The repercussions of declining Facebook friend requests from patients

At the end of a long day at my medical practice, I am sitting at my computer catching up with friends via Facebook. Suddenly, a notification pops up: one of the patients I saw today has sent me a friend request. I know that the ACP, AMA and every other physician organization recommends strongly that doctors not connect with patients via social media, so I quickly click to decline the invitation.

I spend the rest of the evening imagining the awkward conversation when the patient next comes to see me, where I have to explain why I had to decline the request. I know that digital communication with patients can lead to blurring of personal and professional boundaries, miscommunications and confidentiality breaches. But I wonder whether the dangers really outweigh the benefits.

I have limited time available to see each patient in the office and an out-of-office communication channel such as Facebook could allow me to be more accessible to patients. I would be available to answer non-urgent questions in my free time and I could also take advantage of my social networks to send out public health announcements and advocate for important health causes.

But what of that blurring of personal and professional? This is a question that goes far beyond the issue of social media. Doctors are constantly faced with the dilemma of how much to share of their own personal lives. Can empathy help a patient suffering from an ailment the doctor has experienced himself? Can a personal story make the patient feel closer to the physician and instill confidence in her?

Numerous studies show that a positive relationship with the doctor promotes confidence, encourages compliance with treatment, and aids healing. I have occasionally shared a personal anecdote when it seemed to be in the patient’s best interests. My personal problems are of course not the concern of the patients, and they need to feel that I am giving them 100% of my energy. But on the other hand, I don’t want to be one dimensional and inaccessible. A small amount of sharing can go a long way in sending a patient home with a spring in his step and the hope that he will be healed.

Miscommunications can happen through social media, but they can happen in short office visits as well. Social networking is not a short-lived trend; a whole generation has grown up communicating in a digital format. Patients are coming to see the doctor after they have Googled their symptoms and compiled a list of possible diagnoses. This being the case, a social network where the doctor can respond and explain has distinct advantages over the anonymous and often inaccurate information available on the Internet. Digital communication is obviously not a substitute for in-person medical exams, but can serve as a helpful supplement.

Confidentiality breaches are a real issue but can be solved with strict guidelines regarding which types of content are appropriate for digital sharing and using technology to ensure safe communication.

I think the strongest argument for the use of social media for patient-doctor communication is the sheer number of Facebook requests I have declined over the last few years. Patients are reaching out to doctors, wanting to have a direct line of communication without feeling they are intruding on their personal time with a phone call. They are telling us with each friend request that they want a glimpse into the real person behind the white coat. They are saying that they want to be more proactive and involved in their own care, letting their doctors know about their progress in between clinic visits. What kind of message does it send to our patients when they reach out and we take a step backwards?

Nathalie Majorek is co-founder, MDCapsule and can be reached on Twitter and LinkedIn.

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  • guest

    I may be in the minority here, but I do not believe that it is in a patient’s best interest to be Facebook friends with his or her doctor. A Facebook relationship is not the same as a professional relationship, and I can think of no particular reason that the personal information about me and my family that would be available to a patient through Facebook would be of any benefit to their treatment by me. Furthermore, although I am sure that the personal information about a patient that I could derive from studying their Facebook interactions would in fact be helpful to me in treating them, the time involved in gathering such information through Facebook is infinitely expandable, as anyone who has spent time on Facebook should know. We need to ask ourselves: “At what point is it OK for us to stop working and have a personal life that does not include our patients?”

    It is true that patients are hungry for more personal relationships with their physicians. However, our current healthcare system is not set up to accommodate that wish, and to me it seems that substituting a Facebook “relationship” for the quality time with their doctor that a patient really needs, is yet another example of the way that we are all being pushed to provide a hollow semblance of “care” to our patients.

    • Deceased MD

      I think you hit the proverbial nail on the head that the writer is not quite understanding. The wish to be FB friends with a doctor is not finding a friend. After all it is your doctor. THe wish is most likely related to not getting what they need from the relationship with their doctor. At the same time, whether the doctor is aware or not, the doctor’s guilt of refusing FB friends is more likely related to feeling unable to meet those needs in the current HC system.

  • Noni

    Yep, that is awkward. Invariably though once you start accepting patients as FB friends you’ll get a message from someone asking for a prescription without coming to see you. Can you make your profile hidden from searching?

