AIM survey tells of troubling Tweets

Citing misleading information about clinical outcomes topped the list of the social media no-no’s most likely to spur investigation by a state medical board in the U.S., according to a study published Jan. 14 in Annals of Internal Medicine.  

The Federation of State Medical Boards and American Medical Association have issued guidelines for maintaining professionalism when using social media. However, the guidelines do not offer a level of consensus about which behaviors are most likely to result in professional investigation.

S. Ryan Greyson, MD, MHS, MA, from the University of California, San Francisco, and colleagues, attempted to re-interpret the Hippocratic Oath for the social media era by conducting a survey of state medical boards to clarify likelihood of investigation for various online violations of professionalism.

The authors devised 10 hypothetical vignettes and surveyed the 70 state medical and osteopathic boards responsible for licensure and discipline of physicians. They asked respondents to rate the likelihood of further investigation on a 4-point scale, ranging from “very unlikely” to “very likely,” with an option for “I don’t know.”

The total response rate was 71 percent and represented licensing boards from 38 of 50 states.

Four vignettes were “likely” or “very likely” to lead to investigation, according to 75 percent or more respondents. These are: misleading claims of treatment outcomes on the practice website, misrepresentation of board certification on the practice website, posting of patients' images to a website without patient consent and use of online dating to “chat” with a patient.

These violations, according to the authors, parallel common offline violations and provide specific examples of online “never” behaviors for physicians.

At the other end of the spectrum, fewer than 50 percent of respondents indicated likelihood of investigation for three vignettes: a narrative (blog) expressing disrespect for patients, images of physicians holding alcoholic beverages posted on a social networking site and a narrative (blog) of a patient encounter with no identifiers.  

“These gray areas collectively suggest a need to expand the current dialogue about online professionalism to create standards with even broad consensus about what is or is not appropriate online behavior for physicians that parallel standards for offline professional behavior,” wrote Greyson et al.

The authors advised their colleagues to post with caution as other legal and professional consequences beyond board investigation might follow breaches of online professionalism. These include suspension or termination of privileges, termination of employment or initiation of a lawsuit based on negative publicity or violation of privacy.

“Our findings underscore the need for more continuing education of physicians in practice about potential interpretations and consequences of online actions so that their social media presence can be a professional benefit instead of a liability,” the authors concluded.