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.

 

Reasons to be active on social media

  • Engage: Maintain current professional knowledge and join debates about current issues facing the profession.
  • Communicate: Share information with patients, potential patients, and the general public. Network with physiotherapists locally, nationally and internationally.
  • Promote: Target your communication efforts to patients and potential patients, engage with stakeholders to gather feedback and gain input on service development and other issues, and quickly reach more people.6

What’s the downside?

  • Privacy: The ease of information sharing can result in privacy loss and reputational risks as the speed and reach of social media means that posts and negative reviews can spread quickly.
  • Time: It can be time consuming to maintain an active social media presence. Setting aside time to manage a social media presence can be difficult, but in social media you can’t go silent for long.
  • Professional risk: Social media presents unique risks related to patient-therapist boundary crossings and difficulty maintaining appropriate professional relationships. There is also the risk of breaching patient privacy leading to disciplinary or legal action.6

Although it is true there are risks to engaging in social media, these risks can be mitigated through an intentional approach to social media use. The benefits can be significant for the professional or business and also for the patient and general public.

  • Content generator: Creating and sharing new information to guide practice.
  • Curator: Critically reviewing and sharing practice related information with other physiotherapists and the public.
  • Networker: Collaborating with other health professionals, sharing information and resources of shared interest.
  • Business user: Advertising and engaging with patients and potential patients in the pursuit of business interests and to support quality patient care.
  • Personal user: Sharing information and keeping up-to-date with friends and family.

Decisions such as the social media platform(s) you use, content you share, and privacy settings you employ are simplified by defining your role on social media.

Considerations for content generators and curators

  • Consider blogging and micro-blogging sites (such as Twitter).  
  • Use public pages or platforms so content is seen and has impact.
  • Investigate the platforms that your audience is using.
  • Consider multiple platforms. Some to draw content from and others to post to and reach a larger audience.
  • Activity drives impact. Regularly post high quality content.
  • Build your network by “friending” or “following” people and establishing some interaction by responding to posts or tweets from others.

Considerations for networkers

  • Platforms such as LinkedIn tend to attract a professional audience rather than a public one.
  • Facebook Groups can limit your audience to fellow professionals with similar interests.
  • Maintain patient privacy if discussing challenging cases or clinical concerns.
  • Remember that even in a closed group your interactions aren’t private. Sharing any patient information online may constitute a privacy breach.

Considerations for physiotherapy businesses

  • Employ social media for marketing, to engage with patients and others.
  • Focus activity on the platforms your target audience uses.
  • Use public pages or platforms so your content is seen by your audience.
  • Remember social media advertising is a tactic, not an end. Social media marketing plans should include the same considerations and receive the same attention as other marketing tactics.

Not sure which tool to apply? Here’s a breakdown of some common social media platforms, their pros and cons, and suggestions for when to implement their use.6,7

 

Platform Pros Cons Used for Suggested Roles
Facebook Personal Profile

The most common social media platform in use worldwide.

No limit to length of posts.

Profiles can be public meaning they are searchable and accessible to all, or privacy settings of various strengths can be applied to limit who can see information posted.

Not designed for professional use, making it difficult to ensure that posts will be seen by target audience.

Limited control over who “likes” or comments on public posts.

Personal use (required to create a group or business page) Personal User
Facebook Groups (public or closed)

Established by an administrator who decides who is added to the group.

Administrator can block members who don’t follow group rules and/or require a post be approved before appearing on the group page.

Can use settings to control who sees posts (group members or the public).

Must have a Facebook profile to establish a group. Communicating with other members of the profession or others with a shared interest. Networker
Facebook business page

Can create public page that other users can like and follow.

Enables the separation of personal and professional social media activities.

Can set up page so that posts must be approved before they are visible to others.

No way to guarantee posts will be seen by target audience.

Must have a Facebook profile to establish a business page.

Promoting a business, communicating with patients, or sharing health-related information with others. Networker, Curator, Business user
Twitter

International reach.

Commonly used platform.

Can easily follow respected content generators and gain access to high-quality, shareable content.

Hashtags, lists and search enable finding people/topics of interest.

Limited to 140 characters per tweet.

Unmoderated, many documented instances of online bullying.

Can only limit your audience by creating a private account when you first set it up.

Sharing physiotherapy or other practice-related information with others. Curator, Networker, Business user, Personal user
Linkedin

Used by many professionals.

Can be helpful for job searches and to build an online CV.

Lots of advertising targeted to users. Networking with other health-care professionals and potential employers. Curator, Networker, Business user
ignitephysio

Networking specific to physiotherapists.

Discussion forum for challenging cases and professional issues with other physiotherapists.

Large number of Alberta-based physiotherapist users.

Smaller audience than other platforms. Networking with other physiotherapists in Alberta.
Gathering and sharing information.
Curator, Networker
Blogs (Blogger, WordPress, etc.)

Can use a blogging platform such as Blogger or WordPress, or can be set up as part of your website.

Ability to bring quality content to public and be seen as an authority on subject matter.

Can be distributed to other social media platforms (Facebook, Twitter, etc.)

Large time commitment – requires planning, writing, posting and distribution.

Need to post consistently.

Can be a challenge to find regular topics.

Reasons vary. May be used to increase traffic to website or increase online presence. Content Generator, Networker

* This is not an exhaustive list. Social media platforms are continually evolving, with new platforms emerging each day. Physiotherapists and physiotherapy businesses need to research available social media platforms and choose which ones best fit their needs and objectives.

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

Aims/Role What's your social media purpose?

Content generator

Curator

Networker

Business user

Target Audience Who are you trying to reach?

