Policing The Internet: Physician Behavior In Cyberspace

In the last few weeks there have been several articles published examining the behavior of physicians and other healthcare providers on social media outlets. Certainly, professionals must take care as to what is posted online–as I tell my 11 year old daughter–the internet is forever. Social media is now commonplace and smartphones and tablet computers make for almost unlimited access. Because of the ease of use and ubiquitous access to social media, these outlets can be a powerful tool for interacting with patients. As you might imagine because of visibility, the internet and social media outlets in particular, are another enormous area for potential regulation. Physicians are held to high standards for behavior both in and outside of the hospital (as they should be) and the cyberspace is no exception.

In spite of the potential pitfalls of social media, I believe that reaching out to patients and colleagues via cyberspace is the future of medicine and will positively impact our ability to provide healthcare in the future.A recent study published in Archives of Internal Medicine in January identified high risk online physician behaviors to be avoided. As the authors state, there are no formal policies in place to address physician online behavior in most state medical boards. However, the intent of the Archives article was to identify behaviors that are likely to be considered violations of online professionalism. Many of the behaviors identified are just simply common sense–Physicians should not post pictures of drunken debauchery or make inappropriate, sexist or racist comments on social media outlets. In addition, physicians should never inaccurately present outcomes data, present false credentials, or post pictures without patient permission. Most certainly, physicians should not engage in non professional relationships with patients in cyberspace. A recent article on theNPR website published examples of tweets that are likely to get a physician in trouble with professional governing bodies.

Yesterday in the Wall Street Journal, author Anna Mathews explores the controversy associated with physician-patient relationships on Facebook. In the world of social media, Facebook is the number one viewed website in the world. It facilitates connections between old friends and fosters new interactions. However, when physicians become active on Facebook, there is potential for both positive and negative impact. In a survey in the Journal of General Internal Medicine, researchers found that nearly 85% of all medical students are involved in social media sites–this suggests that the next generation of physicians will become increasingly more active and engaged with each other and with patients via sites like Twitter and Facebook in the future. Another survey found that while more than 80% of physicians who are active on Twitter and Facebook are likely to engage and interact with one another, less than 8% interact with patients via social media. However, for those that do use Facebook and Twitter to interact with patients, there are significant legal and ethical questions that arise. In an extreme example discussed in the WSJ article, one physician actually returns calls when contacted via his Facebook account. I worry that universal and unrestricted access to healthcare providers may blur the line between one’s personal and professional lives. In order to provide the highest quality care, physicians and other healthcare providers must also have some downtime–everyone needs to recharge and relax. Moreover, once a provider sets a precedent for interacting via social media with active patients (and establishes a doctor-patient relationship) a legal obligation to continue to respond in the same manner may be created. Just how deep does the rabbit hole go?

I am an active social media user. I enjoy engaging other physicians and patients in cyberspace. I believe that social media is a powerful tool that medicine and physicians must embrace. However, I am careful in how I interact with patients and colleagues in the social media world.

Here are my thoughts:

Things to AVOID in Medical Social Media

1. Never share privileged information
2. Never identify patients or provide information that could be used to identify patients
3. Never, ever give specific medical advice to a patient (never ever engage in patient care and create a doctor-patient relationship)
4. Never misrepresent my credentials or my training and expertise
5. Never provide inaccurate outcomes data
6. Never post pictures or make statements that reflect poorly on my professional reputation

Things to DO EVERY DAY in Medical Social Media

1. Engage your audience with interesting posts–provide commentary on timely medical information as it is released in the press
2. Promote yourself and your abilities–let potential patients and other providers know what you do and how to reach you
3. Become a Key Opinion Leader–engage colleagues in discussions about current therapies, emerging technologies, etc4. Educate–Twitter, Facebook and Blogging are great ways to teach patients about health related topics of interest WITHOUT developing a doctor-patient relationship and giving patient specific device. Patients frequently turn to the internet for medical information.

Social Media is the final frontier for the doctor-patient relationship. As physicians and healthcare providers we are held to high behavioral standards. In addition, legal considerations abound in medicine today and will continue to be an issue until our country addresses tort reform. As a profession, we must develop standards for online behavior based on good judgement and common sense. In addition, we must learn to embrace the power of social media and maximize its potential positive impacts on our patients and our profession.

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