Physicians and nurses, like most professionals today, are apt to log onto a social network to keep up with family and friends, advance their careers or keep in touch with colleagues. While this new trend has created opportunities, it’s also raised questions about what medical professionals should do online. To create guidelines that will help health care workers safely navigate in cyberspace, Robert Wood Johnson Foundation (RWJF) Clinical Scholar (2009-2011) Ryan Greysen, M.D., M.A., explains that he is “conducting ongoing research with state medical boards to find out just what problems may arise when physicians and other medical professionals use the Internet.”
Greysen’s interest in how patient confidentiality and other issues might be impacted by online behavior began shortly before his term as an RWJF Clinical Scholar. “In 2008, I was part of a team led by Katherine Chretien, M.D., that surveyed medical school deans to see if they were having problems with online medical student behavior,” Greysen recalled. Our results were published in “Online Posting of Unprofessional Content by Medical Students,” in the September 2009 issue of the Journal of the American Medical Association (JAMA). “We found that only 13 percent of the deans reported students violating patient confidentiality online, but 60 percent reported incidents of unprofessional online behavior,” said Greysen, who had just completed his residency at George Washington University at the time.
Once joining the RWJF Clinical Scholars program, Greysen looked at the full range of potential issues related to physicians using the Internet and decided to take a broader look at professionals who were further along in their careers.
“Our initial work uncovered many problems with medical students’ online postings. Depictions of intoxication, sexually suggestive material, profanity and the use of discriminatory language were common,” Greysen said. “But with older, working medical professionals we’re also concerned about physicians and nurses chronicling their interactions with patients online--especially since blogs have become so popular--or posting photographs that might include patients without their consent. The photographs posted by American physicians working in Haiti who were writing about their work online are a perfect example of medical professionals crossing boundaries. One of the most troubling pictures showed a patient on an operating table. It was placed on Facebook and then picked up by CNN,” Greysen said.
“Some people may think social media use is limited to young people and therefore not much of a problem, but data from the Pew Research Center’s Internet and American Life Project shows older people are increasingly using it as well,” he added.
A Dangerous Disconnect
The fairly obvious question that arises after looking at Greysen’s research is: “How can physicians and nurses schooled in the importance of the Health Insurance Portability and Accountability Act (HIPPA ) and other patient protections suddenly feel comfortable telling all online?” The answer, Greysen says, is “there’s a type of disassociation. People tend to think their actions online are private. That’s why our new perspective piece, ’Online Professionalism and the Mirror of Social Media,’ published in the November 2010 issue of the Journal of General Internal Medicine discusses the need for online professionalism, even when people are off the clock. Physicians and nurses need to be aware of a constant, professional presence. They cannot afford to think it does not matter what they do in their personal, online time.”
In addition, Greysen notes, “we want to highlight and encourage the positive opportunities the Internet has created for people in the health professions. There are problems, but there is a great potential for social media to bring about good things. There are hospitals, for instance, that encourage surgeons to tweet real-time progress updates to families in waiting rooms.”
“Physicians can also use social media to get healthy messages out to patients—especially teens and parents--by blogging or tweeting. These messages can replace or augment office brochures.” Greysen also points out that using the Internet as a private, professional forum is working well for some students of clinical medicine who, “share the emotional aspects of studying to become a physician with other students in a closed blog,” said Greysen, referring to the reflective blogging course conducted at George Washington School of Medicine by his colleague, Chretien.
Going forward, Greysen is putting his skills and time as an RWJF Clinical Scholar to work on his latest study, a survey of state medical boards across the United States. “We’ve developed several cases to present to the boards. We are asking them to consider how they would handle various scenarios concerning Internet use. We are also asking if they’ve received complaints about physicians using the Internet inappropriately,” he said.
“Throughout this process, RWJF has been phenomenal in terms of providing resources. And at a recent research in progress meeting, my fellow scholars pointed out many of the challenges with this subject—it was a great help. Our discussions on how to collaborate with other organizations guided my approach to the state medical boards,” Greysen added.
Greysen and his colleagues are fully aware that social media use among medical professionals is a trend that will only grow. “We are getting into this issue with state boards and medical schools so that they will be prepared and develop guidelines to handle the issues that will arise. We also want to help physicians, nurses and other professionals realize that when they are online, they leave a digital footprint that can have a negative impact. Ultimately, we want them to see that social media can really be used as a mirror to reflect the positive values of the medical profession to the rest of the world,” Greysen said.
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.
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