SAN FRANCISCO – Tempted to "friend" a patient on your personal Facebook page? That’s probably not a good idea, according to new guidelines issued by the American College of Physicians and the Federation of State Medical Boards.
The ACP and federation guidelines outline many benefits from use of e-mail and social media, including improving access to care, but "the boundaries between professional and social spheres can blur online," said Dr. Humayun J. Chaudhry, president and chief executive officer of the Federation of State Medical Boards (FSMB) and an author of the guidelines. "Physicians should keep the spheres separate and comport themselves professionally online."
Opportunities for misadventure abound with online communications and texting, Dr. Chaudhry said at the annual meeting of the American College of Physicians. Confidentiality can be breached, as can the patient-physician relationship; the communications can be taken out of context or be spread widely beyond the original conversation.
And disciplinary actions are likely to increase. In a recent study of state medical boards, 92% reported that they had dealt with at least one case of unprofessional online behavior that led to punishment, including license revocation (Ann. Intern. Med. 2013;158:124-30).
The ACP and FSMB guidelines, published online Apr. 11 in the Annals of Internal Medicine, are meant "to serve as a wake-up call to physicians, to make them aware of some of the dangers that are out there," he said. Aside from not "friending" patients, the guidelines also recommend the following to physicians:
• Don’t use text messaging for medical interactions, even with established patients, except with caution and the patient’s consent.
• Only use e-mail within the context of an established relationship with a patient, and with that patient’s consent.
• Establish a professional online profile so that it appears at the top of a web-based search, above any physician rating site.
• Discourage e-mail or on-line communications with individuals who are not patients, instead referring them to make an appointment or visit an appropriate health provider.
• Manage their digital image, including refraining from posting about personal social activities that might not reflect positively or providing less-than-measured comments on Twitter, blogs, or in response to online articles.
E-mail presents several dangers, said Dr. David A. Fleming, a member of the ACP Board of Regents and chairman of the ACP Ethics, Professionalism, and Human Rights Committee. The new guidelines urge e-mail communications only with established patients who have a relationship with the physician and understand that the communication might not be secure, he said, adding that information sent via e-mail also can be discoverable for legal purposes.
An e-mail from a patient in a crisis situation presents a different present challenge. "As soon as we respond in any way, then the relationship forms and we have a fiduciary responsibility to, first of all, know our limits, but also the extent to which an intervention is needed," Dr. Fleming said. If the crisis warrants intervention, then the physician is obligated to help the patient.
Social media can be a great way to encourage patients to get vaccinated or exercise or watch their weight, but postings on Twitter or Facebook can still be fraught with peril, Dr. Fleming and Dr. Chaudhry said. Physicians need to be clear when they are expressing their personal opinion or representing a professional organization, for instance.
Both physicians said that the ACP and the FSMB are not advocating censorship.
"We’re not telling people what to say, what not to say, we’re just asking them to think before you press send," said Dr. Chaudhry.
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