Social media has the capacity to engage our patients where they are-in social media platforms. Yet all too often we let risk averse behavior prevent our participation and engagement. This provides an apt overview of the moral obligation and benefits of meeting our patients where they are, engaging them in a professional fashion and an overview of the risks and profound benefits heralded by health care social media.

1. Health Care Social Media and
Professionalism
Farris Timimi, MD
Medical Director, Mayo Clinic Center for Social Media
June 2012

2. Agenda
• What is professionalism?
• Is part of being professional being online?
• Are online rules the same as offline rules?
• Know the risks-know how it to avoid them
• Key elements of professionalism in health care
social media

3. Subtext
• This is how people communicate
• All of your employees are already involved in
social media-and you can’t block them
• All of our patients are involved in social media
• Use of your human bandwidth can either be an
asset or a liability-the line crossed is defined by
orientation and training

4. What is professionalism?

5. Heart and Soul of Medical Care
• Professionalism means safe care
• Health care is delivered by teams who need to
communicate well, honestly, respectfully,
confidentiality and responsibly
• That team includes all of us in health care-including
patients and their families

6. Core Values
• Professional competence
• Honesty with patients
• Patient confidentiality
• Maintaining appropriate relations with patients
• Improving quality of care

7. Core Values
• Improving access to care
• Just distribution of finite resources
• Scientific knowledge
• Maintaining trust by managing conflicts of interest
• Professional responsibility

8. Is part of being professional being online?

9. How is being online part of professionalism?
• Unique moment in history-two overlapping trends
• Information overload at the same time as evolving
information transparency
• Less daily time for direct patient care at the same
time as more time spent by patients online

10. Information Overload
• PubMed-21 million citations, one new/min
• Over 200 Cardiology journals
• 335 cardiology guidelines
• More and more knowledge is being made available
online and in a transparent fashion

11. Who is the lived expert?

12. Where did our time go?

13. Time, the most precious commodity…
Direct Care-20%
Documentation-35%
Assessment/
Vitals-7%
Medication-17% Care Coordination-21%
JONA, 39, 6:266-275

14. Why we need to be online
• Is it any wonder that 61% of us have sought
knowledge and support online?
• The value of that conversation is purely dependent
on two factors: access to the conversation and the
quality of the knowledge shared

15. Why we need to be online
• Yet, all too often, we in health care are absent from
that conversation
• “Don’t want to be sued!”
• “Who will pay for my time online?”
• “What about HIPAA?”

16. Is part of being professional being online?
• Each of us are all the lived experts of our own
disease
• All of us will soon have access to the same shared
knowledge
• If we are strategic we can partner with patients and
walk with them on their journey online as well as
offline
• We can help shape the conversation, leverage
information and ensure that credible content fills the
void

17. What happens when we stay on the
sidelines?

18. The Impact of Silence:
Vaccine Hesitancy
• Efficiency
• Each discussion averages 5-10 mins
• By 24 months, 14 vaccines over 8 visits
• 80% of primary care providers report 1 vaccine
refusal/month; 8% of providers report 1 in 10
parents refused vaccine
• Liability
• Several law suits brought by parents whose
children suffered from vaccine refusal

19. Vaccine Hesitancy
• Health Care
• 13 years since Wakefield, dramatic drop in MMR
in EU with a marked increase in measles and
mumps
• EU-2011-major measles outbreak in 33
countries, to include 10,000 in France alone

20. Is part of being professional being online?
• We must partner with patients in content creation,
curation and decision making
• Leverage the content, leverage the conversation,
leverage the good

21. Advocate for those who may be excluded
• Remember the access angels, libraries, houses of
worship
• Consider mobile capable information
• Remember the disabled and chronically ill
• Remember those with rare disease who
geography isolates

22. Know the risks-know how it to avoid them

23. What do we know about behavior online
• From a general vantage
• From a medical vantage

24. General Online Behavior
• 47% of Facebook users have profanity on their wall
• 56% of profane posts/comments come from friends
• Most common is derivations of “f-word”, second
most common is derivation of “sh*t”

