Social Media Best Practices

4. GENERAL PRINCIPLES IN USING SoMe

When using SoMe platforms, urologists should comply with a number of general principles, as shown in Figure 1.

Figure 1: General principles when using SoMe

4.1. Understand the various types of SoMe platforms

SoMe platforms vary by their style of content presentation, mode of user interactions and audience composition [18]. The optimal SoMe platform depends on the objectives of SoMe usage, the target audience, the nature of content being delivered and the planned key performance indicators [18]. Understanding the various SoMe platforms is important to help you decide which is the best platform with which to engage. In terms of practicality, tweets or posts are useful because they can be scheduled to be released at certain times. Users can also analyse SoMe metrics to decide on the best time and day of the week to release the SoMe content. You can also boost visibility via the SoMe platforms to maximise reach and engagement. This, however, carries additional costs and should be done in a strategic manner.

4.2. Establish and maintain a professional digital identity

Establishing one’s digital identity in a professional manner is important [19, 20]. When setting up a professional account, physicians should state clearly who they are, what their field is and the capacity in which they are interacting via the SoMe platforms. In general, physicians are encouraged to use their own names rather than pseudonyms. When using pseudonyms, their names and professions should still be clearly stated and accessible by the public. Although some users may wish to create anonymous accounts for various purposes, anonymous accounts are not acceptable if these accounts report medical opinions or medical expertise or seek to influence the medical opinions and views of others. Your digital profile and online behaviour must also align with the standards of the profession [21]. Physicians should also remain constantly vigilant of their publicly accessible digital profiles by periodically checking for mentions of their names in the online research results [22, 23].

4.3. Do not breach patients’ privacy or confidentiality

Users of SoMe must not disclose any patient’s sensitive information on SoMe and, if deemed necessary, a patient’s informed consent must be sought before posting their information [19, 20]. It is fundamental practice for physicians not to identify patients, show images that could lead to their identification, or discuss treatment or pathology in a manner that could lead to a patient being identified. While sharing patients’ data, physicians must bear in mind that even vague clinical details can result in patient identification and may violate professional ethical standards and health care privacy laws [24].

According to the Health Insurance Portability and Accountability Act (HIPAA) – a U.S. law that established standards to protect sensitive health information and safeguard patient privacy – protected health information (PHI) under HIPAA is individually identifiable health information that is collected or maintained by an organisation that qualifies as a HIPAA-covered entity of business associate [25]. Any information that identifies, or could be used in combination with other information to identify the subject of the health information is also considered PHI under HIPAA [25]. Examples of PHI include but are not limited to name, dates, telephone number, fax number, geographic data, email address, social security number, medical record number, health plan beneficiary number, account number, certificate or license number, vehicle identifiers, device identifiers, web URL, internal protocol address, Internet Protocol (IP) address, full fact photos and comparable images, biometric identifiers (e.g. retinal scan, fingerprint, etc), or any unique identifying number or code [25].

4.4. Avoid providing medical advice through publicly accessible SoMe platforms

SoMe users should always be aware that conversations on SoMe platforms can be misinterpreted as patient-physician relationships. Personal opinions can be misconstrued as formal medical advice, and any opinions given to an individual may be inadvertently generalised [26]. While generic discussions of medical conditions and their management are acceptable, physicians are recommended not to provide any patient-specific medical advice via the SoMe platforms. When in doubt, physicians should include disclaimers clearly stating that any posted material does not represent medical advice and is not a substitute for a formal medical consultation [27]. When contacted by a patient or family member, physicians should recommend scheduling a formal appointment or refer the interested party to legitimate sources that provide accurate medical information.

