Professionalism and the Internet in Psychiatry: What to Teach and How to Teach It

Taskforce Report

Professionalism and the Internet in Psychiatry:What to Teach and How to Teach It

Sandra M. DeJong, M.D., Sheldon Benjamin, M.D., Joan Meyer Anzia, M.D.

Nadyah John, M.D., Robert J. Boland, M.D., James Lomax, M.D.

Anthony Leon Rostain, M.D., M.A.

The digital revolution has had a profound impact onmedicine and patient care. Patients have a growing ex-

pectation that they can find medical information on the weband discuss it with their physician by e-mail (1). Physicians,including psychiatrists, are increasingly using blogs andTwitter to promote their practices (2, 3). The internet itselfis used as a vehicle for therapeutic modalities, even psycho-therapy (4). Social networking among patients, physicians,and other “friends” are blurring boundaries as never before(5, 6).The potential clinical, legal, ethical, and professionalism

issues in using the internet and digital media in psychiatryhave been outlined elsewhere, including explicit recom-mendations for resident education in this area (7). This ar-ticle focuses on how to teach residents about appropriate useof the internet.The evidence of unprofessional online behavior among

physicians and the complexity of the potential issues raisedwith internet use in psychiatry suggest that psychiatric resi-dents, educators, and administrators need explicit teachingabout potential clinical, ethical, and legal pitfalls of internetuse. In 2010, the President of the American Association ofDirectors of Psychiatric Residency Training (AADPRT) es-tablished a Taskforce on Professionalism and the Internet,charged with reviewing the literature and creating a curric-ulum to teach psychiatric trainees about online profession-alism. Participants in a Taskforce-run workshop on thissubject were asked for examples from their own experience

of online professionalism concerns (8), and an outpouringof vignettes ensued. TheTaskforce undertook to create a cur-riculum based on vignettes designed to promote similardiscussion. The principles elicited in these vignettes mightbe seen as extensions of well-established principles of pro-fessionalism (9, 10). Trainees accustomed to continual useof interactive technologies, however, may overlook bound-ary and other professionalism issues if they are not madeexplicit in training. The curriculum strives to address prin-ciples, rather than specific technologies, since the latter areexpected to continue to evolve rapidly.The vignettes in this curriculum (available online at

aadprt.org (11)) are designed for either group discussionor individual study; they are accompanied by relevant refer-ences and a teacher’s guide. The vignettes are organizedaround nine issues that may be relevant to various teachingvenues: liability, confidentiality, and privacy; psychotherapyand boundaries; safety issues; mandated reporting; libel;conflicts of interest; academic honesty; “netiquette;” andprofessionalism remediation. We discuss the first eight ofthese topics, using vignettes from the curriculum for illus-tration. Where vignettes are based on actual cases, all iden-tifying details are disguised.

Liability

Internet technology has the potential to improve patientcare, but poses new challenges in medical liability. E-mail,in particular, is increasingly common between patients andphysicians, sometimes improved by protected portals andencryption systems that safeguard confidentiality (1, 12,13). Residents require training about clinical challengesposed by online technology. For example, e-mail is limitedby the loss of nonverbal cues, and meanings may be mis-construed. Communication and diagnostic errors may bemade, emergency situations missed, and physicians may“head down a slippery slope” of e-mail exchanges without

Received May 7, 2011; revised September 11, October 22, 2011; acceptedOctober 27, 2011. From the Dept. of Psychiatry, Cambridge Health Alli-ance, Harvard Medical School, Cambridge MA; University of Massachu-setts Medical School; Northwestern Univ. Feinberg School of Medicine;Brody School of Medicine, East Carolina University; Dept. of Psychiatryand Human Behavior, Brown University, Providence, RI; Dept. of Psychi-atry, Baylor College of Medicine, Houston, TX; Dept. of Psychiatry, Univ.of Pennsylvania, Philadelphia, PA. Correspondence: Dr. Sandra DeJong,Cambridge Health Alliance; [email protected] © 2012 Academic Psychiatry

356 http://ap.psychiatryonline.org Academic Psychiatry, 36:5, September-October 2012

setting appropriate limits about when the patient needs to beseen (11) (Vignette #12). A key issue is response time:Given 24/7 e-mail access, are physicians responsible forrapidly responding to e-mails (14)? Consider this clinicalvignette:

