The past decade has seen a rapid rise in the use of social media around the world. You may think of social media as a tool to keep up with friends, but these platforms are increasingly used for other purposes. For example, “many consumers say that information found on social media sites influences decisions to seek a second opinion, choose a specific provider or facility, cope with a chronic condition, or manage diet, exercise, and stress.”1
Social media enables the distribution of knowledge, facilitating communication and collaboration between people from different locations.4 But it can also be fraught with misleading or blatantly incorrect content.
Physiotherapists and other health-care providers have an important role to play on social media; leveraging their knowledge, skills, and influence to have considerable impact on others. Unfortunately, health-care providers, including physiotherapists, have been slow to adopt social media use.1
This document was created to encourage responsible social media use by physiotherapists for professional and business purposes. In this guide we will review the benefits and risks of an active social media presence and provide information about how to safely and professionally develop or enhance your social media presence.
What is social media?
The term social media refers to all “web-based and mobile applications that allow individuals and organizations to create, engage, and share new user-generated or existing content in digital environments through multi-way communication.”5 Common social media platforms include Facebook, Twitter, Instagram, Pinterest, and LinkedIn.
New social media platforms and uses appear daily. Though the use of different social media platforms will change over time, the popularity of social media is not expected to fade any time soon.
Did you know?
- As much as one sixth of the world's population uses Facebook.
- 58 billion tweets are sent daily.
View the Use of Social Media practice guideline in PDF.
Whether you are using social media to advance your business or your personal and professional brand, it’s worthwhile to take some time to plan your efforts. Your plan should include:6
||What's your social media purpose?
||Who are you trying to reach?
||Which platform will you use?
||See "Common Social Media Platforms"
||How will you know you've been successful?
Number of likes or follows
Shares or re-tweets
Mentions or Favorites
Review of audience-who follows you?
Website analytics - how do people find you online?
Advanced metrics - Social media monitoring services
Developing social media policies
Business owners must establish clear policies regarding employee social media use. Policies should include:9
- Intended purposes/goals of social media use.
- Approved social media platforms.
- Content expectations and guidelines.
- Which individuals are authorized to post or respond to comments on the business’s behalf.
- Any business information that must be kept confidential and why.
- Any rules relating to personal profiles or using personal profiles to promote the business.
- The consequences if employees do not comply with policies.
- An employee signature indicating that they are aware of the social media policy and any implications of failing to comply.
- Rules around giving health advice online
- How to deal with online public relations issues/crisis that arise.
- How you will respond to negative comments.
Social media can be an effective way of delivering information to clients and others in the event of a crisis. A crisis may include anything from damage to your clinic (flooding, fire, etc.) to a negative public relations incident that has escalated online or in the media. To be effective, businesses need to develop a crisis communication plan that is in line with marketing/public relations plans and outlines the organizations’ expectations including:
- Possible crisis situations you and/or your business may encounter and a plan for each.
- Who will be responsible for providing social media updates and who will be the spokesperson if needed.
- What information will be shared via social media (e.g., the organization’s messages, public safety announcements, other).
- Where patients or others can go to get further information about how the crisis is impacting business operations or patients.
- When and how frequently updates will be posted.
Questions for business owners
- Who will be responsible for social media activity?
- How will you ensure that the information posted is aligned with business interests?
- How frequently will you post (this may vary depending on platforms you use)?
- Who will respond to comments or negative feedback?
- What are the expectations for responding to comments on evenings or weekends?
- How will you inform your audience of anticipated response times?
- What is the crisis communication plan in the event of a disaster or adverse event?
Interacting with patients online
Physiotherapists are advised to create business social media profiles or accounts that are distinct from their personal social media profiles for use when interacting with patients.
“Friending” a patient can blur boundaries between patients and professionals and can impact the nature and quality of the therapeutic relationship.6,10 Information learned by accessing a personal social media profile may also impact the nature of the relationship.6,10
Challenging situations can be avoided by keeping personal accounts private. Patients may search for and find their physiotherapist’s personal social media accounts so physiotherapists must take steps to ensure their privacy.
