Social media, regardless of whether we are willing to admit it, touches every part of our lives. In taking the Strategic Social Media course, it has come to my attention social media platforms can be utilised for a significant number of purposes, not just circulating photographs and video clips of cats doing the cutest things imaginable.
As part of the course, we were tasked with writing a number of blogs pertaining to the use of social media platforms. In the course of conducting research on the topic, the graduate student happened upon an article pertaining to Figure 1. Figure 1, a medical diagnostic tool, was invented by Dr. Joshua Landy, a Canadian Internist and Critical Care Medicine Specialist.
The social media based app Landy, a doctoral M.D. graduate of the University of Western Ontario, developed allows doctors from all corners of the globe to consult with each other on accurately determining problematic diagnosis.  With the social media platform Landy developed not being the only one currently in use by medical practitioners, the primary focus of this paper is therefore the application of social media platforms to serve the “common good.”
Before we can thoroughly discuss of social media platforms are used, we first have to determine exactly what it is we mean by the term “common good.” What exactly is the common good? The “common good,” as listed in the Encyclopaedia Britannica, is defined as “that which benefits society as a whole, in contrast to the private good of individuals and sections of society.” The common good, as an aspect of Western politics, has been self-evident for centuries. Interestingly, whilst modern conservatives might consider the common good as being un-American, there is nothing more quintessentially American as the common good.
The publication of The Federalist Papers, evidence of how important the common good was in the crafting of what would ultimately become known as the Constitution of the United States. The Federalist Papers, written by Alexander Hamilton, James Madison, and John Jay, was penned as a defence of the intended constitution. Madison writes:
“The aim of every political constitution is, or ought to be, first to obtain for rulers men who possess most wisdom to discern, and most virtue to pursue, the common good of the society; and in the next place, to take the most effectual precautions for keeping them virtuous whilst they continue to hold their public trust.”
With the common good clearly defined, we should determine why it is people have embraced the use of social media platforms with the same intensity one might associate with addicts of one kind or another.
Have any social media platforms been used to serve the common good? Based on the readings reviewed during the past few weeks, there is evidence conclusively confirming that social media platforms are being used to serve the common good. Designed by a medical doctor for use by medical doctors, Figure 1, an Instagram-esk diagnostic tool, is not the only app available to medical practitioners. There are many other apps available for mobile devices.
According to Capterra, a website designed to help businesses find the right software for their needs, when it comes to the top of the line medical apps on the market today, Epocrates is “the gold standard.” The download is free; however, there is an in-app purchase charge of $159.99 a year. Considering the cost of the app, available for both iOS and Android phones, this graduate student would expect nothing less. A highly popular app, “with millions of downloads across [these United States], doctors are using this app” to not only review drug information but also interact with other medical professionals.
Each of the apps have specific functions which aid doctors in their respective daily duties. The mentioned apps, not that there are not any on the market, are not designed for patients to interact with doctors.
According to Professor Poonam Malhotra Kapoor, Department of Cardiac Anaesthesia, “Social Media is one such technology which has had a massive effect on making the world increasingly shrink to become a hub of global knowledge reach more people and increase readership. This makes us all medical professionals across the world, sail in the same boat of social.”
When Kapoor was speaking of “all medical professionals across the world, sail in the same boat of social,” she may have been referencing how websites such as The Social MEDia Course makes medical education and knowledge available to those that would not normally have access to it. As we have discovered with the use of Figure 1, there are significant benefits which can be garnered from the integration of social media based platforms into standard operating procedures for medical issues. People suffering with diabetes have apparently found great comfort from joining online communities, such as groups found on Facebook.
Even though there are many benefits which can be garnered from the use of social media based platforms within the medical field, there are just as many dangers. The dangers are touched upon in the article “Dangers and Opportunities for Social Media in Medicine,” published in the third issue of Clinical Obstetrics and Gynecology, volume 56.
In citing the work of numerous scholars in the same field, the assistant professors that penned the article Dr. Daniel R. George, Ph.D., M.Sc, Dr. Liza S. Rovniak, PhD, MPH, and Dr. Jennifer L. Kraschnewski, argue:
“The dangers posed by social media are myriad. If used recklessly, the technology can blur professional boundaries, serve as a conduit for the display of unprofessional behavior, contribute to building an irreversible online image, open the door for fines, litigation, and imprisonment, and serve as a massive time drain.”
