For example, let us consider a hypothetical tweet from a female doctor to her colleague describing a recent patient: ‘Just saw an 18-year-old unmarried G5P0, with Chlamydia, herpes, and gonorrhea. Disgusting!’ This tweet would have contravened a few of Wilkinsons (2009) so-called ‘behaviors inherent to good medical professionalism.’ This doctor should have had “respect for her patients’ diversity” and shouldn’t have been so judgmental (in this case, about the patients alleged sexual promiscuity and lifestyle). She also should have upheld patient confidentiality (as although the patient’s name wasn’t tweeted, the descriptors used about her obstetric and sexual histories would surely have made her easily identifiable amongst her friends and family who might have come across this tweet). The doctor should have, in my opinion, had better regard for professional boundaries and exercised greater judgment and discretion.

Defining unprofessionalism online and policing it has been challenging. However, with the increase in awareness of such occurrences, regulatory bodies have published various documents in an attempt to regulate physician’s activities on social media sites. The General Medical Council (GMC) has attempted to do exactly this with its paper. It warns against the blurring of boundaries between ones public and private lives and advices that privacy on these sites cannot be guaranteed. Furthermore, it stresses that physicians must be careful with regards to patient confidentiality, elaborating that although one piece of information may not breach confidentiality by itself, together, a few may certainly do so.

In summary, physicians must be cognizant of patient confidentiality and privacy and monitor their Internet presence to ensure that information posted is both accurate and appropriate. With regards to interaction with patients through social media, again, this interaction should fall within the boundaries of established professional norms. If a physician feels that such an interaction transgresses such norms, he/she should report the matter to the relevant authorities. Finally, it is imperative that physicians realize that inappropriate online interactions may have a negative impact on their reputations and that of their institutions, career advancements, and, perhaps most damning, may serve to undermine public trust in the medical profession as a whole.