Offering personal health advice online
- Not an advised practice.
- Can be considered equivalent to providing patient education and treatment, therefore, subject to the same Standards of Practice as other patient care activities.
- Will almost certainly require a breach of privacy to gain information from your patient needed to make recommendations.
- Before providing online health advice, confirm that your liability insurance coverage applies to online activity.6
Businesses and physiotherapists should consider, in advance, how you will handle social media requests for health advice. Recommended practice is to remove any posts that contain confidential information (even if the subject of the post is the person who posted it), let them know you can’t give advice online, and refer the patient to your office.
Even when physiotherapists do not maintain the social media profiles for their organization, they must:
- Ensure advertisements posted on social media are consistent with the Standards of Practice, and to inform employers of required changes if they are not.11
- Share responsibility with business owners to ensure that efforts to engage with patients (such as providing appointment reminders or cues regarding home exercise programs) comply with privacy legislation and that the patient has given consent to be contacted via social media for these purposes.11,12
What if a patient finds your personal profile?
- Use the strongest security/privacy settings available.
- Clearly indicate on your profile that your opinions do not reflect those of your employer or profession.
- Mind your manners! Your behavior and posts will reflect on you, your employer and your profession. You are a physiotherapist 24/7.
- It is not appropriate to accept friend requests from patients. How will you deal with these requests? Develop a policy and script for how to say “no” when the situation arises.
The Code of Ethical Conduct affirms the physiotherapist’s responsibility to “conduct and present themselves with integrity and professionalism,” and to “commit to maintaining and enhancing the reputation and standing of the physiotherapy profession, and to inspring public trust and confidence.”14 The Standards of Practice provide more concrete direction on how to meet the expectations established in the Code of Ethical Conduct.11 Taken together, the Code and Standards make clear the requirement to use professionally appropriate, clear and honest communication when using social media and to safeguard private information at all times.
While traditional professionalism involves meeting the expectations set out in the Code of Ethics and Standards of Practice, legislation relevant to the profession, and the profession’s norms of behaviour, the term e-professionalism is intended to convey the importance of meeting the same expectations and demonstrating the same behaviours when using social media or other electronic communication.
“…as our access to resources and to each other has expanded, we have arguably lost many of the natural pauses for reflection in our lives, while privacy and personal time are being increasingly eroded.”15
Why do we need to be cautious?
Immediacy of posting.3,16
- The ease of sharing information also makes it easy to post a comment without fully considering the ramifications. Take a step back and consider if you would say the same thing in a face-to-face interaction. If not, don’t post it.
- Posting from the comfort of your home or office, you may perceive that you are “alone,” and safe. This can cause you to let down your guard and say more than you would in other contexts, but the information in your social media profile makes you identifiable and can follow you permanently.
Potential for rapid spread and loss of control of where/how far content goes.16
- Information can spread far further than it would in more traditional communication.
- You may not be fully aware of who is following your social media activity and shares or re-tweets your posts, creating a multiplier effect to how far they spread.
- Even if a post is deleted, there is no way of knowing who else has seen the post, made a copy, or shared it before you deleted the original. Once you hit “post” or “tweet” the information should be assumed to be public. Consider if you would want your rival to have the information, or how they could use it maliciously.
The connectivity, global reach, and nature of asynchronous communication enabled by social media platforms means that it is difficult to separate personal and professional identities. In conventional practice we may have been able to walk out of the office and leave our professional persona there, but in the world of social media this is difficult (if not impossible). You are a physiotherapist all day, every day.
Internet browsers and social media settings are, by default, not secure.17
- Both browsers and platforms are owned by advertising companies that are motivated to make it easy to track your online activities (including social media activity) and develop a profile of you as a user, targeting advertising to you that relates to your interests. (There’s a reason that ad for hotels in Kelowna popped up in Facebook after you searched for accommodation online.)
