A study of physicians using Twitter found that 3% of Tweets were unprofessional and 0.7% violated patient privacy. 0.6% contained profanities, 0.3% included sexually explicit material, and 0.1% included discriminatory statements. In 2011 an emergency department physician posted information online about a trauma patient. The posting did not include any patient identifiable information; however enough detail was included that others in the community could identify the patient.

The physician was fired from the hospital and reprimanded by the state medical board.

State medical boards have the authority to discipline physicians for unprofessional behavior relating to inappropriate use of social networking media, such as:

• Inappropriate communication with patients online.
• Use of the Internet for unprofessional behavior.
• Online misrepresentation of credentials.
• Online violations of patient confidentiality.
• Online derogatory remarks regarding a patient.
• Online depiction of intoxication.

Actions can range from a letter of reprimand to revocation of a license. Improper use of social media may violate state and federal laws established to protect privacy and confidentiality, which could include both civil and criminal penalties, including fines and possible jail time. The physician could be sued for defamation, invasion of privacy, or harassment.

Information created or shared via social media could be subject to e-discovery in the course of litigation.

The American Medical Association and Federation of State Medical Boards have developed guidelines for the appropriate use of social networking in medical practice. By following these guidelines, physicians may limit their risk exposure. Some of the recommendations include the following:

• Interaction with current or past patients on personal social networking sites is discouraged.
• When using sites for discussion of medicine online, it is the responsibility of the physician to ensure to the best of their ability, that the professional site for physicians is secure and that only verified and registered users have access to the information. The website should be password protected so that non-physicians do not gain access and view discussions.
• Patient privacy and confidentiality must be protected at all times. Be aware that information you post on a social networking site may be distributed (whether intended or not) to a larger audience, and could be misconstrued. What you say may be taken out of context and remain publicly available forever online. A blog leaves a permanent imprint on the Internet because most blogs are searchable by date, name, or keywords, and an entry from long ago can be quickly accessed.
• You are representing the medical community, so always act professionally. Adhere to the same principles of professionalism online as offline.
• Use separate personal and professional social networking sites.