Don’t talk about your patients on Twitter. Avoid friending them on Facebook. Keep your professional online life distinct from your personal one. Those tips might seem obvious to some physicians who are growing more comfortable navigating social media. But what about conflicts of interests? How should a doctor handle disclosure in 140 characters or less?

Much has been written in the past couple of years about how doctors should conduct themselves online, as more of their communication with patients, colleagues, and the public migrates there. But not enough attention has been paid to management of conflicts of interest online, Dr. Matthew DeCamp, a postdoctoral fellow at Johns Hopkins School of Medicine writes in a commentary published last week by the Journal of General Internal Medicine.

Various medical groups and specialty associations have outlined policies for doctors to use in informing patients or the broader public, in the case of published research, when they benefit financially from prescribing a drug or producing certain results. But enforcing even long-established standards is tricky. Social media programs provide fertile ground for trouble.

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Much is still unknown about how doctors use social media and how their colleagues and physicians interpret their writings online, DeCamp said in an interview Tuesday. But the public increasingly turns to the internet for medical information and some physicians seek out opinions from other doctors online.

It’s critical for doctors to apply the same ethic of disclosing and managing their conflicts of interest online, DeCamp said.

Eventually, he said, there could be a national or international database recording potential conflicts that doctors could easily link to from their blog, Twitter account, or other online profiles. “It could be the kind of social norm that develops from within the profession itself,” he said.

Until then, he offered a few tips for doctors today:

1. Recognize that disclosure is important. DeCamp said he worries that the casual nature of online conversations could lead to “blurred boundaries” for doctors. Social media activity should be seen generally as an extension of a physician’s work.

2. Be up-front. Doctors who have a blog or regularly contribute to online forums should keep an updated account of their potential conflicts of interest online. DeCamp suggested posting something similar to the International Committee of Medical Journal Editors disclosure form, and updating it annually.

3. Without context, refrain from discussing issues tied to potential conflicts. Tweets are shared quickly and often disconnected from their author’s profile. And adding full disclosure within very limited space is a challenge.

“Twitter is actually a quite difficult case,” DeCamp said. “We need to think a little bit more about how to deal with it because of the abridged nature of the content and the rapidity with which it can move.”