PROFESSIONAL DISCIPLINE RELATED TO SOCIAL MEDIA USE
In 2012 the Federation of State Medical Boards (FSMB) completed its Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice. (http://www.fsmb.org/pdf/pub-social-media-guidelines.pdf). The guidelines were the result of an effort started in 2011 for the purpose of educating licensees on the proper use of social media and social networking websites.
Social Media Usage by Physicians
As pointed out in the FSMB guidelines, a survey by QuantiaMD in in September 2011 found that 87% of physicians used a social media website for personal reasons and 67% used one for professional reasons. One third of physicians had received a “friend” request from a patient or member of their family, and fully 16% of physicians have visited an online profile of a patient or a patient’s family member.
The very uncertain nature of the online relationship creates risk for physicians. According to the FSMB, “online interactions” can “constitute the beginning of a relationship,” regardless of whether the physician has met the patient in person and the fact that the physician cannot necessarily verify who is on the other side of the electronic communication. Physicians who use social media may also create unintended consequences, which reflect poorly on the profession. As examples, the FSMB notes instances where physicians have used disrespectful language about patients on their blogs, where physicians have accepted “friend” requests from patients so as not to be rude but were unclear as to how that affected their professional relationship, and where physicians posted photographs of alcohol intoxication. Reflecting poorly on the profession can cause potential discipline from state medical boards.
Guidelines for Physicians
Based on the concerns raised by the high usage of social media and the FSMB came up with the following general guidelines for physicians:
(1) Interacting with Patients: Physicians are discouraged from interacting with current or past patients on personal social networking sites such as Facebook.
(2) Discussion of Medicine Online: Physicians using professional networks for discussion have a responsibility to insure that the network is secure and that only registered and verified users have access to the information.
(3) Privacy/Confidentiality: Patient privacy and confidentiality should be protected at all times, and physicians should never use information that could be used to identify patients.
(4) Disclosure: Physicians must reveal any existing conflicts and be honest about their credentials.
(5) Posting Content: Physicians should be aware that any information they post on a social networking site may be disseminated (whether intended or not) to a larger audience, and that what they say may be taken out of context or remain publicly available online in perpetuity.
(6) Professionalism: Physicians should use separate personal and professional social networking sites, report any witnessed unprofessional behavior, and always adhere to the same principles of professionalism as they would offline.
Violation of the guidelines is not per se grounds for a disciplinary action, but the FSMB does state that state medical boards have authority to discipline physicians for unprofessional behavior relating to the inappropriate use of social media, such as:
Inappropriate communication with patients online.
- Use of the Internet for unprofessional behavior.
- Online misrepresentation of credentials.
- Online violations of patient confidentiality.
- Failure to reveal conflicts of interest online.
- Online derogatory remarks regarding a patient.
- Online depiction of intoxication.
- Discriminatory language or practices online.
This is not just a concern for the future. Currently, many state medical boards are both obtaining reports and meting out professional discipline related to online professionalism violations. A 2012 study in JAMA Physician Violations of Online Professionalism and Disciplinary Actions: A National Survey of State Medical Boards, involved the survey of executive directors of all medical and osteopathic boards in the United States and territories regarding online professionalism violations and disciplinary action. The vast majority, 92%, of the respondents stated that they had received at least one report of a potential violation, and 71% of the respondent boards had instituted disciplinary proceedings. Outcomes varied, but over half, 56%, of the respondents had issued at least one serious disciplinary action such as license restriction, suspension or revocation.
Although there is little doubt social media is here to stay, and that it can have many benefits for physicians, the guidelines put forth by the FSMB should be taken quite seriously, because the risk of professional sanctions is very real. Physicians should critically examine their current social media practices and ensure they are doing everything reasonable to minimize the risk of inadvertently creating a professional discipline issue.