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Social networking services: Implications for the next generation of physicians
Social networking services: Implications for the next generation of physicians Andrew L. Weinstein, BS, Pierre B. Saadeh, MD, FACS, and Stephen M. Warren, MD, FACS, New York, NY
From the Institute of Reconstructive Plastic Surgery, New York, NY
In 2010, the social networking service (SNS) Facebook surpassed Google as the most-visited site in the United States, according to the Internet analytics firm Experian Hitwise.1 The far-reaching success of SNSs is based on their ability to keep friends and family connected as well as to promote new connections between strangers with similar interests. Recently, however, it has become apparent that the modes through which SNSs accomplish these goals expose users to a plethora of privacy risks. For members of the medical community in particular, for whom the perception of professionalism is crucial to maintaining public trust, posting unprofessional material on SNSs compromises the boundaries that protect the physician–patient relationship and challenges the reputation of the medical profession. Current research indicates that medical professionals and preprofessionals commonly belong to SNSs with the highest rate of use among the youngest individuals. Mostaghimi et al2 characterized websites of 250 Massachusetts physicians with a median of 18 years since medical school graduation and determined that 10.8% had SNS profiles. The authors used Google to collect their data set, thus indicating that it is possible for anyone with an Internet connection to identify physicians on SNSs. Considering a younger population, Thompson et al3 showed that 13% of residents and 64% of medical students at the University of Florida, Gainesville had Facebook profiles. Taken together, these studies suggest that there might be a 6-fold
Accepted for publication May 17, 2011. Reprint requests: Stephen M. Warren, MD, FACS, Department of Plastic Surgery, New York University Medical Center, 560 First Avenue, New York, NY 10016. E-mail: stephen.warren.md@ gmail.com. Surgery 2011;150:15-6. 0039-6060/$ - see front matter Ó 2011 Mosby, Inc. All rights reserved. doi:10.1016/j.surg.2011.05.026
increase in the number of SNS users in the next generation of physicians. Not only are medical professionals and preprofessionals on Facebook, but also they post a vast amount of unprofessional content uncensored by privacy controls. Of the medical student and resident profiles examined by Thompson et al,3 70% contained photographs with alcohol of which 10% to 50% implied excessive drinking. Furthermore, 30% displayed inappropriate images of overt sexuality, foul language, and patient privacy violations. Although medical students on Facebook outnumbered residents nearly 5:1, both groups failed to enable their privacy controls 64.3% of the time. As a result, residents and medical students are at a comparably high risk of having their profiles viewed by unintended persons thereby jeopardizing individual credibility as well as that of his or her institution. Moreover, this preoccupation with posting information on Facebook may have adverse effects on patient care. Such was the case on April 9, 2010 when a stabbing victim arrived at the emergency room of a Long Beach, CA hospital. Instead of focusing on treatment, certain health care personnel snapped photos of the dying patient and posted them on Facebook. Although the patient expired soon after the photos were taken, it was unclear whether the death resulted from inattentive care. Nevertheless, 4 staff members were fired and 3 more were disciplined for their roles in the incident.4 As the number of people who rely on the Internet continues to grow, the issue of individual privacy for medical professionals becomes even more important. Recent surveys conducted by the Pew Research Center demonstrated that 75% of all Americans who reported ‘‘going online’’ in 2006 used the Internet as a source of health care information.2 Altogether, this means that patients with a simple Google search have access to the personal information of all medical students and SURGERY 15
16 Weinstein, Saadeh, and Warren
residents who fail to enable their privacy controls. Although it is unknown whether people have begun to use these resources to learn about the personal lives of physicians, the temptation is obvious: What parents would not want to learn more about the person who is going to perform open-heart surgery on their child? The temptation is even stronger when this personal information, which historically remained private, is as simple to obtain as any other online commodity. Although some argue that the sharing of personal information between physicians and patients has advantages, such as creating a climate of trust based on mutual disclosure, others believe that such information is best disclosed at the discretion of the doctor. Professional boundaries and a physician’s nonjudgmental tone ensure a certain distance is maintained between the patient and the physician and make the doctor’s office a safe place for both individuals. As Katherine Chretien, a physician and author of several articles on social media declared: ‘‘We need professional boundaries