Do physician social media guidelines need updating?

Three physicians are calling on organized medicine to change the standard industry guidelines on social media use that call on doctors to separate their personal and professional online personas.

Instead, they argue, guidelines should focus on what is appropriate to post.

Matthew DeCamp, MD, PhD, Thomas Koenig, MD, and Margaret Chisolm, MD, wrote a “Viewpoint” on the subject in the Aug. 14 issue of The Journal of the American Medical Association (link). They argue that it would be impossible from a technical standpoint to abide by current social media guidelines. In addition, they said, the guidelines are potentially harmful to physicians and patients. The physicians are ethics and psychiatry experts affiliated with the Johns Hopkins University School of Medicine in Baltimore. They held a live Twitter chat, with the hashtag #IDcrisis, on Aug. 16 to discuss their piece.

“In ethics, ‘ought’ implies ‘can,’ meaning that an ethical claim is binding only if a person is actually able to carry out the required actions. Separation of identities online is operationally impossible,” the authors wrote. They argue that an online search for a social media page would connect both personal and professional pages. “Despite the increasing availability of paid services to monitor and control a person’s Web presence, no current technology exists to overcome fully this particular barrier.”

The separation of personal and professional personae was a recommendation first made by the American Medical Association in 2010. Other physician organizations followed suit with their own guidelines, each promoting the same personal-professional separation advice. In April, the American College of Physicians and the Federation of State Medical Boards released similar guidelines (link).

The authors of the JAMA article say the draw to social media for many physicians was the intentional blurring of boundaries between professional and personal identities.

“Professional identity constitutes and is constituted by personal identity, perhaps as one of the many ‘subidentities’ or roles individuals might have, such as a spouse, parent and so on. Separation therefore verges on nonsensical,” the doctors wrote. They also make the argument that separation may be harmful. Depersonalized online interactions could lead patients to believe the doctor is hiding something. They also could lead to a physician’s inability to normalize a difficult situation or express empathy.

What should be stressed?

Instead of focusing on professional and personal boundaries, physicians should zero in on the boundary between what is appropriate and what is not, the authors wrote.

“When a physician asks, ‘Should I post this on social media?’ the answer does not depend on whether the content is professional or personal but instead depends on whether it is appropriate for a physician in a public space,” the article said.

Social media should be incorporated into medical education and professionalism curriculum, they argued. “Absent this approach, the professional transgressions motivating guidelines will persist, and the potential benefits of social media will remain unrealized,” the authors concluded.