Social Media and Clinical Care: Ethical, Professional, and Social Implications
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Written from the paper’s full text.
TL;DR
This review examines how social media are being used in clinical care and argues that physician use should be guided by medical ethics and professionalism. It highlights opportunities for patient engagement, peer support, telemedicine, and crowdsourcing alongside risks to privacy, boundaries, and trust.
Key findings
- Patients show interest in social media for care: in one outpatient family practice survey, 56% wanted providers to use social media for appointment setting/reminders, test results, health information, prescription notifications, and general questions; 23% of US adult Internet users with chronic conditions had gone online to find others with the same conditions versus 15% without a chronic condition.
- Physician use is mixed: in a 2011 US survey, 7% of practicing physicians had used video chats with patients; about one third of physicians who use social networking reported receiving a friend request from a patient or family member, while only 5% had extended one themselves; 14% to 18% of pediatric trainees (but no faculty) had searched the Internet or social media for patient information, and 14% of faculty said they would search if necessary.
- Privacy and professionalism concerns appear in the cited literature: among 271 medical blogs by health professionals, 42% described individual patients, 17% of those included enough information to identify patients or providers, and 3 included recognizable patient photographs; 11% of health professional blogs contained product endorsement and none provided conflict-of-interest disclosures; 27% of posts in Facebook diabetes management support groups appeared promotional.
- The authors recommend secure closed systems with encryption, avoiding open third-party sites for direct patient communication, obtaining consent, deidentifying patient narratives, avoiding online “friendships” with patients, disclosing conflicts, and reporting harmful unprofessional content.
Methods
- Narrative review article, not an original empirical study; no systematic search strategy, inclusion criteria, or formal quality appraisal is stated.
- Synthesizes prior surveys, qualitative analyses, reports, and ethical guidance, organized around the American Medical Association principles of medical ethics and tables of recommendations.
- Main analysis is narrative and ethical/professional discussion, with no new data collection or meta-analysis.
Limitations
- Stated by the paper: an in-depth discussion of legal implications is beyond its scope; data were lacking to make many conclusions about telemedicine’s clinical effectiveness versus face-to-face care or cost savings; it is unclear how patient-shared data are used in visits and to what utility; there is a lack of consensus on how best to use patient information found online; the impact of routine patient-search information on the patient-physician relationship is unclear; and the helpfulness of physician rating sites has not been proven.
- Evident from the text: as a narrative review, it relies on cited cross-sectional surveys, qualitative studies, and reports rather than a systematic evidence synthesis, so findings depend on the selected literature and self-reported data.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
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Cites
Statistics
Claims the paper makes
0 of 100 cited sources checked · 0 supported · 0 flagged
- Premisecitation§ Social Media in Clinical Care
Peer-to-peer healthcare is emerging as a source of patient information and support.
“Peer-to-peer healthcare is emerging as a source for patient information and support.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2]
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- Premisecitation§ Introduction
Patients are interested in using social media to communicate with their healthcare providers.
“Naturally, they are also interested in using social media to facilitate communication between themselves and their providers.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [3] source
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- Premisecitation§ Introduction
In a survey of patients at an outpatient family practice clinic, 56% wanted their providers to use social media for appointment setting and reminders, diagnostic test results, health information sharing, prescription notifications, and general questions.
“In a survey of patients of an outpatient family practice clinic, 56% wanted their providers to use social media for appointment setting and reminders, diagnostic test results reporting, health information sharing, prescription notifications, and answering general questions. 3”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] source
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- Premisecitation§ Social Media in Clinical Care
In a 2011 survey, 23% of US adult Internet users with chronic medical conditions had gone online to find others with the same conditions, compared with 15% of users without a chronic condition.
“In a 2011 survey, 23% of US adult Internet users with chronic medical conditions (eg, hypertension, diabetes mellitus, or cancer) had gone online to find others with the same medical conditions compared with 15% of users without a chronic condition.2”
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- Premisecitation§ Social Media in Clinical Care
Patients can join health subcultures on Twitter, including weight-loss communities that provide accountability, encouragement, and advice from health professionals.
“Patients can tap into various “health subcultures” on the microblogging and social networking site Twitter, including weight-loss communities that can provide accountability, encouragement, and advice from health professionals.8”
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- Premisecitation§ Introduction
Many patients who do not use social media would begin using it if they knew they could connect with their providers there.
“For those patients who do not use social media, many would start if they knew that they could connect with their providers there.3”
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- Premisecitation§ Writing About Patients on Social Media
A smaller but still majority (61%) of medical educators felt that writing a deidentified patient narrative using a respectful tone was never or rarely acceptable.
“Fewer, but still a majority, felt that writing this deidentified patient narrative using a respectful tone was never or rarely acceptable (61%).5,6”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisecitation§ Be Honest in All Professional Interactions (AMA Principle II)
Federal Trade Commission regulations released in 2009 require material connections between advertisers and endorsers to be disclosed.
