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      Virtual colleagues, virtually colleagues—physicians’ use of Twitter: a population-based observational study

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          Abstract

          Objective

          To investigate potential violations of patient confidentiality or other breaches of medical ethics committed by physicians and medical students active on the social networking site Twitter.

          Design

          Population-based cross-sectional observational study.

          Setting

          The social networking site Twitter (Swedish-speaking users, n=298819).

          Population

          Physicians and medical students (Swedish-speaking users, n=237) active on the social networking site Twitter between July 2007 and March 2012.

          Main outcome measure

          Postings that reflect unprofessional behaviour and ethical breaches among physicians and medical students.

          Results

          In all, 237 Twitter accounts were established as held by physicians and medical students and a total of 13 780 tweets were analysed by content. In all, 276 (1.9%) tweets were labelled as ‘unprofessional’. Among these, 26 (0.2%) tweets written by 15 (6.3%) physicians and medical students included information that could violate patient privacy. No information on the personal ID number or names was disclosed, but parts of the patient documentation or otherwise specific indicatory information on patients were found. Unprofessional tweets were more common among users writing under a pseudonym and among medical students.

          Conclusions

          In this study of physicians and medical students on Twitter, we observed potential violations of patient privacy and other breaches of medical ethics. Our findings underline that every physician and medical student has to consider his or her presence on social networking sites. It remains to be investigated if the introduction of social networking site guidelines for medical professionals will improve awareness.

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          Most cited references10

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          Online posting of unprofessional content by medical students.

          Web 2.0 applications, such as social networking sites, are creating new challenges for medical professionalism. The scope of this problem in undergraduate medical education is not well-defined. To assess the experience of US medical schools with online posting of unprofessional content by students and existing medical school policies to address online posting. An anonymous electronic survey was sent to deans of student affairs, their representatives, or counterparts from each institution in the Association of American Medical Colleges. Data were collected in March and April 2009. Percentage of schools reporting incidents of students posting unprofessional content online, type of professionalism infraction, disciplinary actions taken, existence of institution policies, and plans for policy development. Sixty percent of US medical schools responded (78/130). Of these schools, 60% (47/78) reported incidents of students posting unprofessional online content. Violations of patient confidentiality were reported by 13% (6/46). Student use of profanity (52%; 22/42), frankly discriminatory language (48%; 19/40), depiction of intoxication (39%; 17/44), and sexually suggestive material (38%; 16/42) were commonly reported. Of 45 schools that reported an incident and responded to the question about disciplinary actions, 30 gave informal warning (67%) and 3 reported student dismissal (7%). Policies that cover student-posted online content were reported by 38% (28/73) of deans. Of schools without such policies, 11% (5/46) were actively developing new policies to cover online content. Deans reporting incidents were significantly more likely to report having such a policy (51% vs 18%; P = .006), believing these issues could be effectively addressed (91% vs 63%; P = .003), and having higher levels of concern (P = .02). Many responding schools had incidents of unprofessional student online postings, but they may not have adequate policy in place.
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            Is Open Access

            Reviewing social media use by clinicians

            Adoption studies of social media use by clinicians were systematically reviewed, up to July 26th, 2011, to determine the extent of adoption and highlight trends in institutional responses. This search led to 370 articles, of which 50 were selected for review, including 15 adoption surveys. The definition of social media is evolving rapidly; the authors define it broadly to include social networks and group-curated reference sites such as Wikipedia. Facebook accounts are very common among health science students (64–96%) and less so for professional clinicians (13–47%). Adoption rates have increased sharply in the past 4 years. Wikipedia is widely used as a reference tool. Attempts at incorporating social media into clinical training have met with mixed success. Posting of unprofessional content and breaches of patient confidentiality, especially by students, are not uncommon and have prompted calls for social media guidelines.
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              Good lamps are the best police: darkness increases dishonesty and self-interested behavior.

              Darkness can conceal identity and encourage moral transgressions; it may also induce a psychological feeling of illusory anonymity that disinhibits dishonest and self-interested behavior regardless of actual anonymity. Three experiments provided empirical evidence supporting this prediction. In Experiment 1, participants in a room with slightly dimmed lighting cheated more and thus earned more undeserved money than those in a well-lit room. In Experiment 2, participants wearing sunglasses behaved more selfishly than those wearing clear glasses. Finally, in Experiment 3, an illusory sense of anonymity mediated the relationship between darkness and self-interested behaviors. Across all three experiments, darkness had no bearing on actual anonymity, yet it still increased morally questionable behaviors. We suggest that the experience of darkness, even when subtle, may induce a sense of anonymity that is not proportionate to actual anonymity in a given situation.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2013
                23 July 2013
                : 3
                : 7
                : e002988
                Affiliations
                [1 ]Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet , Stockholm, Sweden
                [2 ]Department of Journalism, School of Social Sciences, Södertörn University , Huddinge, Sweden
                [3 ]Stockholm Center for Healthcare Ethics, LIME, Karolinska Institutet , Stockholm, Sweden
                Author notes
                [Correspondence to ] Dr Anne Brynolf; anne.brynolf@ 123456gmail.com
                Article
                bmjopen-2013-002988
                10.1136/bmjopen-2013-002988
                3731708
                23883885
                9141a657-da4e-4eab-a32d-6c4ab38a365f
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

                History
                : 2 April 2013
                : 13 June 2013
                : 14 June 2013
                Categories
                Ethics
                Research
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                Medicine
                medical education & training,epidemiology,medical ethics,statistics & research methods,health informatics < biotechnology & bioinformatics

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