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* ALT: : alanine aminotransferase AST: : aspartate aminotransferase BUN: : blood urea nitrogen CBC: : complete blood count CNS: : central nervous system CSF: : cerebrospinal fluid CT: : computed tomography ECG: : electrocardiography ED: : emergency department EEG: : electroencephalography ESR: : erythrocyte sedimentation rate GI: : gastrointestinal GU: : genitourinary Hct: : hematocrit Hgb: : hemoglobin MRI: : magnetic resonance imaging WBC: : white blood cell A 15-year-old boy presents with a 4-day history of fatigue, intermittent mild headache, and a 1-day history of generalized weakness, body aches, sleepiness, dizziness, and three episodes of nonbilious, nonbloody emesis. He denies cough, shortness of breath, palpitations, or chest pain, as well as abdominal pain, joint pain, rash, vision changes, weight loss, polyuria, polydipsia, or change in urine color. He currently takes methylphenidate for attention-deficit/hyperactivity disorder and sertraline for depression. He denies any over-the-counter or illicit drug use. Physical examination reveals a well-developed, tired-appearing adolescent. His temperature is 100.6°F with otherwise normal vital signs, including blood pressure. Physical examination of the heart, lungs, and abdomen are within normal limits. His proximal muscle strength is 4 of 5; the rest of his neurologic examination is within normal limits. Initial laboratory examination includes the following levels: sodium, 133 mmol/L; potassium, 2.4 mmol/L; chloride, 90 mmol/L; bicarbonate, 30 mmol/L; BUN, 9 mg/dL; creatinine, 0.5 mg/dL; glucose, 103 mg/dL; calcium, 9.4 mg/dL; magnesium, 2.0 mg/dL; and phosphorus, 4.3 mg/dL. CBCs, liver function test results, and hepatic enzyme levels are normal. ECG shows a prolonged QT interval at 550 milliseconds. On admission, the patient receives a potassium bolus, followed by maintenance intravenous (IV) fluids containing potassium chloride. He has no vomiting or diarrhea on his first hospital day. A follow-up laboratory examination of his chemistry studies shows persistence of his initial abnormalities. A 19-year-old female presents to the ED 3 hours after intentional ingestion of an unknown substance. On initial presentation, she is afebrile, with a blood pressure of 100/59 mmHg, respiratory rate of 20 breaths per minute, heart rate of 110 beats per minute, and oxygen saturation of 99% on room air. She is alert, oriented, and conversational. Within 20 minutes of arrival to the ED, her blood pressure drops to 61/24 mmHg, …

averse industry in the United States,’’ according to Christensen. The age of information clearly has affected the culture of medicine in ways that we are just beginning to understand. Never before have there been so many ways to communicate. In the past, we were limited to face-to-face conversations, postal mail, telegrams, and telephone calls. Physicians communicated about their credentials through listings in the telephone book and in local medical society publications, or by hanging a shingle outside the office. With the development and diffusion of new technologies, our means of communicating about ourselves, as well as with colleagues, patients, families, and learners grew enormously. At the same time, the types of new technologies expanded; e-mail, video conferences, webinars, text messaging, text pagers, websites, blogs, and social networking sites all entered our culture within the past 20 years. The use of these technologies is pervasive and increasing. Professionalism, as one of the core competencies established by the Accreditation Council of Graduate Medical Education (ACGME), has been the subject of much discussion in the last several years. The American Board of Internal Medicine developed a charter for medical professionalism in the new millennium that articulated fundamental principles and a set of professional responsibilities. 2 The American Board of Pediatrics, in conjunction with the Association of Pediatric Program Directors, developed a guidebook for teaching and assessing professionalism in pediatric residency that set forth specific examples of exemplary behavior, lapses in professionalism, and behaviors that warrant immediate attention. 3 Although much has been written and discussed about this subject recently, it is notable that the subject of professionalism in electronic communication, e-Professionalism, has not been addressed. Examples of lapses in professionalism in the electronic realm are just beginning to be appreciated. Personal cellular phones may be used for professional communication, which challenges the boundaries of patient confidentiality and may lead to blurred hierarchical roles between faculty and learners in education and clinical care. Physicians posting on online social networking sites must be reminded that their professionalism may be judged by such content. For example, photographs, social group affiliations, and personal information that are not generally shared in the doctor-patient relationship may be inadvertently revealed to patients via postings on social networking sites. In 2008, Thompson et al 4 at the University of Florida studied Facebook pages of medical students and residents and found that 46.3% of medical students and 12.8% of residents had accounts. A majority of the accounts were not private and, in some cases, there was inappropriate or unprofessional content posted. At a recent meeting of pediatric program directors, Matz et al 5 facilitated a workshop on e-Professionalism and began to illuminate this developing issue. At this workshop, the 3 that characterize electronic professionalism were coined: electronic communication is Public, Permanent, and Powerful.