Should doctors friend their patients on Facebook?

As more physicians are on social networking sites. that’s an issue that some are grappling with.

The NEJM has a nice perspective piece on the issue. After realizing that a recent friend request came from a former patient, Sachin Jain thinks about the ramifications.

Dr. Jain writes that, “In confirming this patient as my “friend” on Facebook, I was merging my professional and personal lives. From my Facebook page, Ms. Baxter could identify and reach anyone in my network of friends, view an extensive collection of personal photographs, read my personal blog, and review notations that others had left on my “wall.” The anxiety I felt about crossing boundaries is an old problem in clinical medicine, but it has taken a different shape as it has migrated to this new medium.”

More concerning, some doctors have information that may conflict with their professional appearance on Facebook, including, “the medical attending whose clinical judgment is questioned because of photographs posted online, showing him in progressive stages of apparent inebriation at a department holiday party.”  That’s just unwise.

The bottom line is that doctors have to beware of what they write on social networking sites, and who they share it with. With Facebook specifically, it may be reasonable to have two separate profiles, one to share pictures and other personal information with friends and family, and another page (for instance, like the Fan page of this blog) that can be dedicated to professional use.

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  • Doctor D

    Even though I never told any patients about it I just figured patients would eventually read everything I put on social networking sites. Which is good, because patients don’t like it when you decline a friend request. I eventually had to accept several requests to avoid offending patients I really liked. I was able to draw the line and firmly say I won’t be online “friends” with any minors.

  • Mehmet Karaca

    Absolutely no!

  • Helen

    Absolutely not!

    I find it a bit bizarre that patients would want to be “friends” with their physicians. I value my relationships with my doctors a great deal, and most of them are very friendly relationships – but they’re still professional relationships. That said, I don’t need to know what they get up to on a Saturday night, nor do they need to know that about me.

  • Kaitlin

    This question came to my attention a few months ago when one of my health care practitioners requested to “friend” me on Facebook. Just as it’s odd for a practitioner to be asked this by a patient, it’s equally weird for the request to come from the practitioner to the patient. The lines seem to become more blurred with each new social site that arises.

    What disconcerts me more, perhaps, is the fact that such issues are not discussed in medical school. I still wonder about the implications of my classmates posting pictures from events like “no pants parties” from medical school on their sites. Unfortunately, however, no one addresses these issues with students. By the time they become practitioners, it may be too late to undo the damage caused by such posts.

    I wish that the professional organizations would address this issue in their “codes of conduct” and provide clear guidelines.

  • Jay Parkinson

    As of many months ago, Facebook allows users to create “lists” and assign privacy rules to each list. For example, 16 year old kids can put their parents in their “parent” list and then their parents only see whatever the kid wants their parents to see. It’s not hard to do. I have a list for my medical friends and a list for my personal friends and each have their own privacy settings.
    Facebook is simply a social grid that can be used how you want to use it. It can simply be a glorified address book or it can be the collection of photos, ideas, and communications that represent you as a person.
    I, for one, believe that it’s good for a doctor to use their Facebook profile as a marketing tool. Facebook makes it so easy to share. And since people find doctors through word of mouth recommendations, I would think doctors should want their patients to go home and share their doctor’s profile with their 500 friends saying “I just saw the best doctor ever!”
    And of course, when you use Facebook correctly, all of those patient’s friends see only what you want to show professionally.

  • Jen

    To your point Helen that you “don’t need to know what they get up to on a Saturday night” – I completely agree. But my question is, if you did know, would that change your impression of that doctor?

    I know that for me, it wouldn’t. I mean, sure if your doctor has pictures of a kegger in the hospital/clinic then maybe I might change my mind. But c’mon, that’s not happening. And if I find out that my physician has a life outside of the clinic, more power to her. I mean, who are we kidding? Doctors or not, we all need to kick back and have a good time with friends/family from time to time.

    IMO, if my doctor isn’t on-call, she has every right to do whatever she wants on a Saturday night – just like me. Whether or not I know what that is, she’s still the same physician come Monday.

  • Kevin

    I have both a fan page and a personal page. I am VERY careful about what is written and what pics end up online. So I vote that you should friend your patients. Patients want to go to people they like and know.

  • Cospo

    Well, I’m a baby boomer from way back when doctors made housecalls, ate supper with you, went to the same church, etc. We were nearly always associating not only as patients but as friends outside the office. This never caused any problem. When I became a nurse, of course, we associated socially with other members of the healthcare team, incl. physicians. Seeing doctors in the clinical environment and then seeing them when they let their hair down never seemed to make a dent in our opinions of one another. Of course, this may only be in the very friendly South. I, personally, prefer to have this dual relationship with my own doctors. I feel much more at ease with them in either situation. I realize this isn’t always feasible since some folks don’t care for this sort of thing.

  • Melben

    No way!! Absolutely not! There is a difference between a patient and a friend. I prefer seeing my doctor in person when I need to, instead of conversing with him on face book..