“Of note, Federal Trade Commission regulations released in 2009 require material connections (sometimes payments or free products) between advertisers and endorsers to be disclosed.”
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- Premisecitation§ Social Media in Clinical Care
International medical relief organizations working in remote areas have credited social networking for helping coordinate complicated medical and logistical demands, including access to international specialists.
“International medical relief organizations working in remote areas have credited social networking for helping to coordinate complicated medical and logistical demands of their work, including gaining access to international specialists.28”
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- Premisecitation§ Report Physicians Deficient in Character or Competence, or Engaging in Fraud of Deception, to Appropriate Entities (AMA Principle II)
Among violations of online professionalism reported to state medical boards, half were reported by another physician.
“Among violations of online professionalism reported to state medical boards, half were reported to the board by another physician.42”
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- Premisecitation§ Safeguard Patient Confidences and Privacy Within the Constraints of the Law (AMA Principle IV)
The HIPAA Privacy Rule, in effect since 2003, imposes heavy fines and potential criminal charges for unauthorized disclosure of individually identifiable health information by covered entities.
“The Privacy Rule, in effect since 2003, levies heavy fines and potential criminal charges on unauthorized disclosure of individually identifiable health information, also known as protected health information, by covered entities.”
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- Premisecitation§ Looking Up Information About Patients on the Internet
Significant variation exists in how providers would respond to information accessed from a patient's social media.
“However, significant variation exists in how providers would respond to accessed information.”
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- Premisecitation§ Communicating Directly With Patients
Patient privacy breaches can cause greater harm when they occur online than face-to-face because of social media's wide reach and the permanency of digital information.
“Patient privacy breaches can cause much greater harm when occurring online than when face-to-face given the potential wide reach of social media and the permanency of digital information.36”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [36] source
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- Premisecitation§ Uphold the Standards of Professionalism (AMA Principle II)
Published social media guidelines from national medical organizations and medical school policies often lack specific behavioral guidance or definitions of professionalism for the online space.
“Published social media guidelines by national medical organizations and medical school social media policies often lack specific behavioral guidance or definitions of professionalism as applied to the online space.39,40”
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- cites [40]
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- Premisecitation§ Social Media in Clinical Care
For patients with rare diseases, peer-to-peer healthcare can produce meaningful online relationships and support for both patients and their caregivers.
“For those patients with rare diseases, peer-to-peer health care can result in meaningful online relationships and support in ways not possible before the advent of the Internet for both patients and their caregivers.2”
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- Premisecitation§ Social Media in Clinical Care
Emergency physicians were able to contact the spouse of an amnestic patient using Facebook when traditional information sources were exhausted.
“One report in the literature describes how emergency physicians were able to contact the spouse of an amnestic patient using the popular social networking site Facebook when other traditional sources of information were exhausted.17”
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- Premisecitation§ Safeguard Patient Confidences and Privacy Within the Constraints of the Law (AMA Principle IV)
The HIPAA Privacy Rule includes a safeguards standard requiring covered entities to reasonably safeguard protected health information from unauthorized disclosure, both intentional and inadvertent, using physical, administrative, and technical safeguards.
“The HIPAA Privacy Rule includes a safeguards standard that requires covered entities to reasonably safeguard protected health information from unauthorized disclosure, both intentional and inadvertent, using physical, administrative, and technical safeguards.49”
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- Premisecitation§ Social Media in Clinical Care
Some practices have set up closed social media platforms that allow patients to participate in care coordination, track clinical progress, and have greater access to physicians.
“Social media-savvy practices have set-up closed social media platforms that allow for patients to be actively involved in their own care coordination, to track their clinical progress, and for greater access to their physicians.”
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- Premisecitation§ Be Honest in All Professional Interactions (AMA Principle II)
Some physician tweets contain suspect product promotions.
“Some physician tweets also contain suspect product promotions.44”
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- Premisecitation§ Writing About Patients on Social Media
A study of 271 medical blogs written by health professionals found that individual patients were described in 42% of blogs.
“A study of 271 medical blogs written by health professionals found that individual patients were described in 42% of blogs.”
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- Premisecitation§ Social Media in Clinical Care
Some online communities are built around data-sharing platforms where patients share quantitative medical information to learn from aggregated reports and improve their own outcomes.
“Other social networking online communities are built around data-sharing platforms, where patients share quantitative information about their medical conditions to learn from the aggregated data reports to improve their own outcomes.10”
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- Premisecitation§ Writing About Patients on Social Media
When medical educators rated online behaviors, a majority (86-88%) felt it was rarely or never acceptable to write a deidentified patient narrative using a disrespectful tone.
