Climbing social media in medicine's hierarchy of needs.

The social media and medicine landscape is evolving rapidly. Early research, social media policies, and educational efforts focused on risk avoidance, while more current efforts have encouraged reflection and explored opportunities. This trajectory has affirmed physicians' professional commitment to maintaining public trust in the face of new challenges in the digital age. In this Commentary, the authors propose viewing physicians' social media use as a hierarchy of needs, similar to Maslow's psychological theory which posits that more basic levels of needs must be met before higher, aspirational levels can be fully attained. The three levels in the social media in medicine's hierarchy of needs are Security, Reflection, and Discovery. Critical to this model is respecting the essential need for Security in order to move towards Reflection and into Discovery. The social media in medicine hierarchy of needs pyramid rests on a foundation of Public Trust. How physicians as a profession have responded to past--and continue to respond to present and future--social media challenges to professionalism reveals what matters most: maintaining public trust and honoring the physicians' contract with society. A victory for online professionalism would be providing trainees with the tools and guidance needed to ascend to Discovery, while ensuring that their basic social media needs are first met. To do this, physician educators need to continue increasing trainees' awareness through designing relevant curricula, encouraging reflection, and providing positive role modeling and effective mentorship.