25. Online Behavior and Job Application
• 89% of recruiters and HR staff research candidates
online - from this morning’s Tweet to last night's
Facebook picture
• Over 80% admit to rejecting candidates due to
findings

26. Microblogging: Tweeting Docs
• 2011 one month survey
• 260 Users, 5156 Tweets
• Less than 3% of Tweets were characterized as
unprofessional
• 0.7%-potential patient privacy violation
• 0.6%-profanity
• 0.3%-sexually explicit material
• 0.1%-discriminatory statements

27. National Survey of State Medical Boards
• 71% of boards responded
• 92% of boards reported at least 1 online violation
• Most common: inappropriate patient communication
online, Internet prescribing without an established
clinical relationship and misrepresenting credentials
online
• In total, these transgressions represented a
relatively small percentage of the total board actions
in the FSMB database

28. Professionalism and Social Media
• Social Media Tools do not cause professionalism
violations
• They leverage behavior and errors to a larger
audience
• By doing so, they “educate” a larger audience of
transgressions

29. Professionalism and Social Media
• Previously, if you accepted concert tickets from a
vendor, only you and the vendor knew
• In a social media platform, if you accept tickets from
a vendor, everyone following either you or the
vendor will know

30. Offline Breaches of Professionalism
• Legal Departure
• Altering a medical record
• Performing duties outside scope of care
• Ethical Departures
• Carrying out inappropriate orders
• Failure to support a patient’s basic right to privacy
• Practice Departure
• Neglecting signs that result in patient suicide

31. Online Breaches of Professionalism
• Legal Departure
• Internet prescribing without an established clinical
relationship
• Ethical Departures
• Derogatory or racial comments in a social media
platform
• Practice Departure
• Tweets that represent potential patient privacy
violations

32. Key elements of professionalism in health
care social media

33. Social Media and Professionalism
• Online behavior should seamlessly merge with
offline behavior
• Social Media can highlight professional lapses
• But it can also empower our mission in domains of
practice, research and education
• Social Media can facilitate a professional culture

34. Professionalism and Social Media
• Before you take the leap
• Develop/Review your organizational social media
policy guide
• Define your opportunity and operational goals
• Remember you represent your organization as well
as yourself
• Know and review your privacy settings

35. Professionalism and Social Media
• After the plunge
• Be real
• Be professional
• Be respectful
• Learn the rules of the road before driving
• Just like a good marriage, you will be judged more
by how you listen then what you say

36. Professionalism and Social Media
• After the plunge
• Foresee and count to 3
• 1-Who is your audience?
• 2-Is this appropriate for all ages?
• 3-Am I adding value to the ongoing
conversation?

37. General Concepts
• Unless it is still in the cache, you can’t put it in the
trash
• Always surmises that HIPAA applies
• Speak on your behalf, not that of staff
• Anonymity is really gimmicky
• If you chat about your company, identify abundantly

38. General Concepts
• Don’t endorse as a matter of course
• Supervisors: Don’t initiate an employee friend
request at your own behest
• Separate your circle of friends from patient’s you
mend
• Corporate logo in your username is a no go
• Adding a disclaimer is probably saner
• Don’t practice on the Internet, regardless of your
good intent

39. Remember
• Errors will occur
• Develop a social media policy
• Provide orientation and training
• If a mistake happens, remember it is one game in a
season

40. e-Hippocratic Oath-Scott Albin, M.D.
• “What I may see or hear in the course of treatment
or even outside of the treatment in regard to the life
of a patient, I will keep confidential holding such
things shameful to spread online. I will conduct
myself online in accord with the professional ethical
standards I have sworn to uphold and keep myself
far from all ill-doing and seduction”

41. Professionalism and Social Media
• Don’t Lie, Don’t Pry
• Don’t Cheat, Can’t Delete
• Don’t Steal, Don’t Reveal

42. Professionalism and Social Media
• Blog: http://socialmedia.mayoclinic.org/
• Twitter: @FarrisTimimi
• E-mail: timimi.farris@mayo.edu