2010 Interim Meeting

AMA Delegates Back Guidelines on Social Media, Consider Physician Health Issues

November 10, 2010 05:20 pm Barbara Bein

Delegates at the 2010 interim meeting of the AMA House of Delegates, Nov. 6-9 in San Diego, adopted recommendations that urge physicians to maintain professionalism when they use social media, such as Facebook, Twitter and LinkedIn. Delegates also considered, but ultimately referred, recommendations in a report that dealt with the importance of physician health programs.

The recommendations regarding social media that delegates adopted were included in a Council on Ethical and Judicial Affairs, or CEJA, report that provides ethical guidance for physicians who participate in online social networking.

According to Joseph Zebley, M.D., of Baltimore, vice chair of the AAFP delegation to the AMA House of Delegates, the issue of how physicians at any stage of their careers should approach such new technologies really is fairly straightforward.

"It's a matter of professionalism and understanding boundaries -- and this needs to be started in medical school and continue into residency," Zebley told AAFP News Now after the meeting.

"It's hard to be proscriptive in the use of social media," he added. "If an individual has concerns about whether (something he or she has posted to such a resource) is appropriate or not, that individual should hold back."

Know Your Boundaries

The CEJA report acknowledged that social networking resources, blogs and other forms of online communication create "new challenges" in the patient-physician relationship, and it advised physicians to weigh a number of considerations when maintaining an online presence.

  • Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online.
  • When using the Internet for social networking, physicians should use privacy settings to safeguard personal information and content.
  • If physicians interact with patients on the Internet, they must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines.
  • To maintain appropriate professional boundaries, physicians should consider separating personal and professional content online.
  • When physicians see content posted by colleagues that appears unprofessional, they have a responsibility to bring that content to the attention of the individual so he or she can remove it or take other appropriate actions. If the behavior violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.
  • Physicians must recognize that actions online and posted content may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers -- particularly for physicians-in-training and medical students -- and can undermine public trust in the medical profession.

According to the report of the Reference Committee on Amendments to Constitution and Bylaws(www.ama-assn.org), which heard testimony Nov. 7 on the CEJA report, most speakers favored adopting the report's recommendations, although some expressed concern about the recommendation that called for physicians to take action if they see unprofessional content posted online by colleagues.

However, said the reference committee in its report, "this is a common standard of professionalism in non-online professional interaction."

Zebley agreed with that assessment, noting, "It just goes back to common-sense professionalism."

Physician, Heal Thyself

Delegates also considered, but ultimately referred, recommendations contained in a report that dealt with the importance of physician health programs.

Specifically, delegates considered a report from the Council on Science and Public Health, or CSPH, that recommended the AMA affirm the importance of physician health in its strategic plan and the need for ongoing education of its members about physician health.

But after making a number of amendments to the recommendations in the original report, the AMA House of Delegates referred it back to the council.

The original report recommended that the AMA

  • help to further the informational and educational aspects of physician health across the continuum of medical education;
  • recognize a number of components as essential to a state physician health program, including contingency management that includes positive and negative consequences, random drug testing, linkage with 12-step programs and with the abstinence standard espoused by these programs, management of relapses by intensified treatment and monitoring, use of a continuing care approach, a focus on lifelong recovery, and protection of anonymity; and
  • develop state legislative guidelines addressing the design and implementation of physician health programs for physicians in conjunction with the Federation of State Physician Health Programs.

Mack Worthington, M.D., of Chattanooga, Tenn., an AAFP delegate to the AMA, said he testified as an individual in favor of the report and its recommendations during a Nov. 7 hearing of the Reference Committee on Medical Education, Science and Public Health. He is president of the Tennessee Medical Foundation, which runs the physician health program for the state.

"I was glad to see this report from the Council on Science and Public Health," Worthington told AAFP News Now after the meeting. "It has brought things out in the open. It is an important issue and should be given some attention in the AMA."

Worthington said the Tennessee physician health program has been very successful, and he would like to see the AMA develop guidelines -- perhaps based on the Tennessee model -- that would be appropriate across the country.

"I've seen lives changed, careers saved and families brought back together. I hope other states will have similar successful programs."

According to the reference committee's report, however, some speakers expressed concern that the CSPH report focused too much on the addicted physician. These speakers wanted other conditions to be recognized -- for example, disruptive physicians or physicians with mental health disorders -- as reasons to refer physicians to physician health programs. In the end, the House of Delegates voted to refer the matter for more study.