CUA 2018: eCommunications - Using Email, Texting and Social Media Wisely

Halifax, Nova Scotia ( As the world begins to change and technology becomes more advanced and easier to access, the rules and regulations of these technologies in regard to medicine must change as well. With the prevalence of smart phones and social media in today’s society, the medical profession has begun to adopt these technologies in order to provide better care and to allow more communication between physician and patient. However, in the guise of malpractice lawsuits and other legal concerns, proper handling of these technologies is of utmost importance.  

To help elucidate the proper procedure to avoid any potential legal confrontation, Dr. Lorraine LeGrand-Westfall of the Canadian Medical Protective Association gave her lecture on wise e-communication. Interestingly, she requested the participation of the audience by hosting a game of Jeopardy with the following four categories: Social Media, Websites and “Skyping”, Mobile Devices, and E-Mails/Texts. Each category had three questions with point values of 200, 400, or 600, and each participant from the crowd was asked to choose a value and answer the question. The questions focused on a specific case report and the participant was asked whether or not this was ethical and what could possibly be done to make the situation compatible with Personal Health Information (PHI) laws. After answering, Dr. LeGrand-Westfall would then explain each topic in greater detail, which led to some great discussion from the audience. The summaries of each category are given below.   

In the first category explored, Social Media, there was discussion on many popular websites that are often used today. Twitter, in the medical profession, should be used as a way to enlighten colleagues or inform the social sphere of novel ideas that may possibly improve patient care. However, inappropriate tweets, such as sharing that an obese patient came to the clinic, can lead to a myriad of legal concerns. Though there was no patient identifiable data (PID) shared, a colleague may still be able to identify the patient based on this description which leads to a breach of confidentiality and privacy. For the same reason, a physician must not view a patient’s Facebook account without consent to try to obtain more information relevant to their case. In another example, in regard to the “RateMDs” social platform, a physician must show maturity and restraint if they receive a bad review, and the physician should not reply or ask future patients to agree not to post.  

In regard to websites, a legal and effective blog that allows patients to view their own medical records, the physician must ensure that the portal is secure and access to the blog is restricted to patients only. The physician must also ensure that Terms of Use and consent is given for these portals to be accessed. If the blog is unable to have these security features, then the use should be limited to scheduling, educational, or general health promotion rather than sensitive patient data. When using a clinic portal that is also linked to “the cloud”, one must ensure that PHI is protected and be informed about where the data is truly being stored.  

Of all the recent advancements in technology, mobile devices seem to be the most popular and widespread in today’s society. With the advancement in cameras and recording capabilities comes the use of a smartphone as a tool for many patients and physicians. For physicians, taking a photograph or a video of a patient for clinical use (non-advertising) may be done with the proper express consent from the patient. Verbal consent is acceptable if it is properly documented in the patient’s medical record. Additionally, a physician may also record an interaction with a patient as long as the consent is obtained. A patient may be able to record the physician during an interaction, but it is advised that the physician take their own recording of the exact same interaction and enter this information into the patient’s medical record.  

With the prevalence of these smart phones and devices, the communication between a patient and physician can be radically increased, however, proper measures must be taken to ensure that privacy legislation and patient care is not compromised. A physician may take a picture of a patient’s anatomy, for example, and send it to a colleague for a second opinion if the photograph does not contain PHI, the image is sent securely, and both the patient and colleague consent. Also, all information given through the text or email must be saved and submitted to the patient’s medical record. In a situation where a patient emails a physician over the weekend and it goes unanswered due to the clinic being closed, the correct procedure is to follow up with the patient as soon as possible, preferably by phone. For future patients, ensure that patients are aware that email is not for urgent matters and institute an Auto-Reply notification that the patient will receive if no one is available to answer their email.  

In closing Dr. LeGrand-Westfall left the audience with three aspects of e-communication that must always be done to lead a legal health practice: get consent, use encryption or deidentified data, and always provide the proper documentation.  

Presented by: Lorraine LeGrand-Westfall, The Canadian Medical Protective Association, Ottawa, Canada  

Written By: Zachary Valley, Department of Urology, University of California-Irvine, Twitter: @ZacharyAValley at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia


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