According to new study published in JAMA, a majority of medical schools surveyed report that their students have posted unprofessional material online. The authors (Drs. Katherine C. Chretien, S. Ryan Greysen, Jean-Paul Chretien, and Terry Kind) write:
In the past year, 13 percent (6/47) of these had no incidents, 78 percent (36/47) had fewer than 5 incidents, 7 percent (3/47) had 5 to 15 incidents, and 2 percent (1/47) had some incidents but did not know how many. Incidents involving violation of patient confidentiality in the past year were reported by 13 percent (6/46). Student use of profanity, frankly discriminatory language, depiction of intoxication, and sexually suggestive material were more commonly reported. Issues of conflict of interest were rare.
According to the authors, most of the material fell into one of four categories:
Sexual-Relational Content. Ten open-ended text examples detailed sexually suggestive or explicit content or inappropriate relationships. Examples in this category included sexually provocative photographs of students, requesting inappropriate friendships with patients on Facebook, and sexually suggestive comments.
Affiliation With School. Nine open-ended text examples detailed negative comments pertaining to specific medical school experiences. Examples included using profanity or other disparaging language in reference to specific faculty, courses or rotations, classmates, or medical school. Some examples were reported as discriminatory in nature.
Intoxication or Substance Use. Seven open-ended text examples detailed content suggesting intoxication or illicit substance use. Examples involved photographs (illicit substance paraphernalia, depiction of intoxication, students holding alcoholic beverages), video, and comments.
Threats to Patient Confidentiality. Four open-ended text examples detailed references to patients in which patient privacy was at risk. The majority of examples involved blogs that described clinical experiences with enough detail that patients could potentially be identified. One example was related to posting patient details on Facebook.
The authors recommend that the professionalism curriculum include a “digital media component,” as “may not be aware of how online posting can reflect negatively on medical professionalism or jeopardize their careers.”
Agreed. But isn’t the problem bigger than that? What would compel a medical student to post confidential information about a patient? Career or professionalism aside, why so little respect for privacy?
This may be an overlap of several conditions: the sheer volume of personal and suggestive material online (“everybody does it”), the market for confession and sensationalism beyond the Internet (talk shows provide a good clue to this), and the social habits of young adults who, especially in school, tend to mix with others their own age.
The vast majority of medical students probably don’t post inappropriate material online–and some of the material may be only borderline inappropriate. But the problem extends beyond isolated incidents, beyond ignorance or indiscretion. It takes a certain muscle to keep things to oneself, and maybe we have forgotten to exercise it.