Treatment Recommendations Online: Don’t Do it

Why isn’t asking for and giving treatment recommendations online a good idea? With the ascendence of social media, we participate in many online professional communities filled with brilliant folks with diverse experiences. Sometimes these discussions are quite lively with professional discourse and resources; sometimes they feature the pleas for help of a struggling colleague. Sometimes we know things that might be of help, and sometimes we might be the one facing a problem we are unable to solve. Why shouldn’t we offer treatment recommendations if we can? Why should we ask for help if we need it?

In my last post, Social media and client confidentiality: Are you violating your ethics code? I mentioned a situation in which a person posted identifying information when asking a question in a Facebook group. The breach of confidentiality was not the only problem with this post (albeit the most serious), another major issue is this person asked for advice from 8000+ individuals whose experience can not be easily vetted.

I see this daily actually, and I wonder why these posters do not pick up the phone and call their mentor or supervisor for advice. Can you imagine if a pediatrician went to a public social media group called “Medical tips” with 3000 members who are accepted into the group without an interview, without vetting, and without submission of their CV or resume, and asked for advice on how to treat an ailment? If I found out that my pediatrician did that, I would immediately look for a new one.

Many of you will be annoyed that I posted this. Many of you will say, but “I just want suggestions and resources, I will take it from there.” Many of you will say, “We need a community of people who can share their experiences that work!”

My response?

• Please do a thorough literature review before asking for additional resources.
• If you need more resources, ask a reputable source (mentors, supervisors, your graduate school professors).
• It is your professional responsibility to make sure all recommendations are backed by evidence. That means you need to know that they indeed work before implementing them. Anecdotal reports of something working are not necessarily reliable and should not be used as a basis for treatment or intervention.
• Ask for a peer-to-peer mentorship hour where you review the proof that a recommendation or treatment package worked and was the cause of the desired result.
• Stop giving treatment recommendations on social media.
• Advocate for ethical and professional mentorship and supervision.
• Ask people to delete posts that are ethically questionable.
• Remind people about peer-reviewed journals.
• Recommend books written by reputable professionals. Not sure? Don’t recommend it.
• Offer to be a mentor and be open with your experience and background.

This is an informed opinion.

Giving and receiving consultation via social media groups is not yet covered in the standards or guidelines of many major mental, behavioral, or medical health professional organizations. One reason may be that the practice did not exist in the current form when the documents were written. Another reason may be that the practice of a certified or licensed professional asking for professional recommendations and advice from a group of thousands of unvetted individuals is, in my informed opinion, absurd, defined by Oxford Dictionary as “wildly unreasonable, illogical, or inappropriate.” Engaging in this practice is, without a doubt, questionable from a competence or ethical behavior standpoint.

With that in mind, I pulled the pieces that I think could be the basis of future guidelines and standards in this area and should guide our behavior as professionals now. I have added a summary statement after each that relates to all professionals, not just the ones the code or guideline was designed for.

Professional and Ethical Compliance Code for Behavior Analysts 

1.02(b) Behavior analysts provide services, teach, or conduct research in new areas (e.g., populations, techniques, behaviors) only after first undertaking appropriate study, training, supervision, and/or consultation from persons who are competent in those areas.

3.01 (a) Behavior analysts conduct current assessments prior to making recommendations or developing behavior-change programs. The type of assessment used is determined by the client’s needs and consent, environmental parameters, and other contextual variables. When behavior analysts are developing a behavior-reduction program, they must first conduct a functional assessment.

8.04(d) When behavior analysts provide public statements, advice, or comments by means of public lectures, demonstrations, radio or television programs, electronic media, articles, mailed material, or other media, they take reasonable precautions to ensure that (1) the statements are based on appropriate behavior-analytic literature and practice, (2) the statements are otherwise consistent with this Code, and (3) the advice or comment does not create an agreement for service with the recipient.

Summary: If you are a professional asking for advice from someone else you must ensure that the person is competent to give you that advice. If you are a professional considering making a treatment or intervention recommendation you should require that a current assessment be conducted and that you enter into a formal supervision consultative relationship with all the associated waivers etc. so that you can make appropriate recommendations based on the results of the assessment. Finally, you are bound by your ethics codes so if you provide public advice you must be very careful to make sure your advice is rooted in appropriate research (and is evidence-based best practice!).

AMA Policy: Professionalism in the use of social media

(f) Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students), and can undermine public trust in the medical profession.

Summary:

While this is pretty clear cut for physicians, the same goes for all mental health, behavioral health, and medical health professionals. Don’t forget that the internet is a permanent product. Anytime you reach out for treatment recommendations in a public forum (and closed and secret groups are still public forums) you will be seen. If you want to be viewed as a reputable professional, don’t ask unvetted strangers for professional advice. The take-home: If you don’t want it out there or if you think it could negatively affect you or your field don’t post it.

APA Ethical Principles of psychologists and code of conduct

Principle B: Fidelity and Responsibility
Psychologists establish relationships of trust with those with whom they work. They are aware of their professional and scientific responsibilities to society and to the specific communities in which they work. Psychologists uphold professional standards of conduct, clarify their professional roles and obligations, accept appropriate responsibility for their behavior, and seek to manage conflicts of interest that could lead to exploitation or harm. Psychologists consult with, refer to, or cooperate with other professionals and institutions to the extent needed to serve the best interests of those with whom they work. They are concerned about the ethical compliance of their colleagues’ scientific and professional conduct. Psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage.

Summary: Before giving a treatment recommendation in a social media group, determine whether you would be willing to precede that recommendation with your name, professional role, credentials, years of experience, and a waiver stating that you “accept responsibility for this recommendation that may be used as part of a treatment or intervention.” If you are not willing to do so, don’t offer the recommendation.

Code of Ethics of the National Association of Social Workers
2.05 Consultation
(a) Social workers should seek the advice and counsel of colleagues whenever such consultation is in the best interests of clients.

(b) Social workers should keep themselves informed about colleagues’ areas of expertise and competencies. Social workers should seek consultation only from colleagues who have demonstrated knowledge, expertise, and competence related to the subject of the consultation.

(c) When consulting with colleagues about clients, social workers should disclose the least amount of information necessary to achieve the purposes of the consultation.

Summary:

This section is excellent and should be included in every professional standard of conduct. To ensure best-practice, just insert your profession where it says “Social Worker.” Follow those guidelines and you will be way ahead of the pack when it comes to professional and ethical behavior.

National Board of Certified Counselors (NBCC) Code of Ethics

88. NCCs who make statements in a public manner shall state that their opinions represent their personal views and not another organization unless officially authorized to do otherwise.

Summary:

This is a very interesting and important point. If you post your place of work on your profile and give a treatment recommendation that is inappropriate and/or not reflective of the standard of practice where you work, it can put your job at risk.

Final thoughts?

My advice…Want to be an ethical professional? Don’t ask for or give treatment or intervention recommendations in social media group.