How to engage and advocate safely on social media

Dr. Lisa Thurgur: Hi, everyone, and welcome to our webinar entitled How to Engage and Advocate Safely on Social Media.

I think everyone will agree this is a very crucial and timely topic that affects the intersection of modern communication and health care. Before we begin, I'd like to acknowledge the land that we are presenting from today. The CMPA offices are located in Ottawa and are on the unceded, unsurrendered territory of the Anishinaabe Algonquin Nation, whose presence here reaches back to time immemorial.

This photo that you see is actually taken by a CMPA member and is of the land directly across from the CMPA offices. I also want to recognize that today we probably have many participants learning with us from all areas across Canada, and I would like to honor and pay respect to these lands that you are on, and to all First Nations, Inuit, Métis people throughout Turtle Island.

I'd like to introduce our panel for this webinar. So Kerri Best is a family medicine trained physician who practiced comprehensive medicine in smaller communities before joining the CMPA. She is currently a physician advisor at the CMPA and is a physician team leader in this role. She comes to us with a vast amount of knowledge on this topic. As someone who speaks to members every day on the phone about their medico-legal concerns.

Welcome, Kerri. Thanks so much for joining us.

Dr. Kerri Best: Thank you.

Dr. Lisa Thurgur: And Martin Lapner is a partner in our Ottawa law office for Gowling WLG. He practices in health law and privacy, including as counsel to the CMPA and to physicians. Marty practices with an emphasis on professional regulatory and civil liability matters, and he's here today to share a wealth of knowledge on this topic. Thanks so much for joining us, Marty.

Martin Lapner: Thank you.

Dr. Lisa Thurgur: Great to have you here. As a panel, we have no conflicts of interest to disclose except that both Kerri and I are paid members of the CMPA. Employees, that is. And Marty is retained General Council to the CMPA. Now, these are our objectives for this webinar. First and foremost, we would like to delve into talking about the medico-legal risks associated with physicians using social media.

This is on both personal and a professional level. We're going to provide you with a ton of tips during this webinar for using social media as physicians, but two of the most important ones we’ll touch on are establishing professional boundaries and patient confidentiality. And finally, we know that our members really want to understand the role of the CMPA if you encounter a complaint or a legal action as a result of engaging in social media, so we will definitely be discussing this.

Now as the digital landscape continues to evolve, so does the way that health care professionals engage with colleagues and patients and peers and the public. And while social media offers unprecedented opportunities for communication and education, it also presents unique challenges and potential pitfalls that can have significant legal and professional consequences for physicians.

But before we get into our panel discussion, I would like to acknowledge that international conflicts, armed conflicts and other crises and events around the world are currently causing significant anxiety and distress for many physicians. Our hearts go out to all people, including health care workers and their families and their loved ones who are facing the devastating impacts of these crises and conflicts.

We know how difficult it can be to navigate social media, especially when you feel a responsibility or a desire to address these conflicts and these crises. CMPA is here to help with this. Our role is to help you understand the medico-legal risks associated with social media and to help you develop strategies to post safely. I’m so glad you could join us today as we navigate through the complexities of this digital realm.

All right. So let’s start talking about the social media platforms. There are so many. There’s Facebook, Threads, Instagram, X formerly known as Twitter, TikTok. There are way too many to talk about here. As physicians, we’re drawn to these platforms. We want to go to them perhaps to support physician advocacy, to disseminate health information, to engage with peers.

Now, Kerri, as a physician advisor at the CMPA, do you actually get calls about social media? Do people call in and ask for advice on this topic?

Dr. Kerri Best: Yeah, that's a great question. We do definitely. You know, over time, I think we've been getting more as, you know, the digital age is upon us. So there's different reasons why a member would call us about social media.

They may call us before, you know, they engage. So some of the things they'll be thinking about engaging in are education with peers, with colleagues, with… to promote health and wellness with their patients. There's also engagement, you know, with peers, with students and with patients, and then also advocacy on a particular issue. We, as advisors, when they call to speak with us, we will provide some advice, some general advice, but we can also listen to what their plan is and what they're planning to do.

It's not our role as advisors to sanction any particular plan, but to review some things that they need to consider before they engage. And some of those things that we recommend would be to direct them towards resources. The CMPA website has a variety of excellent publications that you can look at. And then we also direct them towards their provincial College and their health care institutions that provide guidelines and various policies on social media use and practice.

