Social Media and the Regulators

Blog post by Pat Rich and Trish Paton. Introduction by Colin Hung.

This week on #hcldr we’re excited to welcome Pat Rich @pat_health and Trish Paton @trishpaton as guest hosts. Pat and Trish are longtime #hcldr contributors, fellow #hcsmca collaborators and solid Canadian friends. They have chosen a topic that is near and dear to all of us in the #hcldr community – the use of social media by healthcare professionals.

You would think that in 2017 the debate about social media would be over, but it remains a controversial topic in healthcare. Some in healthcare embrace social media as a way to connect and learn. Obviously the nurses, clinicians, researchers, administrators and other healthcare insiders in the #hcldr community fall into this camp. Some in healthcare see social media as nothing more than an outlet for humanity’s narcissistic nature.

Next week, Pat and Trish will be leading us in an exploration of social media and healthcare regulatory authorities. In particular we will dive into where the line should be drawn between personal expression and professional misconduct. It will definitely be an interesting discussion.

Please join us Tuesday September 12th at 8:30pm ET (for your local time click here) with our guest hosts Pat and Trish.

On Feb. 25 2015, Carolyn Strom posted a comment on her Facebook page expressing concern about the care received by grandfather at a health centre in Saskatchewan in his last week of life.

Strom is a registered nurse. According to her lawyer, a colleague and Facebook friend of Strom’s saw the post and printed it out and took it to work at the health centre where a supervisor saw the post and encouraged other nurses to complain.

As a result Strom was brought before the discipline committee of the Saskatchewan Registered Nurses’ Association (SRNA), and charged with five breaches of professional standards and the code of ethics: not respecting patient confidentiality by identifying her grandfather (this charge was dropped); failure to follow proper channels in making a complaint; making comments that have a negative impact on the reputation of staff and a facility; failure to first obtain all the facts; and using her status of registered nurse for personal purposes.

Strom was found guilty last year and fined $26,000 earlier this year (and she is appealing this before the courts). In its decision, the committee wrote: “The Discipline Committee does not seek to ‘muzzle’ registered nurses from using social media. However, registered nurses must conduct themselves professionally and with care when communicating on social media.”

As a result of the decision, one of Canada’s top health care journalists and commentators André Picard wrote that the decision was “preposterous.” “It’s bad for nursing and it’s bad for patients,” he said. He said health care providers should be encouraged not deterred from speaking out about sub-par patient care.

The case received widespread attention throughout Canada with almost unanimous condemnation of the nursing college for its decision. It starkly illuminates the challenges facing health care providers who wish to use social media professionally while staying within boundaries set by their regulatory authorities.

The reality is that for most health care professionals using social media puts them in jeopardy of running afoul of their regulatory authority – especially if professional misconduct is defined broadly enough to encompass “making comments that have a negative impact on the reputation of staff” or “failure to follow proper channels.” From a certain perspective, it is actually amazing the number of nurses, pharmacists, physicians and others who do play active ongoing roles on Twitter and other social media channels without apparently getting into any trouble.

Regulatory bodies in health care are not totally insensible to the impact of social media on the professions they govern. Not too many years ago a licensing authority for physicians in Canada stated it saw no valid reason for physicians to use Facebook, period. That type of statement has been replaced in recent years by regulations concerning the use of social media which just stress using a similar level of professionalism on social media as is used with in-person interactions or in print. Some even acknowledge the benefits of social media to support the exchange of information and ideas.

But in Canada at least the tension between professional regulation and use of social media persists.

In Canada, self-regulation in the health professions focuses on protecting and serving the public interest. Regulatory activities are intended to ensure the professions have, and follow, standards and codes of ethics directed to public (including patient) interests; safety, competence, and ethics are common principles. The rapid increase in social media adoption and use by the public, including patient groups, has created challenges as health professionals try to balance patient and regulator expectations.

At its recent annual General Council meeting last month, the Canadian Medical Association held a session on intra-professionalism in which the focus was the lack of civility between doctors on social media. In contrast, some doctors in Ontario have been critical of their peers for registering complaints about their colleagues with the provincial college for bullying and other inappropriate activity on social media.

Many health care practitioners feel it is possible to act professionally on social media without necessarily adhering strictly to the wording in their professional code of conduct. But until and unless such codes are updated to reflect the realities of social media, these individuals will always leave themselves open to the type of treatment accorded Carolyn Strum.

Please join us Tuesday September 12th at 8:30pm ET (for your local time click here) as we discuss the following topics:

  • T1 Do you feel physicians, nurses & staff are “muzzled” by their orgs & professional associations when it comes to social media?
  • T2 Is social media an appropriate place for a health care professional to voice concerns?
  • T3 Should health professionals be held to a different standard in their use of social media vs patients or non-healthcare workers?
  • T4 Should health regulators consider social media part of professional communications, or as something separate?


“Our system suffers when health workers are muzzled”, Andre Picard, Globe and Mail, 6 December 2016,, accessed 6 September 2017

“Physicians behaving badly on Twitter”, Pat Rich,, 1 June 2017,, accessed 6 September 2017

“MDs + Social Media. What do we want and why?”, Bryan Vartabedian MD, HCLDR Blog, 8 February 2015,, accessed 6 September 2017

“15 Reasons Twitter is Worth Physician’s Time”, Lee Aase, Mayo Clinic Social Media Network, 15 April 2015,, accessed 6 September 2017

“How do We Define Professional Physician Behavior in Social Media?”, Mark Ryan MD, Mayo Clinic Social Media Network, 1 August 2011,, accessed 6 September 2017

“Social Media and Health Care Professionals: Benefits, Risks and Best Practices”, C Lee Ventola, Pharmacy and Therapeutics, July 2014,, accessed 6 September 2017

“Canadian physicians and social media: A Prognosis”, Pat Rich, BC Patient Safety and Quality Council, 7 March 2012,, accessed 6 September 2017

Image Credit

Bump – Mike Maguire


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