Experienced physicians have almost as much trouble adhering to professional standards when using the Internet as medical students and trainees, reports Ryan Greysen, MD, MHS, a 2009-2011 Robert Wood Johnson Foundation (RWJF) Clinical Scholar. In research that expands on his previous work tracking the online habits of students and residents, Greysen and his team took a look at how well physicians with established practices were managing their Internet personas.
“In our first study we only looked at the unprofessional online behavior of students, thinking that, well, kids would be kids, but once they graduate, all that will change,” Greysen says. “Instead, we found that the majority of the country’s state medical boards were receiving reports—complaints really—about established physicians violating professional standards online.”
Greysen and his team surveyed 68 executive directors of medical and osteopathic boards in the United States about violations of online professionalism and reported their findings in the article, “Physician Violations of Online Professionalism and Disciplinary Actions: A National Survey of State Medical Boards,” published in the March, 2012 online edition of the Journal of the American Medical Association.
“Many of the behaviors reported are not new, but the impact is amplified because the Internet reaches such a wide audience,” says Greysen, who is also an assistant professor in the division of hospital medicine at University of California, San Francisco. The absence of gatekeepers online, such as the fact checkers or editors one might encounter before being able to publish in a journal or newspaper, also makes it easier for people to post embarrassing photos or statements without seriously considering the consequences.
Online Equals On Call
It’s clear from the broad range of activities reported to the medical boards that most physicians are not intentionally violating professional standards. In some cases, they are just not sure where to draw the line. Doctors who write narratives on their experiences with patients, and physicians who blog, are great examples. On one hand, medical professionals are being asked to share their knowledge, “but it must be done with care,” Greysen says, citing a doctor who blogged about a patient who had been in a terrible construction accident that had received a great deal of publicity. “The blogger did not use the patient’s name, but the patient was recognizable. In another case, a doctor described an incident that happened in an emergency room and the patient recognized himself.”
Other incidents suggest, at the very least, a disregard for medicine’s rules of conduct. “We’ve seen physicians contacting patients through online dating services, violating the appropriate guidelines for a therapeutic relationship,” Greysen says. “As well as problems with doctors misrepresenting their credentials online and images of physicians who were intoxicated, while on call (dressed in scrubs or white coats).”
Even in these cases, there were instances where physicians clearly meant well, but did not anticipate the full impact of their actions. “There’s a well known case of United States physicians who were blowing off steam after helping people in Haiti. Although these doctors had finished their tour and were off-duty, they were still dressed in scrubs and white coats and seemed intoxicated in photos that appeared online,” Greysen explains.
Consider Dual Citizenship
Of course, no one expects physicians to run away from the videographer at weddings or teetotal during special events with family and friends. “It’s expecting too much for doctors to never cut loose or have a drink,” Greysen says. “But we have to remember that when we do those things, we are still representing the profession. It’s a gray area in terms of professional standards, but we have to think of the public’s trust in physicians. I would recommend that doctors exercise discretion and avoid posting photos that could imply drinking on duty (by wearing scrubs or a white coat) or intoxication.”
“If you are a physician blogger, it’s also incumbent upon you to write in ways that will protect a patient’s identity. To make it easier for physicians to know what to do, the American Medical Association now has guidelines for physicians who engage in social media and medical schools are establishing policies for students and including the issue in curricula,” Greysen explains.
One way to reduce the risk of inappropriate online incidents, Greysen suggests, is for physicians to be careful to maintain two distinct personas on the Internet. “Maintain a private Facebook page for family and friends, for instance, and then have one that is only shared with a professional network.” But beware, Greysen adds, “do not post anything you’re not comfortable with online. Nothing is absolutely secure online.”
Benefit from the Internet
Potential pitfalls aside, Greysen is not suggesting that doctors avoid social media altogether. “The Internet provides great opportunities for physicians to network, learn from each other, and stay in touch with colleagues and patients. At the same time, realize that it can harm your career (discipline may include suspension or loss of license) and the profession, so be mindful of what you do and say. Always remember, it is a public space.”
Greysen conducted his research on medical professionals online with the support of the Robert Wood Johnson Foundation. His latest work, also supported by RWJF, examines methods for improving the quality of discharge procedures, including interdisciplinary teamwork, patient communication and post-discharge continuity of care. It will be published in 2012 in the Journal of Hospital Medicine.
The Robert Wood Johnson Foundation Clinical Scholars program advances the development of physicians who are leaders in transforming health care through positions in academic medicine, public health, and other roles. The program trains clinicians in the program development and research methods that will enable them to find solutions to the many challenges posed by the health care system, community health, and health services research.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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