Sandra Adamson Fryhofer, MD


April 29, 2013

Sandra Adamson Fryhofer, MD
Adjunct Clinical Associate Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia; Past President, American College of Physicians


This installment of Staying Well addresses an issue with novel and uncharted challenges now facing physicians: maintaining a professional online image.

A new policy statement from the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB)[1] takes a closer look at online patient/physician relationships in social media and other "Web 2.0" interactions. The policy does not address or examine telemedicine, e-prescribing or e-diagnosing, or electronic health record issues.

I attended a sneak preview at a panel discussion with the study authors and college leadership (Figure) during the ACP Internal Medicine 2013 annual meeting. The study is published in Annals of Internal Medicine, but how appropriate that the paper made its debut at a site close to Silicon Valley.[1]

Figure. Panel on ACP social media policy paper. From left to right: Phyllis Guze, MD, FACP, Chair, Board of Regents, ACP; David Fleming, MD, MA, FACP, Chair, Ethics, Professionalism, and Human Rights Committee, ACP; Humayun Chaudhry, DO, MS, FACP, President and CEO, FSMB

"You" Online

An online presence is becoming essential for health professionals. When is the last time you used a phone book to find a phone number or location? With smartphones getting smarter and tablets getting faster (and smaller), we all want access to information at our fingertips and on demand.

Just about everyone uses the Internet as their information source. Patients use it as a source of medical information. Physicians use it to stay current with the latest medical advances. In fact, a Pew Internet survey ranked seeking health information as the third most popular online activity.[2]

Staying connected is now an engrained part of our culture. Networking sites, media-sharing sites, and blog platforms have increased in popularity. But the introduction of social media is also changing the rules. The physician/patient interface is now a little more complicated. This policy paper sets some guidelines to make sure you don't cross the line.

Connectivity -- Without Crossing the Line

The policy paper includes a quick-look table matching available online activities with potential pitfalls and providing recommended safeguards. It's a must-read. Protecting patient confidentiality and preserving trust are essentials for a positive patient/physician relationship.

Pitfalls of Texting

The policy paper also discusses the pitfalls of texting with immediate expectations. Text messages are short and quick. Some pharmacies and insurers are piloting their use for pharmacy refills and appointments. Security and confidentiality are valid concerns. These technologies also present unintended expectations of immediate access (and answers). The truncated format limits detailed explanation and could increase odds that the message could be misconstrued. These reasons are why the policy paper cautions against routine texting for medical interactions -- even for established patients.

Who Is Googling You?

Everybody's doing it! Patients do it. Peers do it. Potential employers also do it (and so do medical school admission offices and residency training programs.) Your online image influences public, patient, and peer perceptions.

Do a self online audit. Find out what others are reading about you. The policy paper recommends doing this routinely and correcting inaccurate information. Unfortunately, they give no specifics as to how to accomplish the goal of rectifying mistakes and inaccuracies in what others have posted.

The paper does suggest a possible remedy for mitigating misrepresentations on physician ranking Websites. Although there is no way to have these deleted, the paper proposes establishing a professional profile "so that it 'appears' first during a search" as a means of controlling what patients read.

Pause Before Posting

Carefully consider the content of what you post. Because postings on the Internet are archived, they are essentially permanent. That's why reflecting before reacting is a good idea.

Online perceptions include not only what is written about you, but also photos. Provocative or inappropriate postings indicate poor judgment and adverse consequences, including medical board complaints.

ACP and FSMB also advise against "airing frustrations" and "venting" in online forums. Such postings can be misconstrued and can come back to haunt you!

Know the Rules, and Follow Them

When transferring patient information electronically, be sure to stay compliant with the Health Insurance Portability and Accountability Act (HIPAA). Patients should also be made aware of the inherent security risks in communicating via email.

Some states' laws (for example those in Hawaii) do not require a preexisting relationship for emailing between patients and physicians, a practice that is not supported by ACP or the FSMB. The policy paper also points out that some state medical boards consider emailing a violation if the physician is not licensed in the state in which the electronic communication is received. No source or specific examples were given, however.

To Friend or Not to Friend? Setting Personal/Professional Boundaries

The policy gives guidance for responding to online "friend" requests from patients: Don't do it. The position paper specifically discourages "friending" patients on personal social media sites, such as Facebook. This blurs patient/physician boundaries.

Having a separate personal and professional online presence can help mitigate this problem. It is acceptable to use professional profiles in networking and community outreach.

Patient-targeted Googling also raises red flags: "curiosity, voyeurism, and habit." This type of digital tracking could undermine trust in the patient/physician relationship.

Final Words: Online Professionalism Is Paramount

Physicians are professionals. One of the premises of being a professional is that the public expects us to self-regulate. This policy paper provides a good starting point for online relationship discussions. These premises also apply to physicians in training. The authors acknowledge that this policy is a starting point in dialogue and will require more fine-tuning as physicians and patients navigate the online terrain.