Table 5 Common concerns cited as results of HCPs´ SoMe use, ordered by frequency, with quotes.

Negatively affecting physician–patient relationships

10 articles:

Camm (2012); Balog et al. (2012), Jones and Hayter (2013), Ahmed et al. (2015), Varghese et al. (2019), Dorfman et al. (2017), Bennett et al. (2018), McCarthy et al. (2018); Abrams and Greenhawt (2020), Trethewey (2020)

Camm (2012)

However, at what point does interaction between a patient and doctor become ethically unacceptable over SM? Is ‘friending’ on Facebook a step too far? It has certainly been argued as such by other authors.

Balog et al. (2012)

¨Social media use by patients and medical providers has created challenging situations where the lines between personal and professional identity can be blurred. Many health professionals have already faced the personal quandary of accepting a “friend” request from a patient¨

Jones and Hayter (2013)

¨Patients are also users of social media too—raising the additional ethical dilemma of what to do if a patient makes contact through social media.”

Ahmed et al. (2015)

¨Social networking with athletes can result in ‘ethical baggage’, which can complicate the clinician–patient relationship and medical care as social networking are public and a very different entity to private–personal friendship. ¨

Dorfman et al. (2017)

¨…The idea that surgeons and patients are partners in the decision-making process; however, the relationship remains somewhat hierarchical. The patient may feel coerced—even if subconsciously—to participate in being filmed to be a “good patient.”

Bennett et al. (2018)

¨In the context of social media, “medutainment” refers to the use of the surgeon-patient encounter as a source of entertainment for the public under the guise of medical education and degrades the fiduciary responsibility a surgeon has toward his or her patient.¨

McCarthy et al. (2018)

”Such conflicts may create risks for individual patients and can also undermine the integrity of the doctor–patient relationship. Disclosure of potential COI ensures such influences can at least be acknowledged and incorporated into the interpretation of online information.¨

Varghese et al. (2019)

¨It is difficult to evaluate how social media interactions might affect this essential aspect of the patient–surgeon relationship. ¨

Abrams and Greenhawt (2020)

¨If online information is incorrect, as noted in an article about “Dr Google,” this can not only damage the patient–provider relationship, risk polarizing health beliefs and setup discourse between clinician and patient, but also lead patients to seek non-evidence-based promises of miracle cures, costly treatments, or unnecessary testing.” Worse, it may deter actual medical progress being made to address treatment of their allergic disease.¨

Trethewey (2020)

Doctors are well-placed to help to counter medical misinformation online, yet have historically been cautioned against engaging with social media in a professional capacity, due to the risks associated with the blurring of personal and professional boundaries.

Damage to the HCPs’ professional image and to the medical profession overall

8 articles:

Camm (2012), Balog et al. (2012), Jones and Hayter (2013), Varghese et al. (2019), Bennett et al. (2018), Campbell et al. (2020), McCarthy et al. (2018), Sylow (2021)

Camm (2012)

Given recent media outrage regarding posts by doctors in which ‘black humor’ and derogatory slang were used to refer to patients and other professionals, …

such interaction comes at a risk for a profession whose central tenants are based on trust and confidentiality.

Balog et al. (2012)

¨actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers and can undermine public trust in the medical profession.¨

Jones and Hayter (2013)

¨Breaches of confidentiality and lapses of professionalism can lead to issues with patient safety, privacy and an individuals’ professional image being compromised inadvertently¨

McCarthy et al. (2018)

¨Without improvements in COI disclosure and management on social media networks, trust in the medical profession and the validity of social media as an outlet for medical education are both in danger¨

Bennett et al. (2018)

The last recommendation says that “physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers, and can undermine public trust in the medical profession”

Varghese et al. (2019)

“A lively debate can easily devolve into a public squabble with insults and innuendos. It is critical that surgeons who engage in debate through social media maintain a professional demeanor, as inappropriate comments can reflect poorly not only on the person who posts the message but on our profession as a whole.”

Campbell et al. (2020)

¨They often worry how would such engagement affect their reputation among their colleagues¨

Sylow (2021)

In the long run, public trust in science might suffer if highly publicized single study results do not hold up under scrutiny

Patient privacy

7 articles:

Balog et al. (2012), Camm (2012), Jones and Hayter (2013), Varghese et al. (2019), Dorfman et al. (2017), Bennett et al. (2018), McCarthy et al. (2018)

Camm (2012)

¨Interactions on SM websites are often thought of as private; however, this is far from the truth.¨

Balog et al. (2012)

¨Twelve of the 510 students’ profile postings included potential violations of patient confidentiality… some victims were pictured as exposed and suffering, presumably without their consent. … it is our responsibility to continuously promote and monitor our own professionalism, guard, especially against violating patient confidentially, and avoid posting any content that reflects poorly on our profession ¨