“When medical educators were asked to rate a list of specific online behaviors on appropriateness, the majority felt that it was rarely or never acceptable to write a deidentified patient narrative using a disrespectful tone (86-88%).5,6”
Quote in the paperNot a substantial claim0 of 2 sources checked - Premisecitation§ Commercial Interests and Patient Exploitation
Patient members of for-profit social networking communities that involve data-sharing platforms may have their deidentified data shared with research and academic institutions and corporate pharmaceutical sponsors.
“Of note, patient members of for-profit social networking communities involving data-sharing platforms may have their deidentified data shared with various research and academic institutions, as well as corporate pharmaceutical sponsors.”
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- Interpretationreasoning§ Online "Friendships" With Patients on Social Networking Sites
In online settings, especially sites with personal content, much more disclosure-intentional or accidental-is at risk.
“Meanwhile, in the online setting, particularly on sites that contain personal content, there is much more disclosure, intentional and/or inadvertent, at risk.”
Quote in the paperSubstantial claim - Premisecitation§ Online "Friendships" With Patients on Social Networking Sites
Those studies did not distinguish between personal and professional social networking sites.
“However, the distinction between personal and professional social networking sites was not made in these studies.”
Quote in the paperNot a substantial claim0 of 2 sources checked - Interpretationreasoning§ Online "Friendships" With Patients on Social Networking Sites
Starting a social networking connection with a patient on any site can make the patient feel coerced or pressured to accept because of the power imbalance inherent in the relationship.
“Initiating a social networking connection with a patient on any type of site, however, can cause the patient to feel coerced or pressured to accept the request because of the inherent power differential within the relationship.”
Quote in the paperSubstantial claim- Rests on an assumption: There is an inherent power differential in the patient-physician relationship.
- Premisecitation§ Social Implications
Patients want communication with their doctors to be easy.
“Patients desire ease of communication with their doctors”
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- Interpretationcitation§ Commercial Interests and Patient Exploitation
Similar worries about patient exploitation arise in patient-learning communities on social media because of marketing influences.
“Similar concerns for patient exploitation arise in patientlearning communities on social media sites with regard to marketing influences.”
Quote in the paperSubstantial claim - Interpretationreasoning§ Online "Friendships" With Patients on Social Networking Sites
Online friendships can also lead to problematic self-disclosures by patients or doctors that may threaten the therapeutic relationship.
“Such friendships may also lead to problematic self-disclosures (by patients and/or by physicians) that could threaten the therapeutic relationship.”
Quote in the paperSubstantial claim - Premisecitation§ Online "Friendships" With Patients on Social Networking Sites
In another study of medical students, residents, and practicing physicians, most respondents considered it equally unethical to interact with patients through online social networks for social or patient-care reasons.
“In another study involving a sample that included medical students, resident physicians, and practicing physicians, the majority of respondents felt that it was equally unethical to interact with patients using online social networks for either social or patient-care reasons.”
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- Premisecitation§ Physician Rating Sites
Most online physician reviews are positive.
“although most online physician reviews are positive, 61,62 there are those reviews that appear disproportionately poor or even constitute possible acts of sabotage from competing providers.62”
Quote in the paperNot a substantial claim0 of 2 sources checked - Premisecitation§ Commercial Interests and Patient Exploitation
One site gives corporate sponsors analyses of member conversations about their brand.
“One site, for example, provides corporate sponsors with analysis of member conversations about their brand.”
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- Premisecitation§ Future Possibilities
The gap between clinical research and actual practice depends on factors such as the quality, size, and relevance of research and the incentives to adopt practice changes.
“The much lamented gap depends on a number of factors, including the quality, magnitude, and relevance of research, as well as the incentives to adopting practice changes.”
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- Interpretationreasoning§ Support Access to Medical Care for All People (AMA Principle IX)
Social media may increase healthcare access for rural or underserved populations through the growth of telemedicine programs.
“Yet, social media may mediate an increase in healthcare access to those in rural or underserved areas with expansion of telemedicine programs.”
Quote in the paperSubstantial claim - Premisecitation§ Make Relevant Information Available to Patients, Colleagues, and the Public (AMA Principle V) Sharing Credible Health Information and Patient Education
Medical students across multiple continents have used social media to help their institutions adopt patient safety tools.
“Medical students across multiple continents have used social media to help their institutions adopt patient safety tools.59”
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- Premisecitation§ Make Relevant Information Available to Patients, Colleagues, and the Public (AMA Principle V) Sharing Credible Health Information and Patient Education
Through blogging and recording videos, physicians instruct patients on topics such as dosing liquid medication for infants and children and explaining rotator cuff injuries.
“For example, through blogging and recording videos, physicians are instructing patients on everything from dosing liquid medication for infants and children 57 to explaining rotator cuff injuries.58”
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- Premisecitation§ Discoverability
Facebook's data use policy tells users that it may access, preserve, and share their information in response to a legal request both inside and outside US jurisdiction.
“The Facebook data use policy informs users that “we may access, preserve and share your information in response to a legal request” both within and outside of US jurisdiction.”
