Article Review: Facebook, Professionalism, and Physicians

Facebook is worldwide.

The medical educator's dilemma about Facebook and professionalism seems universal. How do we teach medical students the importance of the digital footprints on publicly viewable websites? A landmark article, published by Dr. Chretein in JAMA in 2009, surveyed U.S. medical school deans on unprofessional behavior on Facebook. She found that 60% of medical schools documented incidences of unprofessional online postings.

In contrast, Medical Education just published a cross-sectional study whereby individual Facebook accounts were searched for publicly available content (rather than depend on recall by medical school deans). This study was conducted at the University of Otago in Wellington, New Zealand. The authors assessed recent medical school graduates and their use of Facebook (338 graduates from 2006 and 2007). They particularly focused on the following 3 pages:
  • Info (personal information)
  • Wall (comments to and by user)
  • Photos
Outcome measures included:
  • Facebook membership
  • Exercising the privacy option
  • Nature of publicly available content
220 of 338 graduates (65%) had a Facebook account.
  • 138 of 220 (63%) restricted their information to just Friends.
  • 82 of 220 (37%) allowed their account to be publicly viewed.
    • 38 (46%) showed photos of user drinking alcohol
    • 35 (43%) revealed relationship status
    • 30 (37%) revealed sexual orientation
    • 13 (16%) revealed religious views
    • 8 (10%) showed images of user intoxication
My comments about the study
Two things have changed since 2006-07 with Facebook.
  1. Facebook's active user base has increased from 100 million (2008) to 400 million (2010) users.
  2. Dr. Chretein's 2009 publication in JAMA has generated much publicity about Facebook, transparency, and professionalism in Medicine. Medical students and regulators may have changed their social media practices since then.
A followup study should be done to see if these findings are still true and whether more than 65% of medical students have a Facebook account.

But what IS professionalism in this Web 2.0 age that we live in?
Many experts state that the overarching principle of professionalism in Medicine is to "sustain the public's trust in the medical profession."

With it being so easy to sign up and share information on various social media platforms, how do physicians divide their personal and professional lives? How do you balance the right to free speech with the potential effect of making you and the medical profession look unprofessional The strengths of social media (transparency, immediacy, connectivity) are offset by potential pitfalls for medical practitioners.

One approach is to avoid posting any personal content on publicly viewable sites. Another is to tell your patients that, as a policy, you do not "friend" patients. Check out this great commentary in USA Today.

There is no perfect answer. Here's my personal approach-- Before publishing anything on social media platforms (Facebook, Twitter, this blog), I use this litmus test: "Is this something that I would be embarrassed to share with my idol, my patient, my boss, my future boss, and my grandparents?"

How do you define professionalism on social media?

Macdonald J, Sohn S, & Ellis P (2010). Privacy, professionalism and Facebook: a dilemma for young doctors. Medical education, 44 (8), 805-13 PMID: 20633220

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