4.5. Assume that SoMe posts are permanent

Any material posted on SoMe platforms should be considered permanently available and publicly accessible [19-21]. Users should adopt a ‘pause before you post’ rule to remember the permanence of all SoMe interactions and consider the possible consequences for several reasons. First, the physician may regret posting on impulse or whenever judgment may be clouded. Second, any quotes, photos and commentary can be taken out of context and reposted elsewhere, despite privacy settings. Third, SoMe platforms may apply a policy of “free use”, implying that the use of existing materials from their platforms may not require further permissions [28]. This is often based on an assumption that users who upload material accept public accessibility and consent to its redistribution, and this may result in a copyright breach [28].

4.6. Exercise professionalism

Medical professionals are asked to maintain high standards of professionalism outside of work, and the use of SoMe is no exception [19-21]. Physicians should always ensure their comments and behaviour on SoMe platforms are within the context of appropriate professional opinions, views and standards. When interacting on the SoMe platforms, maintaining a respectful and collegial tone while disagreeing with colleagues is recommended. Physicians must avoid defamatory and personal comments that violate professional norms. While not compulsory, reaching out to and reminding colleagues whose SoMe conduct is inappropriate can be considered. While posting, even for communications that are meant to be private, physicians should bear in mind the potentially wide distribution of their personal messages/posts and the fact that replication outside the original context is possible. A review performed in 2016 showed that 43% of urologists had posted unprofessional content on Facebook and other SoMe platforms [29]. This highlights the importance of proper training and education to enhance online professionalism [30].

4.7. Be aware of SoMe policies utilised by employers and regularity authorities

Some institutions have established policies that may set limits on sharing medically related posts publicly on SoMe platforms. It is the physician’s duty to review any SoMe policies created by his/her institution to stay compliant with these policies [19, 21]. Some employers require their employees to state explicitly that their views expressed on SoMe platforms do not represent those of their institution. Users can consider including a disclaimer in their profiles stating that any posted content represents their own opinion. Sample statements include ‘‘views expressed are my own’’ and ‘‘retweets do not imply endorsement’’ [19].

4.8. Avoid misleading advertisement and self-promotion

Health care professionals have the obligation to offer sound opinions and report factually correct data. Physicians should not make claims that cannot be substantiated or verified and should not advertise their services or results beyond medically verifiable data. They also should not claim superiority over other physicians, as this is often without solid basis and may result in medicolegal consequences. Online discussions or posts which could be associated with financial conflicts of interest must be transparent [19]. Users should be aware of the variations of regulations across different regions; it is the physician’s duty to ensure their online behaviour is compliant with their local regulations.

4.9. Use disease-specific hashtags for structured online communication

On SoMe platforms, content is organised using topic indicators known as “hashtags” [31]. By searching the hashtag on SoMe platforms (symbolised using the hash sign: #), only posts that contain that hashtag will be sorted out for viewing [31]. This can facilitate the relevant information that is of interest to the user. In fact, urology has been one of the first specialties to standardise the hashtags in a systematic way by means of the “Urology Tag Ontology Project” initiated back in 2016 [GM5] [GG6] [JT7] [32-34]. As of 2021, more than 4.2 million tweets contained the proposed hashtags [31]. The list of hashtags is updated regularly and can be readily accessed online (https://www.symplur.com/healthcare-hashtags/ontology/urology/)). Physicians are encouraged to use these proposed hashtags when posting content on SoMe platforms to facilitate sorting and filtering of content according to the needs of the end user [32-34].

4.10 Treat negative comments on SoMe in a constructive manner

Negative comments are common on SoMe platforms [35], and it is important for users to actively monitor their SoMe platforms and moderate responses. Users should attempt to understand the overall incident and the underlying reasons leading to such negative comments. If the negative comments are judged valid, users should respond to the comments promptly and consider apologising if deemed necessary. Rather than arguing and fuelling potential conflicts, users should try to appreciate the negative comments and be open-minded, inquiring as to how they can help to rectify the situation and address any concerns. Deleting negative comments is generally not recommended, unless these comments become offensive and abusive. Similarly, blocking users is generally not recommended, unless these users have posted offensive and abusive comments repeatedly.