  • Kristy Sokoloski

    And what is wrong with having both a personal relationship and a professional relationship with their physician if they are both comfortable with it? I am sure that there are some that would like to have both. Now I have a different question that could kind of touch on this to some level. What is your thought about having a patient come work as an employee for your clinic? The reason I ask this is because a clinic where I did my externship for Medical Assisting school the employees of the doctors in the clinic were also patients. I am a bit bothered by this myself, and I have had a couple of people suggest considering working for one of my own doctors. I won’t do it due to conflict of interest, but even if it was ok to do it would be very awkward for me.

    • Miriam Nockenofsky

      i cant speak from a dr’s point of view bec i am not one, but i dont think it should be a problem. i was a nurse and worked in my ob/gyn’s office and was her patient, you have to know boundaries and privacy laws and all will be fine, i guess you can ask the other patients if they would mind but it shouldnt be an issue

      • Kristy Sokoloski

        Miriam,
        Interesting answer. Thanks so much for sharing.

      • buzzkillerjsmith

        Docs are way, way different from nurses as we have ultimate responsibility. Nurses have more leave to be friends. When something bad, really bad, happens, nurses can tell the pt to ask the doctor.

        • Suzi Q 38

          I would have to agree.
          I enjoyed a friendship of sorts with my nurse.
          I would not have enjoyed a friendship with my doctor in the same manner.
          She said that I inspired her to become a nurse practitioner and she enrolled her self and a program at the local university.

          For whatever reason I could sense that she felt in adequate to her peers who were nurse practitioners.

          I simply told her that if she wanted to she could be a nurse practitioner too.

          • buzzkillerjsmith

            NPs are great folks and we have three in our group and I’m glad to have them. Soon they realize they are in loco doctoris and act so, as well they should.

  • Claire

    What?!?!? Facebook friend your DOCTOR?? Oh good grief. In the spirit of the season, let me express my unequivocal thanks that all of our family’s doctors are old school fuddy duddies whose offices greatest technological intervention is their answering service. If I need one of them, I call on the phone. A human answers. If it’s complicated, a nurse calls me back. If she thinks it’s complicated, I am seen that day or the next day. I go to the office, he sees me and writes it down with a pen on my “chart”. The nurse calls me a day or two later on my [gasp] land line and we talk, person to person. Been doing it for years, never had a problem.

    • Yosef Hershkop

      Claire. I don’t think the author is suggesting that we communicated strictly through Social Media. The type medical care that your receiving sounds amazing, that said sadly most Americans aren’t receiving that kind of care. And sometimes sending a Facebook message sounds more appealing then a 25 min phone hold. hence the need to discuse social media rules.

      • Claire

        I see your point, and maybe I am an old fuddy duddy too. I guess I don’t really know how lucky I am when you call that kind of care “amazing”. It makes me sad to think that good old fashioned medicine is now “amazing”. I wish everyone could have it too. I just can’t even begin to imagine Friending a doctor on Facebook. I guess to me it just seems unprofessional, not that I think we should return to paternalistic medicine. Again, maybe I am an old fuddy duddy, but to me Facebook is for socializing and younger people. I just can’t imagine Friending my kids’ pediatrician who is old enough to have been my pediatrician, [and I am not young!!]. I do see your point though. I guess it’s good to give some guidelines, just sad that medicine has come down to that.

        • Amy Tobin

          What if it isn’t Facebook? What if it’s a less personal network, like Twitter?

    • buzzkillerjsmith

      You’re right. People want to believe their doctors are more than just human. A fantasy yes, but a useful one. I wear a white coat because it increases social distance. Seriously.

      We;re here to help you, not to be your friend.

    • guest

      I’m with you, Claire. I can’t imagine asking to friend my physician on facebook. That just seems weird.

  • guest

    I shouldn’t have used the term “personal relationship,” because that didn’t accurately portray what I was trying to communicate, which is that most patients want to feel that their doctors know and understand them better as people than most doctors are able to do these days. I agree, that’s not the same as having a personal relationship.

  • betsynicoletti

    Dr. Pho, aka KevinMD, has written an excellent book about using social media. Keeping personal and professional accounts separate is critical.

  • Deceased MD

    Yeah. Couldn’t agree more. It is so sad to me. I feel like I was born in the wrong age. This is the hey day of social media. Well here we are on a form of social media.
    But the day of medicine being a career with autonomy and prestige is gone.
    There is an over idealization of anything related to “high tech”now. Many are having a field day with this age. But anyone interested in the “art” of medicine or real social problems, –well this is not the age you want to live in.

