Explore This IssueSeptember 2013
With technology come both risks and rewards. The Internet and social media provide countless new opportunities to educate patients and improve health care but pose significant liability threats for individual clinicians and the health care profession as a whole if they are misused. Without a doubt, authoritative health information and social media sites dedicated to serving the specific needs of patients can be of significant benefit. I refer to my own experience as a vivid example.
Through a colleague in another specialty, I evaluate an unusually large number of patients with symptoms of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAs). In my assessment of their history, I find that nearly every one of the parents has arrived at the diagnosis after searching online for information about sudden onset behavioral problems in their child and has stumbled across PANDAs or pediatric acute-onset neuropsychiatric syndrome. This discovery then leads them to social networking sites, where they find stories similar to their own. That information, in turn, leads them to lists of physicians who know about PANDAs, and other parents’ experiences with the physicians. More often than not, when parents bring these findings to their primary care physicians they get a blank stare and an admission that the physician knows nothing about the disease. The thing I find so fascinating is that information posted online led these parents to the diagnosis and enabled them to find a group of physicians capable of and interested in treating their children.
This experience has really solidified for me the importance of the development of authoritative websites by academies, physicians and other health care providers who are dedicated to diagnosing and treating specific diseases or syndromes. These sites provide an invaluable service to our patients. A 2011 Pew study found that 80 percent of Internet users look for health-related data. This number reinforces the need to provide factual and easily understood information online for our patients. It is easy, however, to fall into the trap of giving advice to parents or patients without first establishing a patient-physician relationship. Clinicians who blog increase their liability risk if they do not adhere strictly to guidelines that govern professional interactions via social media and electronic information systems.
Recent guidelines have been published by the American College of Physicians (Ann Intern Med. 2013;158:620-627). The document outlines behavior for social media, as well as any form of electronic information. In today’s digital world, health care information is difficult to keep confidential. Once it is “out there” it cannot be retrieved, and the damage caused by releasing the information may be ongoing for the patient and clinician. As health care providers, we are held to a very high standard by the Health Insurance Portability and Accountability Act, which is continually being upgraded and revised. This law has teeth, and if the standards are violated, clinicians can be fined, go to prison and/or lose their license to practice medicine.
Now, let’s talk about e-mail for a moment. E-mail can supplement, but should not replace, a face-to-face encounter. With established patients, some types of information sent via e-mail can significantly improve efficiency, communication and patient satisfaction. There is certain information that is factual, difficult to misinterpret and conveniently delivered through an e-mail. One must use discretion, however, with regard to specific patients and content; it goes without saying that it is probably not a good idea to deliver the diagnosis of cancer to a patient through an e-mail.
A physician’s use of e-mail raises significant legal issues, such as interstate licensing restrictions and potential liability issues. These are separate from ethical issues that must also be considered. Almost all guidelines state that there must be a prearranged agreement documenting the willingness of the clinician and the patient to communicate via e-mail. This agreement should be readily retrievable, preferably in an electronic medical record. E-mail communications are like letters and need to be well documented in the medical record.
The other thing to remember is that e-mails are always interpreted through the lens of the reader. The sender’s intent is not always necessarily communicated well, and one of the most important means of communication—body language—is not available. I learned early in my career never to handle sensitive issues through e-mails or texts, because your intent cannot always be accurately delivered and it can be easily misinterpreted. Instead, have a face-to-face encounter with your patients so you can effectively communicate with them.
One last thought regarding e-mail communications: They are not necessarily secure and may be widely distributed out of context. It is always much safer to use an electronic medical record portal that has encrypted texting and implied consent to communicate.