Physicians using social media need clearer guidelines to define the parameters of professional conduct online, a new survey published in the Journal of the American Medical Association suggests. But medical boards are demonstrating a willingness to discipline physicians for unprofessional behavior on social media and online dating websites.
About 71 percent of the 48 medical and osteopathic board executive directors who participated in the survey said the misconduct led to disciplinary proceedings. Among the most commonly reported violations medical boards received were inappropriate communication with patients, Internet prescribing without an established clinical relationship with patients and misrepresentation of credentials online.
At least half of the participating boards said serious disciplinary action led to license restriction, suspension or revocation. Patients or the families of patients were the primary source for reporting the misconduct to the boards.
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Dr. Ryan Greysen, the lead author on the article and an assistant clinical professor in the division of hospital medicine at University of California, San Francisco, said he and his co-authors were surprised how frequently boards are taking serious disciplinary action such as restriction, suspension or revocation (56 percent of boards). In addition to social media websites and dating websites like Match.com, the survey also included blogs, physician practice websites as well as image or multimedia sharing sites like Flickr and YouTube.
“This was higher than we anticipated and I think it underscores … that boards do see this issue as within their responsibilities to regulate,” Greysen said in emailed responses to questions.
With social media use expected to grow among medical staff, conduct issues are likely to become a more critical issue. About 90 percent of physicians use social media, according to a report by QuantiaMedia last year. Frost & Sullivan puts the number at 84 percent. Greysen said that although physician professional conduct should exist online and offline, social media can complicate mattes and physicians and other medical staff need more guidance.
“Some would object that the connected world we live in now makes it so much harder to have any “personal” or “private” life and we can’t/shouldn’t expect doctors to be “on” all the time. I think that’s fair too, but I also think that as we become more aware with the technology and its pitfalls (and advantages), the more we’ll become comfortable with how to maintain professionalism online without feeling like it’s an additional burden.”
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The American Medical Association issued guidelines last year and medical schools have been setting down their own policies for online conduct, which Greysen and his co-authors highlighted in a 2009 JAMA research article. “We think there’s been an increase in schools adopting policies and education for students on this issue since then,” Greysen said.
One of the findings of the survey recommended that physicians and regulators address online emerging practices. It also recommended that state licensing boards categorize online professionalism separately from other violations to get a better sense of the problem. The article noted that online infractions currently accounted for a relatively small number of the 65,000 board actions in the Federation of State Medical Boards’ (FSMB) database.
Next month, the FSMB will look at adopting ethical and professional guidelines for online media by physicians and physician’s assistants covering email, text messages, blogs and social media “to help physicians protect themselves from unintended consequences of online engagement and to maintain the public trust,” according to a statement from the association.
Among the guidelines could be a provision recommending that physicians avoid requests for online medical advice, a move that might undercut efforts by digital health and healthcare IT companies to foster more online contact between physicians and their patients.
Greysen said his next research project will shift the focus onto patients and determine if social media can help patients stay connected and get needed help to recover at home after they are discharged from the hospital.
