Background

Recently I attended the Annual American Association of Colleges of Pharmacy (AACP) Meeting in Grapevine, TX, where I was lucky enough to attend a large workshop/discussion/special session about social media and impact on pharmacy faculty and students, entitled "E-Professionalism: Is there a double standard?"

What I found most interesting was when presented with cases of where students were using social media versus faculty, there was a large difference in outlook upon what qualified as a social media mishap. This ranged from professional statements, opinions, or just simply posts involving life (for instance: Is posting a picture of your margarita at the beach unprofessional?)

One area that I feel was missing was real world examples of social media mishaps, pitfalls, and misadventures that have become increasingly present in the past few years amongst health professionals, which I feel would be of value for academics or others in the realm of teaching about #SoMe that would like give real life examples in their lectures or presentations. As such, I took cases I have seen in the news and have collated them here.

Cases & Incidents

• Radiologist-turn-politician + X-ray of gunshot wounds - This is an interesting case that made a large amount of discourse in the political landscape, and some say factored into the candidate losing the election. While the images being posted itself were graphical, the accompanying posts that seemed indifferent probably did not help as well. Takeaway point probably should be that medical images should not be posted, and if they are, are framed in an educational light or professional manner, and not as daft humor at the patients expense.
• OBGYN + Facebook Patient Complaint - This case highlights that even though medical professionals are no different at venting their complaints on social media, those complaints will ultimately be held to a high standard. Case in point, this physician posted a comment (without any HIPAA relevant information) about a patient (who routinely shows up late per post) showing up late for an induction, and makes a comment about maybe how she should show up late as well. Others commented (including other health professionals), but the image was captured and sent to others, and many were seeking to get the physician canned for the post. They were subsequently reprimanded by their hospital.
• Physician terminated due to Facebook Post - This incident may have a lot going on, with a whole department being reprimanded or terminated for perceived HIPAA violations of an image posted on Facebook and for accompanying comments. In this case, the physician was in charge of the department, and may have made inappropriate comments as well that could constitute as identifiers. However, a following lawsuit contends that the incident should have only deserved a reprimand, and the termination was due to other political matters at hand, that the social media faux pas was then used to help ease the physician out of their position permanently. 
• Physician takes picture of intoxicated patient and posts them on Facebook - Thats a mouthful, and not a good one. It seems the ER physician in question may have known the patient through a mutual friend, and posted those images in their social sphere. Nonetheless, a lawsuit has come out of this, and friend or not, taking pictures of your drunk friend and posting them for the world to see is generally frowned upon, especially when your in a position of responsibility.
• Another case of taking images of patients in the ER - It seems there is a trend of incidences in the ER. In this case, a practitioner took a picture of a patient, stating "I like what I like," on their Facebook.  
• Celebrity Vs Pharmacy Tweet - This case is a little odd in my book, as it demonstrates some issues with capitalizing on a potential free marketing opportunity and the issue of taking images of a person without their permission. Here, the celebrity is suing the pharmacy for using her image for a quick publicity stunt without her permission.
• Nurse takes photo of X-Ray and mentions on Facebook - Things come up in medicine that may cause us to pause, laugh, or chuckle - and sometimes at the patient expense. In this case, it was a sexual device lodge in an orifice. A nurse took a picture of the x-ray, and shared with a friend, but never posted it online. However, she did talk about it on Facebook, and for that reason it became an issue it seems. 
• Medical Student and Cadaver - This incident I feel highlights some of the changes occurring. Students are new to the field of medicine and healthcare, and want to share with friends and colleagues what they are doing. But some boundaries exist, even with the deceased.
• Nurse Posts image of Trauma Room on Instagram then Fired - This case has caused a lot of discussion amongst healthcare providers that use social media - Is posting an image without patients a problem? Or is context key? In this case, a nurse reposted an image on Instagram of a patient that they saved from a subway accident. However, it was declared insensitive and the hospital fired her, despite no HIPAA violation.
• Marathon Runner/Physician takes accidental image of Injured Runner - This is an excellent reflective piece by a physician who recognizes when they made a mistake, and have to live up to it. Essentially, the physician is running in Boston Marathon, taking images the whole time for the news, and helps an injured runner along the way, and accidentally posts that image as well. 
• Nursing Student and Placenta on Facebook - Does a Placenta count? That seems to be the question, especially when kicking out four nursing students for taking pictures of themselves with placentas and posting them on Facebook. 

These cases highlight some of the more interesting ones that have been covered by the media in the past few years. Many are arguable, and it is always interesting to see other healthcare professionals thoughts on the matter. However, several trends have stood out to me.

Social Media Goes Beyond HIPAA

I think most healthcare professionals are up to date on HIPAA and understand what constitutes a breach. However, as some of these cases highlight, it may not always deal with patients. The expectation of a institution and the general public is high for healthcare providers. To have a laugh at a patients expense is a definite error, but to demonstrate characteristics unbecoming of a healthcare professional is also of large concern. That may be the one thing some healthcare workers will find the most bothersome aspect. They find their friends can post about a hard days work, or personal feelings, that will not impact their job, but if they were to do the same that could be perceived in any ill way (e.g. incompetent, inconsiderate, unethical) it may come back to haunt them. The hardest part about this is that social media demands professionalism 24/7, and for new healthcare professionals, that will be the most difficult thing.

Bringing this to the classroom

I am a firm believer of E-Professionalism. It's a much needed topic. We spend so much time teaching students to become a professional, but usually we have them in the safety of the institution to guide and mentor them. Online personas are a different matter with little oversight. A professional aspect does not turn on automatically, and for future students who are used to posting and sharing every moment of their lives, this may come as a shock to learn and adjust with little notice. Someway we need to convey this and teach it to the future healthcare professionals of the next generation.