You Have Major Depressive Disorder. Mind if I Tweet That?

This article is part of an online course: Digital and Social Media Ethics for Psychotherapists for 8 CE credits

Just a couple of weeks ago, New England Baptist Hospital banned Facebook and other social media sites due to concerns that hospital employees were sharing too much about patient care in their online updates. The hospital was reasonably concerned that workers might be violating HIPAA and other privacy policies.

Thanks to a post by Dr. V of 33 Charts, I was led to Paul Levy’s blog Running a Hospital, where I read the full text of the notice the hospital sent about blocking Facebook, MySpace, and Twitter. I soon got sucked into the comments on whether health care organizations should institute blocks on employee access to social networking sites. My own comment is reposted below:

I think a more useful approach by the hospital would be to regularly review confidentiality and HIPAA practices and remind people that even locked, private accounts are not appropriate for posting confidential hospital information.

Blocking access during the work day will not guarantee responsible use after-hours.

I, myself, have occasionally been distressed to see therapists posting about cases without regard to the fact that the client him or herself may later see it (if a public account) or that someone on their follower list may see it and identify the person if it is a locked and private account.

So again, much better to educate internet savvy users about professional identity and how to understand and manage one’s professional role while still being an active user of social media.

As social media use develops and digital natives enter the field, healthcare organizations are going have to do much more to educate employees about the dangers of posting confidential health information. What if you have a locked account? You may feel that you are not providing enough identifying data to compromise a patient’s privacy in 140 characters, but what if one of your followers knows the family you just counseled on the loss of their child? Also, what does it convey to the public about how we embody our professional roles and responsibilities when we are frivolous about posting  the serious and personal issues our clients present to us? It’s worth thinking twice if you’re considering posting information about the session you just completed with your last client.

What about those who maintain public Twitterstreams and who post case details without identifying data? While nobody may know the identity of the male client who just sought your care for erectile dysfunction, what about the impact on the client himself if he should he happen to read your post? Is it fair to say that he may feel exposed? Ashamed? Objectified for the sake of your readership? And what if he’s shared with a close friend or his employer that he’s seeking care from you, but has not divulged the reason for coming to treatment? What if these people know when your client meets with you and later read your Tweets after a session? What if they then ask your client if your mention of the client with sexual problems was about him? We may think we have protected our client by not disclosing age or ethnicity, but in a public forum, we are providing much more information than we may realize.

Given how social networking encourages us to share the details of our days, it is becoming crucial for us to carefully consider our policies when it comes to updating our status updates in regard to our work lives. If you wouldn’t want your therapist Tweeting about your sessions, then think twice before you post about sessions you engage in with your own clients. And if you are a provider who intends to publish information to the web about the services you provide, then at the very least, your confidentiality statements and informed consent forms should reflect this fact and outline the steps you take to preserve privacy.

If you do make it your practice to blog or Tweet about sessions, make this a conversation that happens early in treatment and give patients the opportunity to “opt out,” of treatment with you, or the chance to “opt out,” of being used as a status update. And remember, it may be your day you’re posting about, but it’s your client’s personal life and it is protected health information.

© 2009 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2009) You have major depressive disorder. Mind if I tweet that? Retrieved month/day/year from