to do our job well.’’5 Extending this sentiment to the online arena, a similar type of boundary should be drawn by physicians on the Internet, both to protect individual privacy and to preserve the integrity of the physician–patient relationship. The challenges presented by SNSs are not limited to individual physicians but have the potential to affect the medical profession negatively. As a society, we tend to characterize groups based on the behavior of individuals rather than by the effort of the whole. In the case of physicians and medical students, instances of egregious or unethical behavior can thus tarnish the reputation of the medical community. Society expects physicians to embody altruism, integrity, and trustworthiness. When physicians---or students training to be physicians---fail to live up to these expectations, it
Surgery July 2011
becomes increasingly difficult for members of the medical profession to sustain the tacit contract with society at large that permits them to perform their service. Whether the behaviors that characterize a physician’s personal life are accurate indicators of the quality of care that a physician will provide his patients has yet to be determined. What is certain, however, is that the patient’s perception of the physician’s behavior remains a cornerstone of the physician–patient relationship as well as of the medical profession’s contract with society. Given as much, physicians must recognize that their patients see them, not merely as individuals with individual opinions and private lives, but rather as extensions of the medical profession, its traditions, culture, and ethics. As the next generation of physicians emerges, the growing number of medical professionals with SNS profiles combined with an increasingly internet-savvy public poses a serious threat to the integrity of the physician–patient relationship and the overall reputation of the medical profession. REFERENCES 1. Experian Hitwise. Available from: http://www.hitwise.com/ us/press-center/press-releases/facebook-was-the-top-searchterm-in-2010-for-sec/. Accessed January 2, 2011. 2. Mostaghimi A, Crotty BH, Landon BE. The availability and nature of information on the internet. J Gen Intern Med 2010;25:1152-6. 3. Thompson LA, Dawson K, Ferdig R, et al. The intersection of online social networking with medical professionalism. J Gen Intern Med 2008;23:954-7. 4. Hennessy-Fiske, M. When Facebook goes to the hospital, patients may suffer. Los Angeles Times, August 8, 2010. Available from: http://articles.latimes.com/2010/aug/08/local/ la-me-facebook-20100809. 5. Chretien, K. A doctor’s request: please don’t ‘‘friend’’ me. USA Today. 6 June 2010. Available from: http://www. usatoday.com/news/opinion/forum/2010-06-10-column10_ ST1_N.htm. Accessed August 30, 2010.
From the Institute of Reconstructive Plastic Surgery, New York, NY
In 2010, the social networking service (SNS) Facebook surpassed Google as the most-visited site in the United States, according to the Internet analytics firm Experian Hitwise.1 The far-reaching success of SNSs is based on their ability to keep friends and family connected as well as to promote new connections between strangers with similar interests. Recently, however, it has become apparent that the modes through which SNSs accomplish these goals expose users to a plethora of privacy risks. For members of the medical community in particular, for whom the perception of professionalism is crucial to maintaining public trust, posting unprofessional material on SNSs compromises the boundaries that protect the physician–patient relationship and challenges the reputation of the medical profession. Current research indicates that medical professionals and preprofessionals commonly belong to SNSs with the highest rate of use among the youngest individuals. Mostaghimi et al2 characterized websites of 250 Massachusetts physicians with a median of 18 years since medical school graduation and determined that 10.8% had SNS profiles. The authors used Google to collect their data set, thus indicating that it is possible for anyone with an Internet connection to identify physicians on SNSs. Considering a younger population, Thompson et al3 showed that 13% of residents and 64% of medical students at the University of Florida, Gainesville had Facebook profiles. Taken together, these studies suggest that there might be a 6-fold
Accepted for publication May 17, 2011. Reprint requests: Stephen M. Warren, MD, FACS, Department of Plastic Surgery, New York University Medical Center, 560 First Avenue, New York, NY 10016. E-mail: stephen.warren.md@ gmail.com. Surgery 2011;150:15-6. 0039-6060/$ - see front matter Ó 2011 Mosby, Inc. All rights reserved. doi:10.1016/j.surg.2011.05.026
