HONOLULU – A survey of 178 older, mostly academic psychiatrists found that more than 6% text with patients, 20% post private information online, and 6% conduct an online search for patients.
Of those who post personal information on such social sites as Facebook, one-third do not restrict access; some are unaware of privacy settings that allow such restrictions.
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About a third reported exchanging e-mails with patients as well, but only 7% get written permission first. "We found that half get verbal permission, but some never request permission [at all]. Only a small percent [have patients] sign a release form," although that’s been recommended, said senior investigator Dr. Megan Testa, a fourth-year psychiatry resident at the University Hospitals Health System in Cleveland, referring to guidelines released a few years ago by the American Medical Informatics Association Internet Working Group (J. Am. Med. Inform. Assoc. 1998;5:104-11).
The inconsistencies show that "we need a set of [electronic communication] guidelines" specific to psychiatrists, she said.
These guidelines are needed because social media can quickly blur boundaries between psychiatrists and patients, perhaps more so than with physicians in other specialties, given the interpersonal nature of the profession. "Legal issues, privacy issues, and treatment frame" issues are of particular concern, said Dr. Testa, a 2010 Group for the Advancement of Psychiatry fellow.
The 178 psychiatrists surveyed by Dr. Testa and her colleagues, also 2010 fellows, were all members of the psychiatry group. Their mean age was almost 60 years; 56% were academics, 41% in private practice, and the rest worked in other settings.
The 6% who admitted to looking up their patients online did so for a variety of reasons. Some needed to find contacts for patients who go to the emergency department and are unable to give reliable information. Others wanted to flesh out patient histories. "Sometimes," though, doctors "are curious if patients are lying," Dr. Testa said.
With doctors leaving bigger online footprints, "there is real concern [that] searches go both ways," she noted.
E-communications guidelines do exist for doctors. One set is for looking patients up online, and addresses getting consent, charting results, and sharing results with patients (Harv. Rev. Psychiatry 2010;18:103-12).
A set of social media guidelines discourages "friending" patients and freely posting personal information on sites like Facebook (J. Med. Ethics 2009;35:584-6).
Until psychiatrists come up with their own guidelines, Dr. Testa and her colleagues suggest, psychiatrists must "carefully monitor their online presences from medical school through residency and beyond to maintain a clear boundary between professional and personal identities."