Behaving Badly Online?

The Journal of the American Medical Association (JAMA) published a research letter in the March 21 issue entitled, “Physician Violations of Online Professionalism and Disciplinary Actions: A National Survey of State Medical Boards,” written by S. Ryan Greysen, MD, MHS, MA; Katherine C. Chretien, MD; Terry Kind, MD, MPH; Aaron Young, PhD; and Cary P. Gross, MD, MPH.

The authors surveyed 68 executive directors of state and territorial medical and osteopathic boards about the incidence of violations of online professionalism about which the boards were aware — and what action had been taken in response. Of the 48 boards that responded, 44 (92%) indicated that at least one violation of online professionalism had been reported. The most common violations:

  • Inappropriate communication (i.e. sexual misconduct)
  • Use of the Internet for inappropriate practice (i.e. prescribing without an established physician/patient relationship)
  • Misrepresentation of credentials
  • Violations of patient confidentiality

The authors point out that the absolute number of violations reported was small but they suggest that a) the growing use of social media may result in an increase number of infractions over time; and, b) these activities may reflect offline misbehavior.

Three of the authors of this JAMA research letter also published an article in the Journal of General Internal Medicine (JGIM) in 2010 entitled, “Online Professionalism and the Mirror of Social Media.” In that article, they ask the following question: “If social media is a mirror, what kind of reflections does the public see of physicians?” The findings reported in their letter this week may be the beginning of the unfortunate answer.

In 2011, the American Medical Association published a policy entitled, “Professionalism in the Use of Social Media.” See this prior AmericanEHR blog post on the AMA guidance and another on social media in practice. The American College of Physicians published the 6th Edition of the Ethics Manual in January 2012. With respect to social media and online professionalism, the Ethics Manual states the following simple guidance:

Physicians who use online media, such as social networks, blogs, and video sites, should be aware of the potential to blur social and professional boundaries. They therefore must be careful to extend standards for maintaining professional relationships and confidentiality from the clinic to the online setting. Physicians must remain cognizant of the privacy settings for secure messaging and recording of patient–physician interactions as well as online networks and media and should maintain a professional demeanor in accounts that could be viewed by patients or the public.

Question: Do you use social media? If so, what safeguards do you follow to protect your patients, yourself, and the medical profession?

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.

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