Experts say current social media guidelines are misframing issue of physician professionalism

From the small-town doctor to the Freud—Ferenczi debate over sharing personal anecdotes, controversy over physicians' professional identity is nothing new. The question of physician conduct on social media is simply a new context for an old debate, but ethics and psychiatry experts at Johns Hopkins say current guidelines are misframing the issue of physician professionalism online, missing the opportunity to shed new light on the evergreen issue of physicians' role in society.

In a JAMA Viewpoint opinion published August 14, the experts say that current guidelines, including the recently released by American College of Physicians and Federation of State Medical Boards, are asking the wrong question about medical professionalism online; it's not a question of whether content is professional or personal, but whether it is appropriate of a physician in public.

"Resolving the online identity crisis requires recognizing that social media exist in primarily public or potentially public spaces, not exclusively professional or exclusively personal ones," write authors Matthew DeCamp, MD, PhD, Thomas Koenig, MD, and Margaret Chisolm, MD.

The authors assert that it is "operationally impossible" and therefore "nonsensical" to separate personal and professional identities, as many guidelines suggest. They will underscore their point by participating in a live Twitter chat scheduled for 2:00 PM on Friday, August 16, with the hashtag #IDcrisis, hosted by the Johns Hopkins Berman Institute of Bioethics (@bermaninstitute).

"Professional identity is a component of personal identity, much as a person can identify both as a colleague and parent in different contexts," says Chisolm, a professor in the department of Psychiatry and Behavioral Sciences.

"The internet is a reimagined small-town square for the digital age, where a comment made casually to a friend can suddenly spread like wildfire," says DeCamp, a practicing general internist at Hopkins and faculty member at the Berman Institute. "Social media presents an opportunity for physicians to connect with their community, and they can maintain an appropriate professional identity while doing so by keeping in mind they are speaking in a public forum. So rather than something completely novel, social media is simply a new forum for professional conduct in public, which physicians negotiate all the time," DeCamp says.

The authors warn that attempts to adhere to existing guidelines and "depersonalize" their identity online may backfire, reducing trust of physicians who are attempting to hide something, and increasing patient stress in response to a physician perceived to be impersonal and unsympathetic.