A psychiatrist returns from a long weekend away and checks hise-mail to find an urgent message from a patient reporting that herdepression is significantly worse and she is feeling actively suicidal.The psychiatrist is very upset because he had carefully signed out hisbeeper to a colleague and left amessage on his office voicemail sayinghe would be away, and patients in an urgent situation should contactthe covering psychiatrist. The psychiatrist had communicated bye-mail with the patient on a number of different occasions, but hadalways told the patient that e-mail was not the best way to reach him inurgent situations. The psychiatrist is even more upset when he learnsthat the patient did, indeed, make a suicide attempt and has beenhospitalized (11). (Vignette #11)

Such vignettes can be used to teach the importance ofhaving patients sign a consent form for e-mail commu-nication that establishes turnaround time for messages,restriction on non-urgent use, appropriate message head-ers, privacy and confidentiality issues, and permissiblecontent.

Also, residents need to learn about institutional and legalstandards as they develop, and the fact that electroniccommunication is subject to discovery. Once psychiatristshave established a doctor–patient relationship by providingonline advice to a consenting patient, liability issues mayarise—psychiatrists may be liable if e-mails are not savedinto the record or if response time is not adequate (14).

E-mail is just the beginning: psychiatrists are com-municating by text and “tweet,” and new technologies forinterfacing with patients are undoubtedly on the way.Technology should be used in a boundaried, confiden-tial fashion, with the patient’s written consent, to support,rather than to establish or maintain, the doctor–patientrelationship.

Confidentiality and Privacy

Violation of patient privacy and confidentiality throughsocial-networking sites such as Facebook and Twitter isa significant problem in healthcare settings (7). Numerousmedia reports have documented hospital and clinic staffmembers posting photographs and identifiable informationabout patients; in some of these situations, staff are termi-nated as a consequence (15, 16).

Many hospitals have developed, or are in process of de-veloping, policies for the use of social-networking sites inthe workplace (17). Medical students, residents, staff, and

attending physicians must be educated about the appropriateuse of such sites. In doing so, medical educators need toacknowledge that younger physicians use technology as anintegral part of their personal life, as recognized by theAmerican Medical Association (AMA) in its policy onProfessionalism in the Use of Social Media (18).

Given long work-hours, clinical inexperience, and,sometimes, lack of personal support, residents may be quickto express online their thoughts and feelings about workstresses. They must be trained to be mindful that any di-vulged information that could lead to the identification of apatient would be a violation of the Health Insurance Porta-bility and Accountability Act (HIPAA) (19). Consider thefollowing example:

“Dr. A,” a psychiatry resident leaving his on-call shift in the emer-gency room at a local hospital, decides to send his friends a Facebookupdate. “Justfinishedwith a lousy, 24-year-old jerk,”Dr.Awrites. “Asoldier complaining of pain = addict.” “Dr. B,” who is an emergencymedicine resident in the same local hospital, and Dr. A’s Facebookfriend, sees the status update on his smart phone just before going in tosee a 24-year-old male patient with a military history who is com-plaining of pain (11). (Vignette #31)

In a teaching session, residents can note the obviousHIPAA violation, but also consider the professionalismbreech, and how such a breech may have a negative impacton the whole profession (20, 21). Residents must learn tomanage their feelings about patients in more appropriatesettings, such as supervision and their own individualpsychotherapy.

The AMA suggests separating professional online in-formation frompersonal online content (18). Privacy settingscan help to safeguard personal and sensitive informationfrom the general viewing public. Residents should beguided to helpful resources like ZDNET’s The DefinitiveFacebook LockdownGuide (22) about how to apply goodprivacy settings. Also, residents should learn to regu-larly check search engines like Google, Yahoo, and Bingto be aware of their “web-face” and take appropriateaction when necessary to “wash” it (7, 23). However, asthe AMA policy warns, residents must be careful abouta false sense of security, as “privacy settings are notabsolute and that once on the Internet, content is likelythere permanently.”