And they're very helpful and important to understand those before you engage. Members will also reach out to us after they have engaged on social media. And in those situations, what we'll do is we'll review the facts and circumstances of what their concern is. Perhaps there's been a regulatory matter or a medico-legal matter that's evolved from some type of engagement, and we'll review our extent of assistance at that time and we'll relay any risks that they need to consider.

Dr. Lisa Thurgur: That is so important for our members to know.

So what do physicians need to consider before engaging in social media? What would you say are your top four tips that you give physicians over the phone?

Dr. Kerri Best: Sure. Another good question. So I like to, you know, remember things easily. And so I've broken it down into the ABCs of social media. So you can remind yourself before you engage and maybe you'll remember, too.

So the first is A, so it’s appropriate. So really just ensure that if you use social media to convey a message, that it's an appropriate venue to convey that message. And you'll know that generally that if it involves creating a short, simple general statement, then that sounds reasonable. If it's a more complex, nuanced discussion, then that would have more risk associated with it, as it could be more likely to be misinterpreted, or, you know, someone could take it out of context

B would be for boundaries. So it's generally recommended that physicians have separate personal and professional accounts. But it's just important to be aware that the College and the public and our health care institutions generally hold physicians at a… have higher expectations of physician behavior. And so even when physicians post messaging or interact on social media on their personal accounts, that too may be scrutinized by the College.

C is communication. So we are expected to communicate in the same way on social media that we would in person. And so the general rule of thumb really is if you wouldn't say it out loud, then you probably shouldn't say it online. And finally, D would be for a dialogue. So it is completely appropriate to respond to online comments and questions.

It's just important that we maintain professionalism and that we participate respectfully when engaging, you know, in the comment section or when we're providing a reaction online, when we're supporting a matter or even conveying a contrary view. We need to be mindful of our own biases that we bring to these engagements and our emotional state. And generally, if you read a post or a comment that triggers you emotionally, our recommendation is that you take a step away. That you pause, you know, take a few breaths, go for a run, even wait 24 hours to pause before you post, to maintain some objectivity so that your reaction, you know, doesn't come across as being reactive. And sometimes the best response is no response.

Dr. Lisa Thurgur: You know what, those points are so important to know. And I have to be honest, the emerg doc in me loves the ABCD’s of social media. So thanks for that. Now I know we only asked you for four tips, but I would also imagine that protecting patient privacy is also a very important tip. Would you agree?

Dr. Kerri Best: Absolutely. 100%.

Dr. Lisa Thurgur: I am sure. And I bet you find yourself on the phone with members, perhaps reminding them that they shouldn't be communicating identifiable patient information over social media because a breach can occur even without a patient name. Is that correct? I mean, if you have any kind of identifiable information, even without a patient name, that would count as a breach of privacy information. So it's probably best to keep all information as general as possible. And that even comes to when you're posting a cool case on social media, or a clinical video of something that you want to share. It's so important to keep privacy in mind. Would you agree, Kerri?

Dr. Kerri Best: Yeah, absolutely. Yeah, always. And I also wanted to mention what I would consider the rules of engagement. So it's important that we're aware, as I slightly alluded to, that our provincial Colleges and our health care institutions do have guidelines and policies that guide our behavior. And there may be times where we would like to share some information on behalf of our institution or, you know, a third party and, really, because of those policies, we do encourage direct communication with those in authority before engaging on social media on behalf of someone else or another organization and use that existing structure in place, whether it's a clinic, hospital, health authority or educational institution.

Dr. Lisa Thurgur: Okay. So you mentioned that views and posts should always be delivered respectfully and professionally. Now, I know that a number of regulatory standards, policies, guidelines refer to concepts of maintaining the physician's professional integrity or the reputation of a profession. So what do we actually mean by professionalism?

Dr. Kerri Best: Yeah, so professionalism is a fluid and, you know, contextual matter that really governs the way that physicians act. It includes things such as, you know, protecting patient identity, you know, being aware of conflict of interest, when you're advocating within particular parameters. It really governs all of our actions, whether we're wearing our professional hats or are engaging personally within the community. We always have to maintain a certain standard.

Dr. Lisa Thurgur: I understand. So professionalism is extremely important. Okay. I can really appreciate that. We also talk about professionalism in terms of what the expectations are of Colleges, and if there is, in fact, a difference between personal and professional social media. Marty, I wonder if you could tell us a little bit about the difference between the two and how the courts tend to differentiate that.

