Physicians-in-Training Should Beware the Potential Impact of Social Networking Site Posts on Professionalism

During the past decade, the popularity of user-generated content on sites such as MySpace, Facebook, YouTube, Twitter and Flickr has escalated and become a normal component of many medical students' and residents' daily activities and interactions. This type of communication allows them to promote, project and propagate themselves like never before. However, this mode of communication also has the capability of removing inhibitions and leading students and residents into trouble.

Unfortunately, some students have provided sensitive information on these sites without truly understanding the significant consequences of their actions. These students have crossed over from an innocent mode of socialization to unprofessional behavior, which has the potential to affect their application to a residency program, their first job interview as a physician, and, eventually, their ability to care for patients.

In addition, malicious programs rampaging through these social media Web sites can take over individual accounts and send messages to everyone with whom the account holder communicates. This can result in people inadvertently revealing information they did not want shared or in directing others to e-commerce sites because the "sender" recommends the site. The perpetrators hope to profit from referral fees.

Other individuals become victims because they may lose control of their accounts after clicking on a link purportedly sent by a friend. These new forms of Web-based malware are not self-contained programs that can be stopped by a firewall or antiviral software, and most students are not aware of how vulnerable they are.

I have the unique perspective of working with medical students, as well as with family medicine residents at various levels of training. Nationally, students and residents have received media attention because of incidents of profanity, discriminatory language, depiction of intoxication and sexually suggestive material on social media sites. In addition, some students have posted information about patients, the care patients received and even specific patient encounters. This is occurring on campuses across the nation and not just in medical schools. However, for medical students and residents, such behavior leads to violations of professionalism and patient confidentiality that can have severe consequences.

These consequences can range from placing an undeserved "black mark" on a student's or resident's reputation to impugning the reputation of another student, colleague, peer, patient or faculty member. Social networking posts are public information, so posting such information could jeopardize careers, affect the ability to attend a chosen residency or obtain a job position. In addition, it can result in discrimination against a patient and limit his or her access to care.

The Accreditation Council for Graduate Medical Education has identified specific competencies that should be taught and achieved during medical school and residency training. One of these competencies is professionalism; its components include how students or residents

These competencies are part of learning what it means to be a physician, including the obligation to maintain patient privacy and confidentiality and the importance of being ethical. These standards need to be taught at various levels of interaction, including in the classroom, the hospital, the clinic and on the personal computer.

A Dec. 22, 2005, study in the New England Journal of Medicine demonstrated that unprofessional behavior in medical school was a strong predictor of disciplinary action by a state medical board of a physician in medical practice. Common violations included drug abuse, unprofessional conduct, negligence and inappropriate prescribing. These physicians were likely to be disciplined for multiple violations.

In the study, unprofessional behavior was shown to be a better indicator of later discipline than more traditional measures, such as college admission test scores and poor grades early in medical school.

Professionalism needs to be a part of the medical education process from the first day of medical school and throughout the career of a physician. It is a primary component for evaluating and rating a physician. A California study found that patient satisfaction was the most important criterion patients consider when choosing a primary care physician. The top five attributes patients looked at were

Patients want more from their physician than an effective treatment or a correct diagnosis. Patients want a physician who has empathy, confidence, shows respect toward them and is thorough. Patients usually are not concerned about their physician's technical competence because it is difficult for them to assess. However, patient satisfaction usually rises when a physician demonstrates specific interpersonal skills that are tied to professionalism and quality of care.

Medical practices present an array of situations and decisions intertwined with personal demands and obligations every day. Each time you open the door, the patient on the other side represents a new encounter and a new opportunity to reveal your humanism and integrity.

The profession of medicine asks its members to possess not only the requisite scientific knowledge and clinical and technical skills, but also to have the integrity and goals to fulfill the oath taken, to serve with honor, and to dedicate themselves to the principles and responsibilities of the profession. Professionalism and humanism must be top priorities.

The curriculum in medical schools may need to develop to include a digital media component that teaches students about the risks of using social networks and the proper way to use these networks, privacy settings, and sharing patient stories that are de-identified and respectful. In addition, students should be taught how to do Web searches on themselves to see what is on the Internet for public consumption -- including by residency program directors, future employers and future patients.

In addition, for those students and residents who choose to misuse these networks, medical schools need to have policies in place to address the incidents with appropriate consequences.

George Harris, M.D., M.S., of Lee's Summit, Mo., is the assistant dean for year 1 and 2 medicine at the University of Missouri-Kansas City School of Medicine and professor of medicine in the UMKC Department of Community and Family Medicine.