Psychotherapy and Boundaries

Given the rapidity, breadth, intimacy, and potential per-manence of internet communication, psychotherapy learn-ers need help in navigating this major shift from traditional

Academic Psychiatry, 36:5, September-October 2012 http://ap.psychiatryonline.org 357

DEJONG ET AL.

communication styles (7, 24). The psychotherapy principlesof neutrality, anonymity, and abstinence may be compro-mised when a patient accesses trainees’ postings, whichmay date from before their professional education. Unfor-tunately, such postings may include information that com-promises professional identity and undermines the patient’scomfort in candidly communicating sensitive material,which is so fundamental to successful psychotherapy (7).Residents need to anticipate being confronted by patients

regarding online content about their psychiatrist. Dealingwith inaccuracies or indiscretions without adding unhelpfulamounts of self-disclosure (in the service of neutrality andanonymity) is a difficult clinical problem. Some importantpotential situations to consider in a teaching session include:the impact of a patient’s discovering the psychiatrist’s sexualorientation online; how a psychiatrist with unconscious un-met emotional needs can lose sight of appropriate boundariesby engaging in intimate e-mail exchanges with patients; howa particularly troubled patient can assume a false identityonline to “friend” and ultimately stalk the psychiatrist. Vi-gnettes on such topics can be used to stage role-plays (withresidents playing the therapist and patient) that promote open-ended discussion about confronting and managing thesekinds of clinical dilemmas.The use of e-mail communication with patients is ex-

tremely complex (25) and requires special attention inteaching residents. E-mail communication with patients hasbeen used successfully, including as a way to test the safetyof the treatment relationship (26). But the clinical, ethical,and liability concerns described above must be considered.In child and adolescent psychotherapy practice, e-mail andother technological communication may add a new di-mension to issues around separation and individuation, orappropriate parent–child boundaries. For many patients,written policies or principles regarding electronic commu-nication will need to be revisited in times of crisis.

Safety Issues and Mandated ReportingRequirements

When patients or their potential victims appear to be indanger, we are required to report these unsafe situations toappropriate authorities. Until recently, such investigationswere based on patient-observation, reporting, and clinicalassessment, as well as direct contact with collateral in-formants. The availability of personal information online hasopened up entirely new sources of information about patientbehavior to clinicians. Increasingly, psychiatrists are carryingout information-searches about patients (so-called “patient-

targeted googling”) (27). Few articles have been publishedregarding the extent, circumstances, and reasons used byclinicians to justify online patient searches (7). The APAEthics Committee (2009) offered the following guidelines(27):

Googling a patient is not necessarily unethical. However, it should bedone only in the interests of promoting the patient’s care and well-being and never to satisfy the curiosity or other needs of the psychi-atrist. Also important to consider is how such information willinfluence treatment and how the clinician will ultimately use thisinformation.

A pragmatic framework offered by Clinton et al. (28)suggests that clinicians consider six questions beforesearching online for patient information:

1. Why do I want to conduct this search?2. Would my search advance or compromise the treatment?3. Should I obtain informed consent from the patient prior to

searching?4. Should I share the results of the search with the patient?5. Should I document the findings of the search in the med-

ical record?6. How do I monitor my motivations and the ongoing risk–

benefit profile of searching?

The authors provide case-vignettes that can be easilyadapted for teaching purposes. One of them is particularlycompelling because it raises safety andmandatory-reportingissues. The gist of the case follows:

A 16-year-old girl is seen by a resident in the Psychiatric EmergencyDepartment for very troubling behaviors (missing school, staying outpast curfew, receiving failing grades), which started after she enteredinto a relationship with a 35-year-old man. During the interview, theresident learns that the patient’s boyfriend has been taking pro-vocative pictures of her and posting themon hiswebsite. The patient’smother is unaware of the photographs. The resident decides to searchfor these pictures online (28).

A useful teaching approach is to hold a debate on theresident’s decision, with one side coming up with reasonsjustifying the online search and the other advancing argu-ments against this decision. Here, the thought process, nota single right answer, is the key.