Martin Lapner: Yeah. So what the Colleges have said in their policies and their standards on this issue is that it's difficult to differentiate between professional and personal use. And there are a number of different factors that look at that… that help inform that analysis. So, the nature and seriousness of the post, whether you're identifiable as a physician, either your account is a professional account or your credentials indicate that you're an M.D. The connection between the topic and the practice of medicine or the profession.

Are you speaking about health care provided at your facility? That tends to bring more into the jurisdiction of regulators and courts to consider professionalism. Or is this something that's communicated more privately to only friends where you're not identified as a physician? All of these can be taken into account. But the bottom line is really that the courts and the Colleges can look at this, whether you feel it's personal or professional, and there is regulatory oversight. So it's important to be professional in all social media use.

Dr. Lisa Thurgur: So it sounds like it's difficult to differentiate between personal and professional use on social media. And it also sounds like many different factors go into deciding whether or not a post is unprofessional. Is that right?

Martin Lapner: That's right.

Dr. Lisa Thurgur: Okay. So, Marty, can you tell us a little bit about what type of conduct on social media would qualify as professional misconduct?

Martin Lapner: Absolutely. We've seen a number of cases look into this, and the more obvious examples are sharing inappropriate content or breaching boundaries with social media use or engaging with patients beyond professional boundaries. Privacy breaches are another obvious example where images or a cool case, as you referenced earlier, are shared through social media without consent or advertising of images… using images without consent.

Spreading misinformation is another example. We saw a number of cases during the pandemic relating to that issue. And personal attacks, inflammatory statements. They can attract regulatory oversight. And all of these are examples that address that.

Dr. Lisa Thurgur: Now, that's interesting. Now, you mentioned regulatory action. So in terms of regulatory actions, what are some examples from court decisions that have upheld the College's jurisdiction? Can you give us some examples?

Martin Lapner: Yeah. There have been a couple of seminal cases on this recently, and the main principle arising from those is that freedom of expression has not been forfeited by health professionals, but it's subject to certain restrictions because of the trust that's put in to professionals and the high expectations that are expected of them.

The first case comes out of Saskatchewan and involved a registered nurse. It's called Strom and the Saskatchewan Registered Nurses Association, and the case involved comments about palliative care provided to the nurse’s grandfather who had recently passed away. She was found guilty of professional misconduct, ordered to pay costs of the proceeding, and she was fined. The decision was appealed to the Saskatchewan Court of Queen's Bench, as it then was, which suggested that, yeah, this was appropriate, this was a reasonable outcome and the comments at issue suggested that nurses are potentially incompetent and unprofessional in the delivery of palliative care.

So that's appropriate for Colleges to discipline. There was an appeal to the Court of Appeal, and the court said, well, wait a second, this is more of a contextual analysis. For example, was the nurse on duty? Not in this case. Was there truth to the statement? And the court seemed to acknowledge that there was some truth to the statement that palliative care can be improved generally. There was a question about the nature and extent of the communication, whether it was the result of emotional distress, and that was expressly at issue in this case. The nurse's grandfather had recently passed away. And the court said, you know what? This should actually be overturned. It's not a fair balancing of freedom of expression versus the regulatory oversight. And so that case showed that freedom of expression prevailed in that instance.

Dr. Lisa Thurgur: So does that give free rein to health care providers speaking in a personal capacity?

Martin Lapner: Well, that's interesting you say that, because the next case I was going to talk about is a bit of a counterweight and it swings the pendulum a bit in the other direction.

And that's called Peterson and the College of Psychologists of Ontario. And that case involved political comments that were made on a podcast and on X, formerly Twitter, and the psychologist in that case was ordered to undergo media training and coaching. And he appealed that finding, saying this is an infringement of my freedom of expression.

And it’s at, really at the very margins of the mandate of the College to regulate. And the court said, well, wait a second, you can't have it both ways. You can't say this is a personal expression when you're identified as a psychologist, when you make these statements. And that lends weight to the statements that you're making. And this was not comments only privately made to friends, but publicly to broad audiences. And so those factors were really important to the court. And they said this was a proportional order and a balancing of freedom of expression as against the regulator's mandate.

Dr. Lisa Thurgur: So we are seeing freedom of expression balanced with the College's mandate to protect the public, would you say?