George, Rovniak and Kraschnewski are not the only people concerned by social media being used in the medical field. These findings are supported, at least in part, in an article penned by Mark Terry.
“Twittering Healthcare,” as Terry writes in his article of the same title, is a concern everyone should have an integral role in making sure social media is used as an effective tool for the greater good. Terry points out that social media as a role to play in our lives; however, he questions the use of it within the medical field. For Dr. Daniela J. Lamas, M.D, it was a chance meeting with an individual in a bar and a subsequent Facebook “Friend Request.”
In 2010, Lamas penned the article “Friend Request,” published in The New York Times Magazine, in which she writes:
“‘Are you on Facebook?’ he asked me. ‘I’ll friend you, and you can see the pictures.’ That night, I went online and found the friend request. I clicked on his name. There he was, I thought, though not with swollen cheeks and belly, wasted arms and legs. … He’d been sending upbeat status updates from the I.C.U.; to read them, you’d never know he was so sick, but to me they were missives from a dying man. My rotation in the I.C.U. ended soon after this, and I didn’t see him. But when I couldn’t sleep, sometimes I found myself opening his Facebook page, reading those status reports, glancing at his photos. Meanwhile, I learned that his kidneys were no longer working, that he kept spiking fevers, that he hadn’t received a transplant.”
Lamas questioned the ethical dilemmas of following a patient on a social media platform. Lamas indicated there were no direct guidelines explicitly forbidding interaction with a patient via a social media platform.
The act of interacting with a patient over social media is ethically questionable. One could argue that social media is merely another means of communication a doctor could utilise; however, social media is by no means just another avenue for communication. Social media has a place in society. This much, based on the level of use we find journalists engaged in, is true. The issue at hand is whether or not doctors and other medical professionals are able to adhere to their required ethical standards whilst utilising such communication means in their daily routine.
According to David Lee King, the digital services director at the Topeka and Shawnee County Public Library, people use social media platforms to develop connections with likeminded individuals. King writes:
“Think about your own use of social media for a second. Why do you use it? Most likely, you use social media to connect. You might want to stay connected to friends and family. Maybe you have a favorite hobby and want to discuss it with people who share similar interests. Maybe you have a favorite rock band or TV show and want to stay up-to-date with it. Your community has similar interests.”
The point of view King has presented, a logical one, is substantively true in that evidence of this can be seen in various social media platforms.
Twelve-step-programs, such as A.A. (Alcoholics Anonymous) and N.A. (Narcotics Anonymous), are not organisations which one would expect to see engaged in or even implementing the use of social media platforms as a standard operating procedure. The reasoning for this expectation, a logical one considering the nature of what the word anonymous means, can be seen in the wording of both the eleventh and twelfth traditions of twelve-step-programs.
“Our public relations policy is based on attraction rather than promotion; we need always maintain anonymity at the level of press, radio and films.”
The Eleventh Tradition
“Anonymity is the spiritual foundation of all our Traditions, ever reminding us to place principles before personalities.”
The Twelfth Tradition
Whilst Friends of Bill W., the self-referencing name members of A. A. use amongst ourselves when in the company of non-members, has a significant online community within both Facebook and Twitter, neither community promotes itself to attract followers and or members. That would be a violation of both the eleventh and twelfth traditions.
The truth is many twelve-step-programs have significant social media presences. You might be wondering how twelve-step-programs pertains to the issue being studied, the incorporation of social media into serving the common good. How exactly does a twelve-step-program incorporate social media whilst at the same time maintain the anonymity of the members? How does this serve a medical need? Many times within the A.A. texts, alcoholism is referenced as being a “malady.”  Alcoholism, being considered a malady, at least partially satisfies the requirements of establishing itself as being a medical issue. The social media presence individual twelve-step-groups have is typically set to private, an example of which is the group pages on Facebook. The content of these pages can only be seen by current and former members of the groups.