Potential Libel

Defamation is the communication of false information,stated as fact, which brings harm to the individual aboutwhom the information is communicated. Written defama-tory content, including online content, constitutes libel (29).Thus, patient-generated material on social-networking sites,blogs, or physician-rating websites (30) may be considered


PROFESSIONALISM AND THE INTERNET

libelous if it is both untrue and harmful to the physician.Residents need to be aware of web-based content aboutthem (31); however, residents also need to learn how toapproach the discovery of negative content. Consider thefollowing example:

An early-career psychiatrist discovers that, on an online physicianrating site, someone has submitted a negative review of the psychi-atrist, [alleging that] the psychiatrist “occasionally violated my civilrights.” The psychiatrist is concerned about the potential impact to hisreputation as he begins practice if this review is available on thewebsite. . .The psychiatrist considers whether to submit positivereviews under various pseudonyms, pretending that they are writtenby real patients, to create a more favorable impression of the psy-chiatrist on the website (11). (Vignette #15)

In this case, the single report is unlikely to harm the youngpsychiatrist, and posting pseudonymous reviews will notimprove the psychiatrist’s ethical position. Rather thanacting out his feelings, the psychiatrist may benefit from asupervisory consultation. Unfortunately, some disgrun-tled individuals can post false and harmful content online;residents need to recognize such defamation, and seeklegal counsel and/or the services of a reputation defendercompany.

Potential Conflicts of Interest

Because psychiatrists often hold various roles at once,including those of educators, patient advocates, scholars,researchers, and consultants to industry, they need to beaware of potential conflicts of interest. Roberts and Hoop(32) define conflict of interest in medicine as “a situation inwhich a physician has competing roles, relationships, orinterests that could potentially interfere with the ability tocare for patients.” In learning about conflict of interest inmedicine, psychiatric residents nowmust learn about how itcan apply to online behavior.

A physician may take an online role or express opin-ions that are not aligned with his or her professional re-sponsibilities to patients or colleagues. Here are someexamples:

† Responding to an online survey or social-networkingsite, a physician endorses a particular pharmaceutical com-pany for which she serves as a speaker.† A resident makes derogatory comments about his cur-rent hospital service in an online blog.† Amedical student posts his political opinions regardingan advocacy organization on his Facebook page.

The possibility of online anonymity presents other temp-tations, as described in the following vignette:

A junior facultymember has co-written her first chapter in a text aboutpsychotherapy that is edited by a well-known psychiatrist. . .Somemonths after publication, the junior faculty member is asked to re-spond anonymously to a national online survey of faculty membersabout recommended textbooks for teaching psychotherapy to resi-dents. . .The faculty member. . .write[s] a positive review and re-sounding endorsement of the textbook to which she had contributed. . .(11) (Vignette #24).

Psychiatric educators can use this vignette to help resi-dents delineate the clear conflict of interest between thefaculty member’s role as a chapter author and her role inproviding an anonymous online endorsement of the book toher professional colleagues. Ethics guidelines by pro-fessional organizations can be referenced (33, 34).

The availability of numerous professional e-mail lists,websites, and anonymous surveys presents new oppor-tunities for missteps and poor judgment with regard toconflicts of interest. Recognizing and disclosing poten-tial conflicts so that others are aware of possible bias is thetake-home point.

Academic Issues

Like the clinical setting, the academic setting is bothenhanced and challenged by the digital age. Accessibilitymakes the comprehensive research of a subject more effi-cient than the print medium. Unfortunately, plagiarism ismore efficient as well. “Paraphrase plagiarism,” in whicha writer copies and then changes a few words from anotherauthor’s work and presents it as original, is a commonhazard. One survey of undergraduate students found that19% “occasionally” and 10% “frequently” copied text with-out attribution (35); another survey of students at 23 differentcolleges found that 38% admitted to at least one instance ofparaphrase plagiarism in the past year (36). These decade-oldsurveys likely underestimate the problem. Online servicessuch as “The Doctor Job” (37) can “help” residency appli-cants. Some program directors have resorted to plagiarism-checkers, such as “Turnitin” (38).

The internet did not create plagiarism, nor has it neces-sarily increased the rates (39). One might then assume thatthe current policies on academic honesty at academicinstitutions are sufficient. However, trainees who havegrown up in an age of file-sharing, web linking, wikis, andmusic sampling may find concepts of ownership, original-ity, and copyright more difficult to grasp. Consider thefollowing example:

On reading a student’s paper, a professor notes a strong resemblanceto a Wikipedia article on the subject, including verbatim quotes usedwithout attribution. When confronted, the student is perplexed and


DEJONG ET AL.

explains that, as the material is public domain and has no specificauthor, it is not plagiarism. Furthermore, she argues that, although she‘cut and pasted’ text from the Wiki, the organization and conclusionswere her own, and thus she was not intellectually dishonest (11).(Vignette #26)

