Social Media Use by Physicians Can Spur Medical Board Action

Joe Barber Jr, PhD

January 15, 2013

A new study has identified several online activities by physicians that are likely to result in investigation by state medical boards.

S. Ryan Greysen, MD, from the University of California, San Francisco, and colleagues published their findings in the January 15 issue of the Annals of Internal Medicine.

The authors mention that this study was prompted by the lack of data on what activities were likely to result in investigation. "Previous research by our group has shown that 60% of U.S. medical school deans had concerns about students posting unprofessional content [such as depicted intoxication and sexually explicit material] and that 71% of U.S. state medical boards have investigated physicians for violations of professionalism online in 1 or more of these categories," the authors write. "To date, however, the likelihood of investigation for specific examples of violations in these categories has not been described."

In the study, the authors submitted a survey to the 68 executive directors of state medical and osteopathic boards asking them to determine the likelihood that each of 10 hypothetical vignettes would result in investigations for violations of online professionalism. Among the 48 executive directors who responded, high consensus was identified for citing misleading information about clinical results (81%; 39/48), using patient images without consent (79%; 38/48), misrepresenting credentials (77%; 37/48), and inappropriately contacting patients (77%; 37/48).

For each of the vignettes, the executive directors were asked to grade the likelihood of investigation on a 4-point scale ranging from "very unlikely" to "very likely" in consensus with other members of the board. In addition to an option for "don't know," respondents were also allowed to provide a free-text response for each vignette.

Moderate consensus for investigation was identified for implied intoxication (73%; 35/48), violation of patient confidentiality (65%; 31/48), and discriminatory speech toward patients (60%; 29/48). Conversely, low consensus was noted for 3 categories: using derogatory speech toward patients (46%; 22/48), depicting alcohol use without intoxication (40%; 19/48), and providing clinical narratives without violating patient confidentiality (16%; 7/48).

Although most respondents did not believe that depictions of alcohol use without intoxication were worthy of investigation, this vignette received the highest number of free-text responses, with many respondents indicating that the context of alcohol use or a history of previous abuse would determine whether the activity required investigation.

The authors listed several study limitations, including a lack of validation for the survey instrument, potential bias among the respondents, the hypothetical nature of the vignettes, and the inability to capture all possible violations of online professionalism in the study.

The authors conclude that it was critical for physicians to maintain professionalism in both online and offline settings. "Physicians should be aware of the potential consequences for online behaviors as depicted in these vignettes and apply the same high ethical and professional standards in their online actions as they would in their actions offline," the authors write. "Our findings underscore the need for more continuing education of physicians in practice about potential interpretations and consequences of online actions so that their social media presence can be a professional benefit instead of a liability."

Jeanne Farnan, MD, from the University of Chicago in Illinois, indicated that this study has key implications for medical professionals. "Many practical lessons can be taken from this work, especially given the rising number of both healthcare providers and patients in the online environment," Dr. Farnan told Medscape Medical News by email. "The results underscore the importance of adherence to standards of professionalism, especially given the 'never' events demonstrated here, and encourages continued education and proactive behaviors for those with an active digital presence."

Tara Lagu, MD, MPH, from Baystate Medical Center in Springfield, Massachusetts, added that physicians should remember that social media sites are not private domains. "Most physicians would never post a picture of patient online or approach a patient in an online forum or 'friend' a patient on a social media site, but many might post pictures of themselves drinking alcohol on a blog or social media site or might make backhanded, unprofessional comments about patients in a social media post because these spaces feel private," Dr. Lagu told Medscape Medical News by email. "It is always good to remind oneself that even though you are sitting in your living room and wearing pajamas, when you are using the Internet you have entered a public space, and it is best to err on the sides of caution and professionalism."

One coauthor reported funding from the National Cancer Institute and Medtronic and advisory board membership at Fair Health. One coauthor serves as president and chief executive officer of the Federation of State Medical Boards. The other authors, Dr. Farnan, and Dr. Lagu have disclosed no relevant financial relationships.

Ann Intern Med. 2013;158:124-130. Abstract