Physicians urged to 'pause before posting'

Physicians should exercise caution—and “pause before posting”—when interacting in online settings in order to preserve professionalism and maintain appropriate patient-physician relationships, according to a policy paper released today by the American College of Physicians and the Federation of State Medical Boards.

“This is a very important addition to the ethics literature,” Dr. David Fleming, chair of the ACP's ethics, professionalism and human rights committee, said during a news briefing.

“Online Medical Professionalism: Patient and Public Relationships” addresses the use of online and social media and electronic communication between physicians and patients. The two organizations looked at opportunities and challenges created by new technologies and online forums, and provided recommendations and strategies for physician behavior in these areas.

“Digital communications and social media use continue to increase in popularity among the public and medical profession,” Dr. Phyllis Guze, chair of the ACP's board of regents, said in a release. “This policy paper provides needed guidance on best practices to inform standards for the professional conduct of physicians online.”

The paper includes a chart of online activities and their potential benefits and risks, along with recommendations on how physicians should handle or respond to each.

“There was a strong consensus on the issue of 'friending' patients,” Dr. Humayun Chaudhry, president and CEO of FSMB, said during the briefing.

In addition to discouraging physicians from 'friending' or contacting their patients through their personal social media accounts, the organizations suggest that physicians keep their personal and professional identities separate online; use e-mail communication only in established physician-patient care relationships; explain very clearly their limits when contacted in the absence of an established physician-patient relationship; and do not air their frustrations in online forums.

The ACP and FSMB, however, do not completely discourage an online presence. “We encourage physicians to provide an accurate profile of themselves in a reasonably discoverable fashion to give (patients) a balanced understanding of who we are, what we do and what we can provide them,” Fleming said. “We have an obligation to participate in the public dialog.”

If doing so, the organizations recommend evidence-based, well-referenced educational statements or op-eds that are clearly designated as such.

“We have to be clear about what hat we're wearing and who we're representing,” Fleming said.

The paper, published online today and in the April 16 issue of Annals of Internal Medicine, was authored by ACP's ethics, professionalism and human rights committee; ACP's council of associates; and FSMB's committee on ethics and professionalism.

ACP is the largest medical specialty group and the second-largest physician group in the U.S., including more than 133,000 internists, subspecialists and medical students.

FSMB is a not-for-profit organization that represents all state medical boards within the U.S.

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