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- Premisecitation§ Commercial Interests and Patient Exploitation
Greene et al found that 27% of posts in Facebook diabetes management support groups appeared promotional, usually as testimonials.
“Greene et al 7 found that a significant proportion (27%) of posts on Facebook diabetes management support groups appeared to be promotional in nature, typically in the form of testimonials.”
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- Premisecitation§ Online "Friendships" With Patients on Social Networking Sites
In surveys of internal medicine and pediatrics medical educators, 82% to 84% said it was never or rarely acceptable to become social networking friends with a current patient.
“When medical educators in internal medicine and pediatrics were asked to rate the appropriateness of certain online physician behaviors, 82% to 84% felt that it was never or rarely acceptable to become social networking friends with a current patient.”
Quote in the paperNot a substantial claim0 of 2 sources checked - Premisecitation§ Trust and Social Media Relationships Between Physicians and Patients
Trust can be undermined when people have conflicting expectations about how clinical care delivered through social media should be carried out.
“Trust may be compromised if there are conflicting expectations of how clinical care using social media will be conducted.”
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- Premisecitation§ Future Possibilities
Physician behavior has been shown to contribute to regional differences in healthcare spending.
“because physician behavior has been shown to be a factor in variations in regional healthcare spending.”
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- Premisecitation§ Physician Rating Sites
The helpfulness of physician rating sites has not been proven.
“Although the helpfulness of these ratings has not been proven, these sites could theoretically contribute to health literacy, engagement in patients' own care, and ability to perform quality assessment.60”
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- Premisecitation§ Online "Friendships" With Patients on Social Networking Sites
Online friendships can create a dual relationship between doctor and patient.
“online “friendships” may create a dual relationship”
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- Premisecitation§ Social Implications
Nonverbal cues, rather than verbal utterances, are thought to carry most of the meaning when communicating feelings and attitudes.
“Nonverbal cues, as opposed to verbal utterances, are thought to carry the majority of meaning when communicating messages regarding feelings and attitudes.”
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- Premisereasoning§ Online "Friendships" With Patients on Social Networking Sites
Maintaining professional boundaries online matters for the integrity of the patient-physician relationship.
“Preservation of professional boundaries online is important to the integrity of the patient-physician relationship”
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- Interpretationreasoning§ Online "Friendships" With Patients on Social Networking Sites
This risk of feeling coerced or pressured is especially high for pediatric patients, patients with special needs, and vulnerable populations.
“This is especially true in the case of pediatric patients, those with special needs, and vulnerable populations.”
Quote in the paperSubstantial claim- Rests on an assumption: There is an inherent power differential in the patient-physician relationship.
- May combine two claims. 42
- Classified as probably not a substantial claim. 25
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Premisecitation§ IntroductionPatients have used social media to look for health information, obtain support through discussion groups and forums, and document their illness experiences.
“Patients have been active on social media to find health information, find support through discussion groups and forums, and chronicle their illness journeys.2”
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Premisecitation§ IntroductionPhysicians use social media both personally and professionally, with personal use being more common.
“Physicians are also exploring ways to use social media, both personally and professionally, although personal use is more common.[4][5][6]”
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Premisecitation§ Social Media in Clinical CareQualitative analysis of posts and discussion topics in the 10 largest Facebook diabetes management groups found that patients, family members, and friends share personal clinical information, receive emotional support, and request diabetes management guidance from other group members.
“Qualitative analysis of posts and discussion forum topics on the 10 largest diabetes management groups on Facebook revealed that patients, as well as family members and friends, share personal clinical information, receive emotional support, and request diabetes management guidance from other group members.7”
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Premisecitation§ Safeguard Patient Confidences and Privacy Within the Constraints of the Law (AMA Principle IV)There have been many well-publicized HIPAA breaches involving social media, and in many of these cases disclosure was inadvertent.
“There have been many well-publicized breaches of HIPAA involving social media; 47,48 in many of these cases, disclosure was inadvertent.”
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Premisecitation§ Social Media in Clinical CareOn Sermo, an online physician-only community, credentials are verified during registration, and physicians from all 50 states and 68 specialties use it to network, discuss treatment options, and seek expert advice.
“For example, on Sermo, an online physician-only social networking community, credentials are verified during registration of new members and “physicians across all 50 states representing 68 specialties come to network, discuss treatment options, and curbside peers for expert advice whenever they need it.”14”
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Premisecitation§ Be Honest in All Professional Interactions (AMA Principle II)An analysis of blogs written by health professionals found that 11% contained product endorsement of specific healthcare products, and none provided conflict of interest disclosures.
“When researchers analyzed the content of blogs written by health professionals, 11% contained product endorsement of specific healthcare products; none provided conflict of interest disclosures.43”
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Premisecitation§ Uphold the Standards of Professionalism (AMA Principle II)Professionals, including physicians, have had their professional character judged by how they represent themselves online, and physicians may be viewed in their professional role whenever they are in public, including on social media.