Although older generations will likely interpret this vi-gnette as clear-cut plagiarism, younger psychiatrists may beless convinced, and this attitudinal difference may demon-strate a fundamental cultural change (40). For example,when the content of a recently published online novel wasfound to include unattributed extended passages from blogsand other online sources, the young author’s defense wasthat she represents a new generation of artists who freely“mix and match media to create something new” (41). Thenovel remains a best-seller and was a literary award finalist.As the anthropologist Susan D. Blum suggests, the conceptof plagiarism “is changing because, in higher education, themeaning of a ‘text,’ and notions of the self are changingaround it” (42). If this is true, then insisting on adherence toexisting rules of academic honesty may not be sufficient.Educators must reconsider the philosophy behind academichonesty and find ways to teach it in a manner that is relevantto trainees’ own experience and values.

“Netiquette”

Although medical students learn how to interact pro-fessionally with patients and staff, such lessons on in-terpersonal and professional etiquette may not cover thepotential pitfalls of electronic communication. Most elec-tronic communication relies on the written word and visualimage, and does not provide nonverbal cues about thesender. Thus, details such as the greeting, specific wordchoice, and punctuation (including emphasis techniquessuch as bold-facing), may have heightened impact and de-termine how the message is heard, (which may be differentfrom the sender’s intent). The rapidity of electronic exchangeinvites rapid-fire responses—pausing before responding toan e-mail or a text can be an important lesson to learn. Fi-nally, technology provides ways for messages to be quicklydisseminated beyond the initial intended recipient, not al-ways with that person’s knowledge. Learning when to seta limit on forwarding texts, e-mails, and other online in-formation is an important skill (43, 44). Here is an example:

A program director (PD) receives an e-mail from a supervisor de-lineating concerns about a resident’s performance. The supervisormakes reference to the resident’s “arrogant manner” and “narcissisticneed to dominate conversations.”. . . The PD. . . forwards the super-visor’s e-mail to all seminar leaders and rotation supervisors and asksfor their response (11). (Vignette #19)

This vignette can be used to discuss the inappropriate useof e-mail that includes confidential material, emotionally-charged language, and personal attack. The PD’s decisionto forward the initial e-mail only magnifies the problem. Ina teaching session, residents can brainstorm as to how the PDmight have better managed this situation. A key teaching-point: Technology should never serve to discharge feelingsthat are better worked through in supervision or therapy.

Conclusion

The current generation of learners relates to the internetmore as an extension of themselves than as an external re-source. Interactive technologies have fostered new attitudestoward privacy and boundaries that must be explicitlyaddressed in the process of becoming a physician, particu-larly in psychiatry. Physicians must carefully construct theironline personae in a manner consistent with long-standingprinciples of professionalism. Just as discussions on in-teraction with industry have helped prepare trainees forpractice realities, thoughtful discussion of online pro-fessionalism and boundary issues during training will leadto better decisions by graduates as they establish theirpractices. (See Table 1.)The curriculum suggested in this article represents an

easy-to-implement educational intervention to foster thesediscussions. Public perceptions of psychiatry and the field ofmedicine risk being discolored by the online behavior ofmembers of our profession. It is up to psychiatric educatorsto train a new generation of psychiatrists to think through theprofessionalism issues raised by online technology, in-cluding technologies not yet invented.

TABLE 1. Recommendations for Teaching AboutProfessionalism and the Internet

1. Acknowledge and respect different attitudes toward digitalmedia across generations.

2. Don’t assume trainees recognize professionalism issues; makethem explicit.

3. Teach interactively using vignettes familiar to the residents’own experience.

4. Include vignettes that cover the eight topics outlined above:Liability, Confidentiality and Privacy, Psychotherapy andBoundaries, Safety Issues, Libel, Conflicts of Interest,Academic Issues, and “Netiquette.”

5. Provide references, including institutional guidelines andpolicies, professional codes of ethics, and recommendationsfor maintaining a professional online identity.

6. Emphasize overarching principles and concepts, rather thantechnological details that are likely to change over time.



Members of the AADPRT Task Force on Professionalism andthe Internet are Sandra M. DeJong, M.D. (chair), Joan Anzia,M.D., Sheldon Benjamin, M.D., Robert Boland, M.D., NadyahJohn, M.D., James Lomax, M.D., and Anthony Rostain, M.D.

