Is Online Physician Behavior Really That Risky?

March 22, 2012

A research letter published yesterday in JAMA reports patterns of online physician behavior.  A recall survey of 68 state board executives was taken on disciplinary matters related to online misconduct.  Of the 48 respondents, 44 reported having taken at least one disciplinary action in eight categories covered by the survey.  Transgressions include inappropriate online communications, use of internet for inappropriate practice, online misrepresentation of credentials, and others.  There is no detail referencing specific social media applications.

After reading the study, it would appear that we’re doing pretty well with respect to online professionalism.  Relative to the 65,000 lifetime board actions in the database of the Federation of State Boards, 99.9% appear to be the result of offline behaviors.

One conclusion might be that doctors belong online.  Here we’re safe.  In fact, if I were a hospital or medical school administrator reading this letter, I might consider an immediate move of clinical and administrative operations online as a means of mitigating risk.

Sarcasm aside, professional misconduct is a serious matter, especially for the patients we are charged to serve.  We need complete, accurate data on physician conduct so that we can understand how to properly train our next generation of doctors.  Practicing physicians need to understand how to practically manage their digital presence.

But this letter published by Greyson et al potentially adds to a medical culture already afraid of what it doesn’t understand.  It comfortably supports the confirmation bias of some physician leaders who hope that the digital age will pass as quickly as it came.  And the suggestion that the worst in physician conduct is yet to come propagates a view of technology from the vantage point of risk rather than opportunity.

If you read the study carefully you’ll see that it supports a belief shared by Dr. Wendy Sue Swanson some time back, “We are way worse in the elevator than we are online.”

  • Physician Violations of Online Professionalism and Disciplinary Actions: A National Survey of State Medical Boards.  Greysen SR, Chretien KC, Kind T, Young A, Gross CP  JAMA, March 21, 2012—Vol 307, No. 11, pp 1141-1142.

{ 1 comment }

Thomas M. Lee March 23, 2012 at 2:18 am

This post is quite thought provoking. It displays the divide in thinking that exists between those physicians who choose to be online and those who choose to be offline. Personally, I don’t think that there’s much chance of moving either party from their position for the foreseeable future. But what about those who are on the fence or are still unaware of the options? How they will interpret things such as this research letter?

Dr. Swanson’s remark, “We are way worse in the elevator than we are online.” is likely quite true. And I believe that as time goes on that sentiment will prevail. Besides, “the genie’s out of the bottle”. Whether it be due to patient demand (lack of trust of those who are offline) or the profession’s own new blood (those who have been online most of their lives) the fact is that physicians *will* be online, and *will need* to be online.

The time is coming, if not here already, when the “online or offline” debate needs to end. And the conversation needs to change to guidance on ethics and best practices.

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