“Professionals, not limited to physicians, have had their professional character judged on the basis of the way they represent themselves online; 36 to some extent, physicians will be viewed in their professional role whenever they are in public, including when using social media.37”
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Premisecitation§ Uphold the Standards of Professionalism (AMA Principle II)Professionalism is now a standard part of US medical school curricula; student professionalism is evaluated by observation and, in most medical schools, by formal testing in structured clinical examination settings.
“Professionalism is now a standard part of US medical school curricula; 34 student professionalism is evaluated by observation and, in a majority of medical schools, by formal testing in structured clinical examination settings.35”
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Premisecitation§ Writing About Patients on Social MediaStevenson and Peck offered modified criteria for evaluating social media actions based on Cavanaugh's original criteria.
“On the basis of Cavanaugh's original criteria, 54 Stevenson and Peck 53 offer modified criteria for evaluating social media actions (Figure 2).”
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Premisecitation§ Social Media in Clinical CareResearchers using observational data from a patient platform found that lithium therapy had no impact on amyotrophic lateral sclerosis disease progression, a result later confirmed by randomized trials.
“For example, researchers using observational data housed on such a platform found that lithium therapy had no impact on amyotrophic lateral sclerosis disease progression, later confirmed by subsequent randomized trials.13”
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Premisecitation§ Be Honest in All Professional Interactions (AMA Principle II)Online misrepresentation of credentials was one of the most common online professionalism violations reported to state medical boards, with many resulting in serious disciplinary actions.
“Online misrepresentation of credentials was one of the most common online professionalism violations reported to state medical boards, with many resulting in serious disciplinary actions.42”
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Premisecitation§ Uphold the Standards of Professionalism (AMA Principle II)Medical professionalism generally includes standards of competence and integrity, placing the patient's interest above the physician's, and providing expert advice to society on health matters.
“Medical professionalism has been defined in many ways but generally includes standards of competence and integrity, placing the patient's interest above those of the physician, and providing expert advice to society on matters of health.33”
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Premisecitation§ Social Media in Clinical CareDoximity offers HIPAA-compliant messaging of text and images, supporting point-of-care crowdsourcing.
“Another newer physician-only social networking community, Doximity, boasts Health Insurance Portability and Accountability Act (HIPAA)-compliant messaging of text and images, supporting point-of-care crowdsourcing.16”
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Premisecitation§ Social Media in Clinical CareData were lacking to make many conclusions about telemedicine's clinical effectiveness compared with face-to-face care or about its cost savings.
“Data were lacking, however, to make many conclusions about its clinical effectiveness compared with faceto-face care or cost savings.24”
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Premisecitation§ Writing About Patients on Social MediaOf the blogs that described patients, 17% included sufficient information for patients to identify their providers or themselves, and 3 included recognizable photographic patient images.
“Of these, 17% included sufficient information for patients to identify their providers or themselves, and 3 included recognizable photographic patient images.43”
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Premisecitation§ Social Media in Clinical CareMembers of data-sharing communities have reported benefits including better informed treatment decisions, symptom management, higher quality of life, and perceived control over their condition; a minority use their data in visits with providers, though the ways and utility are unclear.
“Members have reported benefits from participation including better informed treatment decisions, symptom management, higher quality of life, and perceived control over their condition; a minority use their data in their visits with their healthcare providers, although it is unclear in what ways and to what utility.10”
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Premisecitation§ Writing About Patients on Social MediaStevenson and Peck proposed a model of double-effect reasoning for deliberating ethical cases in social media.
“Stevenson and Peck 53 propose the model of double-effect reasoning when deliberating ethical cases in social media.”
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Premisecitation§ Social Media in Clinical CareIn a US study, 37% had consulted physician rating sites when gathering information about a specific provider.
“In a US study, 37% had consulted physician rating sites when gathering information about a specific provider.31”
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Premisecitation§ Safeguard Patient Confidences and Privacy Within the Constraints of the Law (AMA Principle IV)Individual states may have separate privacy laws, and states vary on who may grant permission to release medical charts.
“Individual states may have their own separate privacy laws; for instance, states vary on who may grant permission to release medical charts.50”
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Premisecitation§ Social Media in Clinical CareIn a 2011 US survey of practicing physicians, 7% had used video chats to communicate with patients.
“In a 2011 US survey of practicing physicians, 7% had used video chats to communicate with patients.27”
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Premisecitation§ Safeguard Patient Confidences and Privacy Within the Constraints of the Law (AMA Principle IV)Protected health information applies to health information in oral, paper, or electronic forms.
“Protected health information applies to health information in oral, paper, or electronic forms.46”
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Premisecitation§ Social Media in Clinical CareSystematic reviews have found telemedicine to be feasible, well accepted by patients, and reliable.