Martin Lapner: That's right. Basically, it's a factor of an analysis that looks at whether there's been a proportionate balancing of freedom of expression with the mandate of regulators to protect the public. And what these cases show is that it is very fact driven. But oversight can occur in personal use as well as professional.

Dr. Lisa Thurgur: I love hearing about those cases. Thanks for sharing that. I'm sure our members do as well. So now we've heard a lot about the medico-legal risks associated with using social media. We've heard about some of these court and case examples. And you both have provided some great tips about posting safely on social media. Kerri, can you please tell us and tell the members how the CMPA will assist in the event of a College complaint or a legal action while engaging in social media? Either, you know, if health advocacy is involved or not. Can you comment on the assistance for that?

Dr. Kerri Best: Absolutely. So the CMPA, of course, is unable to guarantee assistance in advance, but we do generally assist matters arising from social media, including health advocacy work, that relate to the professional practice of medicine. When members engage in social media directed at a non-medical audience, then they're generally eligible for assistance within Canada, should a medico-legal matter arise. If members are engaged in social media towards a medical audience, then assistance is generally eligible for members if a medico-legal issue arises from within Canada or outside Canada. And this is regardless of whether or not a member receives financial benefit for their participation. One thing to remember, though, is that members are generally not eligible where medico-legal difficulties arise related to promotion of a particular product or service.

Dr. Lisa Thurgur: Okay, well, that is helpful.

Now, certainly we know that during the pandemic, many physicians were involved with health advocacy and some physicians were using social media to express their opinions about COVID vaccinations and other health measures. Did they get in trouble, Marty?

Martin Lapner: Yes. Colleges have reported on those cases now, and across the country, there were cases reported to various regulators. And they've reported now that health professionals were investigated for a number of different issues that arose during the pandemic, from spreading misinformation to advocating against public health measures, to advocating against vaccine mandates.

And there was really a range of outcomes and sanctions or discipline that were issued. Some resulted in remedial outcomes or advisory dispositions, some resulted in oral cautions, and some had more serious sanctions like suspensions or even revocation of licensure. In our experience, generally what we've seen is that minor cases generally result in minor outcomes and more severe breaches or patterns of conduct can result in serious outcomes, including suspensions or worse.

Dr. Lisa Thurgur: Okay. Let's talk about allegations of defamation. Now, certainly the nature of social media, it creates real risk for allegations of defamation and it allows users to quickly disseminate information widely with little or no editorial oversight. And it's difficult, if not impossible, to retract once it's published. Can you tell our members a bit about allegations of defamation and how it relates to social media?

Martin Lapner: Yeah, well, maybe I'll chime in first just to give a definition. So defamation means the making of false statements that can harm the reputation of another and defamatory comments risk allegations of libel or slander or complaints to regulators or the Human Rights Commission. We've seen examples of hospitals and regulators acting on these complaints and investigating health professionals.

And in some cases, they've resulted in suspensions or loss of privileges or even legal action. Some tips to avoid defamation actions, similar to some of the tips we've talked about for social media use generally, but those include avoiding impulsive personal attacks. Consider how the recipient might feel in receiving or seeing this message. Take time to reflect. And one really important message for defamation in particular is to use appropriate channels if you're reporting or complaining about someone, and that affords certain protections to you against defamation claims.

Dr. Lisa Thurgur: Okay, that's great. Anything to add to that, Kerri?

Dr. Kerri Best: Yeah, I would add to use caution when using email or social media to communicate sensitive information or issues. Even though it may be deleted by you at some point if a screenshot has been taken or an email has been sent around when it's deleted, it's not gone.

So just really use caution. And as Marty said, you know, if you have a concern, you know, with your institution, there are existing structures in place that you should work through. And also not to share any correspondence that's supposed to be contained within a particular group. So if it's a department within the hospital committee or even an online physician group, we really should not share that beyond that group.

Dr. Lisa Thurgur: That makes a lot of sense. All right. Thank you both for that. I want to put in a little plug or a little reminder right now about publishing or posting patient information on social media. We touched on this a little bit earlier, but I think it's really important. So this is referring to many things. But, you know, for example, photographs, names, medical stories, etc.

I really want to emphasize that social media is useful for discussing general health topics with colleagues, but it is very important to continue to comply with your professional and your legal obligations, including those related to privacy and confidentiality. Would you agree, Kerri, anything to add to that? Anything in particular?

