New Social Media Guidelines Issued for Physicians

Jim Kling

April 12, 2013

A new social media policy urges doctors to "pause before posting" and to not "friend" patients online.

The position paper, issued by the American College of Physicians (ACP) and the Federation of State Medical Boards, was released at ACP Internal Medicine 2013 in San Francisco, California, and was simultaneously published online April 11 in the Annals of Internal Medicine.

It addresses the benefits and drawbacks of a number of online interactions, and proposes safeguards.

A recent survey of state medical boards showed that 92% reported at least 1 online violation of professionalism that led to a major action, such as license revocation (JAMA. 2012;307:1141-1142). Those researchers were surprised to find that problems ranged across every age group and demographic.

"We decided to work with the ACP to get this information out to all physicians," Humayun Chaudhry, DO, president and CEO of the Federation of State Medical Boards and one of the authors of the position paper, said at a news conference.

The resulting position paper "is valuable to every physician across the country," Dr. Chaudhry added.

There are legitimate ways that physicians can engage in social media with patients.

"It's really the beginning of a conversation. The online media world is constantly changing. There are legitimate ways that physicians can engage in social media with patients," added Dr. Chaudhry.

Email and electronic communication should be restricted to individuals with whom the physician has an established physician–patient relationship. "This has happened to me and to many of my colleagues: A patient sends an email out of the blue. It may be someone we have an established relationship, but not a healing relationship, with. They may ask very poignant questions about themselves or a loved one. We need to be very careful about the type of information that we provide. It places us at a professional and ethical risk," said David Fleming, MD, chair of ACP Ethics, Professionalism, and Human Rights Committee.

One challenge is ensuring confidentiality. Posts on Facebook, Twitter, and other social media sites can be widely read, and even emails can be forwarded. "We have to assume that any time we send electronic communication, it's not just the patient that's going to see it.... So we have to be careful about the kind of information we provide, particularly private and confidential information that the patient may not want shared," said Dr. Fleming.

Many institutions have set up portals for confidential interactions with patients. The position paper urges physicians to use such options rather than standard social media or personal Web sites. "A post can be taken out of context and go viral...and will last in perpetuity. I don't think every physician is aware of that," Dr. Chaudhry explained.

Social media enables communication with "a larger audience than you might be able to in a practice," which can be helpful when disseminating information on issues such as public health reform or vaccines. However, "you have to realize that any comment you make...can have a life of its own and might spread in a fashion you hadn't intended. Our advice is to pause before posting," said Dr. Chaudhry.

Posts can be objective, such as referenced health information, or subjective, such as opinions on matters of public policy. "Both are legitimate ways of responding; we have a right to do that and, some would argue, an obligation. We just have to be clear which hat we're wearing, whether it's a personal opinion or we're representing an institute or organization," said Dr. Fleming.

Professional and Personal Personas

The position paper provides specific recommendations for users of social media.

First, physicians should keep their professional and personal personas separate; they should not "friend" or contact patients through personal social media.

Establishing a professional profile so that it "appears" first during a search can provide some measure of control that the information patients read is accurate.

Email and other electronic communications should only be used by physicians within an established patient–physician relationship and with patient consent.

When a physician is approached through electronic means for clinical advice in the absence of a patient–physician relationship, the individual should be encouraged to schedule an office visit or go to the nearest emergency department.

Text messaging should never be used for medical interactions, even with an established patient, except with extreme caution and consent from the patient.

It should be remembered that trainees can inadvertently harm their future careers by not posting responsibly or actively policing their online content. Educational programs that stress a proactive approach to maintaining an online reputation are good forums to introduce potential repercussions.

Dr. Chaudhry and Dr. Fleming have reported no relevant financial relationships.

Ann Intern Med. Published online April 11, 2013. Abstract

ACP Internal Medicine 2013. Presented April 11, 2013.