Social Media and Consent: Are Patients Adequately Informed?

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Social media have become a dominant force in today’s world. Nearly 3 billion monthly active users use social media to connect with family, friends, those with shared interests, and society at large. In addition, social media are integral in the dissemination of information, education, and advertisements. Within the field of plastic surgery, the impact of social media is significant.1 Plastic surgeons use them as marketing tools, to promote research, to connect with colleagues, and to create a brand.2 The use of social media within plastic surgery has several benefits. Educational materials are disseminated to a much larger audience. Novel techniques and treatment solutions can be circulated across the globe in a matter of seconds. Most importantly, we have the ability to engage and encourage patients to make evidence-based and informed decisions when considering plastic surgery (e.g., #PlasticSurgery and #DoYourHomework).3
Despite the positive impact of social media, it is crucial to recognize that there is potential for untoward consequences. An example is the distribution of identifiable patient material on social media platforms. Medical photography, whether for clinical, academic, or commercial purposes,4 requires the same level of informed consent and confidentiality as other aspects of the medical record.5 When used for publication, many journals, including Plastic and Reconstructive Surgery, require an additional level of consent in the form of a patient photograph authorization form.6 This is to ensure adequate patient awareness of how photographs will be used.
Plastic surgeons use social media to distribute patient images, for both marketing and educational purposes. Although informed consent must be obtained before distribution on social media, the use of patient images on social media is unique in several ways. Because social media are a recent phenomenon, we have not yet comprehensively elucidated patient privacy issues associated with this use. In addition, medical images used for presentations or publications have a clear copyright owner; in contrast, physicians that post by means of social media lose sole control and ownership of the images. There is also general agreement that once something is uploaded to the Internet, it is virtually impossible to permanently remove. Whether these issues are recognized by patients remains unclear. Furthermore, a fundamental aspect of the ethical principle of informed consent is the right to revoke consent at any time.7 Because of the nature of social media, patients effectively surrender this right when they consent to the distribution of photographs or other identifiable material.
Social media are a powerful tool that is here to stay.8 Therefore, adequate patient protection with respect to use must be implemented. As an initial step, we advocate for an additional level of consent to be obtained before distribution of patient materials on social media. Similar to the Journal’s photograph authorization form, the American Society of Plastic Surgeons should create a “Use of Patient Information and/or Photographs on Social Media” consent form. This document must ensure that patients are fully aware that their photographs may become a permanent fixture on the Internet should they consent to their publication by means of social media.
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