Avoid being too social when using social media
Attracting and keeping patients is vital in today's economy, but advertising and other conventional marketing methods are expensive and must be applied over time. However, help has arrived from the social media revolution: Facebook, Real Self, Twitter and others (and perhaps more in the future) can provide attractive, alternate methods to increase practice exposure and enhance prospective patient interaction.
The trade-off involves the level of exposure inherent in social media, which opens plastic surgeons to a variety of concerns, potential violations and risk. These fall into several groups, the most common of which are office staff issues, practicing within legal standards, HIPAA and reputation protection.
Office issues
Establishing a business Facebook account to expose your practice to your existing patients and others sounds like an attractive proposition. Your office staff will feel the brunt of additional work associated with posting, creating, monitoring and keeping your Facebook page up-to-date - not to mention interesting. This could easily be a full-time job, and it's reasonable to think that the resulting time-management problems could diminish attention to current patients, follow-ups, documentation and the regulatory requirements seemingly inundating our practices.
Your staff must be aware of state regulations covering Internet communication, state licensure issues and HIPAA rules and regulations. Failing to both keep up with and adhere to these requirements is no excuse for violations.
A simple example goes like this: The practice receives an Internet inquiry seeking specific answers to a breast implant issue. The "prospective patient" has neither visited the practice nor met the plastic surgeon, but specific answers are provided that this "patient" may be able to rely upon. This establishes a doctor-patient relationship. If the "patient" lives in another state where the doctor has no medical license, that physician has violated state law by practicing without a license, and the "patient" may bring a negligence lawsuit if the provided information has harmed her in any way - all without the doctor never actually seeing or communicating with the "patient."
It would be wise to plan an approach and a patient response system, and delegate responsibility before you open a business Facebook account. It's wise to create answers to common questions about procedures and trends - while remembering to develop generic, non-specific comments that always suggest urgent local care if necessary. Your own patients, once a part of the practice, can enjoy complete communication without this requirement. The advice should not be negligent, should be documented and should be kept as a business medical record. This should be done after establishing through written confirmation that e-mails are an appropriate method of communication for the patient.
State legal standards
As noted above, states require an active medical license before a doctor can practice medicine. It has been held that providing advice upon which a prospective patient relies falls within the practice of medicine. States also have Internet communication standards that should be followed, so check with your state medical society about these standards or guidelines.
States may also have Informed Consent Panels, which must be disclosed when presenting or obtaining consents for treatment. Make sure the advice provided, if specific, includes accepted advice that falls within the standard of care and includes the state-required risks, if any.
HIPAA observances
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 created significant privacy rules that govern our practices. All patients must be provided with protections in a written statement that governs medical records, photographs and the commercial use of the same in advertising, websites and any other publication. We need to obtain written authorization when patients first consult with us. There must be a Commercial Release for any photographs used in websites, or other practice products - the general photographic consent we use for treatment is inadequate for these purposes.
HIPAA also prevents us from commenting on any posting about our patients, no matter what is said, unless we obtain written permission to disclose any information about their care and treatment. When negative comments are made about the surgeon, staff or practice - even if not truthful or when information is twisted and not fully disclosed - nothing can be refuted unless written permission is obtained. It is good practice to ask patients how they would like to be contacted - by telephone, mail, e-mail, texting and/or social media. Having their written acknowledgement may be helpful should a dispute unfold.
"Tweeting" about the day's surgery also raises many concerns. First, who is actually operating if the tweets occur during surgery? Second, even if no names are mentioned, the patient's family and friends may know that a procedure is being done by that practice on that day - so by actually tweeting, you're violating privacy by disclosing procedures and other details. If a negative outcome or failed expectations lead to litigation, the tweets during surgery will be admitted and may hurt your defense.
Defense of your reputation
The adage, "I don't care what's said about me, as long as something is said about me," may not hold true today. I hear doctors complain about postings detailing patients' bad experiences with care, financial arguments and claims, staff issues and, most glaringly, complications. Complications and inherent risks do occur, but when the patient posts a bad-result photo with the caption "Look at what he did to me!" - it does have an effect on the practice.
"If I can only explain how non-compliant the patient was" or "I tried to warn him, but he missed all follow-up appointments and changed care" are common doctor responses. All of these responses are prohibited by HIPAA.
There are, however, some recommendations for responding without violating any rules. For instance, if the practice has a blog, it can post educational pieces about the importance of follow-up appointments, avoiding aspirin and wine, stopping smoking for certain procedures, etc. While you aren't commenting about any specifics of the complaining patient, the reader may understand that this complainer might not have followed directions, been non-compliant and helped contribute to the negative result. Care must be used to make sure no specifics can reflect back on the patient's specific case.
Another recommendation by Grant Stevens, MD, one of the most social media-savvy plastic surgeons in practice, is to have a counterbalance for such postings. We all have great patient fans, so when such patients ask how they can make a positive unsolicited comment about their care, direct them to do just that. The one negative post may seem drowned by positive posts from happy patients. Again, be careful and follow state law, which might prohibit any solicitations for such comments.
Medical Justice is a company that copyrights any such comments from patients. Therefore, theoretically, a negative comment is actually owned by the practice through contracts with Medical Justice and the patient, so the copyright may be enforced and the posting removed. However, there are those who believe it may be ethically questionable to stifle comments - Yelp and other sites will not remove the posting for this reason.
I also continue to hear unproven stories that competitors - and even companies selling reputation defense - will post negative comments to affect a practice one way or another.
Summary
Social media is here to stay - if you're willing to play, then make big plans to involve your staff with the appropriate time commitment and follow the rules. The best advice is to always accept nice patients with reasonable expectations whom you can help with the appropriate procedure. I keep reviewing lawsuits where good results are achieved yet an inherent risk occurs that was clearly discussed in informed consent - and resolved - yet it led to a lawsuit. Expectations seem to be getting more severe today, so document and acknowledge financial agreements, necessary compliance and corrections, if pertinent.
You cannot sue a patient for stating his or her opinion, no matter how egregious or flat-out wrong. Most states now have Anti-Slapp (Strategic Lawsuit Against Public Participation) laws that prevent lawsuits that strive to prohibit public opinion. Any lawsuit against a patient usually has no merit as the patient is entitled to an opinion, as long as they do not defame the surgeon. Your suit is viewed as pressuring the patient, and this new legislation awards the patient and his or her attorney legal fees - that you have to pay.
False comments sent to you as part of an e-mail or correspondence by an angry patient must be properly (and nicely) corrected, or they might be considered true if no response is given. All comments are part of a business record, so be careful, thorough - and polite.
I know of excellent and productive experiences as well as nightmares born of social media participation, so make sure you thoroughly check your entire practice.
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