Marie E. Gehle, PsyD

More than half of the world’s population now uses the Internet.

 Many of these users access social media sites on a regular basis. Social media can be classified in a plethora of ways to reflect the diverse range of social media platforms, such as collaborative projects (eg, Wikipedia), content communities (eg, YouTube), and social networking sites (eg, Facebook).

 A recent Pew Research Center survey of US adults reports that social media use in early 2018 was characterized by a combination of “long-standing trends and newly emerging narratives”

; 73% of US adults reported using YouTube and 68% reported using Facebook. At the same time, younger Americans (especially those aged 18 to 24 years) are embracing a variety of platforms (eg, Snapchat, Instagram, Twitter) and using them frequently.

Psychiatrists are increasingly using social media to educate the general public, existing patients, and potential patients about various conditions. With their many applications, social media platforms are useful for professional networking, patient and provider education, research collaboration, personal and professional support, and academic dialogues. Social media adds a new dimension to health care because it offers a medium for physicians and patients to communicate about medical issues with the potential to improve health outcomes.

Benefits of using social media in private practice

Using social media in private practice has many benefits. It provides avenues for us to market ourselves and our services. The most popular social media sites for physicians are those where we can participate in online communities, listen to experts in their fields, read news articles, network, and communicate with colleagues regarding patient issues. These sites allow us to acquire and read relevant information related to our patients and practice. Social media allows us to engage with other psychiatrists and mental health professionals by commenting on posts and participating in group discussions or online chats. By identifying and sharing useful information or links with followers or other members of an online community, these interactions can increase the acquisition of salient information.

We can create blogs, forums, videos, and information-sharing websites that provide information to the general public, patients, and other mental health professionals on mental illness, treatments available, and wellness; these efforts can help reduce stigma associated with mental illness and promote psychiatry. Our use of social media can expand access to individuals who may not easily access health information via traditional methods. Social media can provide peer, social, and emotional support for patients, the general public, and other mental health providers. It can allow the general public to discuss sensitive topics and complex information with us and provide opportunities for us to provide online consultations.

Social media provides communication in real time and is inexpensive, although potentially time consuming. We can quickly monitor public response to mental health issues, identify misinformation of mental health information, and disseminate pertinent mental health information to targeted communities. We can compile data about patient experiences from blogs, collect data from patients, and gather opinions regarding our performance (eg, via customer satisfaction surveys). We can use social media to disseminate personalized messages immediately.

Challenges of using social media in private practice

The challenges of using social media can be as numerous as the benefits. Information on the Internet, especially in user-generated forums, is largely unregulated and its accuracy cannot be guaranteed.

 Authors of medical information found on social media sites are often unknown or are identified by limited information, and the medical information may be unreferenced, incomplete, or informal.

 Social media tends to emphasize anecdotal reports while evidence-based medicine tends to de-emphasize it. Using social media may make us susceptible to both known and unknown conflicts of interest that we may be unable to decipher.

Social media conveys information about a person’s personality and values, and the first impression generated by this content (eg, photos, posts) can be lasting. Posting inappropriate content or unfavorable comments can reflect negatively upon us and can be viewed as unprofessional.

We can view our patients’ social media profile to obtain information about them. Their “digital footprint” may help us understand the context of their lives, reconcile discrepancies with what they have told us, or allow us to confront denial and address incomplete reporting. However, perusing our patients’ online profiles could negatively impact treatment and adherence. Patients may choose to portray themselves differently on their online profiles, and their identities often cannot be confirmed.

 Even if some information is accurate, we might discover things that we did not expect to learn about our patients, including important information that they did not share, significant problems they are currently experiencing, or even something they lied about. This can create ethical dilemmas of what to do with the information and whether it should be addressed immediately or at a future session.

Despite their online activities being displayed for the world to see, our patients may not expect us to access their online information. They might perceive such perusal as a breach of trust, which can lead patients to view the doctor-patient relationship as adversarial. Accessing this information could also create a more intimate relationship than intended. Even if we acquire their consent to perform a search, our patients may still feel coerced into allowing it because they might feel that declining to grant permission would make us suspect that they have something to hide, or that we would search without their consent. In addition, if our patients are aware that we are monitoring them, they might change their behavior. For example, they may delete certain data, add additional information that may not be accurate, or censor future social media posts. Knowing that we could be paying attention to them online might motivate patients to act out or become withdrawn.

Breaches of patient privacy can occur when posting information, photos, videos, or comments concerning our patients to a social media platform. These breaches can lead to legal action against us as well as adversely affect our credentials and licensure.

 There is a vast amount of information that is available for us to peruse; however, perusing that information might require excessive time and effort, or divert attention from more productive therapeutic interventions.

Dr Joshi is Associate Professor of Clinical Psychiatry and Associate Director, Forensic Psychiatry Fellowship, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC; Dr Gehle is Chief Psychologist, South Carolina Department of Mental Health, Columbia, SC.

The authors report no conflicts of interest concerning the subject matter of this article.

https://www.kleinerperkins.com/perspectives/internet-trends-report-2018/

 Moorhead SA, Hazlett DE, Harrison L, et al. A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication. 

 Smith A, Anderson M. Social Media Use in 2018. 

http://www.pewinternet.org/2018/03/01/social-media-use-in-2018/

 Fisher CE, Appelbaum PS. Beyond Googling: the ethics of using patients’ electronic footprints in psychiatric practice. 

 Ventola CL. Social media and health care professionals: benefits, risks, and best practices. 

 Stoltz TR, Joshi KG. Looking up patients online: why it’s a bad idea. 

 Logghe HJ, Boeck MA, Gusani NJ, et al. Best practices for surgeons’ social media use: statement of the resident and associate society of the American College of Surgeons. 

 ACOG Committee of Professional Liability. Committee Opinion: professional use of digital and social media, 2015 (reaffirmed 2017). 

https://www.acog.org/-/media/Committee-Opinions/Committee-on-Professional-Liability/co622.pdf?dmc=1

 Farnan JM, Sulmasy LS, Worster BK, et al. Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards. 

 American Medical Association. Professionalism in the use of social media. 

https://www.ama-assn.org/delivering-care/ethics/professionalism-use-social-media

 American Psychiatric Association. Social Media: Best Practices for Psychiatrists. 

https://www.psychiatry.org/psychiatrists/practice/social-media

 Mansfield S, Perry A, Morrison S, et al. Social media and the medical profession: a guide to online professionalism for medical practitioners and medical students. 2010. 

Articles

The challenges of using social media can be as numerous as the benefits.

Marie E. Gehle, PsyD

Articles

The Role of Social Media in Private Practice