I have to admit, when I heard that the Federation of State Medical Boards (FSMB) and the American College of Physicians (ACP) released a position paper in the Annals of Internal Medicine on April 16, 2013 regarding physician communication with patients via social media and the internet, I thought their position would be that social media was bad and should be avoided in the clinical sphere. Totally ignoring reality. I could almost picture them collectively as some old curmudgeon, saying the internet was going nowhere and “doctors shouldn’t communicate with patients through those darned social computers!” But I was wrong, luckily. In the paper, “Online Medical Professionalism: Patient and Public Relationships: Policy Statement From the American College of Physicians and the Federation of State Medical Boards,” they recognized that social media and online communications is here to say and offered advice on how to utilize it as a communication tool while avoiding some medico legal pitfalls.
Protecting A Patient’s Privacy
The table above is very helpful and addresses some of the major risks of online communication with patients by providing recommended safeguards. And while I agree with their recommendations, it really drives home the point that common sense can go a long way. As a doctor, common sense tells me to not reveal a patients identity in a public forum. And even if you don’t identify them by name in a public forum, maybe describing them isn’t a good idea either as in this case on Facebook where a doctor complained about a patient being repeatedly late for appointments (and maybe even mentioned that the patient had previously had a stillborn child?!).
In the case of pre and postop photos, I get their written permission first. And not only do I get their written permission, I further document in my clinical notes that I discussed with them, multiple times, that it’s ok to post their photos. I especially document this in the case of patients that will have their identity revealed in the case of a facelift or other procedure that requires their face to be posted online.
But if a patient posts a message on my Facebook page about their particular condition, I immediately respond to them via a private, direct message rather than responding to the question posted on my wall. And if at all possible, I delete their original question from the wall to protect their privacy. I understand that many people recommend not being “friends” with your patients on Facebook and while I don’t “friend” them, they are still able to contact me through my page and if that’s the route of communication they choose to initiate a discussion, then that is their prerogative. But again, I quickly attempt to shift the conversation to a more private venue such as my office email address.
Medical Advice Online
The recommendations above suggest not giving online medical advice unless you already have a rapport with the patient. Again, this comes under the category of common sense. If a random patient contacts me online to discuss their condition, I give general answers to their question but always end with some standard, “I need to see you during a consultation to give more definitive advice”. And if they are having a problem with a procedure that I recently performed on them, I encourage them to come in for an office exam and in extreme circumstances, refer them to the Emergency Room. Although, if I refer them to an Emergency Room, which maybe has happened once, I meet them there rather than having the ER doctor see them.
A Doctor’s Online Character
Here I want to shift gears a bit. Rather than talk about how a doctor should go about communicating with patients that initiate an online interaction, I want to focus on how the doctor represents themselves, or their character, online. For example, do they take a picture of a new boat they recently bought or highlight their huge wine collection on their Facebook or Twitter account? A doctor that shows off their material possessions can risk alienating themselves from patients that may not have as much disposable income. That being said, I recently asked fans of my practice’s Facebook page to vote online for my dog to become Queen of the Fur Ball. Is that inappropriate or just my attempt to “connect” with patients on a more personal but, I think, healthy level?!