Dr. Kerri Best: Yes, absolutely. There are platforms, many platforms that physicians have joined. These online private physician groups. And we have a bit of a false sense of security when we're engaging with our colleagues within those groups. And sometimes you'll see that patient cases are being shared amongst each other for support or for information. And there is a risk that a patient may be identified through the circumstances, even if their name isn't given. And there's also a risk that things within that group could be… a page could be screenshotted and shared outside the group, even though there's rules of the group. Sometimes that they don't… that doesn't always work. And so our general rule of thumb is just to be very cautious, to try to keep your engagement general, to deidentify patients.

And really the gold standard is to get patient consent. I've been seeing that actually in some of the groups that I've been on. Really, I think the posts that provide the most reassurance is if someone says, just, “I have a question about a patient, I have their permission to ask this question”, and then I feel, it feels a bit more of a safe space for others to engage. And that's really the gold standard. And there have been cases where the College has been critical of physicians who shared information sometimes for, you know, personal purposes or business purposes without consent. And so it's very important to consider that.

Dr. Lisa Thurgur: I love that tip about getting the patient to consent to using that information. I think that's very important. Yeah, that's a great tip.

I'd also like to remind members that College policies and standards, when they define social media, it is actually a non-exhaustive list of platforms. There are so many that it can involve. They include media that might not traditionally be considered social media. So things like online discussion forums like Reddit and Quora. It could be blogs, it could be podcasts or any other online communication that could be broadly disseminated.

Even things like very large emails can be considered to be social media. When we're looking at the College policies. So the tip to remember is that the same expectations of professionalism apply when communicating in person, online, or through social media (however social media might be defined). So that is a very important tip that we would like our members to remember.

We're going to conclude shortly the panel discussion part of the webinar. We do want to reiterate that we understand that many topics can be very difficult to navigate on social media when you're feeling a responsibility or a desire to address them. We do think it's worth repeating that there are both opportunities as well as risks with the use of social media and the expectations for professionalism extend to the online realm.

The CMPA is here to help you navigate the medico-legal risks associated with social media, and so hopefully you were able to grab a few tips from the panel discussion, and I'm sure they'll be… there'll be more coming up in the Q&A, depending on what your questions are. We're going to head to the Q&A. But before we do, I do want to leave the listeners with one takeaway from each of us.

So think about your takeaway for a moment. For me, I would like to remind members that anything you post can be accessed even years into the future. And even when a post has been deleted, a screenshot of that post might circulate and it can become permanent. It can be completely outside of the control of the person who actually posted it originally. So that's my takeaway. Marty, how about you?

Martin Lapner: So my takeaway is to be familiar and comply with your College policies and your institution's policies. The policies from the College boil down to largely an obligation to be respectful and civil. And that's really important. And the hospital policies are similar, but some also require you to obtain authorization prior to posting on certain topics. And that's another important issue to bear in mind.

Dr. Lisa Thurgur: That's awesome. Thanks, Marty. How about you, Kerri? What's your take away?

Dr. Kerri Best: My pearls are to protect privacy, maintain professional boundaries, and to pause before posting.

Dr. Lisa Thurgur: Okay, I like it. Thanks for that. All right. I am sure the questions have been rolling in during the webinar, but if you haven't had a chance to ask your question, you can do so using the Q&A button on the Zoom toolbar.

I'd like to introduce our moderator who's joining us today for the Q&A. This is Dr. Liisa Honey. She's the director of Safe Medical Care Learning at the CMPA, and her background is in obstetrics and gynecology, and she has specialty training in quality improvement, patient safety and physician leadership. We're fortunate to have her join us here for this panel. Thanks very much for joining us, Liisa. And let's get started with the Q&A.

Dr. Liisa Honey: Thank you, Lisa. We've got lots of questions rolling in, so I'm trying to group them by theme. So you may not hear the specific question you've asked, but trying to stick with the theme approach. So first thing I'm going to start with is if I like something on someone else's post, and it's fairly controversial and could in fact cause problems for me as a professional, will it be considered endorsement or my opinion by proxy? And I'll ask Marty if he doesn't mind answering that one.