“Systematic reviews of telemedicine have found telemedicine to be feasible, well accepted by patients, and reliable.24,25”
Quote in the paperNot a substantial claim0 of 2 sources checkedMay combine two claims.
Premisecitation§ Looking Up Information About Patients on the InternetIn general, healthcare providers do not believe it is an invasion of privacy to conduct an Internet or social media search for people they know or work with, and they believe publicly accessible social media profiles are public information.
“In general, healthcare providers do not believe that it is an invasion of privacy to conduct an Internet or social media site search for people that they know or work with, and they believe that publicly accessible social media profiles are public information.18”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] source
Not checked in the free run.
May combine two claims.
Premisecitation§ Social Media in Clinical CareIn a survey of practicing physicians, about one third of those who use social networking reported receiving a friend request from a patient or a patient's family member; only 5% had ever sent a friend request themselves.
“In a survey of practicing physicians, approximately one third of physicians who use social networking reported receiving a friend request from a patient or a patient's family member; however only a small minority (5%) had ever extended the friend request themselves.22”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [22] source
Not checked in the free run.
May combine two claims.
Premisecitation§ Uphold the Standards of Professionalism (AMA Principle II)There is less certainty about what constitutes appropriate professional behavior online, and opinions differ between medical students and faculty and among medical education faculty.
“With the blurring of personal and professional content online, there remains less certainty about what constitutes appropriate professional behaviors online, and these opinions differ between medical students and faculty and even among medical education faculty.5,6,38”
Quote in the paperNot a substantial claim0 of 3 sources checkedMay combine two claims.
Premisecitation§ Communicating Directly With PatientsOn unsecure open sites such as Facebook and Twitter, postings, whether public or private messages, may ultimately belong to the third party, and security breaches have been known to occur.
“On unsecure open sites, such as popular third-party sites Facebook and Twitter, postings, whether open to the public or private message, may ultimately belong to the third party, 51 and security breaches have been known to occur.52”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [51]
Not checked in the free run.
- cites [52]
Not checked in the free run.
May combine two claims.
Premisecitation§ Social Media in Clinical CareA study of pediatric faculty and trainees found that 14% to 18% of trainees, but no faculty, had searched the Internet or social media for information about a patient; 14% of faculty said they would conduct such a search if necessary.
“A study of pediatric faculty and trainees found that 14% to 18% of trainees (but no faculty) had conducted an Internet or social media Web site search for information about a patient; 14% of faculty stated they would conduct an Internet search for additional patient information if necessary.18”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.
Interpretationnone given§ DiscoverabilityThe authors believe that choosing the highest privacy settings for personal social networking pages helps create boundaries between personal and professional content and limits unwanted contact with patients.
“Despite this, we believe that opting for the highest privacy settings for personal social networking site pages helps to create boundaries between personal and professional content and limits any undesired contact with patients.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone given§ Social ImplicationsMarketing a practice on social media may yield a return on investment.
“Marketing one's practice on social media may bring a return on investment”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationreasoning§ Social ImplicationsTwo-way video can provide more authentic communication than instant messages, email, texting, or one-way video.
“Also, the use of 2-way video can provide more authentic communication than instant messages, e-mail, texting, or 1-way video.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationreasoning§ Looking Up Information About Patients on the InternetAlthough the initial act of looking up patient information may be ethically sound, there is no consensus about how best to use that information in clinical care.
“So, while the initial action of looking up patient information may be ethically sound, there lacks consensus about how best to use this information in clinical care.”
Quote in the paperSubstantial claim- Rests on an assumption: Publicly accessible social media profiles are public information that may be accessed without invading privacy.
May combine two claims.
Premisecitation§ Support Access to Medical Care for All People (AMA Principle IX)A 2012 survey found that 97% of US college graduates used the Internet, compared with 45% of people without a high school diploma.
“For example, a 2012 survey found that 97% of US college graduates use the Internet compared with 45% without a high school diploma.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [70]
Not checked in the free run.
May combine two claims.
Premisecitation§ Commercial Interests and Patient ExploitationIn that study, clinically inaccurate recommendations were uncommon but were usually tied to promotion of a specific product.
“In addition, although clinically inaccurate recommendations were infrequent, they were usually associated with promotion of a specific product.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] source
Not checked in the free run.
May combine two claims.
Premisecitation§ Support Access to Medical Care for All People (AMA Principle IX)Social media use is increasing across all age groups, but it is more common among wealthier and more educated people.
“Social media use among all age demographics is growing; however, use is skewed toward the wealthier and more educated.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [70]
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Interpretationreasoning§ Social ImplicationsThere is concern that more time spent interacting online and less face-to-face interaction between doctors and patients may reduce the ability to relate to others and lead to less empathy.
