Journal of General Internal Medicine

, Volume 28, Issue 2, pp 299–303

Physicians, Social Media, and Conflict of Interest

Perspectives

ABSTRACT

Physicians and patients increasingly use social media technologies, such as Facebook, Twitter, and weblogs (blogs), both professionally and personally. Amidst recent reports of physician misbehavior online, as well as concerns about social media’s potential negative effect on trust in the medical profession, several national-level physician organizations have created professional guidelines on social media use by physicians. Missing from these guidelines is adequate attention to conflict of interest. Some guidelines do not explicitly mention conflict of interest; others recommend only disclosure. Recommending disclosure fails to appreciate the unique features of social media that make adequate disclosure difficult to accomplish. Moreover, in emphasizing disclosure alone, current guidelines are inconsistent with medicine’s general trend toward management or elimination, not just disclosure, of potential conflicts. Because social media sites typically rely on physicians’ voluntary compliance with professional norms, physicians necessarily play a major role in shaping these norms’ content and scope. To achieve the benefits of social media and ensure the veracity of social media content while preserving trust in the profession, physicians must reaffirm their commitment to disclose potential conflicts; advocate for better electronic disclosure mechanisms; and develop concrete management strategies—including, where necessary, the elimination of conflicts altogether.

KEY WORDS

professionalism ethics internet conflict of interest blogging social media 

REFERENCES

  1. 1.
    Thompson LA, Dawson K, Ferdig R, et al. The intersection of online social networking with medical professionalism. J Gen Intern Med. 2008;23(7):954–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Manhattan Research LLC. Taking the Pulse: Physicians and Emerging Information Technologies. New York, NY: Manhattan Research; April 2010.Google Scholar
  3. 3.
    Fox S. The Social Life of Health Information. Pew Internet & American Life Project. Washington DC: Pew Research Center; 2011.Google Scholar
  4. 4.
    Modahl, M., Tompsett, L., Moorhead, T. Doctors, Patients & Social Media. QuantiaMD, September 2011. Available at http://www.quantiamd.com/q-qcp/doctorspatientsocialmedia.pdf. Accessed September 26, 2012.
  5. 5.
    Bosslet GT, Torke AM, Hickman SE, Terry CL, Helft PR. The patient–doctor relationship and online social networks: results of a national survey. J Gen Intern Med. 2012;26(10):1168–74.CrossRefGoogle Scholar
  6. 6.
    Merchant RM, Elmer S, Lurie N. Integrating social media into emergency-preparedness efforts. N Engl J Med. 2011;365:289–91.PubMedCrossRefGoogle Scholar
  7. 7.
    Sermo.com. Sermo Highlights Social Media’s Life-Saving Impact on Patient Care. Available at: http://www.sermo.com/news/press-releases/15. Accessed September 26, 2012.
  8. 8.
    Wicks P, Vaughan TE, Massagli MP, Heywood J. Accelerated clinical discovery using self-reported patient data collected online and a patient-matching algorithm. Nat Biotechnol. 2011;29(5):411–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Maier A, Holm T, Wicks P, et al. Online assessment of ALS functional rating scale compares well to in-clinic evaluation: a prospective trial. Amyotroph Lateral Scler. 2012;13(2):210–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Yamout SZ, Glick ZA, Lind DS, Monson RA, Glick PL. Using social media to enhance surgeon and patient education and communication. Bull Am Coll Surg. 2011;96(7):7–15.PubMedGoogle Scholar
  11. 11.
    George DR. “Friending Facebook?” A minicourse on the use of social media by health professionals. J Contin Educ Health Prof. 2011;31(3):215–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Sullivan, T. Why the CME community is lacking in its use of social media. Available at: http://www.kevinmd.com/blog/2011/02/cme-community-lacking-social-media.html. Accessed September 26, 2012.
