E-Professionalism: Challenges in the Age of Information

Abstract

averse industry in the United States,’’ according to Christensen. The age of information clearly has affected the culture of medicine in ways that we are just beginning to understand. Never before have there been so many ways to communicate. In the past, we were limited to face-to-face conversations, postal mail, telegrams, and telephone calls. Physicians communicated about their credentials through listings in the telephone book and in local medical society publications, or by hanging a shingle outside the office. With the development and diffusion of new technologies, our means of communicating about ourselves, as well as with colleagues, patients, families, and learners grew enormously. At the same time, the types of new technologies expanded; e-mail, video conferences, webinars, text messaging, text pagers, websites, blogs, and social networking sites all entered our culture within the past 20 years. The use of these technologies is pervasive and increasing. Professionalism, as one of the core competencies established by the Accreditation Council of Graduate Medical Education (ACGME), has been the subject of much discussion in the last several years. The American Board of Internal Medicine developed a charter for medical professionalism in the new millennium that articulated fundamental principles and a set of professional responsibilities. 2 The American Board of Pediatrics, in conjunction with the Association of Pediatric Program Directors, developed a guidebook for teaching and assessing professionalism in pediatric residency that set forth specific examples of exemplary behavior, lapses in professionalism, and behaviors that warrant immediate attention. 3 Although much has been written and discussed about this subject recently, it is notable that the subject of professionalism in electronic communication, e-Professionalism, has not been addressed. Examples of lapses in professionalism in the electronic realm are just beginning to be appreciated. Personal cellular phones may be used for professional communication, which challenges the boundaries of patient confidentiality and may lead to blurred hierarchical roles between faculty and learners in education and clinical care. Physicians posting on online social networking sites must be reminded that their professionalism may be judged by such content. For example, photographs, social group affiliations, and personal information that are not generally shared in the doctor-patient relationship may be inadvertently revealed to patients via postings on social networking sites. In 2008, Thompson et al 4 at the University of Florida studied Facebook pages of medical students and residents and found that 46.3% of medical students and 12.8% of residents had accounts. A majority of the accounts were not private and, in some cases, there was inappropriate or unprofessional content posted. At a recent meeting of pediatric program directors, Matz et al 5 facilitated a workshop on e-Professionalism and began to illuminate this developing issue. At this workshop, the 3 that characterize electronic professionalism were coined: electronic communication is Public, Permanent, and Powerful.