• Anne Brynolf, Stefan Johansson, Ester Appelgren, Niels Lynoe, and Anna-Karin Edstedt Bonamy.
• Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
• BMJ Open. 2013 Jan 1; 3 (7).

ObjectiveTo investigate potential violations of patient confidentiality or other breaches of medical ethics committed by physicians and medical students active on the social networking site Twitter.DesignPopulation-based cross-sectional observational study.SettingThe social networking site Twitter (Swedish-speaking users, n=298819).PopulationPhysicians and medical students (Swedish-speaking users, n=237) active on the social networking site Twitter between July 2007 and March 2012.Main Outcome MeasurePostings that reflect unprofessional behaviour and ethical breaches among physicians and medical students.ResultsIn all, 237 Twitter accounts were established as held by physicians and medical students and a total of 13 780 tweets were analysed by content. In all, 276 (1.9%) tweets were labelled as 'unprofessional'. Among these, 26 (0.2%) tweets written by 15 (6.3%) physicians and medical students included information that could violate patient privacy. No information on the personal ID number or names was disclosed, but parts of the patient documentation or otherwise specific indicatory information on patients were found. Unprofessional tweets were more common among users writing under a pseudonym and among medical students.ConclusionsIn this study of physicians and medical students on Twitter, we observed potential violations of patient privacy and other breaches of medical ethics. Our findings underline that every physician and medical student has to consider his or her presence on social networking sites. It remains to be investigated if the introduction of social networking site guidelines for medical professionals will improve awareness.

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