Physician Assistants, Practices, and Social Networks:
Gauging the Risks 

By: Thomas M. Gallo, P.A., J.D.
As medical practices react to the growing market pressures to grow and/or maintain their patient populations, many are embarking upon an entry into the world of social networks.  While such environments may hold great reward for many businesses, they also hold many concerns and risks unique to physician assistants and their medical practices.  
A “Social Network” is defined by as an online service, platform or site wherein “family, friends and their families, that together create an interconnected system through which alliances are formed, help is obtained, information is transmitted, and strings are pulled. In an organizational setting, it usually constitutes the group of one's peers, seniors, and subordinates who provide information on how to get things done, how the power structure operates, and who holds the strings.”
The number of social networks continues to grow exponentially every day and a social network heavily favored one moment may quickly find itself an afterthought or viewed as outdated the next moment.  Examples of social networks are illustrated in the chart below: i

Seemingly attractive, an increasing number of healthcare providers interacting within social media are creating some notable, and dire, consequences. It has been alleged that a large number of healthcare students have admitted to using the forums inappropriately to discuss individual patients. Other recent incidents have involved a member of a medical office staff posting entries on Facebook and/or Twitter complaining about “difficult” patients.
Before any practice contemplates their entry into this new, ever evolving environment, they should consider certain preemptive risk management factors before doing so, such as:
Is the practice prepared to devote ongoing time and capital to this environment?
Is the practice prepared to vigorously monitor the information posted in response?
Is the practice committed to routinely updating the information posted?
Absent positive responses to the above noted factors medical practices would be better served to withhold their entry in the realm of social media until such time as they are prepared to provide a strong commitment to the demands of social networking.  Absent such a commitment, a partial or half-hearted effort will only leave the practice exposed to not only potential liabilities but adverse internet “standing”.
If the practice decides to engage in social networking, a large degree of advance planning and the assigning of structural responsibilities must be considered, such as:
Who creates the data to be entered?
Who physically (and routinely) enters the data within the network (and updates the data)?
How often is the data reviewed and authorized by those in charge of the practice?
Often it is the case that the Physician Assistant in the practice is charged with the responsibility of updating and maintaining the social media for their particular practice. This responsibility should not be taken lightly.
Regarding the actual data posted within a social network itself, practices must also be mindful of standards and/or codes of conduct they are bound to abide by – not only those required by the social network itself, but also those required exclusively of practitioners.  Issues such as patient confidentiality under state and federal law (HIPAA), conduct requirements under state licensing requirements (boundary violations), contractual terms under payor (both public and private) and the general obligations of law (e.g., prohibiting defamation, libel, etc.) all dictate that great care be taken, especially for medical practices, as to the actual content within a social network and vigilant scrutiny over the ever changing/updating data.
For even those practices which might decline to pursue efforts within social media, caution should be held over the activities of employees of the practice.  Use of personal e-mail accounts while working should be strictly curtailed due to the growing number of unintentional and intentional violations of patient-privacy laws.  Moreover, many disgruntled former employees use social networking sites to disparage the practice and/or solicit present employees to join pending workplace claims. Moreover, an increasing number of work-place claims (e.g., harassment, stalking, cyber-bullying, discrimination, hostile work environment, etc.) are originating from social media (Facebook, etc.) interactions between employees. To risk manage such threats, every medical practice should develop, adopt and issue a written set of detailed policies addressing these issues and prohibiting the crossover of their role (and responsibilities) as employees and social networking.  Such policies should be reviewed directly with all practice staff, updated routinely and acknowledged in writing, by every member of the practice.
In conclusion, while utilizing social media is not absolutely prohibited, any environment which holds unknown risks, and is ever changing at a breathless pace, should be disquieting to medical practices and practitioners alike. Unlike other forms of business, the practice of medicine carries an extremely onerous degree of oversight and an increasingly powerful body of restrictions.  As a result, the best risk management tool for medicine may well be to simply not enter the world of social media until society sets the permissible boundaries to do so.

i Chart reprinted with permission  
Kern Augustine, P.C., Attorneys to Health Professionals,, is solely devoted to the representation and defense of physicians and other health care professionals. Thomas Gallo may be contacted at 1-800-445-0954 or via email at