ACP指南建议医生勿将患者加为网络好友

《内科学年鉴》4月11日在线发表的美国内科医师协会(ACP)和州医学委员会联盟(FSMB)指南提醒医生，最好不要在脸书(Facebook)等社交网站上添加患者为好友。

Humayun J. Chaudhry博士

另外，指南也建议医生：

·不要使用短信进行医学互动，即使是与熟识的患者也不要这么做，除非非常慎重且患者同意。

·仅在与患者确定关系的情况下才能使用电子邮件，并且需要经过患者同意。

·建立专业在线档案，让其在网页搜索时能够排在页面上部，位于任何医生评级网站之上。

·不鼓励与非患者个体进行电子邮件或在线交流，但可建议其预约或到适当的医生那里就诊。

·管理数字图像，包括不要在推特(Twitter)、博客上发帖谈论可能无正面意义的个人社交活动，或针对网上的文章发表无充分依据的评论。

David Fleming博士

编写组专家表示，网络和短信沟通存在诸多弊端，如保密性可能不佳，医患关系也可能被破坏，而且沟通可能会脱离原本范围。另外，可能导致相关的纪律处分案例增加。最近的州医学委员会研究显示，这些委员会曾处理至少1例导致处分(包括吊销执照)的非专业网络行为(Ann. Intern. Med. 2013;158:124-30)。通过电子邮件进行沟通不太安全，而且所传输的信息可能被挖掘出来用于法律目的。

不过，对于正处于危险情况的患者发来的电子邮件，一旦医生以任何方式回应，则表明与患者建立了关系，此时应本着受托人的责任，不仅需要首先知道自身的限制，而且也要了解患者需要接受干预的程度。如果需要干预，则医生有义务帮助患者。社交媒体是倡导患者进行疫苗接种、运动或留意体重的良好方式，但在推特或脸书上发帖仍存在风险。医生在表达个人观点或代表专业组织时需要考虑清楚。编写组专家表示，ACP和FSMB未主张对医生的网络言论进行审查，但建议他们在点击发送前多加考虑。

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By: ALICIA AULT, Cardiology News Digital Network

SAN FRANCISCO – Tempted to "friend" a patient on your personal Facebook page? That’s probably not a good idea, according to new guidelines issued by the American College of Physicians and the Federation of State Medical Boards.

The ACP and federation guidelines outline many benefits from use of e-mail and social media, including improving access to care, but "the boundaries between professional and social spheres can blur online," said Dr. Humayun J. Chaudhry, president and chief executive officer of the Federation of State Medical Boards (FSMB) and an author of the guidelines. "Physicians should keep the spheres separate and comport themselves professionally online."
 
Opportunities for misadventure abound with online communications and texting, Dr. Chaudhry said at the annual meeting of the American College of Physicians. Confidentiality can be breached, as can the patient-physician relationship; the communications can be taken out of context or be spread widely beyond the original conversation.

And disciplinary actions are likely to increase. In a recent study of state medical boards, 92% reported that they had dealt with at least one case of unprofessional online behavior that led to punishment, including license revocation (Ann. Intern. Med. 2013;158:124-30).

The ACP and FSMB guidelines, published online Apr. 11 in the Annals of Internal Medicine, are meant "to serve as a wake-up call to physicians, to make them aware of some of the dangers that are out there," he said. Aside from not "friending" patients, the guidelines also recommend the following to physicians:

· Don’t use text messaging for medical interactions, even with established patients, except with caution and the patient’s consent.

· Only use e-mail within the context of an established relationship with a patient, and with that patient’s consent.

· Establish a professional online profile so that it appears at the top of a web-based search, above any physician rating site.

· Discourage e-mail or on-line communications with individuals who are not patients, instead referring them to make an appointment or visit an appropriate health provider.

· Manage their digital image, including refraining from posting about personal social activities that might not reflect positively or providing less-than-measured comments on Twitter, blogs, or in response to online articles.

E-mail presents several dangers, said Dr. David A. Fleming, a member of the ACP Board of Regents and chairman of the ACP Ethics, Professionalism, and Human Rights Committee. The new guidelines urge e-mail communications only with established patients who have a relationship with the physician and understand that the communication might not be secure, he said, adding that information sent via e-mail also can be discoverable for legal purposes.
 
An e-mail from a patient in a crisis situation presents a different present challenge. "As soon as we respond in any way, then the relationship forms and we have a fiduciary responsibility to, first of all, know our limits, but also the extent to which an intervention is needed," Dr. Fleming said. If the crisis warrants intervention, then the physician is obligated to help the patient.

Social media can be a great way to encourage patients to get vaccinated or exercise or watch their weight, but postings on Twitter or Facebook can still be fraught with peril, Dr. Fleming and Dr. Chaudhry said. Physicians need to be clear when they are expressing their personal opinion or representing a professional organization, for instance.

Both physicians said that the ACP and the FSMB are not advocating censorship.

"We’re not telling people what to say, what not to say, we’re just asking them to think before you press send," said Dr. Chaudhry.