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What would Hippocrates say?

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Has the Hippocratic oath lost its relevance? A few days ago, a medical doctor shot and killed three persons at a graduation. Yesterday, a media personality referred to breaking the Hippocratic oath in a tweet, declaring that her doctor had unfriended her on social media due to a difference in political views. She apparently needed a consult for some symptoms.

A modern version of the Hippocratic oath written by Louis Lasagna in 1964 can be found here. One need not even refer to the Hippocratic oath to condemn the killing perpetrated by a doctor. Thou shall not kill is after all one of the ten commandments in the Bible. But perhaps the reference to social media and how it has altered the relationship between physician and patient warrants further discussion at the #HealthXPH tweet chat (30 July, 9 pm Manila).

India and Radhika (2019) question the relevance of the oath in today’s world, pointing out that the oath harks back to a time when there was only a tripartite of the patient, the physician and the illness. And now we have Google.

Due to the advent of Google and the availability of medical research articles in the public forum on the Internet, the patient has become a voracious consumer of medical data. Patients consult doctors with semi-literate opinions regarding diagnosis and treatment options. The physician has to act accordingly, keeping not only beneficence in mind but also patient autonomy or risk of suffering legal consequences.

Indla, V., & Radhika, M. S. (2019). Hippocratic oath: Losing relevance in today’s world?. Indian journal of psychiatry, 61(Suppl 4), S773–S775.

And we also have social media! In 2014, I moderated a #HealthXPH tweet chat on the use of SMS between patients and physicians. I asked, do you give your mobile number to patients when they ask for it? Why or why not? But even earlier in 2011, I also wrote a blog post, What Doctors can Do When Patients Friend them on Facebook. That blog post referenced the American Medical Association social media policy.

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

Michelle Leiker advises the following –

Keep your personal and your professional content separate. For example, a physician could create a personal Facebook page for friends and family and a separate page where patients, colleagues and others can “like” and follow the physician’s professional postings. The physician could then refer friend requests from patients and others they have a professional relationship with to the professional page.

Leiker M. (2011). When to ‘friend’ a patient: social media tips for health care professionals. WMJ : official publication of the State Medical Society of Wisconsin, 110(1), 42–43.

A policy statement from the American College of Physicians and the Federation of State Medical Boards cautions physicians against the practice of “friending” patients on social media –

Physicians should not “friend” or contact patients through personal social media. Physicians should familiarize themselves with the privacy settings and terms of agreements for social media platforms to which they subscribe, and they should maintain strict privacy settings on personal accounts.

Farnan, J. M., Snyder Sulmasy, L., Worster, B. K., Chaudhry, H. J., Rhyne, J. A., Arora, V. M., American College of Physicians Ethics, Professionalism and Human Rights Committee, American College of Physicians Council of Associates, & Federation of State Medical Boards Special Committee on Ethics and Professionalism* (2013). Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards. Annals of internal medicine, 158(8), 620–627.

What do most doctors do now?

T1. Do you accept friend requests from patients on Facebook? Why or why not?

A part of that controversial tweet on breaking the Hippocratic oath referred to a physician’s difference in political views. Last October 2021, I moderated a #HealthXPH tweet chat where I asked, Should Healthcare Professionals Talk about Politics? In the blog post, I referenced the American Medical Association Code of Medical Ethics, which said –

Physicians must not allow differences with the patient or family about political matters to interfere with the delivery of professional care.

Taking off from that statement, even if the patient and physician were still Facebook friends despite their political differences, the delivery of professional care i.e. telemedicine, should still not be on a social media platform. Patients should be informed on how to contact their physicians if they wish to consult.

T2. As a doctor, do you accept patient communication via SMS, Viber, Facebook messenger? How do you establish boundaries? As a patient, what are your expectations when communicating with your physician online?

The Oct 2021 #HealthXPH tweet chat was before the Philippine presidential elections. I will ask one question I asked then. Perhaps, the answers may have changed?

T3. Can healthcare professionals talk about politics online? Are there limits?

See you at the #HealthXPH tweet chat!

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