Current patients

Potential patients

Fellow professionals

Potential employers

Potential collaborators

Others?

Channel Which platform will you use? See "Common Social Media Platforms"
Outcome 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.

Crisis communication

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.

Other expectations

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 following are recommendations, best practices and general advice for individuals establishing a social media presence:

  1. Do not expect privacy.6,9
  • Routinely review the privacy statements, policies and settings of the platforms you use.
  • Select settings consistent with your social media role.
  1. Consider what to share.10
  • Choose the strongest privacy settings for personal social media activities.
  • Use caution if sharing personally identifying information which can be used to commit identity theft.
  1. Keep business and personal social media activity separate.6
  • Use different platforms for each purpose.
  • Establish a Facebook page or a group for your professional or business social media activities and maintain a private profile for personal use.
  1. Remember social media platforms must make information available to law enforcement officials and other parties under certain conditions.
  2. Pause before posting.
  • Do you want this information to reach your rival?
  • Is the information embarrassing or something that fraudsters could use?
  • Could the post generate a complaint about you?
  1. Remember that the information you post online is there forever.
  2. Be aware of and follow your employer’s/organization’s policies and standards regarding social media use.
  3. Don’t be a troll.7,8
  • Be careful when offering negative comments. Avoid being intentionally offensive or provocative.
  • Using emojis can help to clarify meaning and tone in your posts, but also lends informality to them. Balance clarity with professionalism.
  • Remember consistent bad behaviour reflects poorly on you and the profession and may get your account suspended or terminated.

Tip:

It is against Facebook’s Terms of Service for the same individual to have two profiles. An individual can only have one profile, but each profile can manage multiple pages.13

Hopefully you are convinced of the value of an active social media presence. If you are new to social media, this section will help you through the process of establishing your online presence.6

  1. Decide on your role and audience.
  • Helps identify the optimal platform, security settings and even how to identify yourself online.
  1. Create your identity (your profile name, avatar and image) wisely.
  • Once it is established it is hard to change your profile name.
  • Your account name and image or avatar are visible to those who follow you.
  • Consider adding a comment that your posts reflect your opinions and not those of your employer or profession.
  1. Look for people to follow.
  • Add organizations you are familiar with, and influencers in your field to your list of “friends” or those you follow.
  • Review their profiles to identify other people you may wish to follow.
  1. Stay active.
  • Check in regularly, add content and reply to comments and the posts of others.
  • Establish conversations with people who respond to your posts.
  • If you mention people in posts or tweets, include their account name so they receive a notification of your post.
  • Spend some time learning about your chosen platforms and learning more about features (lists, hashtags, etc.) to ensure you are getting the most out of the platform.
  1. Find topics and themes of interest to you.
  • Conferences and events often create hashtags (e.g., #PTAB17). Use these if you are tweeting about an event.
  • Follow topics or themes of interest by searching for and following a hashtag.
  1. Promote yourself.
  • Let people know you are on social media.
  • Include your Twitter handle or Facebook page name with your other contact information (business card, email signature).
  1. Measure your social media impact.

Helpful hints

  • Maintain a steady stream of information.
  • Social media is only a method of communication; you still need to consistently provide content.
  • Tweet at different times of the day, or schedule tweets so you reach a variety of followers.
  • Watch out for repetition! Some platforms are more forgiving than others if you post the same content more than once.
  • Responding to or removing negative comments from your social media platforms may backfire.6
  • Don’t remove posts simply because you don’t like the comments.6
  • Develop a social media policy outlining the circumstances when posts will be removed or reported.6
  • Inappropriate posts include private information or comments from trolls.
  • If you haven’t posted for a few months, take down your profile. An inactive profile may make people think you have closed your business.
  • If you don’t want to be active on a social media platform, but don’t want someone else to claim your business name, create an account and put up a statement that it is inactive, directing people to a platform or website where they can reach you.

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.

Perceived anonymity.3

  • 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.

Permanence

  • 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.

Malicious use

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.

Businesses occasionally access/use information gleaned from social media profiles for human resource purposes such as employee background checks.

It is important to note that business owners need to clearly inform their employees if they monitor staff social media profiles. They must also comply with legislation or other rules (e.g., collective bargaining agreements) that may apply to this practice.

Under the Personal Information Protection Act (PIPA), businesses must have employee consent to access their social media content. If the employee revokes consent, the employer cannot use personal information gained from the employee’s social media accounts to make employment decisions. Businesses must also comply with other privacy requirements such as collecting the least necessary information for the stated purpose, gathering data for reasonable purposes only, using data only for the purpose it was collected, and retaining data for the shortest period necessary.21

In other words, businesses need to be very cautious if they gather information from an employee’s social media profile, and avoid using social media profiles as a “fishing expedition.”

Social media background checks

Another potential business use of social media is pre-employment screening. In fact, the risk of a social media background check is a common reason given for not having an active social media presence. The general advice to maintain a professional social media profile at all times stems from the fact that social media background checks can occur unofficially and without potential employees even being aware of them.

However, “under PIPA, an organization must be able to establish that use of social media to collect… personal employee information is reasonable for the purposes of collection;” therefore, employers must be aware of the potential legal implications before engaging in this practice.

Potential pitfalls of social media background checks include:

  • Inaccuracy of the information collected.
  • Consent concerns.
  • Collection of excess or irrelevant information.
  • Collection of personal information of individuals other than the subject of the check.

Businesses must consider what they will gain that they can’t obtain through a traditional reference.  

Businesses that are considering using social media background checks are advised to review the Office of the Information and Privacy Commissioner’s “Guidelines for Social Media Background Checks” in full.24

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