As physicians and other health care professionals expand their presence on
the Internet, consideration of the following points may be helpful. This is
not meant to be an exclusive or exhaustive list of factors to consider.
Patient information must be kept confidential. There is more to
de-identifying information than deleting a name. A study published in the
October 2008 Journal of General Internal Medicine reviewed 271
medical blogs and found that 45 provided sufficient information for patients
to identify their doctors or themselves.
Consequences for breaches of confidentiality could include, but are not
limited to, one or more of the following: discipline by your licensing board,
a civil lawsuit, and governmental enforcement action (such as by the Office
for Civil Rights, the federal agency responsible for enforcing HIPAA's Privacy
Do not comment about cases, lawsuits, or administrative actions in which
you are involved. Doing so can compromise your defense and make an otherwise
winnable case indefensible.
Be aware of APA's Opinions of the Ethics Committee on the Principles of
Medical Ethics, Section Q.4.a, which discusses publication of a casebook
and disguising of identity. Although the opinion notes that obtaining the
patient's informed consent for publication of the case is one option, the
nature of the psychiatrist-patient relationship may place undue pressure on
the patient to agree to the psychiatrist's request.
Avoid inadvertently creating a treatment relationship with your Internet
readers. Keep in mind that it is the perception of the reader that matters,
not the intention of the physician. Make it clear that no treatment
relationship with the reader exists, do not post anything that could be
perceived to be treatment advice, and clarify that nothing on the site is
intended to be medical advice.
Publishing general educational information about a disease or treatment
usually is not viewed legally as being "medical advice." However,
making suggestions to a person about what his or her diagnosis is or treatment
should be is almost always considered "medical advice" and may
establish a treatment relationship.
Be aware that you are responsible for all content that you publish and, if
you have your own blog, everything that appears on it. Carefully consider the
permissions you will give to others with regard to posting content or
comments. Ideally, no one but you should be able to publish posts or write
comments that appear on your blog.
If others are allowed to write on your blog, be sure that you can and will
review all writings before they appear and that they are not misleading or in
violation of your ethical or legal obligations. Remember that since you are
responsible for all content, all content is held to your standards. For
example, even nonphysician contributors should not be allowed to publish
patient information on your blog.
Remember that even if no one else can write on your blog, it is still a
public forum, and you are responsible for the content. If your intent is to
present a fictional story, that should be clear to the readers. AMA Ethics
Opinion 5.027 states, "Physicians responsible for the health-related
content of an online site should ensure that the information is accurate,
timely, reliable, and scientifically sound, and includes appropriate
AMA Ethics Opinion 5.027 also discusses conflicts of interest. Generally,
any potential conflicts should be disclosed. Refer to the opinion for more
Do not assume that you are anonymous, even if you have taken steps to
disguise your identity. Because blogs are accessible to such a large
population, the ways in which your identity may be discovered increase
exponentially, and the amount of detail required for someone to identify you
Bottom line: assume that everything you write will be seen by your patients
and by the opposing side in any claim, lawsuit, or administrative action.
Participants in the Psychiatrists' Program, the APA-endorsed Psychiatrists'
Professional Liability Insurance Program, managed by PRMS Inc., may access
additional valuable resources such as detailed articles and tips on topics of
interest and phone consultations through the Risk Management Consultation
Helpline at (800) 527-9181 from 8:30 a.m. to 5:30 p.m. Eastern time.
This column is provided by PRMS, manager of the Psychiatrists'
Program, for the benefit of members. More information about the Program is
available by visiting its Web site at<www.psychprogram.com>;
calling (800) 245-3333, ext. 389; or sending an e-mail to