  • Ron Smith

    Hi, Nathalie.

    I’ve been a practicing Pediatrician, mostly solo for the last three decades. I remember the time when pagers were the bane of my existence.

    I don’t personally use or like Facebook for any professional contacts. I don’t even have a Facebook account (for significant security reasons from years back…I’m a veteran computer geek too though).

    But I do like and encourage patients to use my professional email address which is easy and even posted on my web site. My NPs and several key office staff have email addresses as well.

    While we as professionals care about our patients, we tend also to hold them at arms length or even further. Phone trees, and even live person contacts where patients can leave a message serve both to try and give them a means to contact us, but to also provide us a barrier to unrestrained patient access. Sanity and self-preservation are our concerns.

    What I have found is that email is quite an advantage for me as much as it is the patient. I can get more information from parents as well as images that help me make better decisions. I am not on the hook to return a phone call that is dictated by a page either. The whole interaction experience with parents is both satisfying and has allowed me to continue as a solo practitioner.

    I would suppose that most would be fearful of being ‘solo.’ But I am enjoying medicine more than ever because I am effectively using technology. My best guess is that I’m probably the technical analogy to the old country doctor of 70 years ago.

    That appeals to me.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

  • Kristy Sokoloski

    My Primary Care Physician and I (and same with some of my other doctors) have other parts of the conversations that make it a bit more personal as well. However, even with that said we make sure to do the business at hand. But sometimes having that personal conversation makes the experience of having to go to the doctor to begin with more tolerable.

  • buzzkillerjsmith

    Doctors should be friendly but not friends.Think about the airline captain when you get on the plane. Think about the firefighters that take you to the hospital. Do you want to get to know these people? I don’t. I don’t want to hear about their hopes and dreams, their successes and their follies. I want them to do a professional job.

    I see my patients everywhere in this small town and nod them a good day and they do likewise. That’s as far as in goes in the grocery store and it is as far as it will ever go Some isolation is what you sign up for as a doc as with a judge or a politician.

    The gut-spilling confessionals that characterize American society hurt interpersonal relationships in the long run. Perhaps I am in the minority thinking this, but I am right. Maybe being male and being older has something to do with my thoughts on this.

    And I’m here to tell you, as the late great Lenny Bruce put it, we’re all the same schmuck. There is nothing new in humanity under the sun. Docs learn (or should learn) that pretty quickly.

    Familiarity often breeds contempt or a least lack of respect. It is important for everyone, including docs, to have friends, but find them somewhere else than the exam room.

    • MDCapsule

      I have to disagree. Even though I live in a big city, I come across patients in grocery stores, movie theaters, etc and have NEVER experienced that familiarity breeds contempt or lack of respect.
      Have you experienced this for any particular patients?

      • buzzkillerjsmith

        Saying hi is fine. I’m talking about having a beer, or talking about what i think about life, or my health problems and hopes and dreams and fears. Keep ‘em under your hat, doc, if you know what’s good for you and your pts.

  • http://www.caduceusblog.com/ Deep Ramachandran

    Great post! I Agree with Dr. K, a practice or professional facebook page can be a great way to interact with patients who desire interaction via social media. It can also help to cement the provider-patient relationship, (as you eluded to), and can prove to be a useful way to communicate information to your patients. We just presented a talk about this at Chest 2013 conference.
    However, there are downsides, as the site needs to be monitored, so that people who are trying to communicate with you can be heard, and also to remove inappropriate comments.

  • Suzi Q 38

    I just don’t think having a Facebook account is a good idea for a physician.
    My husband doesn’t even have one and he said it’s because he doesn’t want his clients knowing everything about him.
    He is a higher level manager at a city.
    For most of my physicians an email account is just as good or better.
    If the doctor doesn’t return my email fast enough I just call is nurse.

  • rbthe4th2

    Hmmm, I would think docs could put up their professional faces and leave us to our own lives. I wouldn’t want any of my docs (and I like several of them) to friend me on Facebook. I have to divulge enough information to them, some things I would like to keep private and I really don’t need to know if they visited their parents over Christmas or not. Same things for lawyers, plumbers, etc. I mean a few exchanges is one thing, but Facebook, give me a break. Too much togetherness …
    but being a guy, I’m not touchy feely.

  • MabelMabel

    As a mental health professional, I completely agree.