  13. 13.
    Aronson SH. The Lancet on the telephone 1876–1975. Med Hist. 1977;21(1):69–87.PubMedCrossRefGoogle Scholar
  14. 14.
    Jain SH. Practicing medicine in the age of Facebook. N Engl J Med. 2009;361(7):649–51.PubMedCrossRefGoogle Scholar
  15. 15.
    Greysen SR, Kind T, Chretien KC. Online professionalism and the mirror of social media. J Gen Intern Med. 2010;25:1227–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Chretien KC. Should I be “friends” with my patients on social networking web sites? Am Fam Physician. 2011;84(1):105. 108.PubMedGoogle Scholar
  17. 17.
    Guseh JS 2nd, Brendel RW, Brendel DH. Medical professionalism in the age of online social networking. J Med Ethics. 2009;35(9):584–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Chretien KC, Azar J, Kind T. Physicians on Twitter. JAMA. 2011;305:566–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Chretien KC, Greysen SR, Chretien JP, Kind T. Online posting of unprofessional content by medical students. JAMA. 2009;302:1308–15.CrossRefGoogle Scholar
  20. 20.
    MacDonald J, Sohn S, Ellis P. Privacy, professionalism and Facebook: a dilemma for young doctors. Med Educ. 2010;44(8):805–13.PubMedCrossRefGoogle Scholar
  21. 21.
    Shore R, Halsey J, Shah K, Crigger BJ, Douglas SP, AMA Council on Ethical and Judicial Affairs (CEJA). Report of the AMA Council on Ethical and Judicial Affairs: professionalism in the use of social media. J Clin Ethics. 2011;22(2):165–172.PubMedGoogle Scholar
  22. 22.
    Snyder L, American College of Physicians Ethics, Professionalism, and Human Rights Committee. American College of Physicians Ethics Manual, Sixth Edition. Ann Intern Med. 2012;156:73–104.PubMedGoogle Scholar
  23. 23.
    Federation of State Medical Boards. Medical Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice. Available at: http://www.fsmb.org/pdf/pub-social-media-guidelines.pdf. Accessed September 26, 2012.
  24. 24.
    Canadian Medical Association. Social media and Canadian physicians—issues and rules of engagement. Available at: http://www.cma.ca/socialmedia. Accessed September 26, 2012.
  25. 25.
    British Medical Association. Using social media: practical and ethical guidance for doctors and medical students. 2011. Available at: http://bma.org.uk/-/media/Files/PDFs/Practical%20advice%20at%20work/Ethics/socialmediaguidance.pdf. Accessed September 26, 2012.
  26. 26.
    United Kingdom General Medical Council. Doctors’ use of social media: A draft for consultation. Available at: http://www.gmc-uk.org/Draft_explanatory_guidance___Doctors_use_of_social_media.pdf_48499903.pdf. Accessed September 26, 2012.
  27. 27.
    Mansfield SJ, Morrison SG, Stephens HO, et al. Social media and the medical profession. Med J Aust. 2011;194(12):642–4.PubMedGoogle Scholar
  28. 28.
    Derse AR, Miller TE. Net effect: professional and ethical challenges of medicine online. Camb Q Healthc Ethics. 2008;17(4):453–64.PubMedCrossRefGoogle Scholar
  29. 29.
    Mostaghimi A, Crotty BH. Professionalism in the digital age. Ann Intern Med. 2011;154(8):560–562.PubMedGoogle Scholar
  30. 30.
    McGee SJ. To friend or not to friend. Is that the question for healthcare? Am J Bioeth. 2011;8:2–5.Google Scholar
  31. 31.
    Leiker M. When to ‘friend’ a patient: social media tips for healthcare professionals. WMJ. 2011;110(1):42–3.PubMedGoogle Scholar
  32. 32.
    Kind, T., Genrich, G., Sodhi, A., Chretien, K.C. Social media policies at US medical schools. Med Educ Online. 2010;15:5324. doi:10.3402/meo.v15i0.5324.
  33. 33.
    Blumenthal D. Doctors and drug companies. N Engl J Med. 2004;351(18):1885–90.PubMedCrossRefGoogle Scholar
  34. 34.
    Watkins C, Moore L, Harvey I, Carthy P, Robinson E, Brawn R. Characteristics of general practitioners who frequently see drug industry representatives: national cross sectional study. BMJ. 2003;326:1178–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Shrank WH, Choudhry NK, Swanton K, et al. Variations in structure and content of online social networks for patients with diabetes. Arch Intern Med. 2011;171(17):1589–91.PubMedCrossRefGoogle Scholar
