Doctors don’t disclose conflicts of interest on social media

As the use of Twitter and other social media by physicians and patients rises, some professionals worry that physicians increasingly seem to forget to do what many consider crucial for building doctor-patient trust: disclose potential conflicts of interest. However, physicians are not entirely at fault, according to a researcher at The Johns Hopkins University School of Medicine in Baltimore, MD.

Prominent medical societies have failed to lay out comprehensive guidelines for physicians on when and how to disclose a conflict of interest when using social media, says Matthew DeCamp, MD, PhD, a researcher in the Division of General Internal Medicine at Johns Hopkins. He also holds a fellowship at the Johns Hopkins Berman Institute of Bioethics.

In a commentary published online in the Journal of General Internal Medicine, DeCamp argues that some physicians use social media to give advice to patients and the public without revealing drug industry ties or other information that might bias their opinions.1 Without serious efforts to divulge such information, which is standard practice when publishing in medical journals and recommended in one-on-one contacts with patients, DeCamp says consumers are left in the dark. “As physicians and patients increasingly interact online, the standards of appropriate behavior become really unclear,” DeCamp says. “In light of norms of disclosure accepted throughout medicine, it’s surprising that major medical guidelines fail to adequately address this issue.”

Among the national organizations that have issued social media guidelines are the American Medical Association and the Federation of State Medical Boards. (See resources at end of article.) DeCamp acknowledges that use of social media has the potential to improve patient care and trust by increasing patient access to information, but he says vigorous online boundaries are needed to not only ensure privacy and confidentiality, but also to protect patients from misinformation and biased advice.

In an office setting, for example, when doctors prescribe a blood pressure medication, professional guidelines say they are ethically bound to tell patients if they have any financial relationship, such as receipt of consulting fees, with the company that manufactures the drug. Guidelines also call for disclosure when they publish studies about blood pressure medication, and medical journals require them to fill out a detailed disclosure form. But online, it’s “an unacceptably gray area,” DeCamp says.

One reason might be difficulty in determining just how to disclose within the constraints of the online world, DeCamp notes. The popular social media tool Twitter, for example, allows each entry to be just 140 characters long. But a generic disclosure — “The author has no conflict of interest to report related to this tweet” — has 70, leaving little room to discuss the research itself.

DeCamp says one solution is the use of electronic tags that disclose conflicts of interest and follow the information tweeted and re-tweeted by a physician. At the very least, he says, doctors should post potential conflicts in their online profiles, and consumers should be wary of posts and advice from anyone claiming to be a doctor.

“The history of conflict of interest in medicine is such that you don’t want to be late to the table,” DeCamp says. “You need to be proactive so that your undisclosed conflict doesn’t end up on the front page of The New York Times. Conflicts need to be disclosed, and it’s surprising that we have so far to go regarding disclosure and management on social media.”

Reference

  1. Decamp M. Physicians, social media, and conflict of interest. J Gen Intern Med 2012; Nov. 6. [Epub ahead of print.]

Source/Resources

  • Matthew DeCamp, MD, PhD, Division of General Internal Medicine, The Johns Hopkins Hospital, Lutherville, MD. Telephone: (410) 583-2926.
  • American Medical Association. AMA Policy: Professionalism in the Use of Social Media. Web: http://tinyurl.com/2bykytd.
  • Federation of State Medical Boards. Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice Policy on Social Media. Web: http://www.fsmb.org/pdf/pub-social-media-guidelines.pdf.