Jul 27 2012
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Physicians and Social Media: First, Do No Harm.

By Ryan Greysen, MD, MHS, an alumnus of the Robert Wood Johnson Foundation Clinical Scholars program and assistant clinical professor of medicine at the University of California, San Francisco

It seems commonplace today to hear of someone who’s done something online that they wish they hadn’t. Social media use has skyrocketed, and the Internet has pervaded our everyday lives, both personally and professionally. In 2009, my colleagues and I began thinking about this online content and how medical students might be using—or misusing—social media. We were among the first to look at this topic, and we focused on medical students because we assumed they were more frequent users of social media.

But while doing research for a perspective piece where we described “online professionalism” and the role of social media as a “mirror” of physician’s values to the public, we found a few reported incidents of licensed physicians getting into trouble with licensing boards. That begged the question: was this just an issue among medical trainees, or was this a trend among licensed physicians as well?

We approached the Federation of State Medical Boards (FSMB) to see if they would partner with us in a study of all medical boards to see how this issue was playing out on a national scale. We surveyed the 68 medical boards across the U.S. to assess violations of online professionalism and actions taken by state medical boards and published our findings in the Journal of the American Medical Association.

The majority of respondents at medical boards we surveyed (92 percent) said at least one online violation of professionalism had ever been reported. The most common problems were inappropriate patient communication online, such as sexual misconduct (69 percent); use of the Internet for inappropriate practice, including Internet prescribing without an established clinical relationship (63 percent); and doctors misrepresenting their credentials (60 percent).

The boards also answered questions about how they handled the violations. Fifty-six percent of the boards said physician misconduct online led to serious disciplinary outcomes—license to practice was either restricted, suspended, or revoked. My colleagues and I were surprised at how frequently boards were taking serious disciplinary actions. This was higher than we anticipated and I think it underscores that boards do see this issue as within their responsibilities to regulate.

Nonetheless, I would characterize the overall responses by licensing boards as variable. Although most reported at least one violation of online professionalism, there was quite a range in terms of how many violations at any given board. More interestingly, perhaps, there was also variation in responses to these violations; some boards took more serious actions than others.  I would surmise that those with more actions had more severe violations, but we didn’t ask them to link specific violations to actions so we can’t say for certain. Nonetheless, I do think that different boards may respond differently to the same material which may suggest more consensus between boards is needed.

Fortunately, one of the remarkable outcomes of our partnership with the FSMB is that they immediately appreciated the importance of this issue and were proactive in forming new policy and guidance in response to our study data, even before it was published. As a result, there is a new, consensus-driven FSMB policy on social media that was recently released.

These new policies should make it easier for boards to adopt very similar standards for oversight on this issue, so I think we will see increased awareness about this issue at the regulatory level. Certainly, the FSMB policies need to be widely circulated to practicing physicians so that they know what standards are being promoted, but there is also a need for continued education about this issue as the technology continues to change in the future.

Physicians should also be aware that many hospitals, medical schools, health care systems, or other large practices have their own policies about social media use by physicians and other health care professionals at their institutions. It makes good sense for physicians to familiarize themselves with these more “local” policies as well. Even though these new policies are necessary and will hopefully make it easier for boards to adopt very similar standards for oversight on this issue, I think the larger issue going forward is less about how to more effectively monitor or report and more about how to educate and prevent unprofessional behavior online.

These developments notwithstanding, the only good advice about reducing one’s liability online is to avoid doing things that could be deemed “unprofessional” in any setting (online or not). In our study, boards reported that physicians misrepresented their credentials online, communicated with patients through online dating sites, used the Internet to prescribe medications to patients they had no therapeutic relationship with, and violated patient confidentiality. These are all things that physicians should already know not to do “offline” so the best advice is to avoid thinking that doing them online is any different in the eyes of state medical boards.

We hope that our work has sketched the harms of this technology, but this is only one part of the big picture. One way to think of this is in terms of ethical traditions in our profession. The Hippocratic Oath calls for physicians to use good judgment, even restraint:  “First do no harm.” We think this should guide doctors in their online actions as well as in the medical practice.

We’ve also been trying to think beyond this paradigm. The first priority may be to do no harm but certainly this is not enough; we need to push ourselves as a profession to find ways that we can hone in on what are the uses of social media to promote professionalism, the well being of our patients, and the health of society. For example, in the research I’m beginning now, I’m trying to understand if social media can help patients stay connected and get needed help to recover at home after discharge from the hospital.

Our findings build on what we already know: bad online behavior is happening all around us and medical professionals are responsible for what they put online. The question that remains to be answered is: how can physicians and other medical professionals go beyond respecting this basic responsibility and harness the best aspects of social media to promote health and help patients?

Read more about Greysen’s work here.

Tags: Clinical Scholars, Ethics/bioethics, Human Capital, Patients, Physician Workforce, Physicians, Privacy and confidentiality, Research & Analysis, Social marketing, Voices from the Field