Martin Lapner: Sure, sure. So that question hasn't been specifically addressed by courts or Colleges, but the framework that they provided does provide some insight. And what it says or suggests is that liking would be lower risk than creating content yourself. But it's not zero risk. If made public or if that information is reported to a regulator or your hospital, it could be seen as agreement with the post. So the nature and content of the post would be taken into account. And if you're identifiable as a physician – you have to remember the reach and the permanency of social media. That's going to be indelibly on the Internet. So there's a contextual approach, and liking a post is less risky than posting it yourself. And then, the explanation you might provide would also be relevant if it is investigated, but it's not zero risk.

Dr. Liisa Honey: Thanks, Marty. I'm going to ask a follow-up to that. Can I follow whoever I want on social media without repercussions?

Martin Lapner: The analysis there is quite similar to your previous question. Again, it's lower risk, but it's not zero risk. And following is probably even lower risk than liking a particular comment because an account may post information about a wide variety of topics and maybe you follow that account for only a subset of those topics. And, you can explain, in a reasonable way, why that's not unprofessional. But again, the fact that you follow the account can be public, can be linked to your professional account, or people who identified you as a professional. And the nature of the post, by that account, the truth of those posts, whether you have a reasonable explanation etc., would be considered if reported to the College.

Dr. Liisa Honey: Thanks for that, Marty. I'm going to ask this next question of Kerri as a physician perspective. So I got a bad rating on RateMD and someone posted some very unfair comments. How do I respond? How do I get it taken down? And can I take action against them? Can I sue them?

Dr. Kerri Best: Okay, so those are three questions in one. So I will try to remember them all. So first of all, I just want to say as a colleague and a fellow physician, I know how disheartening it can be to read something negative about yourself online. And there is fear of reputational risk. And there's also just a feeling of defeat, sometimes. So I think it's important to acknowledge how it makes you feel. And this is one of those moments where we talk about a pause-before-you-post kind of philosophy in terms of, you know, before you respond or do anything, just take a step back, take a pause, do something for yourself to just decompress and to maintain some objectivity with what you read.

I encourage you to contact the CMPA and speak with one of us. This is something that we do take calls on and we do understand how you're feeling and we can support you. We can also provide some advice and, you know, let you know what your options are. And it's just really important that you reach out for support.

Our general advice would be that we recommend against publicly responding to comments on public… on rating websites. And the reason for that is that these websites are typically public and viewable by all. And so your responses may come across as defensive. They may be misinterpreted, and they also could be used in College or legal proceedings because they're public.

If you would like to have the post taken down, there are ways that you can reach out to the ratings website and request that a post be removed that's defamatory in nature. We do understand that some members still would like to respond or would like to take action against the ratings website or against an individual. We would like to let you know that we, as we are a mutual defense organization, we would not participate in initiating action against a ratings website or an individual, as it's not within our extent of assistance. And so if that's something that a member would be wanting to pursue, then we'd recommend that you speak with personal counsel or a public relations consultant.

Dr. Lisa Thurgur: I feel like we all know a colleague that that has happened to.

Dr. Kerri Best: Yeah.

Dr. Lisa Thurgur: Unfortunately.

Dr. Liisa Honey: Wonderful. Thanks for that, Kerri. All right, Lisa, next question I'm going to direct to you, and this is a tough one. So what is the CMPA doing to support doctors that are being targeted by Colleges and hospitals for complaints arising from their stance on international issues?

Dr. Lisa Thurgur: That is a tough one, Liisa. I mean, it's an important question. I think I mean, I mentioned this earlier in the panel discussion, but we certainly understand that international events right now, armed conflicts, other crises around the world are definitely causing members significant anxiety and distress. And it’s something, you know, we feel this, and we understand that there's devastating impacts of these crises for so many people, these crises and this… these conflicts. We can't ignore it. We know also that some members feel the responsibility to post about this, to comment online, and that this can actually increase the risk of complaints and defamation claims, unfortunately.

So our role at the CMPA is to help members understand the risks, the medico-legal risks in posting and to help you develop strategies to post safely. And I mean, that's why we're having events like this, right? That's why we designed this webinar, was to help with that. At the CMPA, we also provide support when it's needed, if we determine that the activities relate to the professional practice of medicine. So when a member faces a regulatory complaint or allegations of defamation, the CMPA will consider whether the allegations arise out of health advocacy activities that related to the member's professional practice of medicine. So that piece is important, because the CMPA assistance will not generally be available for matters that arise from personal lives or business lives.