- You can disable some tracking mechanisms and implement security settings.
- However, as users become aware of and apply security settings to their profiles, companies develop new ways to track and gather user activity. This makes it difficult for users to keep up with and disable new tracking methods.
- Social media platforms regularly update security settings and parameters. When platforms are updated, security settings often revert to the default (low) security settings. Users need to routinely update their privacy settings within their social media profile, as well as in their internet browser.
- Other businesses exploit “holes” in internet browsers to track online activities, using the information for their own purposes.
- Posting information online is the equivalent of posting information on a public bulletin board.18 Private content can be saved through a screenshot, downloaded, copied, or shared by other users. Even if you delete a post you never truly know if or where it is saved, stored, or shared by others.
- When you go online you leave an electronic data trail behind you, markers of websites visited, searches completed, information and images posted.17
- Over time, the aggregate data trail creates a digital shadow revealing a great deal about you, creating a data mine that is attractive to those who may seek to use the information maliciously.
Information is essentially permanently available online, and could be used maliciously by people trying to trick you into sharing financial or other sensitive information, commonly referred to as phishing.19
Other possible users of social media content include employers, recruiters, co-workers, competitors, and patients. While they may not search for information with the intent of malicious use, they may discover more in your social media profile than you would typically share in a professional relationship or a face-to-face interaction.
Regularly check your security settings. Make sure you understand the implications of your security settings.17 For example, low security settings or public pages may be desirable for some uses.
Did you know?
Health information has been identified as a prime target for cyber-attack. Unauthorized use of health information by insurance providers, potential employers and others can have significant implications for individuals.20
There are several pieces of privacy legislation that apply to physiotherapy practice in Alberta; however, the underlying principles are similar. Physiotherapists are required to collect the minimum amount of private information required for an identified, specific, purpose, to use the information only for the purpose for which it was collected, to secure private information against unauthorized access and use, and to retain and discard information in a manner that protects privacy and confidentiality.12
What information is protected?
Personal information is defined as “information about an identifiable individual.” Personal employee information is personal information “reasonably required” by an organization “for the purposes of establishing, managing or terminating an employment or volunteer-work relationship, or managing a post-employment or post-volunteer work relationship between an individual and an organization.” Both personal information and personal employee information are protected under the Personal Information Protection Act (PIPA).21
Health information is “diagnostic, treatment and care information; or registration information.” Individually identifying health information and registration information, in which “the identity of the individual who is the subject of the information can be readily ascertained from the information” are protected under the Health Information Act (HIA).22
Physiotherapists must recognize that posting any information about a patient is a breach of privacy law. This is also potentially the case if “de-identified” information about a patient is posted online.
In several cases on record, individuals have posted comments about patients after removing names and other unique identifiers, thinking that this was sufficient to safeguard patient privacy.23 However, the combination of information in a social media profile about the individual writing the post, and details of the patient’s characteristics and condition can be sufficient for individuals (especially the patient and their family, or fellow health professionals) to identify the subject of the post. This constitutes a breach of patient privacy and of privacy legislation.
Sharing any information protected under privacy legislation through social media or any other mechanism constitutes a breach of legislation and could result in disciplinary or legal action.
- Gagnon K & Sabus C. Professionalism in a digital age: Opportunities and considerations for using social media in health care. Physical Therapy 2015; 95(3):406-414.
- Peate, I. The community nurse and the use of social media. British Journal of Community Nursing 2013; 18(4): 180-185.
- Lachman VD. Social media: Managing the ethical issues. MedSurg Nursing 2013; 22(5):326-329.
- Lemke C & Coughlin E. The change agents. Educational Leadership 2009; 67(1): 54-59.
- Bodell S & Hook A. Developing online professional networks for undergraduate occupational therapy students: An evaluation of an extracurricular facilitated blended learning package. British Journal of Occupational Therapy 2014; 77(6):320-323.