Jones and Hayter (2013)

Breaches of confidentiality and lapses of professionalism can lead to issues with patient safety, privacy and an individuals’ professional image being compromised inadvertently

Dorfman et al. (2017)

If the patient requests subsequent removal of posted media, the surgeon has no means to guarantee complete removal, as images and video may have been copied

McCarthy et al. (2018)

”Protection of patient and physician privacy, distribution of inaccurate healthcare information, violation of personal–professional boundaries, misrepresentation of credentials, and bias in physicians’ recommendations on social media remain significant concerns.¨

Bennett et al. (2018)

Breaches of patient confidentiality still occur, and these infractions are not without serious consequences

Varghese et al. (2019)

“An important problem with all communications using social media is the potential for information to become publicly accessible. … One meta-analysis of physician blogs found that nearly 17 percent included enough information to permit identification of patients.”

The poor quality of information/content provided

6 articles:

Trethewey (2020), Collier (2018), Bennett et al. (2018), Rossi (2020), Sylow (2021), Eysenbach (2020)

Collier (2018)

Well-known physicians and scientists with large numbers of followers on social media frequently dismiss views they deem unworthy of respect, with disparaging remarks and putdowns.

Bennett et al. (2018)

¨Even more disquieting is the sensationalism that distinguishes the content of social media posts by a small percentage of plastic surgeons¨

Rossi (2020)

The orthopedic community needs to develop better educational online videos with high reliability and quality to better inform patients.

Trethewey (2020)

However, it is important to consider how well a tweet, containing only 280 characters, summarizes findings from a complex study

Eysenbach (2020)

¨Even a publication of a clinical is not the last word and studies may be contradicted or proven wrong.

… In the early phases of a pandemic, “facts” are perhaps more accurately referred to as “BETs” (best evidence at the time). Facts are sparse and recommendations based on BETs are subject to change¨

Sylow (2021)

There are actions that scientists themselves can take to avoid the pitfalls of communicating uncertain science in increasingly polarized (mis)information environments. … schism between the need for fast scientific communication and scientific trustworthiness

Conflict of Interest declarations and marketing efforts

5 articles:

Camm (2012), McCarthy et al. (2018), Hill et al. (2019), Varghese et al. (2019), Goitz (2021)

Camm (2012)

¨In particular plastic surgery has been shown to have a high use of both Facebook and Twitter when marketing. However, use of such techniques is not without risk, Wong et al. have highlighted the need for an ethical overview of such practices.¨

McCarthy et al. (2018)

¨Should consumers of social media be concerned about potential COI amongst physicians dis-tributing health care information on these platforms? Available studies raise concerns.¨

Hill et al. (2019)

“Sadly, we cannot exclude that some in the professions of science and medicine act on the basis of motives driven by financial considerations; incomplete declarations of potential conflict of interest persist.”

Varghese et al. (2019)

When CT surgeons post online about their experiences and their commercial relations, medical credentials should be honestly reported and conflicts of interest should be properly disclosed.

Goitz (2021)

Since the emphasis on these presentations is marketing, most of the information may be generally correct but not be entirely accurate and may propagate some misconceptions that could lead patients to make unhealthy choices

Ethical, legal and licensure risks

4 articles:

Balog et al. (2012), Varghese et al. (2019), Dorfman et al. (2017), Bennett et al. (2018)

Balog et al. (2012)

“Failure to follow these guiding principles may be considered a breach of professionalism, resulting in any and all consequences deemed appropriate by the individual’s program, the Graduate Medical Education Committee and medical center commanders.”

Dorfman et al. (2017)

¨… were concerned about compromising patient confidentiality and violating Health Insurance Portability and Accountability Act regulations on social media¨

Bennett et al. (2018)

¨Photographs and videos capturing sensitive anatomy and operative procedures in a sometimes casual manner render these posts potentially unprofessional and disrespectful, which violates the American Society of Plastic Surgeons (ASPS) Code of Ethics’ mandate to always use respectful language and images. …

surgeons’ posts might be viewed as specific medical advice if appropriate disclaimers are not provided, leading to potentially litigious consequences.¨

Varghese et al. (2019)

A special temptation of social media is an exaggeration of a CT surgeon’s skills and special expertise, which can be misleading or deceptive in violation of ethical obligations.

The importance and effect of individual HCP voices and the perception of medical consensus

4 articles:

Camm (2012), Hill et al. (2019), Varghese et al. (2019), Sylow (2021)

Camm (2012)

¨a compelling ethical argument has been put forward against the move to control doctors’ SM interactions. First, it limits free speech in a way that would be, and in reality should be, unacceptable to the general public. Secondly, it detracts from doctors’ ability to informally raise concerns regarding aspects of the work environment with which they are discontented.¨

Hill et al. (2019)

“Furthermore, scientists are appropriately skeptical, as any individual scientist or study can be wrong. Yet, science ultimately self‐corrects. When a scientist gets it wrong, as happens, people sometimes vilify the entire, self‐correcting scientific enterprise.”