And therefore members should not expect the CMPA to support them with matters that are primarily personal or business. But we are here to assist and to support with matters that do arise from medical professional work.

Dr. Liisa Honey: Thank you, Lisa. All right, back to Kerri. How do I know if a topic is just too controversial to be posting about it?

Dr. Kerri Best: Yeah, that's a good question. You know, there's really no clear test to assess if a matter is too controversial or not for social media. Our general advice, if we go back to kind of the social media tips, is, if it's something that you can respond to in a straightforward and general way and it doesn't require a more nuanced or complex discussion, then that sounds like it may be appropriate because really it's a matter of, “Is this something that is appropriate for that kind of a social media type dialogue?”

We also need to be mindful, I think also, as I mentioned before, of our emotional state. So if you see a topic or know of a topic that really creates an emotional reaction in you, that's probably not the best time to respond to a topic like that. But just to kind of do the 24-hour wait, or take a breath, and really think about if that's something you want to engage with online. And are you engaging with your professional hat on or with your personal hat on?

We've talked about how blurred those boundaries can be. And also, if there's a lot of controversy and it could be misperceived or there’s misinformation, then certainly you want to be aware of that as well.

Dr. Liisa Honey: Wonderful. Thank you. So, Marty, I haven't forgotten about you, I’m coming back to you. Do we need to include disclaimers that our posts are not a substitute for medical advice?

Martin Lapner: That's a good question. And you know, it's not a bad idea. The CMPA has a number of publications on its website that talk about information portals and information dissemination which say it should be clear to those who are receiving and the recipients of that information to… so that they understand this is not medical advice you're giving. You're giving general information. They should not be providing care to themselves based on this information. They should see a physician or another allied health professional if they need case-specific advice. So, it's actually a good risk management practice to specifically have a disclaimer that this is not medical advice. You need to see… you need to see someone. But here's some general information that I'm sharing for broader health care purposes.

Dr. Kerri Best: And can I just add, Liisa, actually to that answer? You know, when you are posting things online, it's also important to express that it's Canadian content, because there is a wide reach to what we post online. And it's important to specify that what you're posting is intended for a Canadian audience.

Dr. Liisa Honey: Wonderful. Thank you. So I've had a few different questions around political advocacy. So, Marty, I'm going to come back to you. What is the limit of political engagement in social media? So, for example, some doctors will run for office. Can we endorse them? Can we endorse non-physicians on social media?

Martin Lapner: That's a good question. And there's no… there's no blanket prohibition against any postings on… in the area. But what we've seen from the Colleges is that there are high expectations for physicians as professionals. They have a great deal of influence in society. And that is incorporated into any review of their behavior by the Colleges and the courts. So, while there's no blanket prohibition, at the same time, it may be reviewed to see if it is professional.

And again, that'll be a contextual analysis. They'll look at the truth of the statement, whether it's made in a more personal capacity or whether it's made in a professional capacity. And there's a bit of a spectrum there. And what you see is that the courts and the regulators give more deference on the personal side of things, off-duty conduct versus professional conduct and all of those factors again. So whether you're identified as a physician, what the actual communication or posting is, those will all be taken into account in evaluating whether it is unprofessional and whether there should be any sanction.

Dr. Liisa Honey: Wonderful. And a similar question is… how do we advocate against government? And can I express political views that have nothing to do with medicine?

Martin Lapner: Again, the analysis is going to be similar. There's no blanket prohibition on speaking about broader health issues or broader issues that you'd like to make in a personal capacity. There are some tips you might consider for trying to reduce the risk if you're going to do so. Again, still be respectful and civil. Don't use your professional account or identify yourself as a physician if you don't want to, attract regulatory scrutiny. But at the same time, even posts that are believed to be made in a personal capacity can be reviewed. So you can do your best to reduce the risk and then consider whether it is appropriate to comment and with open eyes.

Dr. Liisa Honey: Thank you. All right, Kerri, I'm going to ask you this one to start. And Marty may like to chime in, but are the Colleges really allowed to censor my comments? And what about my right to free speech?

Dr. Kerri Best: OK. “Are the Colleges allowed to censor my comments?” Well, you know, Colleges recognize that… So, we’re talking about advocacy, sounds like. You know, Colleges recognize that health advocacy is a core competency for physicians and are generally supportive of health advocacy when it is done, when physicians respond… or advocate response… responsibly. And if this advocacy does not interrupt the provision of safe patient care. And so that's really the standard at which they consider that, and if you're responding in a… whether it's a professional capacity or a personal capacity, or advocating in that way, as we said, the College may scrutinize advocacy that does not align with the principles of professionalism and may be seen as disruptive.

