By: Darwin Wan, MS3


A stern warning regarding social media usage has been delivered to the medical community in April with news of Dr. Alexandra Thran’s reprimanding by Rhode Island’s state medical board.  Dr. Thran had already been fired last year from Westerly Hospital in Rhode Island for the posting of confidential patient information online.  Although the patient’s name was not included, the board filing stated that enough information was included that enabled others to identify the patient. The action by the state board signifies that a doctor may not just lose a job for a social media transgression but, in a severe case, her livelihood.

Social media such as Facebook and Twitter are relatively new creations, having only come into existence in the past few years.  Given the swift pace with which technology, media and medicine evolve, it is nearly impossible for ethics, law and guidelines to keep abreast with every new development.  Similar to the way controversial medical research and practices can spring up before society has decided on its stance, social networking sites like Facebook can quickly reach a critical mass of users long before medical institutions have had a chance to produce of usage guidelines.We are currently at such a critical point.

As mobile technology and social media explode and attract the previously apathetic or indifferent, more and more users are entering the unfamiliar world of the internet.

Technologically savvy physicians, students and other health providers, including readers of, are likely to be involved in social media.  But many of us who may be new to social media may have no idea of what the rules of engagement are on the internet, and may not fully realize that posting on the internet is more public than hospital elevator chatter.

While one can see who is in proximity of the hospital elevator, one has no way of knowing who might read a Facebook status update or tweet.  And while elevator speech disappears after the sound rarefactions dissipate, internet posts do not easily vanish.

One should assume that anything posted on the internet is permanent and traceable.

In that sense, we as health care providers should hold our social media posts to higher standards than we do our everyday hallway conversations.  When posting medical information online, we must ensure the information is accurate, or a disclaimer is given to keep liability at a distance.  Clarify that your post represents your opinion, and not the opinion of your affiliated institutions.

While the present commentary may seem like an indictment of social media and the internet, there are many positive qualities that more than justify its usage.  From the most obvious benefit of being mostly free of charge to subtler benefits of facilitating transmission of information, health care organizations and personnel would be amiss to dismiss social media.

The Mayo Clinic Center for Social Media is a prime example of a health care organization realizing the power of social media to disseminate information to patients and the general public and taking advantage of it early on.  In their own words, “Social media tools make the once-scarce power of mass media available to everyone”.  While some health organizations are banning social media others are in the process of producing guidelines. I am hoping more will follow the Mayo Clinic’s example and take advantage of this powerful tool.

Though many schools and hospitals have yet to produce clear guidelines for usage, there are existing ones that we can learn from:

  • The American Medical Association’s “Professionalism in the Use of Social Media” (read here) policy provides short and succinct instructions on conduct in cyberspace.
  • The Washington University in St. Louis School of Medicine’s guidelines (read here) contain quite a bit more detail on social media usage, especially when one is identifiable as being affiliated with an institution.
  • Mount Sinai Medical Center’s Addendum to Social Media Guideline (read here) are helpful in that they provide a dozen fictional but conceivable examples in which improper social media usage can occur, and prompts readers to reconsider their own online interactions in a different light.

In the end we must not forget the apt Spiderman quote, “With great power comes great responsibility”.  With the power of mass media at our fingertips, we must be certain that no matter what we post, we must be comfortable seeing it on primetime television.  We are ambassadors of our profession and institutions, when we are online and even ostensibly anonymous.  And, as the new adage goes, “the Internet is forever”.