As intimated in this research paper, there are significant ethical considerations one must take it to account when using social media style for medical purposes. For those living in these United States, this is essentially when HIPAA kicks in. There is a vast number of scholarly articles covering patient privacy   issues and how social media, if used inappropriately, can be detrimental to that privacy. One such article pertaining to patient privacy and social media is was penned by Sara Simrall Rorer. Rorer, a partner at Taft Law, eloquently discussed in her article titled Social Media and HIPAA Privacy Concerns for Healthcare Providers how to address issues healthcare providers and patients have with using social media as part of medical practice.
In her article, Rorer presented a number of hypothetical scenarios, which if played out in reality, could give certain parties cause to file for legal action. One such scenario, pertaining to a registered nurse working in an Orthopaedics Department of Large Hospital System, discussed the use of Facebook between colleagues working at the same hospital. The scenario goes thus:
On May 4, 2011 “Mary,” using her personal Smartphone and after work hours, posts on her Facebook webpage (after describing her daughter’s soccer game and shopping excursion earlier that day) the following: “I just met [Famous Football Player]! Such a nice guy! Nbot [sic] bad on the eyes too!” Later that same day (May 4, 2011), in response to a “Friend’s” question Mary responded: “He came in for a broken [arm].” Meanwhile, one of Mary’s Friends, “Susan,” responded to Mary’s original post with a simple “Likes” reply.
In order to provide needed context, it is important to note the following:
- Mary’s “Profile” details that she is a Registered Nurse, who works at the Orthopedics Department of Large Hospital System in Cincinnati, Ohio; and
- Among her “Friends” is a co-worker, “Susan,” a licensed Physical Therapist, who works in the same Department/Hospital. Susan’s Profile also details her profession and place of work.
On June 26, 2011, Large Hospital System received a Letter dated June 23, 2011 from the Office of Civil Rights (“OCR”) of the U.S. Department of Health and Human Services advising that it received an anonymous complaint on June 14, 2011 alleging that it was not in compliance with the HIPAA Privacy Standards and, more specifically, that Mary had impermissibly disclosed protected health information (PHI) of individuals who were patients of the Hospital’s Department of Orthopedics. Specifically, it is alleged that Mary posted PHI on her Facebook webpage on May 4, 2011 related to the patient status and medical condition of a “Famous Football Player.” (This is the hospital’s first notice of a possible HIPAA violation.)
Queries: Was this a HIPAA Violation? What are the consequences? What steps does Large Hospital System need to take? 
From June 26 – July 21, 2011, Large Hospital System conducts an investigation to determine if the allegations in the OCR Complaint Letter are true – and if true, whether a “Breach” has occurred – in order to respond to the Letter and to determine if a “Breach Notification” to Famous Football Player is needed.
The scenario Rorer poses, even though there is no ambiguity in the way the scenario plays out, is more complex than it first appears. The Orthopaedics nurse, in violation of HIPAA codes of conduct for medical professionals, revealed the medical status of a patient at the hospital she worked at. Not only that, revealing that that person, regardless of whether or not the individual in question is famous, is in itself a violation. Even though what took place can arguable be construed as being a HIPAA violation, there are mitigating circumstances need addressing.
Was the violation intentional? The scenario indicates the nurse posted the picture to her Facebook profile as an anther thought of attending her daughter’s “soccer game.” This in itself also indicates the violation of HIPAA guidelines was unintentional. Does it matter whether or not the violation was unintentional? HIPPA guidelines clearly stipulate that “if the unintentional use is by a workforce member (which includes employees, volunteers, etc.) who used the PHI in good faith and within the scope of his or her employment or professional relationship, the violation does not constitute a ‘breach.’ However, the unintentional use cannot result in further use or disclosure.”
Even with mitigating circumstances, the scenario played out with the hospital having determined the nurse had indeed committed a “breach” of HIPAA guidelines and was subsequently received “five-day suspension without pay.” The nurse’s “friend” and hospital colleague received a “two-day suspension without pay for her “reply” post and for failing to report Mary’s potential HIPAA breach.” There are many more examples of scholarly work which can be drawn upon for this research paper. The work presented for us by Rorer clearly establishes there is a clear and present danger to using social media, intentional or otherwise, to the fabric of patient privacy and the medical field as a whole.
