Since 2016, no fewer than 4 publications in Archives of Pathology & Laboratory Medicine have touted the increasing use of social media by pathologists.14  Smart phones with cameras make social media available at our fingertips around the clock, at home and at work. With nearly 2 billion Facebook (Menlo Park, California) users, there is no doubt that there is value in pathology's use of social media for professional networking and communications.5 

In a recently published article in Archives, Brissette et al6  found that social media could be a source of unprofessional behavior, but because “social media is less frequently discussed during professionalism training sessions [for pathology residents], these data indicate a need for more discussion.” We could not agree more with this statement. In fact, one study7  found that 92% of state medical boards have reviewed at least one report of unprofessional online behavior by physicians. As social media becomes more ubiquitous, explicit discussions of professional behavior on social media should be incorporated in the training and continuing education of all pathologists. To that end, we have compiled several talking points that could be included in discussions with our trainees and colleagues.

Content posted to social media can be electronically captured through a screenshot and potentially disseminated, even if the author deletes the original post. Social media posts, even on private accounts, should contain only content that the author would be comfortable sharing with professional contacts or patients. Additionally, medical trainees and faculty members should carefully consider their social media status with one another, given the unique dynamics of the medical community.

Other medical specialties have easily identified unprofessional content on physicians' social media accounts. One study8  identified public Facebook profiles for 72% of urology residency graduates in 2015; 40% of these public profiles contained content that the authors deemed unprofessional. A similar study9  identified public Facebook profiles for 25.7% of general surgery faculty; 15% of these public profiles contained content that the authors deemed potentially unprofessional. At a minimum, pathologists should consider the privacy settings of their personal social media profiles to reduce the risk of publicly viewable posts of any nature.

One important concern raised by Brissette et al6  pertained to posting about colleagues. Four percent of residents and program directors surveyed did not believe that making “disparaging comment[s]” about colleagues or support staff, either on social media or in public, constituted unprofessional behavior. Pathologists should carefully consider comments made on social media about colleagues, trainees, other employees, or their place of employment, as negative content, should such content be identified, could have serious professional consequences. Pathologists may be wise to consider the old adage, “If you have nothing nice to say, don't say anything at all.”

The posting of visual images on social media seems a natural fit with pathology, particularly with platforms like Instagram (Menlo Park, California) or Snapchat (Venice, California) that exist solely for image sharing. However, pathologists should exercise good judgment about posting images of gross specimens, microscopic images, autopsies, or notable clinical laboratory specimens, both on personal and on professional social media accounts. Although the pathologists' relative lack of direct patient contact may engender a more detached interaction with pathologic material, all pathologists would do well to remember the patient behind the specimen. Although obvious breaches of patient privacy are typically grounds for immediate employee dismissal, less obvious breaches, like those on social media, could be just as problematic. In their recent article, Crane and Gardner10  make several excellent suggestions about de-identifying pathology images for publication on social media, including altering identifying patient information in the case description, categorizing age by decade, and delaying the posting of easily identifiable cases.

Patient consent forms may request the use of specimens for educational purposes, but likely not for posting on social media. Patient consent ideally should be confirmed prior to describing or sharing images of pathologic material. Additionally, if pathologic material is obtained within an academic institution, describing or sharing images of these materials without permission of the institution may constitute copyright infringement. Pathologists who plan to share educationally relevant pathologic material on social media should consider doing so through an institutionally sanctioned social media account with the appropriate patient consent and, likely, the input of risk management.

Social media has the potential to advance pathology into the 21st century, whether it's through sharing challenging or interesting cases, teaching the next generation of pathologists, or networking with colleagues around the globe. The appropriate use of social media should be discussed with trainees and faculty, in both formal and informal formats. Pathologists should maintain their professional standards on social media, just as they do in any other public forum.

1
Freitag
CE.
Arnold
MA.
Gardner
JM.
Arnold
CA.
If you are not on social media, here's what you're missing! #DoTheThing
.
Arch Pathol Lab Med
.
2017
;
141
(
11
):
1567
1576
.
2
Gonzalez
RS.
Amer
SM.
Yahia
NB.
et al.
Facebook discussion groups provide a robust worldwide platform for free pathology education
.
Arch Pathol Lab Med
.
2017
;
141
(
5
):
690
695
.
3
Fuller
MY.
Allen
TC.
Let's have a Tweetup: the case for using Twitter professionally
.
Arch Pathol Lab Med
.
2016
;
140
(
9
):
956
957
.
4
Misialek
MJ.
Allen
TC.
You're on social media!: so now what?
Arch Pathol Lab Med
.
2016
;
140
(
5
):
393
.
5
Fiegerman
S.
Facebook tops 1.9 billion monthly users
.
CNN Web site
.
2017
. Accessed October 11, 2017
.
6
Brissette
MD.
Johnson
KA.
Raciti
PM.
et al.
Perceptions of unprofessional attitudes and behaviors: implications for faculty role modeling and teaching professionalism during pathology residency
.
Arch Pathol Lab Med
.
2017
;
141
(
10
):
1394
1401
.
7
Greysen
SR.
Chretien
KC.
Kind
T.
Young
A.
Gross
CP.
Physician violations of online professionalism and disciplinary actions: a national survey of state medical boards
.
JAMA
.
2017
;
307
(
11
):
1141
1142
.
8
Koo
K.
Ficko
Z.
Gormley
E.
Unprofessional content on Facebook accounts of US urology residency graduates
.
BJU Int
.
2017
;
119
(
6
):
955
960
.
9
Langenfeld
SJ.
Sudbeck
C.
Luers
T.
Adamson
P.
Cook
G.
Schenarts
PJ.
The glass houses of attending surgeons: an assessment of unprofessional behavior on Facebook among practicing surgeons
.
J Surg Educ
.
2015
;
72
(
6
):
e280
e285
.
10
Crane
GM.
Gardner
JM.
Pathology image-sharing on social media: recommendations for protecting privacy while motivating education
.
AMA J Ethics
.
2016
;
18
(
8
);
817
825
.

Competing Interests

The authors have no relevant financial interest in the products or companies described in this article.