New policy outlines ethical social media use

When physicians were first using the Internet to do e-prescribing back in the 1990s, this led to the Federation of State Medical Boards (FSMB) forming a committee to define a physician-patient relationship, recalls Humayun J. Chaudhry, DO, MS, FACP, FACOI, the FSMB's president and CEO.

"What we came up with is that it begins any time a patient seeks out a clinician for medical care or advice and that clinician agrees to provide that care, whether at the bedside or electronically," he says.

This year, the FSMB became focused on social media due to research showing that a significant number of medical students were inappropriately using Facebook. "We wondered if there was a similar issue with licensed physicians who had been in practice much longer," says Chaudhry.

Research revealed that almost half of the state boards that investigated unprofessional online behaviors by physicians had to limit a doctor's license to practice medicine as a result.1

"The mission of the state medical boards in the U.S. is to protect the public, so if they see examples of ethical violations, they will take action," he says. "What was surprising was the extent to which they had been doing this on social media. That was a wake-up call."

Physicians need reminder

One of the most commonly reported ethical violations involved physicians contacting patients socially. "Obviously, that is wrong under any circumstance, but the numbers were quite high when it came to social media," he says.

As a result of the study's findings, an FSMB committee adopted a policy to educate physicians on how to behave ethically online. Often, physicians who behave inappropriately online would never do the same behaviors in person, adds Chaudhry.

"Physicians don't always realize that it's the exact same equivalent of talking to somebody or examining somebody," says Chaudhry. "It's a little impersonal, yet people end up saying things that are quite personal. These are the kind of conversations that typically occur in the privacy of an examining room."

According to the policy, physicians should not communicate with patients using social media sites accessible by the public at all. "This is not the setting to engage in conversations about health care," says Chaudhry. "The dangers are too great, with too many possibilities for things to go wrong."

Other individuals may see a physician's advice and act on it themselves, third parties may view the communication, and individuals may misrepresent themselves as either the patient or the physician.

"That doesn't mean that physicians and patients should never engage online. There are settings under which those types of encounters can be quite beneficial, especially if there is an access-to-care issue," says Chaudhry, adding that a number of health systems have patient portals with safeguards such as password protection.

"Medical regulators and educators will do their best to educate physicians about what's right and wrong," he says. "But sometimes, technology moves so far ahead that the precautions lag behind a little bit."


  1. Greysen SR, Chretien KC, Kind T, et al. Physician violations of online professionalism and disciplinary actions: A national survey of state medical boards. JAMA. 2012; 307(11):1141-1142.