Do the benefits of relying on social media based medical apps outweigh the dangers? All of the apps mentioned, with the exception of Facebook and Twitter, in this research assignment were designed for a particular section of society, the medical community, to use. None of the apps were designed for doctor-patient-interaction. This is not to say that there are not any medical apps on the market which can be used for doctor-patient-interaction. There are a number of apps which can be used to serve that function. It is those apps which doctors need use sparingly. There are significant ethical issues with divulging medical information via an app when there is no clear way of knowing the person receiving the information is the patient or a third party. There are ethical concerns with every aspect of medicine, not just the way doctors choose to interact with either each other or their patients. The debate is therefore ongoing.
 Landy, Joshua. ‘Dr. Joshua Landy.’ LinkedIN. Accessed July 27, 2015. https://www.linkedin.com/pub/joshua-landy/6a/417/298.
 Thomas, Shain Ellison. July 15, 2015. ‘Social Media and Healthcare.’ Eagle Strategies Class Blog. Eagle Strategies Class Blog. Last modified July 15, 2015. Accessed July 27, 2015. https://unteaglestrategies.com/2015/07/15/social-media-and-healthcare/.
 Hamilton, Alexander; James Madison, and John Jay. The Federalist Papers. (Penguin Classics). Kindle Electronic Edition, (2011): Pg. 185.
 Kapoor, Poonam Malhotra, ‘Nuances of Social Media in Medical Journalism.’ Annals of Cardiac Anaesthesia 18, no. 3 (2015).
 Jeremy A. Greene et al., ‘Online Social Networking by Patients with Diabetes: A Qualitative Evaluation of Communication with Facebook,’ Journal of General Internal Medicine 26, no. 3 (February 22, 2011): 287–292.
 Daniel R. George, Liza S. Rovniak, and Jennifer L. Kraschnewski, ‘Dangers and Opportunities for Social Media in Medicine’, Clinical Obstetrics and Gynecology 56, no. 3 (2013): 453–462.
 Shore R, Halsey J, Shah K, et al. Report of the AMA Council on Ethical and Judicial Affairs: Professionalism in the Use of Social Media. J Clin Ethics. (2011); 22(2):165–172.
 Daniela J. Lamas, ‘Friend Request’, The New York Times Magazine, March 11, 2010. Accessed August 8, 2015, http://www.nytimes.com/2010/03/14/magazine/14lives-t.html?_r=0.
 King, David Lee, “Why Use Social Media?” Library Technology Reports 51, no. 1: 6-9,2, http://search.proquest.com/docview/1646465090?accountid=7113 (2015).
 Alcoholics Anonymous, ‘The A.A. Tradition’, in Alcoholics Anonymous the Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. (Calif.: The Recovery Zone, 2004), 561–566.
 –, Twelve Steps and Twelve Traditions, Gift. (New York: Alcoholics Anonymous World Services, 1987), 15, 23, 33, 104.
 –, ‘The A.A. Tradition’, in Alcoholics Anonymous the Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. (Calif.: The Recovery Zone, 2004), XVI, 23, 64, 92, 139.
 Health Insurance Portability and Accountability Act of 1996.
 HIPAA has numerous discrete parts. One of those parts is particularly pertinent to this subject matter: the Privacy
 Pub. Law No. 104-191 at § 264. The Privacy Standards required the Department of Health and Human Services to the establish standards for the comprehensive protection for the privacy of health information and giving Individuals access to their health information.
 45 C.F.R. Parts 160 and 164 published at 65 Fed. Register 82462 (Dec. 20, 2002) (the “Privacy Rules”). Modifications to the Privacy Rules were published in August 2002. See 67 Fed. Register 53181 (August 14, 2002). The Compliance Date for most “Covered Entities” was April 14, 2003.
 Title XIII, Div. A and Title IV, Div. B of the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-05 Stat. 115 (Feb. 17, 2009), key provisions are codified at: 42 U.S.C. §1792 (definitions); 42 U.S.C. §17931-17932 (breach notification); 42 U.S.C. §17934 (business associates); and 42 U.S.C. §17936 (new marketing rules).
 Sara Simrall Rorer, ‘Social Media and HIPAA Privacy Concerns for Healthcare Providers’, Taft Law, accessed August 12, 2015, https://www.healthlawyers.org/Events/Programs/Materials/Documents/HHS13/Z_rorer.pdf.
 Sara Simrall Rorer, ‘Social Media and HIPAA Privacy Concerns for Healthcare Providers’, Taft Law, accessed August 12, 2015, https://www.healthlawyers.org/Events/Programs/Materials/Documents/HHS13/Z_rorer.pdf.
Alcoholics Anonymous. Alcoholics Anonymous the Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. Abridged edition. Calif.: The Recovery Zone, 2004.
–. Twelve Steps and Twelve Traditions. Gift. New York: Alcoholics Anonymous World Services, 1987.
Brown, Clint. ‘Unite Blue.’ Twitter, n.d. Accessed July 27, 2015. https://twitter.com/uniteblue.
George, Daniel R., Liza S. Rovniak, and Jennifer L. Kraschnewski. ‘Dangers and Opportunities for Social Media in Medicine.’ Clinical Obstetrics and Gynecology 56, no. 3 (2013): 453–462.
Greene, Jeremy A., Niteesh K. Choudhry, Elaine Kilabuk, and William H. Shrank. ‘Online Social Networking by Patients with Diabetes: A Qualitative Evaluation of Communication with Facebook.’ Journal of General Internal Medicine 26, no. 3 (February 22, 2011): 287–292.
Hamilton, Alexander, James Madison, and John Jay. The Federalist Papers. United States: Irvington Publishers, 2011.
Kapoor, Poonam Malhotra. ‘Nuances of Social Media in Medical Journalism.’ Annals of Cardiac Anaesthesia 18, no. 3 (2015).
Lamas, Daniela J. ‘Friend Request.’ The New York Times Magazine, March 11, 2010.
Landy, Joshua. ‘Dr. Joshua Landy.’ LinkedIN. Accessed July 27, 2015. https://www.linkedin.com/pub/joshua-landy/6a/417/298.
–. ‘Figure 1 Home.’ Figure 1 – Photo Sharing for Healthcare. Figure 1 – Photo Sharing for Healthcare, n.d. Accessed July 27, 2015. https://figure1.com/.
Medved, JP. ‘The Top 7 Medical Apps for Doctors – Capterra Blog.’ Accessed August 10, 2015. http://blog.capterra.com/top-7-medical-apps-for-doctors/.
Merchant, Raina M., Stacy Elmer, and Nicole Lurie. ‘Integrating Social Media into Emergency-Preparedness Efforts.’ New England Journal of Medicine 365, no. 4 (2011): 289–291.
Rorer, Sara Simrall. ‘Social Media and HIPAA Privacy Concerns for Healthcare Providers.’ Taft Law. Accessed August 12, 2015. https://www.healthlawyers.org/Events/Programs/Materials/Documents/HHS13/Z_rorer.pdf.
– .‘Sara Simrall Rorer – Taft Stettinius & Hollister LLP.’ Accessed August 12, 2015. http://www.taftlaw.com/attorneys/98-sara-simrall-rorer.
Terry, Mark. ‘Twittering Healthcare: Social Media and Medicine.’ Telemedicine and e-Health 15, no. 6 (2009): 507–510.
‘The Social MEDia Course – Social Media in Medicine: Introduction.’ Accessed August 8, 2015. http://thecourse.webicina.com/presentations/introduction/.
Thomas, Shain Ellison. ‘Social Media and Healthcare.’ Eagle Strategies Class Blog. Eagle Strategies Class Blog, July 15, 2015. Last modified July 15, 2015. Accessed July 27, 2015. https://unteaglestrategies.com/2015/07/15/social-media-and-healthcare/.
Wilson, Bill, and Bob Smith. ‘The A.A. Tradition.’ In Alcoholics Anonymous the Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, by Alcoholics Anonymous, 561–566. Abridged edition. Calif.: The Recovery Zone, 2004.