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Academia and the Profession |

Online Professionalism Investigations by State Medical Boards: First, Do No Harm

S. Ryan Greysen, MD, MHS, MA; David Johnson, MA; Terry Kind, MD, MPH; Katherine C. Chretien, MD; Cary P. Gross, MD, MPH; Aaron Young, PhD; and Humayun J. Chaudhry, DO, MS, SM
[+] Article and Author Information

From the University of California, San Francisco, School of Medicine, San Francisco, California; Federation of State Medical Boards, Euless, Texas; Children's National Medical Center, George Washington University School of Medicine, and Washington DC Veterans Affairs Medical Center, Washington, DC; Yale University School of Medicine, New Haven, Connecticut; and University of Texas Southwestern Medical School, Dallas, Texas.

Disclaimer: Dr. Greysen had full access to all of the data in the study and takes responsibility for their integrity and the accuracy of the data analysis.

Acknowledgment: The authors thank the Robert Wood Johnson Foundation Clinical Scholars program and the Department of Veterans Affairs for support of this research. They also thank the key informants at state medical boards and the FSMB for their valuable insight into the structure and function of state medical and osteopathic boards.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1641.

Requests for Single Reprints: S. Ryan Greysen, MD, MHS, MA, Division of Hospital Medicine, University of California, San Francisco, 533 Parnassus Avenue, Box 0131, San Francisco, CA 94113; e-mail, Ryan.Greysen@ucsf.edu.

Current Author Addresses: Dr. Greysen: Division of Hospital Medicine, University of California, San Francisco, 533 Parnassus Avenue, Box 0131, San Francisco, CA 94113.

Mr. Johnson and Drs. Young and Chaudhry: Federation of State Medical Boards, 400 Fuller Wiser Road, Suite 300, Euless, TX 76039.

Dr. Kind: Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010.

Dr. Chretien: 11220 Upton Drive, Kensington, MD 20895.

Dr. Gross: Yale University School of Medicine, 333 Cedar Street, Box 208093, New Haven, CT 06520-8093.

Author Contributions: Conception and design: S.R. Greysen, D. Johnson, T. Kind, K.C. Chretien, C.P. Gross, A. Young, H.J. Chaudhry.

Analysis and interpretation of the data: S.R. Greysen, D. Johnson, T. Kind.

Drafting of the article: S.R. Greysen, K.C. Chretien.

Critical revision of the article for important intellectual content: S.R. Greysen, D. Johnson, T. Kind, K.C. Chretien, C.P. Gross, A. Young, H.J. Chaudhry.

Final approval of the article: S.R. Greysen, D. Johnson, T. Kind, K.C. Chretien, C.P. Gross, A. Young, H.J. Chaudhry.

Administrative, technical, or logistic support: C.P. Gross, A. Young, H.J. Chaudhry.

Collection and assembly of data: S.R. Greysen, A. Young, H.J. Chaudhry.


Ann Intern Med. 2013;158(2):124-130. doi:10.7326/0003-4819-158-2-201301150-00008
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Despite recent guidelines promoting online professionalism, consequences for specific violations by physicians have not been explored. In this article, the authors gauged consensus among state medical boards in the United States (response rate, 71%) about the likelihood of investigations for violations of online professionalism by using 10 hypothetical vignettes. High consensus was defined as more than 75% of respondents indicating that investigation was “likely” or “very likely,” moderate consensus as 50% to 75% indicating this, and low consensus as fewer than 50% indicating this.

Four online vignettes demonstrated high consensus: Citing misleading information about clinical outcomes (81%; 39/48), using patient images without consent (79%; 38/48), misrepresenting credentials (77%; 37/48), and inappropriately contacting patients (77%; 37/48). Three demonstrated moderate consensus for investigation: depicting alcohol intoxication (73%; 35/48), violating patient confidentiality (65%; 31/48), and using discriminatory speech (60%; 29/48). Three demonstrated low consensus: using derogatory speech toward patients (46%; 22/48), showing alcohol use without intoxication (40%; 19/48), and providing clinical narratives without violation of confidentiality (16%; 7/48).

Areas of high consensus suggest “online behaviors” that physicians should never engage in, whereas moderate- and low-consensus areas provide useful contextual information about “gray areas.” Increased awareness of these specific behaviors may reduce investigations and improve online professionalism for physicians.

Figures

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Figure 1.

Vignettes with high consensus for investigation.

More than 75% of respondents indicated that investigation was “likely” or “very likely.” Photograph on the left ©iStockphoto.com/ryangreysen; photograph on the right courtesy of Dr. Greysen.

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Figure 2.

Vignettes with moderate consensus for investigation.

50% to 75% of respondents indicated that investigation was “likely” or “very likely.” Photograph courtesy of Dr. Greysen.

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Figure 3.

Vignettes with low consensus for investigation.

Fewer than 50% of respondents indicated that investigation was “likely” or “very likely.” Photograph courtesy of Dr. Greysen.

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