JMIR Publications

ABSTRACT

Background:

Social media posts by clinicians are not bounded by the same rules as peer reviewed publication, raising ethical concerns which have not been extensively characterized or quantified.

Objective:

To develop a scale to assess ethical issues on medical social media and use it to determine the prevalence of these issues among posts with three different hashtags: #MedTwitter, #IRad, #CardioTwitter.

Methods:

A scale was developed based on previous descriptions of professionalism and validated via semi-structured cognitive interviewing with a sample of 11 diverse clinicians and trainees, inter-rater agreement and correlation of 100 posts. The final scale assessed social media posts in 6 domains. This was used to analyze 1500 Twitter posts, 500 each from the three hashtags. Analysis of posts was limited to original Twitter posts in English made by healthcare professionals in North America. The prevalence of potential issues was determined using descriptive statistics and compared across hashtags using Fisher exact and Chi-squared tests with Yates’s correction.

Results:

The final scale was considered reflective of potential ethical issues of medical social media by participants. There was good interrater agreement (Cohen’s Kappa = 0.620, p<0.01) and moderate to strong positive interrater correlation (=0.602, p<0.001). The 6 scale domains showed minimal to no inter-relation (Cronbach’s alpha = 0.206). Ethical concerns across all hashtags had a prevalence of 1.5% or less except conflict of interest concerns on #IRad, which had a prevalence of 3.6%. Compared to #Medtwitter, posts with specialty-specific hashtags had more patient privacy and conflict of interest concerns.

Conclusions:

The developed medical social media professionalism scale reliably reflects potential ethical issues. Ethical issues on medical social media are rare but important and vary in prevalence across medical communities.