Meeting purpose

This BC-PAN meeting was part of a two day Zoom conference on November 23 and 24, 2020. The purpose of this day was to seek input from public advisors on the appropriate use of social media by health care providers.

Key messages from public advisors

• The public believes that health professionals should be held to high standards when using social media because they have a duty to protect the public.
• Resources for the public, such as guidelines on professional and personal relationships, can be helpful to identify the public’s boundaries when connecting with practitioners online.
• Professionals should not provide unsolicited medical advice to individuals through social media.

Health care practitioners’ use of social media

Susanna Haas Lyons provided brief context about social media. Social media encompasses the online spaces were people create, engage, and share new or existing content. Regarding health, social media can be used to get health related information, to connect with others and discuss issues concerning health, to be educated by reading medical documents about a certain condition or disease, or to find treatment options.

Susanna initiated a poll about social media, asking:

• Do you ever use social media?
• If you do use social media, what do you use it for?
• Have you used social media to:
  • Look at reviews of health treatments or practitioners
  • Post about your health experience
  • Join a health forum or online community
  • Discuss your health with a health care provider
  • Support a health issue

Most advisors use social media multiple times a day to keep in touch with friends, family, and receive news. 70% of public advisors have looked at reviews for health treatments or practitioners.

How colleges regulate health care practitioners with regards to social media

Kathy Corbett explained the difficulties of developing guidelines for social media use. Regulators face tensions balancing public life as a professional and health practitioners’ personal life, and freedom of expression and off duty conduct. Potential issues in regulating use of social media involves client privacy and confidentiality, regulators’ and colleges’ reputation or public image, conflicts of interests, and supporting registrants to monitor their online presence. Regulators are seeking guidance on how to balance the right to freedom of speech and protecting public safety.

Questions from BC-PAN members:

• Do regulators actively monitor registrants on social media?
  • CPBC and BCCNP: Colleges do not look at a registrant’s social media activity until they receive a complaint or alert.
  • CCBC: College is very active in monitoring social media of registrants for the purpose of initiating investigations and removing unacceptable social media posts.

Crystal Chung, CTCMABC Director of Compliance, gave a brief background of CTCMABC’s Professional and Personal Relationships guideline. Professional boundaries set limits and clearly define a safe, therapeutic relationship between practitioners and patients. Certain relationship characteristics, such as its structure, length, and power balance, are different in personal relationships than in professional. Practitioners are required to follow specific guidelines that ensure a professional, not personal, relationship with the patient. These lines may become blurred in a social media context.

Thinking about social media usage

Susanna asked the advisors, “what benefits might you hope for by engaging with a health care practitioner through social media? What harms might you be concerned about?”

Benefits identified by BC-PAN advisors:

• Social media helps to personalize the patient; to be seen as a person not a diagnosis.
• Expanding the scope of opportunities to discuss an issue with input from other doctors and patients.
• Ease of access for those who have other barriers to engaging with clinicians in person.
• Health practitioners are easier to relate to when the public can see their personal lifestyle.
• Social media can be used for prevention, to develop continuity of care, to help people understand certain professions.

Harms identified by BC-PAN advisors:

• Privacy concerns: screenshotting information, accessing private information.
• Someone may rely solely on an online diagnosis or suggestion without following up with a medical professional.
• Social media is supposed to be social, not professional. May blur personal-professional boundaries.

Public expectations of health practitioners’ social media presence

Advisors participated in break out rooms to discuss their expectations of health practitioners when they are active online. Each group focused on a separate topic and were asked several questions:

Providing Information and News

Appropriate content: in your view, what content do you think is inappropriate for a health care practitioner to post on social media? How would you describe an acceptable social media post from a health care practitioner?

Inappropriate content:

• Diagnosing individuals via social media.
• Negative content that a professional “feels”; based on emotions and not facts.
• Treatment options that are not supported by studies, treatment targeted at individuals instead of generalized information.

Appropriate content:

• Examples of what certain conditions may look like and when to inquire with your health practitioner if exhibiting certain symptoms. (Ex. Melanoma).
• Proven prevention methods. (Ex. Sunscreen).
• Content posted should align with practitioner’s daily professions.

Valuable content: what advice do you have for practitioners if they are sharing information via social media with the goal of improving people’s health outcomes

• Content should not be used to promote sales or be compensated. Information should be supported by valid medical research.
• Practitioners mentioning that they are associated with a college and licensed helps to improve public trust.

Practitioner-Public Boundaries

Participation: should health care practitioners be encouraged or discouraged from participating in social media, and why?

• Registrants must be reminded to consider the perspective of their public persona or private persona whenever they post online.
• There are potential risks when professionals post content and the audience is aware that they are a professional.
• Professionals must be cautious of what they “like” and “share” as well as post.
• The public expects higher standards for professionals because they have a duty to protect the public.
• Social media platforms are constantly changing and have different purposes. Regulators must be aware of this when regulating practitioners.

Applying boundaries: knowing that a practitioner must carefully observe professional boundaries, what advice do you have about how they communicate or observe these boundaries? What might the public need to know in order to be able to recognize that a boundary has been broken?

• Professionals should not be using social media to practice their profession by providing advice.
• Alternative therapies are difficult to identify boundaries and distinguish facts from opinion.
• There is an individual responsibility on health care practitioners; they should state that content provided is their personal opinion.
• Information for the public such as CTCMABC’s Professional and Personal Relationships guideline can be helpful to identify professional and personal boundaries.

Consent

Giving consent: what information does the public need in order to give consent for a practitioner to engage with them in a social media context?

• The type of platform being used influences perceptions of consent. (Ex. Private online group vs. Twitter).
• Giving targeted medical advice that is unsolicited is not consent. General health information is okay.
• Members of the public putting information on social media may be taken as consent by default. Consenting to have an online presence may dismiss further need for consent.
• Public needs clarification on who they are giving consent to: the practitioner or the platform?

Withdrawing consent: what guidance do you have about helping patients withdraw consent for online engagement? What are the signals that it is time to adjust, what is the practitioner’s responsibility to support ongoing consent and comfort?

• The onus is on the health care professional to monitor consent as an ongoing process.
• May be useful to incorporate online consent in regular consent forms.
• Health regulators should be regularly monitoring health care practitioner’s social media.

Regulator use of digital tools/social media

The group briefly discussed how colleges use social media. Regulators interact with the public through:

• Complaints
• Sharing important updates about the regulated health field and practice
• “What to expect” information about interacting with a practitioner
• Requesting feedback on college’s work and/or consultation processes

Advisors were asked split into pairs and asked:

How should BC’s health regulators use social media to engage with the public? Ideas on other digital tools are also welcome.

Advisor comments

• Social media can be a good resource on directing the public on how to use the complaints process in a simplified way.
• Social media is easier to navigate and may sometimes be used more than a college’s website.
  • The public can use social media to gain basic information but then being redirected to the actual website to find out more.
• Include information about:
  • Registrants needing to comply with code of ethics.
  • Education about roles of the college.
  • What to expect from practitioners on social media and what not to expect.