  • stargirl65

    I think doctor D needs to tell those patients NO. He could set up a different website for patients. The exception would be patients that are truly your friends. These are the people you regularly socialize with anyway. They have probably already seen you drunk and probably gotten drunk with you! Otherwise it is important to separate work and personal.

  • Whitny

    Oh no! I’m so confused! How ever do I distinguish between that which is personal and that which is professional? I mean, I’m totally like a professional. See my professional white coat? But I’m also, like, a person. You know? I have… all these…. feelings. And it’s so difficult to navigate the world of social networking websites! Just because I have this MD behind my name doesn’t mean I know how to manage my online persona any better than Joe the Plumber (NOT a FB friend, BTW)! I’m a human being, like the rest of you all. Except when I’m at work. Then I’m more of a white collar diety. The social landscape is very scary for us professionals in today’s modern era. The agony! The uncertainty! Technically speaking, I could eliminate this entire dilemma by deleting my Facebook account, but… no, no. I simply can’t fathom a world without Facebook–Goddammit, man, I’m HUMAN, after all. And now Facebook will revolutionized the way we practice medicine, so we must tread uncertainly into a dangerous new future in which we may be viewed as both a doctor AND a friend by some of our clients. I simply can’t….does not compute…. (head explodes).

    “No minors.” -DoctorD

  • Whitny

    ahem. deity. it sucks when you’re trying to mock someone but then you spell something wrong.

  • Nuclear Fire

    No, but for a different reason. I need a break from work. I really don’t want to be thinking about patients at home.

  • David Cohen

    This is a major concern for all professionals, and should be considered carefully. Social media like Facebook is a great way for doctors to keep their patients up to date on what’s going on with their practice, but it can be abused in many, many ways. Sometimes it’s best to keep a public, professional profile and restrict your relationship with your clientele to the office.

  • Bernice Remage

    I have to agree in the need to separate clearly your personal and professional relationships with your patients. Physicians are entitled to a personal life that isn’t well known to their patient list, and opening the doors to your personal Facebook account is going to shut down any opportunity of being able to use that social media to share time with the friends you have outside of work. A good rule of thumb: If you have to censor your Facebook posts because you don’t want to give the wrong impression, that person probably doesn’t belong on your friends list.

  • Jack Chary

    Social media is meant to be exactly that-social. Its use professionally is, I think, sometimes suspect anyway. When you have to censor your content because you’re afraid of what your patients will think it’s time to censor your friends list instead.

  • SocialNets101

    By Facebook’s EULA you are NOT allowed to maintain 2 profiles, so they are free to shut one or the other down or both.

    It will be fun to see when residents complaining about staff become attendings and forget to delete old posts.

    Oh, and the insurance disputes showing the attending was playing golf and billing for being at the OR at the same time.

    Its disconcerting hospitals are not prescriptive about this.

    off-topic: An obvious avenue of research i dont see being done is to combine EMR records with queries to facebook, twitter, linkedin and the likes, and get group behavior correlations (e.g. drinking problems, abusive behavior, life habits…). Of course insurance can capitalize on it really easily.: “Add your med insurance ‘ app’ or ‘robot’ as a friend in facebook and qualify for 5% discount next month”
    Or legal agencies looking at malpraxis risk probabilities based on network behavior.

  • Nuclear Fire

    @ SocialNets101: Hospitals are not the bosses of independent physicians. They have no right limiting physicians social networking activities that aren’t done in hospital property. Trying to be “prescriptive” about that would lose business and support from the medical staff.

  • Dr Bikash

    This definitely is a problem. But more so for student doctors like me who are at the cross road of being a student as well as a blogger. I for instance now have very little existence as a blogger or as a doctor(undergoing internship). But I am active in social networks like Orkut.
    Friends and relatives are one thing, but in the professional life I am definitely going to meet many new people. As people in India are jumping on to social networking so many of my future patients will be in Orkut, Facebook or Myspace.
    It will then be embarrasing to have your personal life, fun and pictures shared.
    The only solution apart from having a separate profile page for personal and professional page is to restrict people viewing your personal information, images, scraps etc. All of these sites have those options . One needs to find them out only.

  • Beth

    How about simply adding your patients as “friends” but only giving them access to limited information in your profile? You can prohibit them from seeing notes, photos, blogs, etc very easily, eliminating the need to create two profiles.

  • AnonymousQuestion

    So I’ve been reading this thread discussion and now I have a question for everyone here: I’m in my mid twenties, have a new dentist that’s around my age (who is cute and single) and I stumbled on his Facebook profile.. should I request him as a friend, or would that be awkward?

  • Nuclear Fire

    Fire him as your dentist. Have your records transfered to another dentist. Ask him out.

  • rhon91

    Im a nurse and connected with many co-workers and a few of my favorite docs on FB. My neurologist and GI doc are also my FB friends. I dont have an issue with it because I dont put anything out there incredibly personal. I utilize it for political interests mainly and the incidental day to day issues. I am who I am whether with friends or my doctors that just happen to also treat me. I understand where the boundaries are.

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