Physician Misconduct Showing Up on the Internet: Survey
TUESDAY March 20, 2012 -- Some doctors are sliding down a slippery slope in their online lives, committing professional violations, whether intentional or not, and risking their careers, a new survey suggests.
The survey of 68 medical boards across the United States aimed to ferret out types of unprofessional physician behaviors online and the repercussions of those actions. The findings, published in a research letter in the March 21 issue of the Journal of the American Medical Association, suggest physicians and patients need to be aware of medical misconduct on blogs, Twitter, Facebook and other social media and online venues.
"Just about everyone now has heard of someone they know who's done something online that they wish they hadn't done. I think the message is that medical professionals are responsible for what they put online -- not only responsible for the information, but accountable," said lead letter author Dr. Ryan Greysen, an assistant professor in the division of hospital medicine at the University of California, San Francisco.
Greysen said the response was good at 71 percent (48 of 68 medical board executive directors responded). The majority (92 percent) said at least one online violation of professionalism had ever been reported. The most common problems were inappropriate patient communication online, such as sexual misconduct (69 percent); use of the Internet for inappropriate practice, including Internet prescribing without an established real-life clinical relationship (63 percent); and doctors misrepresenting their credentials (60 percent).
The respondents also answered questions about how they handled the violations. Seventy-one percent conducted disciplinary proceedings, including formal hearings. Forty percent issued informal warnings and 25 percent reported at least one instance in which no action was taken. Greysen said altogether, 56 percent of the boards said physician misconduct online led to serious disciplinary outcomes -- a doctor's license to practice was either restricted, suspended or revoked.
"I think the big picture about where we're going with social media is getting through to medical students and deans of med schools, and medical boards. We're trying to sketch out the harms of this technology," Greysen said.
Medical blogger Dr. Wendy Sue Swanson, a pediatrician at the Everett Clinic at Seattle Children's Hospital, who says she has 8,000-plus Twitter followers, said the survey builds on what physicians and patients already know.
"The online environment is similar to the offline one; physicians can have a breach of professional conduct in either space. The online environment is a reflection of the real world. Over half of the boards have had serious disciplinary outcomes based on unprofessional behavior online," said Swanson, who had no involvement in the survey.
She'd like to see the research dig deeper, though. "My concerns are that this survey doesn't include the number of serious disciplinary outcomes offline as well. Having that data as a comparison would help us understand if the online environment mirrors the offline one or exaggerates it," she said.
Swanson pointed out that the actual number of violations reported to the boards is very small, given that the boards represent about 850,000 physicians.
"My hunch is the number of unprofessional behaviors is much higher. But because there is no current standard for monitoring online professionalism and policing it, it's difficult to harness the reality," she added.
Dr. Philip Rosoff, a professor of pediatrics and medicine, and director of the Clinical Ethics Program at Duke University Medical Center, who was not involved in the research, said a lot of physicians and medical students who use social media and other forms of electronic communication may not even realize their behaviors pose a professional risk.
"I suspect a lot of people who make these mistakes online -- who have negative outcomes -- do it not out of malicious intent. We need to teach ourselves to use these methods of communication constructively, not destructively," Rosoff said. He added that the American Medical Association has a policy statement on the use of electronic media, and many medical boards and societies, if they don't already have them, are developing similar guidelines.
Rosoff said the survey further raises the question of whether a doctor should maintain any form of private life online, such as a Facebook page, even if it's just for friends and family. He pointed to a recent case involving one emergency room doctor who posted information about a medical case on Facebook. The activity was reported, the doctor was reprimanded by the state medical board, and she lost her job at the hospital, he said.
He said there are ways patients can watch their steps online, too. Rosoff said those with diseases who feel a sense of desperation are especially vulnerable to medical scams and should be guided by the old advice: "If it looks too good to be true, it probably is." Patients could also check reputable websites, such as that of the U.S. National Cancer Institute, to see if another cancer site is reputable. They can scan their state medical board websites, too, to see if a doctor has been sanctioned or has a record.
"But that bar is pretty high, meaning you have to do something pretty bad, and perhaps repeatedly, to get caught and sanctioned," Rosoff said.
Medical blogger Swanson said patients could take action, too. "If a patient hears about online prescribing outside of a professional relationship, privacy violations with protected health information, or inappropriate behavior on a clinician's part in the online space, it should be reported," she said.
Greysen said the Hippocratic Oath -- the promise a medical student makes at graduation to "First, do no harm" -- should guide doctors in the online world as well as the real world. "We've been trying to hone in on, what are the harms of using this technology?" he said. "What needs to come after this is, how can we use social media to promote health?"
The U.S. National Cancer Institute explains how to evaluate online sources of health information.
Posted: March 2012
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