At the time of submission, the authors reported no competinginterests.

References

1. Baker L, Wagner TH, Singer S, et al: Use of the Internet ande-mail for healthcare information: results from a nationalsurvey. JAMA 2003; 289:2400–2406

2. Speller J, Korkosz T: Dr. Jeff’s and Dr. Tanya’s blog, 2010;available at http://drjeffanddrtanya.typepad.com; accessed 05/07/2011

3. Handelman K: ADD-ADHD Blog: The internet blog of Dr.Kenny Handelman, 2011; available at http://www.addadhd-blog.com; accessed 05/07/2011

4. Yager J: E-mail as a therapeutic adjunct in the outpatienttreatment of anorexia nervosa: illustrative case material anddiscussion of the issues. Int J Eat Disord 2001; 29:125–138

5. Yellowlees P, Nafiz N: The psychiatrist–patient relationshipof the future: anytime, anywhere? Harv Rev Psychiatry 2010;18:96–102

6. Fletcher D: Facebook and how it’s redefining privacy. TimeMagazine 2010; 175:32–38

7. Gabbard GO, Kassaw KA, Perez-Garcia G: Professionalboundaries in the era of the Internet. Acad Psychiatry 2011; 35:168–174

8. Benjamin S, Anzia J, Boland R, et al: Workshop 2.09–Web 2.0and Psychiatry: Professional and Ethical Issues for Trainees.American Association of Directors of Psychiatry ResidencyTraining (AADPRT) Annual Meeting, Orlando FL, March2010

9. Gabbard GO, Nadelson C: Professional boundaries in thephysician–patient relationship. JAMA 1995; 273:1445–1449

10. ABIM Foundation: ACP-ASIM Foundation, European Foun-dation of Internal Medicine: Medical professionalism in thenew millennium: a physician’s charter. Ann Intern Med 2002;136:243–246

11. DeJong S, Benjamin S, Anzia J et al: Curriculum onProfessionalism and the Internet in Psychiatry, 2011; availableat http://www.aadprt.org/vtodocs/professionalism_and_the_internet/AADPRT_Professionalism_and_the_Internet_Curriculum.pdf; accessed 05/07/2011

12. Car J, Sheikh A: E-mail consultations in health care, 1: scopeand effectiveness. BMJ 2004; 329:435–438

13. Stone J: Communication between physicians and patients inthe era of e-medicine (Perspective column). N Engl J Med2007; 355:2451–2454

14. Recupero PR: E-mail and the psychiatrist–patient relationship.J Am Acad Psychiatry Law 2005; 33:465–475

15. Hennessy-Fiske M: When Facebook goes to the hospital, pa-tients may suffer. Los Angeles Times, August 8, 2010; latimes.com/news/local/la-me-facebook-20100809,0,7484743.story

16. Conaboy C: For doctors, social media a tricky case. TheBoston Globe, April 20, 2011; 279: A1, A14

17. University of Toronto: Guidelines for Appropriate Use of theInternet, Electronic Networking, and Other Media, 2010;available at http://www.pgme.utoronto.ca/Assets/PGME+Digital+Assets/policies/Guidelines+Internet.pdf, accessed05/07/2011

18. American Medical Association: Professionalism in the use ofsocial media, AMA.org, 2010; available at http://www.ama-assn.org/ama/pub/meeting/professionalism-social-media_print.html; accessed 05/07/2011

19. U.S. Department of Health and Human Services: Health In-surance Portability and Accountability Act, 1996; available athttp://www.hhs.gov/ocr/privacy; accessed 05/07/2011

20. Chin J: Editorial: Medical professionalism in the internet age.Ann Acad Med 2010; 38:5

21. Farnan JM, Paro JAM, Higa JT, et al: Commentary: The re-lationship status of digital media and professionalism: it’scomplicated. Acad Med 2008; 4:11

22. ZDNET: The Definitive Facebook Lockdown Guide; avail-able at http://www.zdnet.com/photos/the-definitive-facebook-lockdown-guide-securing-your-profile-page; accessed 05/07/2011

23. Banjo S: Washing your web face. Wall Street Journal, Feb17, 2008; available at http:onlinewsj.com/public/article/SB120320660446474003.html

