Facebook friends with patients can violate HIPAA privacy laws

Should you friend your doctor on Facebook?

It’s a question that’s gaining increasing relevance as Facebook increases its social networking dominance.

I’ve touched upon the issue in the past. So has the New England Journal of Medicine.

Washington, DC physician Katherine Chretian gives her take on the issue in a recent USA Today op-ed. She is an expert of the Facebook-medicine intersection, having authored a JAMA study on the issue.

She says, no, doctors should not be friending their patients:

Having a so-called dual relationship with a patient — that is, a financial, social or professional relationship in addition to the therapeutic relationship — can lead to serious ethical issues and potentially impair professional judgment. We need professional boundaries to do our job well.

Furthermore, there’s the little matter of patient privacy and HIPAA. I wasn’t aware of this, but simply becoming Facebook friends with patients can infringe upon uncertain ground:

Much more serious are the potential threats to patient privacy that can occur when patients and physicians are communicating on a public platform such as Facebook.

Violations of the Health Insurance Portability and Accountability Act, the law that protects against unauthorized disclosure of identifying health information, can result in fines up to $250,000 and/or imprisonment, besides being an ethical breach. The mere existence of a patient-physician relationship (e.g. having others suspect a Facebook friend is a patient) could be a violation of HIPAA.

Facebook pages, which many doctors and practices have — KevinMD.com is no exception — are the best way to interact with patients. Separate your personal and professional entities on Facebook.

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  • http://www.drmintz.com Matthew Mintz

    I agree that there are important barriers regarding privacy and boundaries, but that these hurdles can be overcome with a few simple precautions. Since social media has such great potential to improve the doctor patient relationship, I don’t think we should be so dogmatic about saying “no” to Facebook. See my detailed response to Dr. Chretian’s outstanding USA column at
    Should You Friend Your Doctor

  • Alice

    This sounds more like a personal preference from a physician who wants the law interpreted in a way that will give her boundaries she may feel she needs. Boundaries are understandable, but the last thing patients want is a moat around their relationship with their doctor. Many patients have a deep, profound longing to know their doctor cares and that they have a face, and that they are not just a clinic number. Can’t doctors have two Facebook pages? One for anyone, and one for their personal family members and friends?

    The hospital our doctor practices at published a really cute picture of his family and I told him how precious that was to see them. I am not Facebook friends with any of our physicians, but the more they share about their personal lives the more we trust them. Of course, this can backfire, but I tend to think bad cases don’t make good law. Although, I did read some humorous questions people ask doctors about on Facebook……..this article seemed to imply that doctors may want to go and live in caves lest the neighbors break a HIPPA law by getting to know them too personally and breaking some self-imposed ethical boundaries.

  • stargirl65

    I live in a small town. Many of my patients are my friends. They were my friends before they were my patients often. If I were to choose not to socialize with my patients then basically I would never socialize. I cannot recall a social event I attended in the last year where one of my patients was not present.

    That being said, my facebook page is for social interests only. If a friend were to ask for anything medical on my facebook they would be instructed that the page is only social interactions and medical information should be directed to my office. This has not been a problem yet.

  • http://www.dr-bob.org/babble/ dr. bob

    1. patients can be informed of the risk that others might suspect they’re patients and decide for themselves whether to accept it or not, see, for example:

    http://www.dr-bob.org/facebook/friends.html

    2. i recommend separate personal and professional profiles, too, but there’s still the above risk with professional ones.

  • enterneeko

    Dr. Chretian says in her JAMA article, “The mere existence of a patient-physician relationship (e.g. having others suspect a Facebook friend is a patient) could be a violation of HIPAA.”

    Really? I’m curious to know exactly how and where?

    • Carmen

      I agree with the comment from “enterneeko” that the doctor is making unfounded assumptions about followers on FB. I can follow someone for any number of reasons unrelated to their profession. To assume a patient-doctor relationship only from following behavior is absurd. If there is open medical solicitation or reference to the professional practice of the doctor by the follower, then you have a reason to suspect something, but not otherwise. Besides, the doctor can make it clear that under no circumstances will diagnosis or treatment activity be conducted online. The doctor has the burden of establishing rules and boundaries. Any person can openly share their PHI—that’s every person’s right. But a doctor should not get in the practice of encouraging PHI sharing by a person online as it would raise HIPPA violations. That’s why a doctor should make clear what is acceptable online chatter (general medical news and tips) versus what is not (direct medical diagnosis and treatment).

  • doctormom

    I agree with stargirl65. I live in a town of 1,500 people. I would have no life other than work if I was not friends with my patients. Maybe there can be distinct fences around personal and professional lives in a big city. Not here. I have had no issues with the intermixing. I can’t go to the grocery store (like a quick trip to the store on the weekend with garden dirt smeared everywhere) without seeing people I treat in the clinic. You have to become skilled at being friendly and directing their medical questions to the clinic and not on facebook or the store. It works.

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