By David Pittman
SAN FRANCISCO — Physicians should avoid making or accepting “friend” requests through social networking websites with past or current patients, a new policy statement advises.
Instead, doctors should separate their professional and social lives online and direct patients to correct avenues of information if they contact doctors through social networks, according to the policy statement issued jointly on Thursday by the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB).
“There is this notion of blurring of our identity, blurring of our persona,” David Fleming, MD, chair of ACP’s Ethics, Professionalism, and Human Rights Committee, which helped draft the guidelines, said here at the ACP’s annual meeting.
“With Facebook, where we get in trouble at times as professionals is when we start friending patients in ways that are perhaps inappropriate, or when patients start friending us,” Fleming said.
Social networking sites have been lauded as a way for physicians to observe patient behavior, Fleming, of the University of Missouri in Columbia, Mo., admitted at a news conference releasing the paper. For example, doctors can find out if patients have quit smoking, changed their diet, or are blogging about suicide.
While there are benefits social networks can provide, the sites can also pose ethical problems. In a survey of state medical boards, 92% said they received complaints about the behavior of physicians on the Internet that eventually led to board action including license revocation, Humayun Chaudhry, DO, president of the FSMB in Euless, Texas, said at the news conference.
Digitally tracking patient behavior may threaten the trust in the doctor-patient relationship. Online searches, known as patient-targeted Googling, can quickly devolve into voyeurism and physicians should consider the intent of their searches, according to the policy paper, published online in the Annals of Internal Medicine.
The paper recommends clinicians consider the intent of such searches and the implications they could have for ongoing care. When patients contact them through social networking sites, physicians should remember that not all communications are secure and should advise patients of the correct channels to receive and relay information.
“The purpose of this paper is really for both organizations to really serve as sort of a wake up call for physicians to make them aware of some of the dangers that are out there,” Chaudhry said. “It’s really the beginning of a conversation, an important step in that conversation.”
While social media sites have boomed in recent years, there has been little guidance on the best practices to inform standards for doctors in a digital environment, the paper stated.
Chaudhry said there was strong consensus among the members developing the policy that doctors shouldn’t “friend” patients on social networks like Facebook.
If doctors do receive requests from patients, they should be honest with them, set boundaries, and tell them how best to handle inquires and their professional relationship, Fleming and Chaudhry advised.
“I would argue that virtually every physician in some fashion has had an opportunity or has in fact communicated with a patient, or more than a few patients, by this means, perhaps even without thinking in terms of the consequences that might be there,” Fleming said.
Meanwhile, a 2011 paper in the Journal of Medical Ethics found that few physicians respond when they receive a “friend” request from patients.
Business pages of physician or group practices are acceptable, but physicians should keep that separate from their personal pages, they said.
The ACP and FSMB laid out five principles in the paper. Physicians should:
Protect the trust, confidentiality, privacy, and respect for patients in online communications
Keep professional and social spheres online separate, but act professionally in both
Use email and other electronic communications only in established patient-physician relationships
Periodically “self audit” to access the accuracy of available information online about them, including in physician-ranking websites
Be aware that online postings may have further implications for their professional lives
The paper cautions doctors to “pause before posting” on the Internet.
“Anything that physicians post on such sites can be forwarded, taken out of context, and accessed and be received in perpetuity,” Chaudhry said. “I think that’s a fact that many physicians don’t always think about when they engage in social media.”
The use of email and other electronic communication should be limited to patients who maintain a close face-to-face relationship with that doctor, the policy stated. Practices should develop their own policies for sharing health information with patients while vetting the accuracy of online content.
Thursday’s policy did not address telemedicine or electronic health records