University of California, San Francisco, School of Medicine, USA.
Ann Intern Med. 2013 Jan 15;158(2):124-30. doi: 10.7326/0003-4819-158-2-201301150-00008.
Despite recent guidelines promoting online professionalism, consequences for specific violations by physicians have not been explored. In this article, the authors gauged consensus among state medical boards in the United States (response rate, 71%) about the likelihood of investigations for violations of online professionalism by using 10 hypothetical vignettes. High consensus was defined as more than 75% of respondents indicating that investigation was "likely" or "very likely," moderate consensus as 50% to 75% indicating this, and low consensus as fewer than 50% indicating this. Four online vignettes demonstrated high consensus: Citing misleading information about clinical outcomes (81%; 39/48), using patient images without consent (79%; 38/48), misrepresenting credentials (77%; 37/48), and inappropriately contacting patients (77%; 37/48). Three demonstrated moderate consensus for investigation: depicting alcohol intoxication (73%; 35/48), violating patient confidentiality (65%; 31/48), and using discriminatory speech (60%; 29/48). Three demonstrated low consensus: using derogatory speech toward patients (46%; 22/48), showing alcohol use without intoxication (40%; 19/48), and providing clinical narratives without violation of confidentiality (16%; 7/48). Areas of high consensus suggest "online behaviors" that physicians should never engage in, whereas moderate- and low-consensus areas provide useful contextual information about "gray areas." Increased awareness of these specific behaviors may reduce investigations and improve online professionalism for physicians.
尽管最近有指导方针提倡在线专业精神，但尚未探讨医生具体违规行为的后果。在本文中，作者通过使用 10 个假设情景来衡量美国各州医学委员会对医生违反在线专业精神进行调查的可能性的共识（回复率为 71%）。高共识定义为超过 75%的受访者表示调查“很可能”或“极有可能”，中度共识为 50%至 75%表示如此，低共识为不到 50%表示如此。四个在线情景表现出高度共识：引用有关临床结果的误导性信息（81%；48/48），未经同意使用患者图像（79%；48/48），伪造证书（77%；48/48）和不恰当地联系患者（77%；48/48）。有三个情景表现出中度共识，需要进行调查：描绘酒精中毒（73%；48/48），侵犯患者隐私（65%；48/48）和使用歧视性言论（60%；48/48）。有三个情景表现出低度共识：对患者使用贬损性语言（46%；48/48），显示无醉酒的酒精使用（40%；48/48），以及提供未违反保密性的临床叙述（16%；48/48）。高度共识的领域表明医生永远不应从事的“在线行为”，而中度和低度共识的领域提供了有关“灰色地带”的有用背景信息。提高对这些特定行为的认识可能会减少调查，并提高医生的在线专业精神。