24. DeJong S, Anzia J, Benjamin S et al: Blogs, Tweets, E-mails,and Friending: Teaching About Professionalism and the In-ternet. Workshop: American Association of Directors ofPsychiatry Residency Training, Austin TX, March 2011

25. Seeman MV, Seeman BS: E-psychiatry: the patient–psychia-trist relationship in the electronic age. CMAJ 1999; 161:1147–1149

26. Lomax JW, Pargament KI: Seeking ‘Sacred Moments’ inPsychotherapy and in Life. Psyche &Geloof [Spirit] 2011; 22:79–90

27. American Psychiatric Association Ethics Committee: Is itethical to “Google” patients? Psychiatr News 2009; 44:11

28. Clinton BK, Silverman BC, Brendel DH: Patient-targetedgoogling: the ethics of searching online for patient in-formation. Harv Rev Psychiatry 2010; 18:103–112

29. Van VechtenVeeder: The History and Theory of the Lawof Defamation, Columbia Law Review 1903; 3: 546-573;available at http://www.jstor.org/stable/1109121; accessed05/07/2011

30. Rate MDs.com: Find and rate doctors and dentists; availableat http://www.ratemds.com, accessed 05/07/2011

31. Mostaghimi A, Crotty BH, Landon BE: The availability andnature of physician information on the internet. J Gen InternMed 2010; 25:1152–1156

32. Roberts LW, Hoop JG: Professionalism and Ethics for MentalHealth Professionals: A Q&A Self-Study Guide for MentalHealth Professionals. Arlington, VA, American PsychiatricPublishing, Inc., 2008

33. American Academy of Child and Adolescent Psychiatry Codeof Ethics: 2009; available at http://www.aacap.org/galleries/AboutUs/AACAP_Code_of_Ethics.pdf; accessed 05/07/2011


DEJONG ET AL.

34. American Psychiatric Association: The Principles of MedicalEthics,With Annotations Especially Applicable to Psychiatry,2010; available at http://www.psych.org/MainMenu/PsychiatricPractice/Ethics/ResourcesStandards/Principles-of-Medical-Ethics-2010-Edition.aspx?FT=.pdf; accessed05/07/2011

35. Scanlon PM, Neumann DR: Internet plagiarism among col-lege students. J Coll Student Dev 2002; 43:375–385

36. McCabe D: Cheating: why students do it and howwe can helpthem stop. Am Educ 2001; 25:38–43

37. The Doctor Job: 2004–2010; available at http://www.thedoctorjob.com; accessed 05/07/2011

38. iParadigms, LLC: Turnitin, 1998–2011; available at http://www.turnitin.com; accessed 05/07/2011

39. McCabe DL, Stephens JM: “Epidemic” as Opportunity: In-ternet Plagiarism as a Lever for Cultural Change. TeachersCollege Record, 2006; ID Number: 12860

40. Gabriel T: Plagiarism Lines Blur for Students in Digital Age.Wall Street Journal, August 1, 2010; available at http://www.nytimes.com/2010/08/02/education/02cheat.html?_r=2; accessed05/07/2011

41. Kulish N: Author, 17, Says It’s “Mixing,” Not Plagiarism.NewYork Times, February 11, 2010; available at http://www.nytimes.com/2010/02/12/world/europe/12germany.html, accessed05/07/2011

42. Rosen C: It’s Not Theft, It’s Pastiche: College Students Pla-giarize Routinely, Especially From the Internet. Wall StreetJournal, April 16, 2009; available at http://online.wsj.com/article/SB123984974506823779.html; accessed 05/07/2011

43. Chan JF: E-mail: A Write It Well Guide: How to Write andManage E-Mail in theWorkplace. Oakland, CA,Write ItWell,2008

44. Smith LA: Business E-Mail: How to Make it Professional andEffective. San Anselmo, CA,Writing & Editing atWork, 2002

Call for Papers: Psychiatric Education and Neuroscience

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-chiatric workforce presently unprepared for understanding these innovations, interfacing with patients

are concerns among clinicians that an exclusive focus on neuroscience may diminish the historically Academic Psychiatry is creating a special issue of articles

psychiatry.

In keeping with the overall mission of Academic Psychiatry,drawing upon data and outcome measures, and/or involving multiple sites. Compre hen sive reviews

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Professionalism and the Internet in Psychiatry: What to Teach and How to Teach It

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