Recently the American Medical Association (AMA) released its policy on Professionalism in the Use of Social Media. Below quotes the “considerations” the AMA policy encourages physicians to weigh when maintaining a presence online.

(a) Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online.

(b) When using the Internet for social networking, physicians should use privacy settings to safeguard personal information and content to the extent possible, but should realize that privacy settings are not absolute and that once on the Internet, content is likely there permanently. Thus, physicians should routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate.

(c) If they interact with patients on the Internet, physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context.

(d) To maintain appropriate professional boundaries physicians should consider separating personal and professional content online.

(e) When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.

(f) Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students), and can undermine public trust in the medical profession.

While this is the AMA’s attempt to “[help] physicians to maintain a positive online presence and preserve the integrity of the patient-physician relationship,” the policy falls short of offering physicians any real guidance. Instead, the policy provides physicians with common sense “considerations” that are generic and overly broad. In his article, AMA Guidelines for Physicians in Social Media, Dr. Bertalan Meskó exposes what is lacking in the new AMA policy: “Clear recommendations about how to use Facebook privacy settings properly with videos or screenshots; what to do when a patient sends us a friendship request on Facebook or when a patient writes about an adverse drug event on our blogs. Case studies, clear examples, tutorials, presentations.” Guidance from the AMA regarding social media was already overdue, and it seems physicians will still have to wait for any practical assistance.

Although most of the AMA’s “considerations” are elementary, one consideration is unusual. Colin J. Zick, author of AMA Adopts Policy on “Professionalism in the Use of Social Media” calls (e) the “snitch rule.” According to (e) physicians have a duty to report unprofessional content. First the physician must report to the poster to give her an opportunity to take “appropriate action.” If “appropriate action” is not taken the physician must then report the user to the appropriate authorities. However, the AMA policy does not define unprofessional content or appropriate action, thereby leaving physicians with very little guidance as to the duty it created. In response to (e) GruntDoc, author of New AMA Policy Helps Guide Physicians’ Use of Social Media, writes, “Plenty of thoughtful people disagree with things I’ve written (and a few unthoughtful folks disagree with everything), but I’m not a fan of giving AMA blessing to harass.”

Now that using social networks and blogs to communicate has become commonplace, physicians have to learn how to deal with long-standing challenges on this new forum. Moreover, physicians must learn how to use social networking to better serve patients. Hopefully, the AMA will provide more useful guidance in the near future. Until then, physicians must navigate the Wild Web on their own.