Should doctors separate their personal and professional identities?

Most social media guidelines for physicians, most recently from the American College of Physicians and Federation of State Medical Boards, suggest that doctors separate their personal and professional identity.

Until physicians are better educated on how best to act professionally on social networks, keeping their online personal lives private is more likely to keep them out of trouble.

But is it time for that recommendation to be revised?

In a recent JAMA perspective piece, bioethicists from Johns Hopkins argue against separating physician personal and professional identities:

We contend that this is operationally impossible, lacking in agreement among active physician social media users, inconsistent with the concept of professional identity, and potentially harmful to physicians and patients. A simpler approach that avoids these pitfalls asks physicians not whether potential social media content is personal or professional but whether it is appropriate for a public space.

Instead, they argue that physicians are held to a higher standard of behavior than the public, and shouldn’t frame social media as personal versus professional. Instead they should ask themselves before posting on a social media site, “Is this appropriate for a physician in a public space?”

“Is this appropriate” is a question doctors should ask themselves before posting anything on a social media site. And while this model works well for public social media spaces like Twitter or Google+, I wonder about Facebook.

Without separating identities, how do the JAMA authors suggest handling Facebook friend requests from patients?

35% of physicians receive friend requests from patients.  Every physician social media guideline I’ve read says to reject them.

Facebook too easily blurs that line between one’s personal and professional life.  My personal Facebook profile doesn’t cross any professional boundaries, and would be appropriate in a public space.  But I wouldn’t be comfortable sharing those updates, which can include vacation pictures or stories of my kids, with patients.  That’s one reason why my Facebook profile is closed to both the public and my patients.

Yet Facebook has tremendous potential as a platform for patient education.  But unless physicians friend patients, they can only do so with a Facebook page.  In other words, a separate, professional identity.

(And yes, I’m aware that Facebook and Google+ allows you to group friends onto lists and circles respectively, where you can control the stream of information you broadcast to. But isn’t that just another way of separating your identity?)

Here’s my bottom line, which is more nuanced than both the JAMA perspective piece and current social media physician guidelines.

On public social networks like Twitter or Google+, separating identities isn’t often feasible. I have a single persona on these platforms, where as a physician, I accept the expectation of being held to a higher public standard of behavior.

However, the personal nature of Facebook presents a greater professionalism risk for doctors. I continue to recommend that if physicians want to use that platform to educate patients, they do so with a page separate from their personal profile.

Should doctors separate their personal and professional identities?Kevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • suzanne spina

    very interesting.

  • Suzi Q 38

    Who cares.

  • querywoman

    Facebook is one area where a poster must be very careful. You an request that only your friends see your posts, but the privacy protections are constantly broken and lax.
    Very risky!
    Anonymity on the net is quite liberating. I feel very free to post about issues with my family under pseudonyms.

  • openyourmind

    “Instead, they argue that physicians are held to a higher standard of behavior than the public…”
    Really? Who gives a crap? What is this with all the higher standards stuff? Standards should be the same for every human being. Stop acting like physicians are so special – the majority of them are grateful for their path and their place. The ones that think “I am a physician and I am special” are basically useless.

    • rtpinfla

      I agree with your comment about all the “higher standard ” stuff. I wish it were actually the way life was. Unfortunately, certain professions; teachers, police, firefighters, and doctors do seem to come under extra scrutiny when certain online posts -be it pictures, comments, or whatever.
      I certainly don’t feel I’m particularly special as a physician, but I am aware that if I post something online that is taken out of context and picks up interest it could hurt my reputation. Therefore I am a little more careful not to put up a picture of me drinking from a beer bong in a speedo at the lake. Stuff like this has resulted in terminations before.

      • Suzi Q 38

        You are so right.
        Sometimes, my husband sends me stuff on the internet that is not PC. I remind him that he should not send it to others……

  • querywoman

    I taught children’s Sunday school once with a medical doctor who couldn’t shut up about being a doctor. His father was a doctor, and his mother a nurse.
    The children would tease him, “Will you press on my stomach?”
    I reminded him that he was not at work.
    I did not want knowing much about my own health problems, though I think he intuited some things.

  • http://briarcroft.wordpress.com/ Emily Gibson

    I agree there should exist a higher standard for a physician’s life choices which informs their credibility and integrity as a care provider and educator.

    I choose to blend my personal and professional life experiences in my blog writing, because I identify as so much more than a physician. If I was still raising young children at home, I would not choose such transparency in order to protect their privacy.

    Facebook allows different levels of revealing oneself — too many people routinely provide too much information. Although I don’t “friend” patients who ask, I do keep my professional image in mind any time I post, share or comment on anything. How I live my life and interact with my friends and family does impact who I am as a healer. I think the public scrutiny provides accountability and being accountable for one’s statements and actions is always a beneficial thing.

  • Kara

    Using Facebook for patient education could prove to be a huge liability for physicians. Some physicians want to use electronic communication methods without any thought to potential liability. JAMA is right, physicians should be held to a higher standard of behavior due to the liability associated with their occupation — not because they are superior human beings. When general social media site users post misinformation or have their accounts breached, most cannot be held legally responsible. They also are not in jeopardy of losing hard-earned medical degrees or cited for misconduct. Is social media worth the risk?

  • guest

    Difficult to do when you practice in a very small town. Your friends are also your patients when you’re the only full time provider In a town. You kids go to school with their kids. Everyone just knows my facebook is for personal stuff and if they approach me on facebook about medicine, then I gently direct them to call my office in the morning.

  • Jay Berger

    Good morning:

    The flyer below and attached is our invitation to the
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    We have worked with the Ventura County Medical Center to get
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    Please feel free to pass this on to others servicing the
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    Loose drugs being consumed by our teens is too important a
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    6 p.m., Wednesday, September 11 in the conference room of
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    Reservations are required to earn the CME.

    Feel free to contact me if you need more information about
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    Jay Berger, CAS
    805-485-2865

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