Physicians advised not to 'friend' patients

Physicians advised not to 'friend' patients

The American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB) want doctors to "pause before posting" when it comes to their social media activities. The two organizations stated their position in a policy paper released April 11 during ACP's Internal Medicine 2013 meeting in San Francisco.

The paper, published online in advance of the April 16 issue of the Annals of Internal Medicine, advises physicians on how to protect patient interests – and themselves – while applying principles of professionalism to online settings. It also addresses the public perception of physician behaviors and recommends strategies for patient-physician communications that preserve confidentiality while best utilizing new technologies.

"It is important for physicians to be aware of the implications for confidentiality and how the use of online media for non-clinical purposes impacts trust in the medical profession," said Humayun Chaudhry, DO, MS, FACP, president and CEO of FSMB, in a prepared statement.

During a press briefing announcing the paper's release, Chaudhry added, "Last year in research we published in JAMA with colleagues from Yale University, we were quite alarmed to learn that 92 percent of state medical boards responding to a survey said that they had had at least one case in which an online professionalism violation led to board actions such as licensure revocation."

Chaudhry continued, "Poor judgment [in online behavior] is really no excuse, and reflects badly on the individual as well as the practice of medicine."

David Fleming, MD, MA, FACP, who is director of the Center for Health Ethics at the University of Missouri School of Medicine, added during the press briefing, "Now we're in the public domain. I would argue that every physician in some fashion has had an opportunity to communicate – or has, in fact, communicated – with patients [through} electronic means, perhaps without thinking of the consequences."

Notable recommendations from ACP and FSMB include the following:

  • Physicians should keep their professional and personal personas separate. Physicians should not "friend" or contact patients through personal social media.
  • Physicians should not use text messaging for medical interactions even with an established patient except with extreme caution and consent by the patient.
  • E-mail or other electronic communications should only be used by physicians within an established patient-physician relationship and with patient consent.
  • Situations in which a physician is approached through electronic means for clinical advice in the absence of a patient-physician relationship should be handled with judgment and usually should be addressed with encouragement that the individual schedule an office visit or, in the case of an urgent matter, go to the nearest emergency department.
  • Establishing a professional profile so that it "appears" first during a search -- instead of on a physician ranking site -- can provide some measure of control that the information read by patients prior to the initial encounter or thereafter is accurate.
  • Medical trainees may inadvertently harm their future careers by not responsibly posting material or actively policing their online content. Educational programs stressing a pro-active approach to digital image (online reputation) are good forums to introduce these potential repercussions.

The paper cautions that communicating with patients using e-mail offers the potential benefits of great accessibility and immediacy of answers to non-urgent issues. However, the potential dangers are confidentiality concerns, replacement of face-to-face or phone interaction, and ambiguity or misinterpretation of digital interactions. Suggested safeguards include reserving digital communications for patients that maintain face-to-face follow-up only.

Click here to view a chart of online activities, potential benefits and dangers, and recommended safeguards for physician behavior.