Since 2016, no fewer than 4 publications in Archives of Pathology & Laboratory Medicine have touted the increasing use of social media by pathologists.1–4 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.
GENERAL BEHAVIOR ON SOCIAL MEDIA
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.
SOCIAL MEDIA POSTS ABOUT COLLEAGUES/PLACE OF EMPLOYMENT
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.”
SOCIAL MEDIA POSTS ABOUT PATIENTS
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.
The authors have no relevant financial interest in the products or companies described in this article.