Professionalism and Adolescent Psychiatry in the Digital Age
Sandra M. DeJong
Affiliation: Macht 336, The Cambridge Hospital, 1493 Cambridge Street, Cambridge, MA 02139, USA.
Keywords: Confidentiality, conflicts of interest, digital technology, ethics, liability, libel, netiquette, online professionalism,
privacy, psychotherapy, safety/mandated reporting, social media.
Background: The digital revolution has changed healthcare forever. In adolescent psychiatry, the infrastructure
of our practice – billing, record-keeping and communication with patients and colleagues – is increasingly occurring electronically
and online. Adolescent psychiatrists are likely to interface with technology in their practice, in part because of
the high prevalence of use of social media among their patients and also among practitioners. Online professionalism
means adhering to the clinical, ethical and legal principles of professional behavior while communicating via the Internet.
Due to the unique characteristics of digital technology, professionalism breaches involving technology are easier to commit
and have the potential for a broader impact than communication with traditional media. Physicians’ lapses in professionalism
online have been documented by the media, researchers and state medical boards, and physicians have increasingly
faced various kinds of censure for such lapses. Professional guidelines are emerging; however, these documents do
not always provide straightforward answers to complex clinical scenarios.
Method: This paper focuses on eight core issues in professionalism and digital technology: confidentiality, patient and
practitioner privacy, liability, safety/mandated reporting, libel, netiquette, conflicts of interest and issues unique to psychotherapy.
Each concept, as it applies to working with adolescents, is illustrated and discussed in the context of clinical
vignettes. Thus, an overall conceptual framework and underlying thought process are emphasized here, rather than specific
“do’s and don’ts.” While much of the research cited in this article is from studies of physicians, especially psychiatrists,
the principles identified are applicable to all mental health professionals.
Results: Online professionalism concerns for mental health professionals who work with adolescents cover a wide range
of activities and types of communication. They may be usefully grouped into eight domains: 1) confidentiality, 2) privacy,
3) liability, 4) safety/mandated reporting, 5) libel, 6) “netiquette,” 7) conflicts of interest, and 8) issues unique to psychotherapy.
Conclusions: Many situations do not have a clear-cut solution, but having an increased consciousness about and being
able to think through relevant issues can prevent online professionalism breaches before they happen. Adolescent mental
health providers need to exercise a judicious balance between embracing technology that serves to improve patient care
and spurning online behaviors and digital modalities that threaten the fundamentals of professionalism.
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