While the Federation of State Medical Boards
and the American Medical Association
have developed policies for physicians and social media professionalism, the consequences for violating these standards are still undefined, according to a report in the Annals of Internal Medicine
A team of researchers, including FSMB President and CEO Dr. Humayun Chaudhry
, distributed a set of 10 hypothetical vignettes depicting various violations of online professionalism to the executive directors of the 70 medical and osteopathic boards for the 50 states, Washington and the U.S. territories, and they were asked in a survey whether the violations warranted further investigation. (Two states have the same director for their medical and osteopathic boards, so 68 surveys were sent. Though invited, directors of the four territories with medical boards did not participate.)
Of the 48 directors who responded, the highest consensus for behavior that was most likely to spark an investigation included: Citing misleading information about clinical outcomes, 81%; using patient images without consent, 79%; misrepresenting credentials, 77%; and inappropriately contacting patients, 77%.
Behavior that warranted a moderate consensus for investigation included images depicting alcohol intoxication, 73%; violating patient confidentiality, 65%; and using discriminatory speech toward patients, 60%
There was low consensus for investigation of online behavior that included using derogatory speech toward patients, 46%; showing alcohol use without intoxication, 40%; and providing clinical narratives without violations of confidentiality, 16%.
The researchers noted that the highest number of comments they received were related to the vignette about online images depicting alcohol use without intoxication.
“Our data suggest that online images of physicians consuming alcohol where intoxication is not implied are unlikely to draw unwanted attention from boards, provided that there are no other 'red flags,' such as evidence of drinking while on duty or an established history of alcohol or substance misuse,” the researchers wrote. “This finding is consistent with the general stance of medical boards toward alcohol use; boards are most concerned about the use of alcohol when it endangers the public or is problematic as manifested by patterns of abuse (for example, dependence or alcoholism).”
They concluded that their findings “underscore the need for more continuing education of physicians in practice about potential interpretations and consequences of online actions so that their social presence can be a professional benefit instead of a liability.”
A similar board-director survey was published as a research letter
last March in the Journal of the American Medical Association. It had found that 69% of the 48 responding boards had received reports of inappropriate online patient communications or sexual misconduct; 63% received reports of inappropriate practices such as Internet prescribing for patients they did not have an established clinical relationship with; and 60% received reports of online misrepresentation of credentials.
The authors of the new study said the 48 directors responding to their survey led boards in 38 states and were responsible for the discipline and licensure of 88% of the roughly 850,000 physicians with an active license in the U.S. The study received support from the Robert Wood Johnson Clinical Scholars program and the Veterans Affairs Department.