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Dear Director,
I’m Facebook friends with a bunch of the nurses I work with and when this came up in a conversation with my chairman, he told me that I’m setting myself up for disaster and that I shouldn’t be social network “friends” with the people I work with. Is he right?

While Facebook and other social networking sites have become part of the fabric of our daily life, I think we’re just beginning to see the potential consequences of intertwining our professional and personal lives. Many physicians these days are more likely to write a post about a bad shift than to pick up a phone and commiserate with a friend. While some industries, particularly those in government services and the law, seem to have a certain amount of paranoia about sharing work issues in a public forum, healthcare workers have not been as quick to adapt a separation of personal and professional personas. And this tell-all online culture puts EPs at risk for “crossing the professional line” in a couple of important ways.

Hostile Work Environment
Let’s start with a primer on “hostile work environments” and how they are created. Per Title VII of the Civil Rights Act of 1964, a hostile work environment is defined as follows: “Unwelcome verbal or physical conduct based on race, color, religion, sex (whether or not of a sexual nature and including same-gender harassment and gender identity harassment), national origin, age (40 and over), disability (mental or physical), sexual orientation, or retaliation (sometimes collectively referred to as “legally protected characteristics”). This environment constitutes “harassment” when “a supervisor’s harassing conduct results in a tangible change in an employee’s employment status or benefits (for example, demotion, termination, failure to promote, etc.).

It must be underscored that this definition goes beyond sexual harassment. Regarding sexually-based claims, behaviors that have contributed to creating a hostile work environment include discussing sexual activities, telling off-color jokes, commenting on physical attributes, and using crude and offensive language.

One problem with social networking sites is that they make it easy to cross this line of appropriateness because posts have a false sense of existing in a personal web space. When you post a joke, or make a comment about a party you went to, you don’t know how it will be taken by each of your “friends.” Social media also makes it tempting to hash out tough issues in writing, since it allows us to avoid face-to-face confrontation. But only 15% of our message is delivered by the spoken word; the other 85% is accomplished by tone, inflection, and pacing. That means that when written, your intended joke or comment is all the more likely to be taken in the wrong light by a colleague.

Adding to the problem of written miscommunication is the fact that what’s written in cyberspace stays in cyberspace. Any off-color joke or comment you make on a social network will be searchable and viewable for the forseeable future. Such behaviour is likely to change how colleagues view you and as they start to paint you as a sexist, racist, etc… every word out of your mouth will be scrutinized.

Think you can solve this problem be simply blocking access to your account or “unfriending” a colleauge? Think again. Once you’ve friended someone, you’ve created a social contract, and by blocking them or un-friending them, feelings could be hurt and that can further lead to a case being made for a hostile work environment. The converse could also be true, that they fear retaliation if they de-friend you because they don’t like your posts.

HIPAA
In 2010, a Rhode Island emergency physician posted comments on Facebook about one of her patients. Even though the physician felt that no confidential or personal information was disclosed, enough information was posted for a third party to figure out who the patient was based on injuries and other public information. Thus, the information was not “deidentifed.” Though patient identification was unintentional, this may constitute an unauthorized disclosure of PHI.  The physician lost their job and was reprimanded and fined by the state medical board. I’ve seen this within the EMS community as well when pictures or details of accidents are placed on Facebook. In other industries, people have posted personal thoughts about their work only to be terminated for poorly representing their company.  

Social networking is a part of many peoples’ lives and is a great way to communicate with friends. However, it blurs the lines between our professional and personal lives. I urge all of us to think twice before making any kind of post. You may consider it personal – “between friends” – but if it involves sex, race, or ethnicity, one of your “friends” who happens to be a co-worker could easily take it the wrong way.

Writing “I’m off to work a night shift,” is a whole lot different than writing that “I had a great airway and cracked the chest of a dude who got shot 5 times. What a bloody mess,” or “I can’t stand my hospitalists, they don’t think anyone needs to be in the hospital.” Although the last two postings make for great fodder, that patient will likely be identifiable and the hospitalists will likely find out how you feel and take great offense. My advice, join a social network like Linked-In that is designed to maintain professional contacts or maintain separate personal and professional Facebook accounts. And always think before you post.
 
Michael Silverman, MD, is a member of Emergency Medicine Associates and is chairman of emergency medicine at the Virginia Hospital Center.

 

Comments   

# HDoc 2011-07-06 04:23
So long, First Amendment ! We'll miss you !
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# Nick 2011-07-06 10:44
If readers are interested in some constructive healthcare social media policies, check out Ed Bennett's comprehensive list at http://ebennett.org/hsnl/hsmp/
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# Separate accounts not permitted on FacebookSarahG 2011-07-07 10:08
I had separate accounts for my personal and professional 'selves'. Facebook found out and made me deactivate one of them. I personally consider this a bad business decision on their part, but it's their service.
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# great stufftext message from computer 2011-07-18 22:35
Well thanks for your suggestion regarding careful use of this social network; I agreed that we need to get attentive before making any post in between personal and professional ones.

text message from computer
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