Medical Boards Discipline Physicians for Online Behavior

Jenni Laidman

March 20, 2012

March 20, 2012 — Most medical licensing boards have received at least 1 complaint about unprofessional online behavior by physicians, and many of these complaints resulted in serious disciplinary actions, including license revocation, according to a research letter published in the March 21 issue of JAMA.

S. Ryan Greysen, MD, from the Division of Hospital Medicine, University of California, San Francisco, and colleagues report that 48 (71%) of the 68 executive directors of medical licensing boards responded to the study survey. Of those, 44 (92%; 95% confidence interval [CI], 86% - 98%) indicated receiving at least 1 complaint about an online professional breach.

The most common complaints reported inappropriate communication with a patient, such as sexual misconduct, which was reported to 33 (69%) of 48 boards (95% CI, 58% - 80%); inappropriate practice, such as Internet prescribing without an established clinical relationship, reported to 30 (63%) of 48 boards (95% CI, 52% - 74%); and online misrepresentation of credentials, reported to 29 (60%) of 48 boards (95% CI, 48% - 72%). Thirty-one boards indicated that reports were made by patients or their families (31/48; 65%), and 24 (50%) of 48 boards said other physicians made the complaint.

A New Way to Violate Our Standards

"We've just found a new way to violate our own standards," Jason Jent, PhD, assistant professor of clinical pediatrics, Division of Clinical Psychology, Department of Pediatrics, University of Miami Miller School of Medicine, Florida, said to Medscape Medical News. Dr. Jent, who has published about physician online behavior, has no association with the JAMA letter. "Some of the violations we've seen in face-to-face communication, or over the phone, or by mail have now extended to online behavior. This is something we have to pay attention to," he added.

The study authors say much the same: "Furthermore, these violations also may be important online manifestations of serious and common violations offline, including substance abuse, sexual misconduct, and abuse of prescription privileges."

Among boards that received violation reports, 27 (56%; 95% CI, 44% - 68%) took a serious disciplinary action, including of letters of reprimand by 23 boards (48%; 95% CI, 36% - 60%), license restriction by 21 (44%; 95% CI, 32% - 56%), mandated education or community service by 19 (40%; 95% CI, 28% - 52%), fines by 16 (33%; 95% CI, 22% - 44%), license suspension by 16 (33%; 95% CI, 22% - 44%), license revocation by 10 (21%; 95% CI, 11% - 31%), and probation by 4 (8%; 95% CI, 2% - 14%). Another 8% (95% CI, 2% - 14%) had active investigations at the time of the survey.

At the moment, online violations make up a small proportion of the approximately 65,000 lifetime board actions against all licensed physicians, but the authors warn, "[t]his is likely to change as the use of social media continues to grow."

In fact, Dr. Jent said, violations may actually be underreported. "People come across these, and it's so new they're not sure they should report it," he said. "Or, on the flip side, are we seeing an increasing prevalence of online professional violations that may call for more specific training for online behaviors?"

Some Complaints Difficult to Interpret

Although some complaints involved clear violations of medical ethics, others were murkier and more difficult to interpret, Dr. Jent said. For instance, many boards received complaints of online depictions of intoxication, which is not further defined and could mean something as simple as a photograph of a physician holding a glass of wine.

"This raises the question on things like Facebook or Twitter, as healthcare professionals, to what degree can you post things about yourself, and what is the impact, " Dr. Jent said. Assumptions about privacy on social media sites are often incorrect, he added.

"More guidelines need to be developed, more education needs to take place," Vineet Arora, MD, MAPP, associate professor of medicine and associate director, Internal Medicine Residency, Pritzker School of Medicine, University of Chicago, Illinois, told Medscape Medical News. Dr. Arora publishes on questions of physician online use and is also a blogger and Twitter user. "People who are more casual users are more likely to make mistakes," she said.

One author has disclosed serving as a scientific advisory board member for Fair Health Inc and receiving funding as a collaborator on the Yale University Open Data Access project, which is facilitating the objective analysis of Medtronic Clinical Data. The other authors and commentators have disclosed no relevant financial relationships.

JAMA. 2012;307:1141-1142.