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New recommendations offer physicians ethical guidance for preserving trust in patient-physician relationships and the profession when using social media

American College of Physicians and Federation of State Medical Boards encourage doctors to always ‘pause before posting’ and not ‘friend’ patients in new policy paper

April 11, 2013 -- The creation and use of information online and the widespread use of the Internet offer exciting new opportunities for patient care, but also require physicians to consider how to best protect patient interests and apply principles of professionalism to online settings, the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB) said today in a newly released policy paper, “Online Medical Professionalism: Patient and Public Relationships.”

“Digital communications and social media use continue to increase in popularity among the public and the medical profession,” said Phyllis Guze, MD, FACP, chair, Board of Regents, ACP. “This policy paper provides needed guidance on best practices to inform standards for the professional conduct of physicians online.”

Published online today at www.acponline.org and www.annals.org and in the April 16 issue of Annals of Internal Medicine, the paper examines and provides recommendations regarding the influence of social media on the patient-physician relationship. It also addresses the role of online media and public perception of physician behaviors and strategies for patient-physician communications that preserve confidentiality while best utilizing new technologies.

“It is important for physicians to be aware of the implications for confidentiality and how the use of online media for non-clinical purposes impacts trust in the medical profession,” said Humayun Chaudhry, DO, MS, FACP, president and CEO, FSMB.

Notable recommendations from ACP and FSMB include:

  • Physicians should keep their professional and personal personas separate. Physicians should not “friend” or contact patients through personal social media.
  • Physicians should not use text messaging for medical interactions even with an established patient except with extreme caution and consent by the patient.
  • E-mail or other electronic communications should only be used by physicians within an established patient-physician relationship and with patient consent.
  • Situations in which a physician is approached through electronic means for clinical advice in the absence of a patient-physician relationship should be handled with judgment and usually should be addressed with encouragement that the individual schedule an office visit or, in the case of an urgent matter, go to the nearest emergency department.
  • Establishing a professional profile so that it “appears” first during a search, instead of a physician ranking site, can provide some measure of control that the information read by patients prior to the initial encounter or thereafter is accurate.
  • Many trainees may inadvertently harm their future careers by not responsibly posting material or actively policing their online content. Educational programs stressing a pro-active approach to digital image (online reputation) are good forums to introduce these potential repercussions.

The paper includes a chart of online activities, potential benefits and dangers, and recommended safeguards for physician behavior.

For example, communicating with patients using e-mail offers the potential benefits of great accessibility and immediacy of answers to non-urgent issues. The potential dangers are confidentiality concerns, replacement of face-to-face or phone interaction, and ambiguity or misinterpretation of digital interactions. The safeguards include reserving digital communications for patients that maintain face-to-face follow-up only.

The paper was authored by ACP’s Ethics, Professionalism and Human Rights Committee; ACP’s Council of Associates; and FSMB’s Committee on Ethics and Professionalism.

About the American College of Physicians
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 133,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

About the Federation of State Medical Boards
The FSMB is a national non-profit organization representing all medical boards within the United States and its territories that license and discipline allopathic and osteopathic physicians and, in some jurisdictions, other health care professionals. It assists these state and territorial medical boards as they go about their mandate of protecting the public’s health, safety and welfare. The FSMB leads by promoting excellence in medical practice, licensure and regulation. For more information, please visit www.fsmb.org.

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