Martin Lapner: Yeah, Yeah. And the decisions that we talked about earlier confirmed that, yes, the Colleges do have jurisdiction to regulate in this space. And that was a bit of an open question as to whether they had that jurisdiction and whether it violated health professionals’ freedom of expression. And the courts said the professionals still have freedom of expression, but it's restricted. And that's because of the position of trust that they're given in society. And Colleges do have a mandate to restrict it appropriately. And again, it's a contextual analysis. More deference is given for personal postings, off-duty conduct, but it can still all be the subject of regulatory intervention.

Dr. Liisa Honey: Thank you. So, Lisa, I'm going to direct this one to you. What are your recommendations and advice about calling out blatant misinformation and harmful content on social media?

Dr. Lisa Thurgur: I wonder, Liisa, is that someone saying if they see harmful content on social media, should they call it out?

Dr. Liisa Honey: Yes.

Dr. Lisa Thurgur: I mean, I think it relates back a little bit to Kerri's comment about: it's always good to take a deep breath and pause before posting or calling out. It's important to think about what the other person meant by it. Maybe there's a different meaning. It's always difficult to sort of try and interpret what other people are trying to say on social media. And I think in the end, maybe Kerri will add some points that she made on her comment afterwards. But the 24-hour rule of taking a pause is very important.

In the end, you have to remember that what you're putting out on social media, whether it's calling someone out or commenting on what they've posted, will then become public knowledge and up for scrutiny as well. And that certainly is something that could get critiqued or a complaint could come as a result of it or legal action, just the same as the other person's comment on social media. I'm not sure if you have anything to add to that, Kerri.

Dr. Kerri Best: What I would add is, you know, it kind of goes to that hot button issue or, you know, controversial post issue. Some things even though, you know, we want to respond, we want to engage… Is that platform, the appropriate platform to engage on? If it requires more than a few simple statements and it's a more nuanced, complex discussion. You know, it may be difficult to engage in that way. And it really just depends on the facts and circumstances. And I know we say that a lot, but it does, because we really have to be aware of the purpose of our response and what are we trying to achieve. And sometimes it just leads to a really unhealthy back and forth. And anything that we do respond with should be based in evidence. And we should always be professional and compassionate and put our best foot forward.

Martin Lapner: And I would just add to that, and your last point really was what I wanted to emphasize.

The Colleges do recognize that, where you're making a contribution to clarifying information and it's evidence-based, that that is professional behavior. It will always depend on the context and the facts and circumstances. But if you're making a contribution to clarify misinformation or misinterpretation, that can be helpful and that can be a positive of social media use.

Dr. Lisa Thurgur: That's what we think of as health advocacy.

Martin Lapner: That’s right.

Dr. Liisa Honey: All right. So in the interest of time, we've got about 5 minutes left. I'm going to ask one last quick question, and I'm going to direct it to Marty. Can a physician such as a dermatologist promote products such as sunscreen where there may be a financial arrangement to discuss these products?

Martin Lapner: That's an interesting question that raises broader issues about conflicts of interest, and some Colleges prohibit that kind of conduct. And you should really review your College's requirements about conflicts of interest and endorsement of specific products. Because that area is fraught with regulatory risk. So before doing that, really call the College and see if you're permitted to do that. But a number of Colleges don't allow that.

Dr. Liisa Honey: Wonderful. Thank you. So I have lots more questions that I wish we could get to them all. But unfortunately, we are running out of time. So I'm going to pass it back to you, Lisa.

Dr. Lisa Thurgur: Thanks, Liisa. I was going to ask you that if we managed to get through all the questions or if there were quite a few more. All right. So we didn't have time, it looks like, to address all of your questions. Or perhaps we addressed them during the panel discussion, but a little more generally than what you needed. Remember, though, that you can call the CMPA at any time to speak with a physician advisor, someone like Kerri, who will delve into all the specifics of your medico-legal question or case that you would like to discuss.

So we're definitely here for you for that. Remember: your engagement today, all of those questions, will definitely help inform future content for us. So we really appreciate you joining us. We hope that you keep well and continue to post safely. Thank you.