one?s credentials.
Disciplinary measures have ranged from limiting or suspending physicians? licenses to revoking them, the UCSF study found.
In one instance, a physician asked one of his patients for a date through an online dating website.
Another physician, on his blog, called a patient ?lazy? and ?ignorant? because she had made several visits to the emergency room after failing to monitor her sugar levels. In yet another case, a medical student filmed a doctor inserting a chest tube into a patient, whose face was clearly visible, and posted the footage on YouTube.
The federal Health Insurance Portability and Accountability Act sets boundaries on the ways health care providers use and disclose information that identifies patients. That includes a patient?s health condition, birth date and even the existence of enrollment with a provider.
In California, a pair of laws since 2009 has authorized the state to investigate and fine medical facilities for health information privacy breaches. Those laws resulted from a string of widely publicized security violations at UCLA, where employees looked at celebrities? medical records.
So far, the state Department of Public Health has issued 18 fines worth $2.2 million to medical facilities. The agency received reports of about 2,500 violations last year. The department does not separately track online violations.
?Lapse in judgment?
Nearly 90 percent of physicians use a social-media website for personal use, and 67 percent use it professionally, according to a survey of 4,000 physicians by QuantiaMD, an online forum for doctors.
?My hunch is that in the majority of cases, people had a lapse in judgment about something, but because it?s online, the reach of these online behaviors is so much greater,? said Greysen, who maintains a professional Facebook page and tweets about social media and medicine. ?The impact can be a lot broader and faster because of the speed at which information travels.?
Health care providers need to be especially aware of the risk as they turn to keeping patients? records on electronic databases, said Anthony Wright, executive director of Health Access California, a patient advocacy group.
?We are entering into a world where we need to have a balance between a legitimate desire for seamlessness and sharing of information and data collection,? he said, ?with strong privacy guarantees and guidelines.?
Guiding principles
This spring, the Federation of State Medical Boards, which oversees the groups that license doctors, established guidelines for physicians? use of social-networking sites. The group recommends that doctors interact with patients online only when discussing medical treatment in a professional context, and avoid doing so on personal social-media sites. In fact, doctors are encouraged to set up separate professional and private accounts.
In addition, the group said, physicians may write online about their experiences as health professionals, but should also reveal their conflicts of interest and credentials.
For doctors who want to chat about work online, they may find an outlet in Doximity, a new social-networking site in San Mateo.
Begun in spring 2011, the site is a confidential forum that allows verified physicians to discuss research and talk about medical cases, which the law permits as long as the conversation is confined to health professionals. So far, Doximity has drawn more than 567,000 physicians from 87 specialties nationwide.
?We think there?s a need for someone to be the hospital, the place where doctors and health care professionals can have their discussions,? said Jeff Tangney, Doximity?s chief executive officer. ?Unfortunately, that can?t be LinkedIn and Facebook for patient privacy reasons.?
That said, more discussions lead to more problems solved, Tangney said. ?We see cases solved all the time on the network,? he said.
Online legitimacy
Other forms of electronic communication between physicians and patients have emerged from the health care industry. In 2004, Kaiser Permanente started HealthConnect, a secure electronic database that lets patients view their health records and e-mail questions to doctors.
Those patients include Susan Benz, 53, an educational administrator in Oakland, and her husband and daughter, all of whom frequently use the system.
Before HealthConnect, Benz said, ?It was a lot of phone tag. I?ve always been a busy working mom, and with kids? appointments and family appointments, it was frustrating.?
Now, Benz said, she e-mails her doctor with questions about everything from menopause to dry skin and within a day receives advice or is told to make an appointment. Benz has cut her annual face-to-face visits from 10 to three.
Around 80,000 Kaiser members send their doctors 850,000 e-mails through HealthConnect each month, according to the company. Patients are not billed extra for the service because the time doctors spend answering questions is built into their daily schedules, said Joe Fragola, a Kaiser spokesman.
Benz has Facebook, but says she would never use it to pose a health problem to her physician. She doesn?t need to.
?To go from the old world of pen and paper and phone calls and getting appointments to being able to do it all on e-mail and through smart phone,? she said, ?it?s been fabulous.?
Article source: http://www.sfgate.com/health/article/Social-media-in-health-care-create-risks-benefits-3650284.php
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