“With a greater amount of time spent interacting online, there is concern that the corresponding decrease in face-to-face interactions between physicians and patients may result in less ability to relate to others and a decline in empathy.”
Quote in the paperSubstantial claim- Rests on an assumption: Online relationships lack critical nonverbal cues.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Giving Medical AdviceTerry warns that any personalized response may imply the creation of a physician-patient relationship even if a disclaimer is given.
“Terry warns that any personalized response may imply the creation of a physician-patient relationship regardless of whether a disclaimer is given.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [72] source
Not checked in the free run.
May combine two claims.
Premisecitation§ Support Access to Medical Care for All People (AMA Principle IX)Evidence shows telemedicine provides at least comparable care in emergency departments and benefits in surgical and neonatal intensive care unit settings, among others.
“There is evidence that telemedicine provides at least comparable care in emergency department settings, as well as benefit in surgical and neonatal intensive care unit settings, among others.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [25] source
Not checked in the free run.
Classified as probably not a substantial claim.
Interpretationnone given§ Giving Medical AdviceA nonpatient may ask a doctor for medical advice while the doctor is using social media or email.
“While using social media (or e-mail), it is possible that a nonpatient asks a physician for medical advice.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based). May combine two claims.
Interpretationnone given§ ConclusionsSocial media has changed communication and is beginning to change healthcare.
“Social media has transformed communication and is on its way to transforming healthcare.”
Quote in the paperNot a substantial claimMay combine two claims.
Premisecitation§ Online "Friendships" With Patients on Social Networking SitesResearch indicates that doctors' self-disclosures in clinical settings may not benefit patients and can sometimes be disruptive.
“Research suggests that physician selfdisclosures in the clinical setting may not help patients and, in some cases, may be a disruptive influence.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [67] source
Not checked in the free run.
May combine two claims.
Premisecitation§ Physician Rating SitesSome online physician reviews appear disproportionately poor or may constitute possible acts of sabotage from competing providers.
“there are those reviews that appear disproportionately poor or even constitute possible acts of sabotage from competing providers.62”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [62] source
Not checked in the free run.
May combine two claims.
Premisecitation§ DiscoverabilityContent posted on social networks is discoverable regardless of privacy settings and can be used to judge a person's character in lawsuits.
“Content posted on social networks, regardless of whether privacy settings are used, is discoverable and can be used to judge an individual's character in lawsuits.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [51]
Not checked in the free run.
- cites [72] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationcitation§ Online "Friendships" With Patients on Social Networking SitesThat majority view may have arisen because respondents assumed interactions would happen on public sites rather than secure patient-provider portals.
“This may have been because respondents assumed that interactions would be occurring on public sites and not secure patient-provider portals”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [22] source
Not checked in the free run.
May combine two claims.
Premisecitation§ Future PossibilitiesRegional differences in medical treatment have been shown, and both patients and doctors are not always aware of current best practices.
“Regional variations in medical treatment have been demonstrated, 75,76 with both patients and physicians not always aware of the current best practices.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [75]
Not checked in the free run.
- cites [76] source
Not checked in the free run.
May combine two claims.
Interpretationreasoning§ Support Access to Medical Care for All People (AMA Principle IX)Health literacy, computer literacy, computer access, and language barriers can all limit how far social media reaches in clinical care.
“Health literacy, computer literacy, computer access, and language barriers can all play a role in limiting the reach of social media in clinical care.”
Quote in the paperSubstantial claimMay combine two claims.
Premisecitation§ Trust and Social Media Relationships Between Physicians and PatientsA patient-physician relationship is strengthened when doctors give information, support independent decisions, act respectfully and promptly, keep confidences, and make care accessible.
“The patient-physician relationship is nurtured when physicians provide information, encourage autonomous decisionmaking, act respectfully and in a timely manner, preserve confidentiality, and facilitate access to care.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [63]
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
Interpretationcitation§ Establishing Patient-Physician Relationships Using Social MediaIt is questionable to establish a patient-physician relationship only through social media, just as establishing one by email outside an existing relationship raises concerns about the relationship's integrity, trust, and the patient's best interests.
“Just as establishing a patient-physician relationship via email outside of a preexisting relationship may be medically and ethically objectionable because of questions about the integrity of the patient-physician relationship, trust, and the patient's best medical interests, 65 so comes into question establishing a relationship solely via social media.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [65] source
Not checked in the free run.
May combine two claims.
Premisecitation§ Online "Friendships" With Patients on Social Networking SitesA dual relationship can harm the medical care given to the patient or add interactions that are not part of the therapeutic relationship.
“that may compromise medical care provided to the patient and/or introduce interactions extraneous to the relationship.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [66] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ Commercial Interests and Patient ExploitationThis practice has raised the question of whether patients are being exploited for more targeted drug marketing as well as for scientific research.