- Chartered Society of Physiotherapy. Social media guidance for CSP members. London: Chartered Society of Physiotherapy, 2014.
- Chartered Society of Physiotherapy. Information paper-Social media. London: Chartered Society of Physiotherapy, 2014.
- Litzy K. The dos and don’ts of social media. 2016. Available at: http://podcast.healthywealthysmart.com/2016/07/dos-donts-social-media/ Accessed on March 14, 2017.
- Office of the Information and Privacy Commissioner of Canada. Privacy and social networking in the workplace-Fact sheet. Available at: https://www.priv.gc.ca/en/privacy-topics/privacy-at-work/02_05_d_41_sn/. Accessed on March 14, 2017.
- Laliberte M, Beaulieu-Poulin C, Larrivee AC, Charbonneau M, Samson E, Feldman DE. Current uses (and potential misuses) of Facebook: An online survey in physiotherapy. Physiotherapy Canada 2016; 68(1):5-12.
- Physiotherapy Alberta – College + Association. Standards of Practice for Physiotherapists in Alberta. 2017. Available at: https://www.physiotherapyalberta.ca/files/standards_of_practice.pdf. Accessed on March 14, 2017.
- Physiotherapy Alberta – College + Association. Privacy Guide for Alberta Physiotherapists. 2013. Available at: https://www.physiotherapyalberta.ca/files/guide_privacy_for_ab_physiotherapists.pdf. Accessed on March 14, 2017.
- Facebook. Why should I convert my personal account to a Facebook page? Available at: https://www.facebook.com/help/201994686510247. Accessed on March 14, 2017.
- Physiotherapy Alberta – College + Association. Code of Ethical Conduct. Available at https://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/code_of_ethical_conduct. Accessed on March 14, 2017.
- Ellaway RH, Coral J, Topps D, Topps M. Exploring digital professionalism. Medical Teacher 2015; 37(9): 844-849.
- Cleary M, Ferguson C, Jackson D, Watson R. Editorial: Social media and the new e-professionalism. Contemporary Nurse 2013; 45(2):152-154.
- Soghoian C & Hirsch J. Insights on privacy-Jesse Hirsch and Chris Soghoian on the frontiers of the privacy landscape. Speech for the Office of the Privacy Commissioner of Canada. 2010. Available at: https://www.youtube.com/watch?v=RHPEtc3ZGhs. Accessed on March 14, 2017.
- Westrick SJ. Nursing students’ use of electronic and social media: Law, ethics, and e-professionalism. Nursing Education Perspectives 2016; 37(1):16-22.
- Office of the Information and Privacy Commissioner of Canada. Protecting your privacy online. Available at: https://www.oipc.ab.ca/media/527869/Guide_Social_Media_Background_Checks_Dec2011.pdf. Accessed on March 14, 2017.
- KPMG. Health care and cyber security: Increasing threats require increased capabilities. 2015. Available at: https://assets.kpmg.com/content/dam/kpmg/pdf/2015/09/cyber-health-care-survey-kpmg-2015.pdf. Accessed on March 14, 2017.
- Province of Alberta. Personal Information Protection Act. Edmonton: Alberta Queen’s Printer, 2003. Available at: http://www.qp.alberta.ca/documents/Acts/P06P5.pdf. Accessed on March 14, 2017.
- Province of Alberta. Health Information Act. Edmonton: Alberta Queen’s Printer, 2000. Available at: http://www.qp.alberta.ca/documents/Acts/H05.pdf. Accessed on March 14, 2017.
- Maranocha S, Maranocha MR, Pilliow T. Unprofessional content posted online among nursing students. Nurse Educator 2015; 40(3): 119-123.
- Office of the Information and Privacy Commissioner of Alberta. Guidelines for Social Media Background Checks. 2011. Available at: https://www.oipc.ab.ca/media/527869/Guide_Social_Media_Background_Checks_Dec2011.pdf. Accessed on March 14, 2017.