Medicolegal Issues

Facebook: Social networking meets professional duty

Current Psychiatry. 2012 March;11(3):34-37

References

1. Facebook. Statistics. http://www.facebook.com/press/info.php?statistics. Accessed January 30, 2012.

2. MacDonald J, Sohn S, Ellis P. Privacy professionalism and Facebook: a dilemma for young doctors. Med Educ. 2010;44(8):805-813.

3. Gorrindo T, Gorrindo PC, Groves JE. Intersection of online social networking with medical professionalism: can medicine police the Facebook boom? J Gen Intern Med. 2008;23(12):2155.-

4. Baer W, Schwartz AC. Teaching professionalism in the digital age on the psychiatric consultation-liaison service. Psychosomatics. 2011;52(4):303-309.

5. Landman MP, Shelton J, Kauffmann RM, et al. Guidelines for maintaining a professional compass in the era of social networking. J Surg Educ. 2010;67(6):381-386.

6. Guseh JS 2nd, Brendel RW, Brendel DH. Medical professionalism in the age of online social networking. J Med Ethics. 2009;35(9):584-586.

7. Devi S. Facebook friend request from a patient? Lancet. 2011;377(9772):1141-1142.

8. Gruenberg PB. Boundary violations. In: Wahl DS Polster DS, eds. Ethics primer. Arlington, VA: American Psychiatric Association; 2001. http://www.psych.org/Departments/EDU/residentmit/dl01.aspx. Accessed January 4, 2012.

9. Moubarak G, Guiot A, Benhamou Y, et al. Facebook activity of residents and fellows and its impact on the doctor-patient relationship. J Med Ethics. 2011;37(2):101-104.

10. American Medical Association. AMA policy: professionalism in the use of social media. http://www.ama-assn.org/ama/pub/meeting/professionalism-social-media.shtml. Accessed January 4 2012.

11. British Medical Association. Using social media: practical and ethical guidance for doctors and medical students. http://www.bma.org.uk/press_centre/video_social_media/socialmediaguidance2011.jsp. Accessed January 4 2012.

12. Wilson S. A bigger threat to patient privacy when doctors use Facebook. J Med Ethics. http://jme.bmj.com/content/37/2/101.abstract/reply#medethics_el_3625. Published December 20 2010. Accessed January 4, 2012.

13. Thompson LA, Dawson K, Ferdig R, et al. The intersection of online social networking with medical professionalism. J Gen Intern Med. 2008;23(7):954-957.

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18. O’Hanlon S, Shannon B. Comments further to: privacy professionalism and Facebook: a dilemma for young doctors. Med Educ. 2011;45(2):209.-

19. Metzger AH, Finley KN, Ulbrich TR, et al. Pharmacy faculty members’ perspectives on the student/faculty relationship in online social networks. Am J Pharm Educ. 2010;74(10):188.-

20. Ben-Yakov M, Snider C. How Facebook saved our day! Acad Emerg Med. 2011;18(11):1217-1219.

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Discuss this article at www.facebook.com/CurrentPsychiatry

Dear Dr. Mossman:
A patient has invited me to “friend” her on Facebook. I’m uncomfortable with this request, but I don’t want her to feel rejected. How should I respond?—Submitted by “Dr. V”

Among the many cultural developments that characterize the Internet era, few have had the impact of the social networking Web site Facebook. Because of Facebook, “friend” has become a transitive verb, and “like,” “wall,” “poke,” and “post” have acquired meanings that reflect new modes of communication and interpersonal connection. As of early 2012, Facebook had >800 million users.¹ If you’re like most medical students, residents, and junior faculty members,² you have a Facebook page.

The ubiquity of Facebook has added new dimensions to defining, teaching, and modeling professionalism in medicine.^3,4 Facebook can be used to rapidly disseminate medical information through status updates and medical support groups.⁵ Professionals can create profiles, post their curricula vitae, and “like” professional journals—including Current Psychiatry.

But social media such as Facebook also present clinicians with new ethical and professional challenges.⁶ If you use Facebook personally or professionally, you need to decide how you will separate your personal and professional identities in a forum that rapidly distributes information across the Web for all to see. Sound, responsible decisions about your online profile can let you and your employing institutions prosper from the many benefits that accrue to savvy Facebook users—while avoiding potential embarrassments and liability.

Before you create a profile or “post” your next “status update” on your “wall,” you should:

understand potential boundary violations
know how to activate your security and privacy settings
remember that you represent not only yourself but your profession.

Boundary crossings, violations

Feelings of online closeness and informality make receiving “friend” requests from patients far from uncommon.⁷ The Internet lets individuals quickly check out people and learn personal information (eg, where they live and what their homes cost) that was hard to discover 15 years ago. But the information on a person’s Facebook page usually is much more personal than what Internet searches reveal—and often much less dignified.

A quick Internet search of the phrase “professional boundaries” will show that concern about maintaining proper relationships between professionals and service recipients is not restricted to psychiatry. Yet the special, intensely personal nature of mental health care—especially psychotherapy—traditionally has made psychiatrists place special constraints on their relationships with patients.

Because psychiatrists recognize that even brief comments about ourselves can affect how patients feel, we refrain from forms of self-disclosure that non-psychiatric colleagues view as innocent.⁸ Psychiatrists also do not freely socialize with patients or provide care to persons we know well. We avoid blurring therapeutic and other types of relationships because such “boundary crossings” can cause problems and because “crossings” can be precursors to serious “boundary violations”—eg, sexual contact with patients.

Clinical Point

Information on a person’s Facebook page usually is much more personal than Internet searches reveal and often much less dignified

Most doctors decline “friend” requests from patients because friending them could adversely affect the treatment relationship and could lead to new relationships that might interfere with patient care.⁹ The American Medical Association’s social media guidelines do not forbid friending patients, but physicians are advised to “consider separating personal and professional content online” and “maintain appropriate boundaries” with patients.¹⁰ The British Medical Association simply tells physicians to “politely refuse” patients’ friend requests.¹¹

Privacy problems

Psychiatrists who friend patients need to be aware of potential privacy breeches among Facebook users. Individuals whose presence among a psychiatrist’s friends becomes known (eg, via a wall post) are revealing their connection to the psychiatrist, and other friends may surmise that an individual is a patient.

Also, Facebook’s “find friends” feature ostensibly lets Facebook locate individuals who are common to pairs of people and who can then be suggested as potential friends to others, but “find friends” imports members’ entire e-mail address books. If doctors who are on Facebook have patients in their webmail address books and have allowed “find friends,” then Facebook will import e-mail addresses, potentially disclosing associations between patients and their doctors.¹²

Facebook has tools that let users block their profiles from public view, but these privacy settings can be difficult to access and understand. Although social networking among medical trainees and new graduates is common in the culture of emerging professionals, most Facebook users allow anyone to view their profile—the default privacy setting.^2,13 Even if you don’t friend patients, failing to privatize your account leaves your Facebook information readily available to the public, including your patients.