Friday, August 12, 2011

Social media risks for medical students

Social media use by medical students is a dangerous proposition for five reasons:

1) The information that medical students steward is particularly sensitive, has massive consequences for the vulnerable populations from which it's drawn, and the privacy of which is protected by federal law.

2) Sharing this information with one’s colleagues and superiors, in write-ups, presentations, and casual discussion, is expected as part of a med student's medical education. Doing so appropriately within the traditional contexts is hard enough without trying to determine what's tweetable.

3) Medical students have a lot to lose, both in terms of resources invested and future career ramifications, if they are found in violation of patient privacy, if they insult their school, or if they say something boneheaded. Crucially, students are often naive to their own personal stakes.

4) As digital natives (having matured entirely in the connected, internet age), today’s medical students have deeply ingrained information sharing habits that may be incommensurate with their new responsibilities.  

5) There is a growing body of MD’s, healthcare workers, and commentators who encourage medical students to engage with social media as a central feature of medical education and future practice without adequately preparing these students to be responsible (and often without consensus even amongst themselves). 

Three concerns come to mind: 

1) How do we protect patients?
2) How do we protect institutions?
3) How do we protect students themselves?

Until we can robustly offer these three protections, I do not think it is right to encourage medical students to join the social media space.

Am I being overly cautionary? 

Am I missing any areas of protection?

Your thoughts are SO, so welcome!


mark said...

My bias is to encourage medical schools to help students understand how to use social media safely and professionally, as opposed to withholding my support for student involvement. There is significant value in social media engagement; I would hate to throw the baby out with the bathwater.

astupple said...


I certainly agree that medical students should get involved. It's a very valuable baby. My concern is that medical students need specific help to understand its safe and professional use, much more than the typical social media policies that I've seen.

Thanks for your input!

Emily Lu said...

I had to read and reread this post to try and figure out whether it was coming from the same person who wrote this post on how students could use social media in electives to listen and learn. Sorry, the stark list post format acting like all your saying is the be-all and end-all of your relationship with social media is really not doing it for me.

That said - you do raise very real questions. I've often felt that a strictly proscriptive or even a vague "common sense"-based social media policies are problematic as really capturing the potential of social media -- both to be an asset to learning and a danger, as you highlight here. I don't have any great comprehensive answers, but my initial thoughts are: great mentors and role models and the willingness to listen and learn.

astupple said...

Haha, it is pretty stark, but I think the points stand. We can be very enthusiastic while maintaining some serious concerns. My ultimate point is that, just because social media is great (and I think it is), that doesn't mean it's not a risky proposition. Furthermore, we should address these risks to students BEFORE encouraging them to dive in.

Kinda funny how it's a lot like other aspects of medicine. For example, I'm a big fan of prescribing drugs for people when they're sick, but just because medications are helpful doesn't mean that there aren't serious risks involved. These risks should be addressed, in stark terms, before encouraging someone to use medications.

Thanks for your comments Emily!

Anne Marie said...

Thanks for posting this Aaron. I know that a conversation we had one day contributed to this a little.

My personal rule is never to talk about experiences with patients online, without very explicit consent. I know that some people feel that is over-the-top, but I write in my own name and it is easy to identify where I work so therefore it would not be hard for my patients or those who know them to figure out if I was talking about them without there consent.

Medical students tend to move around a lot more (work in different hospitals and different specialties) so for them talking about an encounter with a patient might not make that patient as identifiable as if I did. But we have to think as educators how we frame that kind of activity for students. Because it might be less risky as a student doesn't mean that it is the right thing to do, and certainly doesn't mean that we should be encouraging this as an activity which they carry on through to their working lives.

I agree with you that I have seen mixed messages about this from educators.

I have never encouraged a medical student in my own institution to start using social media but I have had some very initial conversations with them about how they feel about an online presence.

I have been contacted by students who have been in the process of writing blog posts to provide advice on what they are writing and I have obliged. I have told them about my rules.

I feel that the main purpose of my social media presence is to learn about the risks and possibilities for myself. I am not an evangelist. I want to have considered discussions with others and I am very cautious about saying that all students (or doctors) should participate in this activity.

I am aware that when I facilitate a discussion such as #meded chat I am possibly amplifying the contributions of medical students because these tweets are archived and much easier to identify afterwards.

So far we have deliberately chose topics for EU/UK #meded chat which are unlikely to lead to conversations which infringe patient confidentiality. In that way I hope that these conversations might model how social media can be used constructively.

Thanks again for your post.

astupple said...

Anne Marie,

Thank you for your comments. I'm struck by your active voice, first person accounting.

I like the idea of clear boundaries that, while perhaps over-the-top, are valuable for their clarity. "Never talk about experiences with patients online" is a nice place for the uninitiated to start. Being bold is great, but starting bold, without understanding the consequences, is dangerous.

I've got some follow-up pieces about what a robust social media policy for med students would look like, I look forward to your thoughts!

