Doctors' online practices need improvement

A research letter published in the Journal of the American Medical Association found that most state medical licensing boards have reported cases of “physician violations of online professionalism,” and some of these violations have resulted in serious disciplinary actions such as license revocation or suspension.

In a survey of 68 licensing boards, researchers found that inappropriate online patient communications or sexual misconduct were reported to the boards at 69% of the 48 boards responding. Also, 63% reported cases of inappropriate practices such as Internet prescribing for patients they did not have an established clinical relationship with and 60% reported cases of online misrepresentation of credentials.

Researchers from the University of California San Francisco, Washington DC Veterans Affairs Medical Center, Yale School of Medicine and others surveyed directors from 68 medical and osteopathic licensing boards from the 50 states, District of Columbia and U.S. territories in a study funded by the Robert Wood Johnson Program and the Veterans Affairs Department. Forty-eight (71%) directors responded, with 44 reporting that at least one violation had been reported to them.

As a result of the violations, 34 boards held disciplinary proceedings, including 24 holding informal hearings, and 19 issued consent orders which involved physicians agreeing to sanctions without a hearing. Nineteen reported cases resolved with an informal warning, 16 boards issued fines, 12 reported at least one instance where no action was taken, and 27 reported cases resulting in medical licenses being lost, suspended or restricted in some way.

The researchers acknowledged that limitations of their study included that online violations of professionalism are not tracked by the Federation of State Medical Boards and may be subject to recall bias, though they add that tracking these violations “could be of value to better gauge the extent of the problem.”

“Our findings highlight the need to promote physician understanding and self monitoring of online professionalism and to create consensus-driven, broadly disseminated principles to guide physicians toward high-integrity interactions online,” the authors concluded.

While relatively small compared to the 5,652 physician disciplinary actions reported to the Federation of State Medical Boards in 2010, the researchers said the problem is likely to grow as the use of social media increases. They added that the online violations may reflect manifestations of other problems such as such as substance abuse, sexual misconduct or abuse of prescribing privileges.