Varghese et al. (2019)

Justice in the health care system includes the promotion of equitable distribution of resources and the elimination of discrimination. Publicly defending patients’ rights, especially in a wide-reaching social media universe, can be daunting, but is among the highest ideals of the medical profession.

Sylow (2021)

“Celebrity scientists with a significant social media following might therefore shape public discourse in ways that are consistent with her or his own research agendas or viewpoints, but inconsistent with the broader scientific consensus emerging from the literature. In the long-run, such ‘skewed observations’ might well influence public perceptions of scientific consensus and ultimately shape which policy choices are seen as viable”

Lack of resources

4 articles:

Jones and Hayter (2013), Dorfman et al. (2017), Trethewey (2020), Campbell et al. (2020)

Jones and Hayter (2013)

“There is little training given on the concept and patterns of information revelation, online privacy and ‘crossing the line’ within social media, … and busy clinicians do not have the time or resources to discuss the ethical dilemmas that arise.”

Dorfman et al. (2017)

¨is it realistically possible for the clinician to remain up-to-date regarding each social media platform’s ever-evolving terms of use policy?…the physician lacks the prerequisite information to properly educate the patient.¨

Trethewey (2020)

It is, therefore, important that doctors receive appropriate training regarding effective use of social media for health promotion

Campbell et al. (2020)

¨However, most scientists are not at all trained in communicating the results of their research to massive, large audiences of lay people in general population. Moreover, research has shown that scientists are not clear about how does public engagement fit into their job. There are often no benchmarks or rewards for this work, it takes a lot of time while distracting them from the work they must do¨

The challenge of competing with entertainment

4 articles:

Dorfman et al. (2017), Bennett et al. (2018), Hill (2019), Campbell et al. (2020)

Dorfman et al. (2017)

¨…videos including theatrics such as dressing in costumes, dancing, and flaunting removed tissue such as abdominoplasty specimens. Many plastic surgeons question the ethics of broadcasts done more for the purposes of entertainment than for education¨

Bennett et al. (2018)

In the context of social media, “medutainment” refers to the use of the surgeon-patient encounter as a source of entertainment for the public under the guise of medical education and degrades the fiduciary responsibility a surgeon has toward his or her patient.

Hill (2019)

Once again, celebrities, actors, activists, and politicians with no specific knowledge or training use their fame to promote a message that causes serious harm … The nuanced voices of scientists often do not resonate with the public as much as the strident alarms sounded by people of fame, speaking in absolute terms.

Campbell et al. (2020)

¨…the problem is how to make global public health topics and issues attractive for viewing online and engaging with. They need to compete with popular music, celebrity gossip, sports, movies and other forms of entertainment.¨

¨Fake balances¨: The potential confusion of reliable and unreliable information when placed on the same platforms

3 articles:

Hill et al. (2019), Donovan (2020), Scott (2021)

Hill et al. (2019)

“It is unacceptable to position false equivalents in these discussions, often done to foster debate and controversy. It is easy to find a rogue voice but inappropriate to suggest that voice carries the same weight as that emerging from mainstream science.”

Donovan (2020)

Research on antivaccination movements shows how celebrities, activists, and discredited physicians gain influence over vaccination policies, while also promoting quackery, misinformation, and conspiracies on social media.

Scott (2021)

Publications exist which highlight the key role that social media companies can/should play in limiting the spread or legitimization of misinformation (‘for balance’) and in flagging disinformation.

Algorithm challenges

3 articles:

Donovan (2020), Rossi (2020), Sylow (2021)

Donovan (2020)

¨The pandemic lays bare how the algorithmic design of search engines and social media, which prioritize fresh and relevant content, contributes to confusion by mixing different kinds of information into a single feed: the mundane, the newsworthy, and critical medical recommendations ¨

Rossi (2020)

¨There is room for improvement in the education of patients rather than leaving the searches to Google algorithms and viewer popularity.¨

Sylow (2021)

”Information tailored by algorithms toward users’ pre-existing preferences and business models that incentivize outrage over facts on platforms like Google and Twitter are well beyond the control of individual scientists.”

The potential risk to the professional reputation, based on institutionally vetted information

2 articles:

Varghese et al. (2019), Leininger et al. (2022)

Varghese et al. (2019)

“Online posts are virtually indelible, and if new information comes to light that is inconsistent with or contrary to an initial post, it may not be shared with the social media community.”

Leininger et al. (2022)

“Although message consistency is considered a best practice in risk communication, this ideal is not always feasible in crisis contexts characterized by high levels of uncertainty. Unfortunately, shifting scientific guidance has been weaponized against public health leaders during the pandemic.