increase in the number of SNS users in the next generation of physicians. Not only are medical professionals and preprofessionals on Facebook, but also they post a vast amount of unprofessional content uncensored by privacy controls. Of the medical student and resident profiles examined by Thompson et al,3 70% contained photographs with alcohol of which 10% to 50% implied excessive drinking. Furthermore, 30% displayed inappropriate images of overt sexuality, foul language, and patient privacy violations. Although medical students on Facebook outnumbered residents nearly 5:1, both groups failed to enable their privacy controls 64.3% of the time. As a result, residents and medical students are at a comparably high risk of having their profiles viewed by unintended persons thereby jeopardizing individual credibility as well as that of his or her institution. Moreover, this preoccupation with posting information on Facebook may have adverse effects on patient care. Such was the case on April 9, 2010 when a stabbing victim arrived at the emergency room of a Long Beach, CA hospital. Instead of focusing on treatment, certain health care personnel snapped photos of the dying patient and posted them on Facebook. Although the patient expired soon after the photos were taken, it was unclear whether the death resulted from inattentive care. Nevertheless, 4 staff members were fired and 3 more were disciplined for their roles in the incident.4 As the number of people who rely on the Internet continues to grow, the issue of individual privacy for medical professionals becomes even more important. Recent surveys conducted by the Pew Research Center demonstrated that 75% of all Americans who reported ‘‘going online’’ in 2006 used the Internet as a source of health care information.2 Altogether, this means that patients with a simple Google search have access to the personal information of all medical students and SURGERY 15
16 Weinstein, Saadeh, and Warren
residents who fail to enable their privacy controls. Although it is unknown whether people have begun to use these resources to learn about the personal lives of physicians, the temptation is obvious: What parents would not want to learn more about the person who is going to perform open-heart surgery on their child? The temptation is even stronger when this personal information, which historically remained private, is as simple to obtain as any other online commodity. Although some argue that the sharing of personal information between physicians and patients has advantages, such as creating a climate of trust based on mutual disclosure, others believe that such information is best disclosed at the discretion of the doctor. Professional boundaries and a physician’s nonjudgmental tone ensure a certain distance is maintained between the patient and the physician and make the doctor’s office a safe place for both individuals. As Katherine Chretien, a physician and author of several articles on social media declared: ‘‘We need professional boundaries to do our job well.’’5 Extending this sentiment to the online arena, a similar type of boundary should be drawn by physicians on the Internet, both to protect individual privacy and to preserve the integrity of the physician–patient relationship. The challenges presented by SNSs are not limited to individual physicians but have the potential to affect the medical profession negatively. As a society, we tend to characterize groups based on the behavior of individuals rather than by the effort of the whole. In the case of physicians and medical students, instances of egregious or unethical behavior can thus tarnish the reputation of the medical community. Society expects physicians to embody altruism, integrity, and trustworthiness. When physicians---or students training to be physicians---fail to live up to these expectations, it
Surgery July 2011
becomes increasingly difficult for members of the medical profession to sustain the tacit contract with society at large that permits them to perform their service. Whether the behaviors that characterize a physician’s personal life are accurate indicators of the quality of care that a physician will provide his patients has yet to be determined. What is certain, however, is that the patient’s perception of the physician’s behavior remains a cornerstone of the physician–patient relationship as well as of the medical profession’s contract with society. Given as much, physicians must recognize that their patients see them, not merely as individuals with individual opinions and private lives, but rather as extensions of the medical profession, its traditions, culture, and ethics. As the next generation of physicians emerges, the growing number of medical professionals with SNS profiles combined with an increasingly internet-savvy public poses a serious threat to the integrity of the physician–patient relationship and the overall reputation of the medical profession. REFERENCES 1. Experian Hitwise. Available from: http://www.hitwise.com/ us/press-center/press-releases/facebook-was-the-top-searchterm-in-2010-for-sec/. Accessed January 2, 2011. 2. Mostaghimi A, Crotty BH, Landon BE. The availability and nature of information on the internet. J Gen Intern Med 2010;25:1152-6. 3. Thompson LA, Dawson K, Ferdig R, et al. The intersection of online social networking with medical professionalism. J Gen Intern Med 2008;23:954-7. 4. Hennessy-Fiske, M. When Facebook goes to the hospital, patients may suffer. Los Angeles Times, August 8, 2010. Available from: http://articles.latimes.com/2010/aug/08/local/ la-me-facebook-20100809. 5. Chretien, K. A doctor’s request: please don’t ‘‘friend’’ me. USA Today. 6 June 2010. Available from: http://www. usatoday.com/news/opinion/forum/2010-06-10-column10_ ST1_N.htm. Accessed August 30, 2010.