AMA House of Delegates

AMA meeting: Doctors' online conduct addressed at CEJA forum

■ Other issues explored include whether doctors and patients should be Facebook friends and if flu shots should be mandatory for physicians.

By Kevin B. O’Reilly — Posted June 28, 2010

Chicago -- Business and English majors aren't the only students who have run into trouble over risqu� content posted to social networking websites such as Facebook and Twitter. So have medical students.

Meanwhile, one physician-blogger had his identity unmasked when he wrote about ongoing litigation.

How do standards of physician professionalism apply online? Must the same rules of decorum that patients expect from doctors in the clinic or the hospital also apply on physicians' private Facebook pages? Should physicians "friend" their patients on Facebook?

These were among questions delegates discussed at the Council on Ethical and Judicial Affairs open forum at the American Medical Association's Annual Meeting in June.

Some delegates advised their physician colleagues to be wary of disclosing too much on the Internet.

"Common sense prevails here," said Robert T. Phillips, MD, PhD, an Annapolis, Md., psychiatrist and delegate for the American Academy of Psychiatry and the Law. "We've had this issue long before the Internet. Certain behaviors may cast aspersions on your character, and how you behave will put your career in jeopardy. There always will be someone out there looking -- that's the nature of our society. So, caveat emptor."

Dr. Phillips

Sixty percent of medical schools reported incidents of students posting unprofessional content online, according to survey results published in the Sept. 23/30, 2009, Journal of the American Medical Association.

Some younger doctors said it can be difficult to resist the pressure to join social networking websites that have become the nearly universal way that their far-flung colleagues keep in touch. But using the Internet to connect with family, friends and other physicians is different from crossing boundaries with patients, said Paul O'Leary, MD, a sectional delegate for the Resident and Fellow Section.

"No matter where I go, I'm called Dr. O'Leary. It doesn't turn off and turn on. We should respect that," said Dr. O'Leary, a Birmingham, Ala., child and adolescent psychiatrist. "I don't text patients. I don't Facebook friend them."

Dr. O'Leary suggested that just as Facebook has different levels of privacy settings that users can apply, ethical guidance also could differ based on how openly physicians use social media. "If you're going to let it all hang out, so to speak, then you probably shouldn't make it public to the world," he said.

The House of Delegates is asking the AMA to study physician use of social media.

CEJA already is at work on ethical guidance that could be presented as a report within the next 12 to 18 months.

Mandating physician immunization

Dr. Levine

Delegates also addressed pros and cons of whether health care organizations should require physicians to get flu shots. CEJA is studying the topic pursuant to a resolution proposed by the Infectious Diseases Society of America at the 2009 Interim Meeting. The resolution said the AMA should back universal seasonal and H1N1 flu immunization unless health professionals have medical contraindications or religious objections.

Several delegates said that in formulating guidance, CEJA should be careful to allow opt-outs for physicians who are pregnant or living with immunocompromised family members. Mark A. Levine, MD, a Denver internist and former CEJA chair, said the council should take into account the potential backlash of requiring vaccination.

"Whatever the benefits of mandatory immunization would be, that must be proportional to the effect you'd anticipate from the social consequences of instituting that mandatory policy," he said. "Obviously, there's going to be some degree of social disruption. That's the balance that needs to be solved."

The national influenza immunization rate was 48% among health care workers in 2008, the most recent year data were available from the Centers for Disease Control and Prevention. Hospitals that have mandatory vaccination policies, such as Virginia Mason Medical Center in Seattle and Barnes-Jewish Hospital in St. Louis, have immunization rates exceeding 95%.

ADDITIONAL INFORMATION

Meeting notes: Medical ethics

Issue: Men who have had sex with men since 1977 are banned from donating blood. A previous AMA report concluded that medical evidence supports allowing men to donate five years after their last same-sex contact, but said the ethical aspects of such a change should be explored.

Proposed action: Study the societal and ethical consequences of moving to a five-year deferral policy and report back at the 2011 Annual Meeting. [Adopted]

Issue: Few adults age 18 to 24 have completed advance directives or named health care proxies, making it difficult for physicians and loved ones to make care decisions on their behalf.

Proposed action: Educate young adults about the importance of advance directives and health care proxies and encourage physicians to talk with their younger adult patients about such planning. [Adopted]

Issue: A growing number of for-profit hospice care organizations have helped double the number of patients in hospice since 2000, to more than 1 million, and nearly quadrupled Medicare hospice costs to $11.2 billion.

Proposed action: Reaffirm physicians' responsibility to authorize hospice care in appropriate circumstances, develop educational materials and call on CMS to study the hospice benefit's structure, pay methodology and quality assurance. [Adopted]

Issue: Industry funding of continuing medical education and CME faculty with financial conflicts may compromise the independence of educational content.

Proposed action: Adopt ethical guidance saying physicians should expect conflict-free CME when possible and that, when unavoidable, the conflicts should be scrutinized closely and disclosed in detail. [Referred]

Issue: Commercial sponsorship of clinical practice guidelines and guideline-committee members with financial conflicts may improperly influence the recommendations made to physicians.

Proposed action: Support the position that physician organizations should not receive industry support for writing or promoting practice guidelines and call for independent review of guidelines before publication. [Referred]