Ryan Madanick, MD said...

I agree with Mark, and Anne Marie's comments are very important. I do not think we should DIS-courage students from using SM, but we should not be punishing those who do.

Instead, it is encumbent upon us to train students in the meaning of being a physician, aka professionalism. There is a great article in the Annals of Internal Medicine ( addressing this issue. It is akin to addressing professionalism in the "new" age of the telephone or "new" age of email from eras past. The major difference now is that there are more inherent privacy risks. Thanks for posting.

Mike Moore said...


Like Emily I had to read this post several times to figure out your POV for this one given your previous posts. I can immediately think of a counterpoint to each of "dangers" you point out and I think that is going to be addressed in a separate post.

But I would like to hinge off Emily's closing comment about "great mentors and role models and the willingness to listen and learn" and go a little bit further to posit that we need to engage professionally with both the SM space and the Real Life (RL) space professionally...and that professionalism in RL will carry over to SM. Furthermore, the way we learn that professionalism is by interaction with mentors and role models. Not in a vacuum. SM is like the old school Doctor's Lounge, challenging...but a key professional skill to master for success.

Nice post Aaron. You made me think. I read dozens of #medstudent blog posts a week and you made me comment! Appreciate you!


astupple said...

Dr. Madanick,
I love the "dual citizenship" idea in that article. I've been working on some recommendations for using dual citizenship to achieve the three concerns I outlined here at the end. I see how it can protect students (a little), but I'm not seeing how it can help with the other two... would love your thoughts here.
And thanks for reading!

Mike Moore said...

I've thought about "dual-citizenship" a lot, especially with the all of the recent discussion on tw about anonymity and professionalism in health care. The more I think about it it I believe that "dual-citizenship" provides a false sense of security. In the end you have to accept that your personal life and professional life are intermingled to a certain extent, and that you really need to act with propriety within both realms. Being accountable in this sense is difficult for some, but the reality (for me at least) is that an integrated "presence" can be the most viable option to maximizing the value added characteristics of SM personally and professionally; as well as minimizing the risks to provider (little discussed) and patient privacy. In the end, transparency and communication will succeed.

astupple said...


I don't think anyone would disagree that we need to pay attention to "great mentors and role models and the willingness to listen and learn." However, there's a huge difference between sharing this sentiment and actually having some specific guidelines, "hot-to's", and training modules to point med students towards. Until we have that; a robust set of resources that can adequately protect patients, institutions, and student, then I for one do not at all feel comfortable encouraging any students to get involved.

We can quibble about the specific nature of the risks and the chances that they'll cause problems. But if a single student compromised a patient's privacy, or jeopardizes their own career, or triggers a scandal for their school with social media, I would be devastated if they had done so at my encouragement had I not pointed to some robust guidelines.

I use the word robust to move the discussion beyond simple statements about the value of professionalism. Students need to be shown precisely what this means, specifically how it is violated, and practically how to actually do this right.

Yes we need to master professionalism. But HOW?

Greatly appreciate your attention here!

*^_^* said...

Nice post! Keep it coming!!

Scott said...

What is your opinion of Social Media in the private health care sector for communication with patients? Additionally, I would love to know your thoughts about email communication. I believe the MCR changes need to look carefully at non-face to face communication as a source of reimbursement in our future reform.

astupple said...


I think communication with patients is an absolute necessity, but only after the details get worked out, devilish as they are. I mean, how much of the doctor-patient relationship is sharing? And it's hard to share easier than through social media. We just have to figure out how to do it right, and more robust guidelines are a start.

My understanding of email communication is that, like most forms, it is not secure. If patients initiate info sharing via email, that's one thing. Otherwise, there again should be guidelines about what info is amenable to email and what isn't. For instance, offering specific diagnoses is not a good idea; offering general recommendations about diet and exercise, yes.

Overall, a great deal of medicine is information mastery. According to some (Clay Shirky being my current favorite commentator/philosopher) we are in the midst of an information and communication revolution akin to the introduction of the printing press. Such a revolution has to touch medicine. More than touch it, it has to fundamentally alter it. It feels way too early to predict how. It feels to early to even predict that Twitter will be a player. But, Twitter is here, and it can serve some purpose with patients, and if I was a practicing doc, I'd try a little bit of doctor-patient communication with it. Not a ton, and I'd be awfully careful, but I'd try it.

I liked your article. The topic of democratizing medicine is of particular interest to me, especially how this should reduce costs. I would guess that democratizing would hurt doctors' bottom line, unless they shift and become masters of the new game- another reason that I think docs gotta dive in.

Again, as per the post, I'm advocating seasoned DOCTORS dive in, doctors who understand the subtleties of professionalism, patient privacy, etc., not medical students.

Thanks for reading!

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Jesse Torres said...

I wanted to share this social media risk resource. It's the Human Resources Guide to Social Media Risks. It is available at

astupple said...

Jesse- Fantastic, thanks for mentioning this book!

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Dominic said...

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