Although principles and commitments for medical professionalism already exist,10
we believe that many physicians may have difficulty applying these principals to their online actions for at least three reasons. First, some of the online content that has been identified as unprofessional in both the medical literature and mass media may not clearly violate existing principles of medical professionalism. For example, some physicians may not realize that images of off-duty drinking on a social networking site may raise questions from the public about unprofessional behavior, especially if intoxication is implied. A second and related concern is that many people experience a sense of disinhibition in their online actions. Social media in particular can create a perception of anonymity and detachment from social cues and consequences for online actions.11
Thus, medical professionals may say or do things they would not say or do in person, such as disclosure of confidential information (including pictures of patients), or display speech and behaviors that are disrespectful to colleagues or patients and their families. Third, the potential impact of such indiscretions is much greater than typical face-to-face interactions because of the wide reach of this media. While physicians must always be vigilant to avoid violating patient confidentiality, a slip made online can have far greater impact than one made over lunch with a colleague.
Regrettably, social media can enable content posted in a momentary lapse in judgment to spread rapidly beyond the intended audience with a simple “click.” In this sense, social media can act as a mirror reflecting intimate thoughts and behaviors back to oneself as well as to others around the world. For an increasingly Internet-savvy public, “images” reflected by this social media mirror may prove very important in sizing up not only the credentials, but also the character of professionals. Moreover, when amplified by press coverage, unprofessional images of professionals in the social media mirror may also be magnified or distorted as in the case of the physicians providing aid in Haiti.
While rigorous studies on patient perceptions of physicians’ social media use are lacking, recent media coverage of the topic12
and online reader responses, such as the following, are illuminating: “Medicine is a very serious profession…[but] teetering on the edge of respectability and trust in some areas. Soon there will be so little trust that it will undermine the respectable people who have chosen this profession.”13
Other readers posted similar comments, “Anybody who isn't smart enough to figure out what's OK to post on the Internet has absolutely no business being in charge of other people's health,” and “As professionals, doctors, teachers, lawyers, etc., are held to a certain standard. If that's not your cup of tea, find a different job.” These comments suggest that some may view a physician’s online activity as a proxy for the common sense and trustworthiness needed to handle the responsibilities of patient care. Moreover, when technology such as social media has the ability to alter ways in which physicians can interact with individual patients and the public at large, physicians must reconsider the implications of their professional commitments.14
While it may not be necessary to expand the existing framework for professionalism, physicians should at least consider the issues raised by social media and make informed decisions for themselves, or in collaboration with colleagues or superiors, to decide what is appropriate and inappropriate for their group, institution, or workplace as they represent themselves in a new web where user-generated content abounds.