  • MDCapsule

    thanks for sharing….exactly the point :)

  • LongBeachSandySurvivor

    Dr K.-Please do not assume that your patients can not access your personal FB page, see your vacation photo, or read your
    rants about what you would do in the zombie apocalypse.
    If you’ve ever posted a photo of yourself on FB ,you’ve given
    up any Facebook privacy.
    Your FB vacation photos ARE viewable to your patients
    If anyone else posts a vacation photo of you. your patients can see that.
    If you comment on anyone’s post, your patients can view your comment. FB privacy is a myth.

  • Ron Smith

    One of the most important ways to make that kind of information available is by your blog site and publishing your own ebook. I’ve done both as adjuncts so that patients have the information that I would give them in the office.

    Take a look at iTunes and you’ll see my ebook ‘The Pediatric Guide for Parents.’ This is an extensive work that addresses the most important things that I have communicated to parents over the last 30 years. I’m not plugging it here as it is $15. It was a tremendous amount of work.

    Also take a look at www (adot) the pediatric guide (adot) com. There is a wealth of information (typos and such all included) much of which was the basis for my ebook. This information is free.

    Consider that this does two things. First it speaks to your patients that you are interested in them and that they are important enough to spend time creating resources for them.

    Secondly, publishing articles is THE most important way to get your information highest in a Google search. For example, do a search for ‘ron smith md pediatrics’ and you can see mostly me there. I didn’t pay someone to do anything to improve my standings in search results. The knowledge that I share in my web sites does that. The more you share, the better your ranking.

    Facebook works best as an adjunct to this things. It is a place for patients to tell others about their experience with you. I don’t need to be on Facebook…my patients already are!

    Focus on patient/parent experience in your office, take the time to get a personal medical article blog going, develop a practice web site and don’t let it get eaten up by the dust bunnies. Your rankings will go up by simply communicating what you already communicate in your exam rooms.

    Creating your own website is easy. I use WordPress. I’ve also used Joomla. I do it myself, but you can even get space on the WordPress.com site I believe. You don’t have to know the inner workings of WordPress to publish articles with it.

    You can do it too!

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

  • Pat Mastors

    I think so many of the viable concerns expressed here could be solved with a physician having a web site – very simple and not necessarily with email capability (which as we know adds work for docs that is not currently financially compensated) which states the basics about your practice, personal mission, contact info, map, and perhaps curated inks to information for patients that relate to your specialty. (e.g. if you’re an oncologist, link to acor.org. mayo clinic, cdc.gov, curetogether.org, local support groups, etc.) Your Facebook page can (by default) invite patients to learn more about you/get questions answered by going to your website. This is a very small investment of time and resources, and creates an interface with your patients that is sincere, personalizing and manageable. (If you’re stuck, ask your teenager or 20-something to help…that’s what I did!)

    Not convinced? Google your name and see what a patient sees about you. They’ll see HealthGrades and other stuff that may not necessarily reflect who you are.

  • querywoman

    I am approaching 100 friends on Facebook, and I already have more than I can handle. I don’t need to Facebook friend doctors.

  • http://HalonaBlack.com/ Halona Black

    I’m not a doctor, but don’t see any reason to be FB friends with any doctor. Just forward them to your business page.

  • http://omnimedicalmarketing.com/ Patrick Chavoustie

    It is easy enough to separate your personal relationships from your “business” relationships on Facebook by setting up a fan page. This allows you to post the types of articles and links that you mention while keeping your personal life separate. In addition to keeping your personal life separate setting up a fan page can benefit your overall practice exposure. Google plus and twitter will allow this as well. FYI, if you are not on Google plus you are missing out.

    • http://www.arielmarketinggroup.com/ Amy McCloskey Tobin

      Why Patrick? I ask because I spend a lot of time on social networks for biz, I actually like G+ for specific things, but is there a reason YOU prefer G+?

  • Amy Tobin

    Isn’t Twitter or LinkedIn a much better place to connect with patients? Less personal – more ‘public?’

  • Amy Tobin

    Dr. K – if a patient messages you a simple question that would be easier for you to answer online, wouldn’t you prefer that?

    Is the Facebook Page simply for marketing purposes? I’m asking because I’m doing research on this very subject. Thanks for any input.

  • Amy Tobin

    Or, what if you don’t have the time to manage it? Opening a page and then NOT responding when engaged is WORSE than not having it all. It’s like having a phone you never answer.

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