For doctors, social media a tricky case

By Chelsea Conaboy
Globe Staff / April 20, 2011

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Facebook is a great place to unload after a long day at work. But what if you work in an emergency room, where privacy is paramount? And what if the thing you want to discuss is not the evening traffic or a grumpy colleague but your patients?

Don’t do it, experts caution — a lesson that a physician at Westerly Hospital in Rhode Island just learned the hard way.

Dr. Alexandra Thran, 48, was fired from the hospital last year and reprimanded by the state medical board last week. The hospital took away her privileges to work in the emergency room for posting information online about a trauma patient.

Thran’s posting did not include the patient’s name, but she wrote enough that others in the community could identify the patient, according to a board filing. Thran, who did not return calls for comment yesterday, also was fined $500.

The case was the first involving a physician’s use of social media that the Rhode Island board has heard. No such complaints have come before regula tors in Massachusetts, said medical board spokesman Russell Aims.

That’s likely to change as the use of social media in health care grows, said Bradley H. Crotty, a physician at Beth Israel Deaconess Medical Center who has studied the role of social media in health care.

“I think we should all learn from [the Rhode Island case] and get to work on doing education and training in our hospitals to promote the professional use of social media,’’ Crotty said.

Navigating the tell-all online culture can be tricky for any professional but particularly for those who must balance strict rules on patient protection. Cases across the country have highlighted the institutional challenge.

A Wisconsin hospital and several in California have made headlines in recent years as nurses and other staff members were fired for talking about patients on Facebook or posting photographs of them online.

Crotty and his colleague at Beth Israel Deaconess, Dr. Arash Mostaghimi, write in an editorial published this week by the Annals of Internal Medicine that physicians should think of the Internet as the world’s elevator: Someone nearby is always listening in.

When deciding what is appropriate to write online, “err on the side of caution, because you can’t go the other way,’’ Crotty said. “We first have to put ourselves in the shoes of the patient we may be discussing and then reflect if what we’re saying is appropriate.’’

Crotty and Mostaghimi recommend that physicians set up separate personal and professional social media accounts. Keep the personal ones set to private and use the professional ones as an extension of the practice, they say.

They suggest not communicating directly with patients through social media. That’s better left to work e-mail and other secure portals.

Crotty said hospitals should be teaching staff members what’s appropriate, especially those accustomed to living part of their lives online.

“People don’t mean to do the wrong thing,’’ he said. “They either get excited or get impassioned or want to vent. With social media, as soon as it’s posted, it’s there, and it doesn’t allow one to think twice about it.’’

The Massachusetts medical board has not discussed creating any new social media policies, Aims said. That’s largely because many of the issues that might arise are already covered under state and federal patient protections or rules dictating that physicians represent themselves in a forthright manner, he said.

Under the federal patient protection laws commonly known as HIPAA, doctors can face civil or criminal penalties for disclosing personal information — online or off.

The attention that hospitals in the Boston area are giving the issue varies considerably. Boston Medical Center, for example, doesn’t have a policy. “It just doesn’t seem to have been an issue as of yet,’’ spokeswoman Gina DiGravio said.

Tufts Medical Center is working on one now, said spokeswoman Julie Jette.

Children’s Hospital Boston this year published its first social media policy, a six-page document outlining the do’s and don’ts. The policy explicitly prohibits disclosing patient or employee information.

That’s the easy part, said Dr. Dan Nigrin, chief information officer and an endocrinologist. What happens when a longtime patient “friends’’ a doctor or nurse on Facebook? Nigrin said it has happened to him, and it made him uncomfortable, despite the good relationship he had with the patient.

“Is it appropriate for a patient that I’m caring for to see comments that my high school friends are talking about from 30 years ago?’’ he said. “Probably not.’’

The policy suggests declining the request and even recommends an explanation that can be provided to the patient, saying the online connection “can sometimes cause strains on the clinician, patient, and family relationships that we work so hard to develop.’’

Nigrin said the hospital doesn’t want to deter the use of social media. It could have blocked access to Twitter and Facebook from its network but chose not to, he said. And, in fact, the public affairs office has embraced its use. As of Tuesday evening, 564,455 people had “liked’’ the official Children’s Facebook page.

The goal of the policy, he said, is to help staff make the best decisions on how they use the tools.

Westerly Hospital wants its employees to do the same. A spokesman there said a social media policy is in the works.

Chelsea Conaboy can be reached at