“Although this is disclosed to members as a matter of transparency, the practice has brought into question whether patients are being exploited for the purposes of more targeted drug marketing, alongside contributions to scientific research.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [69]
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationreasoning§ Social ImplicationsAs with email, using social media for clinical care brings issues of time and reimbursement to the forefront.
“Similar to e-mail, social media use by clinicians for clinical care brings the concepts of time and reimbursement to the forefront.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ Online "Friendships" With Patients on Social Networking SitesOn professional social networking sites where little personal content is shared, doctors may be able to connect with patients while keeping the relationship professional.
“However, in other cases, such as professional social networking sites where limited personal content is shared, physicians may be able to connect with patients and still maintain the professional nature of the relationship.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ Future PossibilitiesThe time needed for research to spread, expert opinions to be voiced, and important discussions to occur certainly contributes to that gap.
“However, certainly contributing is the time it takes for research to disseminate, expert opinions to be voiced, and important discussions to take place.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationreasoning§ Trust and Social Media Relationships Between Physicians and PatientsSocial media can help doctors meet some of these relationship goals by making information sharing easier and improving patient access to their providers, which builds trust.
“Social media can help physicians accomplish some of these goals through facilitation of information sharing and improving accessibility to their providers, thereby building trust.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationcitation§ Support Access to Medical Care for All People (AMA Principle IX)Overcoming these barriers is essential for social media to advance healthcare delivery and communication for everyone.
“Addressing these barriers is pivotal to social media advances in healthcare delivery and communication to benefit all.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [71] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ DiscoverabilityThe policy also says information may be shared for many reasons, including aiding investigations, preventing fraud or illegal activity, or protecting Facebook, the user, or others.
“The policy also states that information may be shared for any number of reasons, including to aid investigations, prevent fraud or illegal activity, or to protect Facebook, the user, or anyone else.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [51]
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.
Interpretationreasoning§ Future PossibilitiesSocial media may speed up this process and lead to faster translation of evidence into current practice.
“Social media may streamline this process and lead to faster translation of evidence to current practice.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Publicly accessible social media profiles are public information that may be accessed without invading privacy.
“The act in of itself is not wrong, because the search accesses public information.”
The paper relies on this without support.
Deidentification by omitting or changing key patient details prevents patients from being identified.
“Deidentification can be accomplished by omitting or changing key patient details, avoiding description of rare medical problems, and not including a specific time frame or location when and where the encounter occurred (Table 2).”
The paper relies on this without support.
Closed, secure systems with data encryption can adequately safeguard protected health information in social media communication.
“Closed, secure systems with data encryption can maximize safeguards.”
The paper relies on this without support.
There is an inherent power differential in the patient-physician relationship.
“because of the inherent power differential within the relationship”
The paper relies on this without support.
Online relationships lack critical nonverbal cues.
“Relationships online lack critical nonverbal cues”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Various concerns about potential professionalism implications exist, particularly related to breaches of patient confidentiality, professional boundaries, and depiction of unprofessional behaviors.
“Various concerns about potential professionalism implications [151-153] exist, particularly related to breaches of patient confidentiality, professional boundaries, and depiction of unprofessional behaviors.”
From Dangers and Benefits of Social Media on E-Professionalism of Health Care Professionals: Scoping Review (2021) · cites this paper as [153]
Physician-bloggers have used social media to share health information, network with colleagues, disseminate research, market their practice and engage in health advocacy.
“Physician-bloggers have used social media to share health information, network with colleagues, disseminate research, market their practice and engage in health advocacy [14].”
From Social media use by physicians: a qualitative study of the new frontier of medicine (2016) · cites this paper as [14]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Reference 47 gives conflicting years
MinorThe reference states a publication date in 2001, while its URL contains the date path 2011/04/18.
“Published April 18, 2001.”
“http:// www.boston.com/news/local/rhode_island/articles/2011/04/18/ri_doctor_”
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- Authors
- Chretien, K. C., & Kind, T.
- Affiliations
- Children's National (US)
- Venue
- Circulation
- Published
- 2013-04-02
- Volume
- 127
- Issue
- 13
- Pages
- 1413-1421
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2126763155
- Semantic Scholar
- df8eb661c9617b80e5cac9ebc4b55c01b195d7ab
- Cited by
- 355
- References
- 52
- Citations by year
- 2026: 17 · 2025: 17 · 2024: 23 · 2023: 27 · 2022: 29 · 2021: 38 · 2020: 31 · 2019: 32 · 2018: 30 · 2017: 33 · 2016: 25 · 2015: 25 · 2014: 20 · 2013: 8
- FWCI
- 4.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Health › Social Media in Health Education
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Physical Sciences › Computer Science › Information Systems › Web and Library Services
- Keywords
- social media, clinical care, physician social media use, patient engagement, health communication
- MeSH terms
- Patient Care, Humans, Professional-Patient Relations, Social Behavior, Social Media
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.
Statistics and arithmetic are recomputed, not judged.
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