In a previous post, I talked about whether doctors can be “friends” with patients on Facebook. I had said then that No, that would be inappropriate. But what can be done then? Should we just ignore friend requests from patients?

Shortly after I posted a link to my previous post about this topic on yes, a Facebook page, the group page of the Philippine Medical Informatics Society, Dr. Paul Fontelo of the National Library of Medicine kindly posted links to three articles that provided some information about this topic. The first was the American Medical Association social media policy that I had mentioned in that post, but the second and third links were documents that I’d not seen before.

1. Leiker M. When to ‘friend’ a patient: Social media tips for healthcare professionals. WMJ Feb 2011;42-43. She is the Associate General Counsel for the Wisconsin Medical Society.
2. Memorandum from the Ohio State Medical Association, 2010. Social Networking and the Medical Practice: Guidelines for Physicians, Office Staff and Patients.

Using these two articles, I’ll attempt to answer what we can do when patients attempt to “friend” us doctors on Facebook.

If you wish to take advantage of the benefits of social media, create a personal page and a secondary page that represents your practice, allowing patients to become fans only of the latter (Berkman, Massachusetts Medical Law Report, Social Networking for Physicians, 2009). Keep your personal social networking pages personal.

This is in consonance with what the AMA policy also suggests. This implies that the doctor maintains an awareness of what she can post on her personal page vs the professional page. Leiker also gives the same advice. Furthermore, she says:

If you accept patients as friends on your personal Facebook page you should take extra precautions such as: (1) not posting anything too intimate, contentious, or that could be viewed as disrespectful of patients; (2) advising patients that the confidentiality of the existence of a patient-physician relationship between them may be compromised once they are identified as a “friend,” and (3) limit the ability of “friends” to post to your wall or account.

Finally, Leiker asks that doctors be very cautious in their interactions with patients on social networks.

A physician’s “friend” on Facebook asks a health-related question, and the physician responds with a form of advisory answer.

Caution: This seems like just a physician being helpful. He is offering the same type of response one might offer a family friend one runs into at the grocery store. It might be the same question and the same response.

Warning: The physician most likely has created an electronic record of an exchange that could be construed as a physician-patient relationship.

What does this mean: All the risks associated with physician-patient relationships might apply, such as malpractice, patient abandonment and HIPAA.

I still think that simply not accepting patients as “friends” on Facebook is better and easier. I’d rather not put up a Facebook fan page at this point – but then I don’t get that many patient friend requests anyway. And while I do care deeply for my patients, to keep my life-work balance, I try to leave patient concerns at the door when I leave the clinic. Since I only go online after work, putting up a fan page will be like bringing work home.

Photo credit: http://www.flickr.com/photos/birgerking/5600215736/

This is updated from a post in my old blog dated 10/05/10.

Last week, a patient surprised me by saying, “Doc, ang ganda mo pala sa Facebook!” Translated: Doctor, you look pretty in Facebook! Though she said it as a compliment, I felt uncomfortable on two counts. First, did she mean that I wasn’t pretty in person? Ah, vanity! Second, and more importantly, why was she looking me up in Facebook? She must have sensed my discomfort and didn’t say anything further. I was afraid she might ask me directly if we could be Facebook friends. Thankfully, she didn’t! Because I would have said No.

A few months back, I got a PM on Facebook from someone saying she was the daughter of my patient. She was asking me something about the patient’s case. I decided to ignore the message, for two reasons. First, I could not confirm her identity and second, I did not think it wise to discuss such matters on Facebook. Apparently, I’m not the only doctor who has had such encounters.  And I cannot agree more with SH Jain who said in Practicing Medicine in the Age of Facebook (N Engl J Med 2009;361:649-651)

“By creating a new environment for individual and group interaction, social-networking sites also create new challenges for those who work in clinical settings.”

In my post on social media policy, I mentioned the best practices outlined in the social media guidelines of the Mount Sinai School of Medicine. In this same guideline, a few examples of fictional cases are given, the first of which is exactly this situation – a patient attempts to friend a doctor on Facebook. Best practice 3 refers to protecting patient privacy.

A patient attempts to “friend” an attending physician on Facebook.  This is almost always inappropriate, unless the doctor-patient relationship has ended.  Even after the doctor-patient relationship has ended, it would be inappropriate to discuss health-related information. (Best Practice 3)

Finally, let me quote from the American Medical Association Policy: Professionalism in the Use of Social Media.

If they interact with patients on the Internet, physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context.

 

That being said, I would prefer not to be Facebook friends with my patients. Not everyone will agree. In the end, it is a personal decision.

Photo by birgerking http://www.flickr.com/photos/birgerking/5600215736/ Accessed 26 Oct 2011

I was very surprised to see that the cover photo on my Flipboard Facebook page this morning was that of someone’s patient at the Emergency Room. When I saw the picture, I did shoot off a quick comment, “A gentle reminder, posting a patient’s picture without his consent is unethical.” Thankfully, the person messaged me in a few minutes and took down the picture.

I’d rather not describe the photo or why it was posted. That is not the topic for discussion. What I’d like to talk about is what happens when you report an offensive photo on Facebook. I’d contemplated doing that this morning! When you click on “Report this photo,” a pop-up window appears and it asks

1. Yes, this photo is about me or a friend

• I don’t like this photo of me
• It’s harassing me
• It’s harassing a friend.

2. No, this photo is about something else

• Spam or scam
• Nudity or pornography
• Graphic violence
• Hate speech or symbol
• Illegal drug use
• My friend’s account might be compromised or hacked

3. Is this your intellectual property?

Not one seemed to fit what I needed to say, that the picture violated patient confidentiality. I decided to just comment directly. I did not know what would happen  when a picture is reported and I was afraid it might take too long. Thank goodness, the picture was taken down soon after and I didn’t have to report it!

So what happens when you report a photo? This is what it says in the Facebook FAQ:

We will make every effort to review your report as quickly as we can. So long as everything appears to be in order, we will promptly remove or disable access to the content. We will also notify the user and, if requested, provide your report to the user. We will terminate repeat infringers when appropriate.

Hmm, I wonder how long that will take?

The Facebook Help Center FAQ further says

Reporting a profile (timeline), group, page, or any other content doesn’t guarantee that they or it will be removed. The Facebook community is extremely diverse. It’s possible that something could be disagreeable or disturbing to you without meeting the criteria for removal. That’s why we offer personal controls, such as the ability to quietly cut ties with or hide people, pages, and applications that offend you. Content that does violate the Facebook Terms may be removed from Facebook and (in some cases) subject to legal or other action. The person reported is not notified of the identity of the person who made the report.

I had also messaged a friend about this disturbing picture and opined that the posting of the picture pointed to a lack of sensitivity, a certain degree of callousness.  To which my friend had replied that this was not necessarily true. It is just that people have become so used to Facebook! Apparently, some people (okay, okay, the younger generation … I’m getting old ) find it as easy as breathing to post minutiae about their lives. So the picture was just that – a documentation of an event in someone’s life. Maybe, maybe not!