  36. 36.
    Greene JA, Choudhry NK, Kilabuk E, Shrank WH. Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook. J Gen Intern Med. 2011;26(3):287–92.PubMedCrossRefGoogle Scholar
  37. 37.
    Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ. 2003;326(7400):1167–70.PubMedCrossRefGoogle Scholar
  38. 38.
    Ghinn, D. Pharma gets social: Pharma lessons in social media and clinical trials. March 21, 2012. Available at: http://www.pharmaphorum.com/2012/03/21/pharma-gets-social-pharma-lessons-social-media-clinical-trials/. Accessed September 26, 2012.
  39. 39.
    Blue Chip Patient Recruitment. Engaging E-patients in Clinical Trials through Social Media. March 2011. Available at: http://bluechipmarketingworldwide.com/BCPR_form/BlueChip_SocialMedia_5-2011.pdf. Accessed September 26, 2012.
  40. 40.
    Ramo DE, Prochaska JJ. Broad reach and targeted recruitment using Facebook for an online survey of young adult substance use. J Med Internet Res. 2012;14(1):e28.PubMedCrossRefGoogle Scholar
  41. 41.
    Zipkin DA, Steinman MA. Interactions between pharmaceutical representatives and doctors in training. A thematic review. J Gen Intern Med. 2005;20(8):777–86.PubMedCrossRefGoogle Scholar
  42. 42.
    Farnan JM, Paro JA, Higa JT, Reddy ST, Humphrey HJ, Arora VM. Commentary: The relationship status of digital media and professionalism: it’s complicated. Acad Med. 2009;84(11):1479–81.PubMedCrossRefGoogle Scholar
  43. 43.
    Lagu T, Kaufman EJ, Asch DA, Armstrong K. Content of weblogs written by health professionals. J Gen Intern Med. 2008;23(10):1642–1646.PubMedCrossRefGoogle Scholar
  44. 44.
    Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. 2005;165(22):2618–24.PubMedCrossRefGoogle Scholar
  45. 45.
    Price Waterhouse Cooper Health Research Institute. Social media “likes” healthcare. April 2012. Available at: http://www.pwc.com/us/en/health-industries/publications/health-care-social-media.jhtml. Accessed September 26, 2012.
  46. 46.
    Loewenstein G, Cain DM, Sah S. The limits of transparency: pitfalls and potential of disclosing conflicts of interest. AER Papers Proc. 2011;101(3):423–428.CrossRefGoogle Scholar
  47. 47.
    Compilation of Patient Protection and Affordable Care Act. 111th Congress, 2nd session. Title VI. Subtitle A. Section 6002. May 1, 2010.Google Scholar
  48. 48.
    Bovi AM, Council on Ethical and Judicial Affairs of the American Medical Association. Use of health-related online sites. Am J Bioeth. 2003;3(3):W-IF3.PubMedGoogle Scholar
  49. 49.
    Gibbons RV, Landry FJ, Blouch DL, et al. A comparison of physicians’ and patients’ attitudes toward pharmaceutical industry gifts. J Gen Intern Med. 1998;13(3):151–4.PubMedCrossRefGoogle Scholar
  50. 50.
    Lo B, Field MJ, for the Committee on Conflict of Interest in Medical Research, Education, and Practice. Conflict of interest in medical research, education and practice. Washington DC: The National Academies Press; 2009.Google Scholar
  51. 51.
    Council of Medical Specialty Societies. Code for Interactions with Companies. March 2011. Available at: http://cmss.org/codeforinteractions.aspx. Accessed September 26, 2012.
  52. 52.
    Steinman MA, Landefeld CS, Baron RB. Industry support of CME—are we at the tipping point? N Engl J Med. 2012;366:1069–71.PubMedCrossRefGoogle Scholar
  53. 53.
    International Committee of Medical Journal Editors. ICMJE Form for Disclosure of Potential Conflicts of Interest. Available at: http://www.icmje.org/coi_disclosure.pdf. Accessed September 26, 2012.
  54. 54.
    Loewenstein G, Sah S, Cain DM. The unintended consequences of conflict of interest disclosure. JAMA. 2012;307:669–70.PubMedCrossRefGoogle Scholar
  55. 55.
    Lesser CS, Lucey CR, Egener B, Braddock CH 3rd, Linas SL, Levinson W. A behavioral and systems view of professionalism. JAMA. 2010;304:2732–7.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  1. 1.Berman Institute of Bioethics, Division of General Internal MedicineJohns Hopkins University and School of MedicineBaltimoreUSA

Personalised recommendations