Focus on ethics of social networking

Patient/physician relationship is issue

Of 600 residency program directors and medical school admissions officers surveyed, 64% reported being somewhat or very familiar with searching individual profiles on social networking sites, 9% reported routinely using social networking sites in the selection process, and 53% stated that unprofessional information on applicants’ websites could compromise their admission into medical school or residency.1

“Some might consider it surprising that a majority of respondents thought it was acceptable to use such information in the selection process, but this is clearly the norm today,” says Carl I. Schulman, MD, PhD, the study’s lead author and associate program director for the surgical residency program at the University of Miami. “The study’s findings probably underestimate the true impact of social networking sites on selection.”

“What should be considered when assessing the professionalism of a potential applicant? Should what one does in their personal life influence the selection process?” he asks. “There are certain things that are not allowed to be asked during an applicant’s interview, which would most likely be easily discovered through modern social networking sites.”

What is appropriate for physicians to post on a social networking site? How much influence should a professional organization, college, or employer have outside of the work environment? “These are ethically challenging questions,” says Rosalind Abdool, PhD(c) a fellow at the Centre for Clinical Ethics at St. Joseph’s Health Centre in Toronto, Canada. “Some may argue that this is a relatively new concept. However, questions of professionalism outside of employment have been raised for decades.”

For example, many professional colleges have strict standards about the kind of behaviors and relationships that are appropriate outside of expected or standard interactions between professionals and their patients, which can even extend once the clinical relationship has ended.

Observing one’s clinician participating in perceived reckless behaviors can influence a patient to believe that the clinician lacks good judgment, which the patient might believe adversely influences the clinician’s ability to treat and care for him or her. “Although the reactions may not always be accurate, this can have an enormous impact on trust, credibility, and reliability,” says Abdool. “This is why judgment is extremely important when considering what to post and what views to express in a social media setting.”

Transparency needed

Many medical schools lack formal policies on social media use, notes Kayhan Parsi, JD, PhD, professor of bioethics and health policy/graduate program director at Loyola University Chicago’s Neiswanger Institute for Bioethics and Health Policy in Maywood, IL. “Is it appropriate for students to tweet things that are obscene or inappropriate even though they aren’t breaching confidentiality? It may be that we should start cultivating these norms with medical students who are in training,” he says.

Abdool says it is not ethically problematic for medical schools and residency programs to inquire further, through Internet searches, about potential candidates. “Exercising good judgment regarding what to post publicly shows a concern for trust, credibility, and reliability, which is the kind of character that medical schools and residency programs look for in future physicians,” she explains.

Medical schools and residency programs should be fully transparent regarding their use of Internet searches to inform candidate applications, however, says Abdool, and candidates should be made aware that this process could ultimately affect their chances of being selected for medical and residency programs. “The ethical importance and value of professionalism and public perception should be made explicit in medical schools, especially how they pertain to social networking,” she says. “Professional judgment should also be discussed, and how one’s actions outside of the profession can impact the fiduciary relationship between a professional and his or her patient.”

Clear guidelines should be offered to applicants for medical schools and residencies, recommends Schulman, so they at least know that this information could be used in the selection process. “The same issues will clearly affect practicing physicians,” he says. “It is important for all professionals to be aware that their online information can shape the way they are viewed by other physicians, hospitals, and patients.”

Maintain boundaries

Historically, physicians could maintain sharper boundaries with regard to their personal and professional lives, says Parsi, “but with the proliferation of social media, those kinds of boundaries have really gone out the window. If images you post seem incongruous with the identity of a physician, professional societies or medical boards might look upon that as not the best representation of health care.”

Parsi says connecting with patients on professional networking sites is “a little bit more nuanced. It offers a different kind of professional boundary issue than Facebook, which is typically a more social networking site.”

Parsi says that physicians need to keep their personal and professional identities separate online, but even with accounts that are for personal use only, physicians must consider whether their postings will reflect poorly on the profession. “Even there, you are still perceived as a physician, and anything can be reposted or forwarded,” he says. “If patients see their physician behaving in a way that is unprofessional, it could undermine their trust not only in the physician, but also the profession of medicine.”


1. Schulman CI, Kuchkarian FM, Withum KF, et al. Influence of social networking websites on medical school and residency selection process. Postgrad Med J 2013;89(1049):126-130.


• Rosalind Abdool, PhD(c) Clinical Ethics Fellow, Centre for Clinical Ethics, St. Joseph’s Health Centre, Toronto, Canada. E-mail:

• Kayhan Parsi, JD, PhD, Professor of Bioethics & Health Policy/Graduate Program Director, Neiswanger Institute for Bioethics and Health Policy, Loyola University Chicago, Maywood, IL. Phone: (708) 327-9214. E-mail:

Carl I. Schulman, MD, PhD, Associate Program Director, Surgical Residency Program, University of Miami. Phone: (305) 585-1076. E-mail: