Ethics

Social media guidance for physicians taps timeless principles

Social media has come a long way since Friendster, permeating every facet of American life—and medicine is no exception. If the decade and a half since Facebook was launched seems like an eternity on the social media timeline, it is but a blip for a guide to physician conduct that debuted more than 150 years ago.

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Yet that guide, the AMA Code of Medical Ethics, has quite a bit to say about how physicians should navigate Instagram, Twitter, Snapchat and more. Learn how to apply the enduring principles of medical ethics to the quickly moving world of social media.

The Code recognizes both the attraction of social media and the special need for caution when physicians use it.

“Participating in social networking and other similar opportunities can support physicians' personal expression, enable individual physicians to have a professional presence online, foster collegiality and camaraderie within the profession, provide opportunities to widely disseminate public health messages and other health communication,” notes the preamble to Opinion, 2.3.2, “Professionalism in the Use of Social Media.”

“Social networks, blogs and other forms of communication online also create new challenges to the patient-physician relationship,” the Code of Medical Ethics says.

Physicians widely—and, most often, wisely—use social media. It has also been misused, including shared images and other violations of patient privacy, as well as emails and texts that never should have been sent.

CEJA cited three of the nine Principles of Medical Ethics in rendering its opinion on physician use of social media. Those principles include respect for human dignity and rights, honesty and upholding the standards of professionalism, and the duty to safeguard patient confidences and privacy.

The opinion states:

Physicians should weigh a number of considerations when maintaining a presence online:

(a) Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online.

(b) When using social media for educational purposes or to exchange information professionally with other physicians, follow ethics guidance regarding confidentiality, privacy and informed consent.

(c) When using the internet for social networking, physicians should use privacy settings to safeguard personal information and content to the extent possible, but should realize that privacy settings are not absolute and that once on the internet, content is likely there permanently.

Thus, physicians should routinely monitor their own internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate.

(d) If they interact with patients on the internet, physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethics guidance just as they would in any other context.

(e) To maintain appropriate professional boundaries physicians should consider separating personal and professional content online.

(f) When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions.

If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.

(g) Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students) and can undermine public trust in the medical profession.

There’s a CME course for that

A central theme of the guidance in Opinion 2.3.2 has to do with understanding and maintaining boundaries.

The AMA offers a credit-eligible CME course, Boundaries for Physicians: The Code of Medical Ethics, “to help physicians identify and understand how to maintain proper boundaries with their patients and to articulate and understand the underlying importance of those boundaries to the practice of medicine.” The module is free to members ($20 for non-embers) and covers a wide range of situations, including social media.