ACP, FSMB Issue Stern Guidance on Social Media

Physicians should never "friend" their patients on Facebook, and should be extra careful about anything they post online because it could come back to haunt them ethically, and professionally in a way that jeopardizes their licenses.

That's new guidance in a position paper issued Thursday by the American College of Physicians and the Federation of State Medical Boards.

"As we've seen too often, the boundaries of professional and social spheres can blur online," said Humayun Chaudhry, DO, FSMB president and CEO.

"Anything physicians post on sites can be forwarded, taken out of context, and accessed and be retrieved in perpetuity. That's a fact that many physicians don't always think about when they engage in social media. And we also feel that doctors should not 'friend' their patients."

Chaudhry and David Fleming, MD, Chair of the ACP's Ethics, Professionalism, and Human Rights Committee, made cautionary remarks during a press briefing at the ACP's annual meeting in San Francisco.

"There's this notion of blurring of our identity, and blurring of our persona as well," Fleming added. "With Facebook, where we get in trouble, at times, as healthcare professionals are when we start friending patients in ways that are perhaps inappropriate or when patients start friending us. We have to realize that although we may be friends with them, when we have a physician-patient relationship, that's a different context."

The briefing was called to publicize publication Thursday of the jointly authored ACP-FSMB paper, Online Medical Professionalism: Patient and Public Relationships: Policy Statement, which makes the following five points:

1. Use of online media can bring significant educational benefits to patients and physicians, but may also pose ethical challenges. Maintaining trust in the profession and in patient-physician relationships requires that physicians consistently apply ethical principles for preserving the relationship, confidentiality, privacy, and respect for persons to online settings and communications.
2. Boundaries between professional and social spheres can blur online, and physicians should keep them separate and comport themselves professionally in both.
3. E-mail or other electronic communication should only be used by physicians in an established patient-physician relationship and with patient consent, with documentation about patient care communications included in the patient's medical record.
4. Physicians should consider periodically "self-auditing" to assess accuracy of information available about them on physician-ranking Web sites and other sources online.
5. Because what's online and on the Internet is often permanent, physicians, trainees, and medical students should be aware that online postings may have future implications for their professional lives.

Fleming characterized electronic communication with patients as "a new domain of ethical concern," but in many ways, he said, "the horse has left the barn.

"I would argue virtually every physician in some fashion has had an opportunity to, or has in fact communicated with a patient by this means, perhaps even without thinking in terms of the consequences."

Fleming emphasized that e-mail, and other electronic communication regarding a person's medical issues, "should only be used by physicians within an established physician-patient relationship."

"It's happened to me, and it's happened to many of my colleagues [that] when a patient who either knows our e-mail address or finds a way to obtain it, will just contact us out of the blue," Fleming said.

"It may be someone who starts asking us pointed questions regarding their health or the health of a loved one, and it really evolves very quickly into important private communication. And when you don't have a relationship with this patient, just like you bump into someone on the street and have a casual conversation at a cocktail party, you have to be very careful in terms of the kind of information we provide them.

"To give advice in an incomplete fashion, in an unprotected way, places us at ethical and professional risk."

Chaudhry said the complex issues caught the federation's attention after a paper published last year in the Journal of the American Medical Association. That researchreporting on a survey that found "92% of state medical boards responding said they had at least one case of an online professionalism violation that led to board actions like licensure revocation," Chaudhry said.

The federation's committee members were "surprised," he said, because they expected it would be young physicians and medical students who might "get into trouble" in this area because social media for them "is so ubiquitous… they've been using the Internet and smart phones since they were young… [We felt] surely practicing physicians who've worked hard to earn that license, they would surely be a little bit more careful in taking risks."

But, he said, the numbers "didn't bear that out." The reports indicate that doctors getting into ethical trouble with postings on social media "crossed all age groups and all demographics, which prompted us to work with the ACP to get this information out.

"This paper is valuable to every physician in this country."