Facebook: Social networking meets professional duty
Professionalism in cyberspace
Under some circumstances, medical advice given in casual, outside-the-office contexts can establish a doctor-patient relationship, with all its accompanying obligations and liability risks. This is true of Facebook communications. If you communicate medical information or advice to someone in a form specific enough to be relied upon, you may be establishing a doctor-patient relationship. If harm comes to a person who relied upon your information, a negligence lawsuit could result—even though you never saw or spoke to the “patient.”14
Medical training programs have found that medical students and residents have posted work-related comments on Facebook that directly referenced specific patient situations or other patient care matters. Such actions can breach the Health Insurance Portability and Accountability Act of 1996 and can jeopardize careers.15 Medical professionals also have posted uncouth, inappropriate, and embarrassing content—profanity, frankly discriminatory language, tales of intoxication, and sexually explicit information. In a recent survey of 78 medical schools, 60% responded that their students had posted unprofessional online content.16 In 45 cases, schools reported such incidents and responded to follow-up questions about disciplinary actions; 30 schools gave informal warnings, and 2 schools reported student dismissals.
Using Facebook
Should psychiatrists stay off Facebook? Of course not. Many prominent American psychiatrists are on Facebook because, like everyone else, they enjoy keeping in contact with friends and family.17 Thousands of professional groups (eg, the American Psychiatric Association) and physician practices have Facebook pages. Institutions, schools, and agencies use social media to promote their curricula, notify students and staff of course changes, or organize meetings. Professionals join groups or “like” groups associated with their specialty to affiliate with each other, and they use Facebook to promote their practices, disseminate information, and network with colleagues.
Psychiatrists need not shy away from establishing an account on Facebook,18 but they should do so with greater circumspection than most persons, including physicians in other specialties. Table 1 lists several examples of Facebook behavior that all physicians should avoid.2,13,16,19,20
What about using Facebook to learn about your patients? Medical reports about checking Facebook to resolve emergencies have appeared,20 and forensic psychiatrists can use Facebook and other Internet resources to learn about evaluees.21 But if doctors search for information about a patient’s out-of-office behavior or statements, it may be like “driving down a patient’s street to see what he or she is up to,” which, although legal, seems inappropriate in a professional relationship.22
Recent experience suggests that medical schools and residencies should include “e-professionalism” in their curricula, emphasizing instruction and guidance on where personal and professional identities may intersect and where they should be kept separate. Table 2 lists several responses to the new challenges to medical professionalism posed by Facebook and other social media.5,6
Table 1
Facebook errors: What to avoid
| Category | Pitfalls |
|---|---|
| Information | Relationships, religious views, home address, and telephone number all may be readily viewable to the general public and patients if privacy settings are not properly configured |
| Photos | Intoxication, sexually explicit material, risk-taking behavior |
| “Wall posts” | Blatant comments about patients, disgruntlement with institution or supervisors |
| Security settings | Lack of privacy restrictions |
| “Friends” | Friending patients and supervisors |
| “Like” | “Liking” groups that contain pornographic material or other controversial topics |
| Source: References 2,13,16,19,20 | |
Table 2
Promoting e-professionalism
| Understand and activate all relevant privacy and security settings on social networking sites |
| Recognize the need to teach e-professionalism in the curricula of medical schools and residency training programs |
| Combine instruction on professional use of Facebook with teaching about relevant legal regulations in medicine (eg, HIPAA) |
| Guidance in online professionalism should come from faculty supervisors or program directors |
| Faculty should model appropriate Facebook behaviors for employees, medical students, and residents |
| Users of social media are well-advised to conduct Web searches on themselves and modify their pages to conform with professional standards |
| Politely decline patients’ “friend” requests |
| Discussions of medical professionalism, involving students, faculty, and employers, can help identify issues and define responses |
| Institutions should establish and enforce guidelines for Facebook professionalism |
| HIPAA: Health Insurance Portability and Accountability Act of 1996 Source: References 5,6 |
Responding to Dr. V
Psychiatrists should not “friend” patients. If you receive a “friend” request, you should proceed in 1 of the following ways:17
- Simply ignore the request. If your patient asks why you didn’t respond, explain that you use Facebook only for personal matters
- Ignore the request, and at the patient’s next appointment, mention the request and politely explain that you do not “friend” patients
- Ignore the request, but ask the patient about it at your next meeting. This is especially important for a patient whose treatment examines the doctor-patient relationship (eg, psychodynamic therapy), but may be valuable even in medication-focused care.
