What Are Doctors Doing on Facebook?

In a survey of 405 postgraduate trainee doctors (residents and fellows) from France, researchers examined how doctors are using Facebook — not only for themselves, but also in their interactions with patients.

Facebook, if you’ve been sleeping for the past year and didn’t notice TIME magazine just named Mark Zuckerberg — Facebook’s CEO and founder — Person of the Year, is the world’s largest social networking site. It allows you to connect with other acquaintances (they use the term “friends,” but this is a ridiculous use of the word since most people’s Facebook connections are not traditional friends) easily, online.

Perhaps too easily. The relationship between doctor and patient (or therapist and client) isn’t one based upon friendship. It’s a professional relationship with boundaries. Apparently, though, some doctors aren’t aware of those boundaries — at least according to this survey.

Seventy-three percent of the physicians surveyed said they had a Facebook profile. But only 61 percent had adjusted the default privacy settings of Facebook (suggesting 39 percent of physicians either don’t know enough or don’t care about their privacy). Yikes! But here’s where it gets interesting:

Only a few Facebookers had received a friend request from a patient (6 percent), four of whom accepted it. But such requests are likely to become more common, the authors said.

While most respondents (85 percent) said they would automatically refuse a friend request from a patient, one in seven (15 percent) said they would decide on a case by case basis.

When would it ever be appropriate for a doctor to “friend” a patient? When would it ever be appropriate for a therapist to “friend” a client?

In the latter case, the answer is “almost never.” Therapist’s professional ethics tend to emphasize reducing the possibility of “dual relationship” forming — that is, two relationships with a client. For instance, a professional one in the office, and then a secondary one outside of the office (as a friend, co-worker, etc.). Anything that could encourage such a dual relationship is frowned upon, so to keep things easy and play it safe, a therapist should never “friend” a client (especially an active client they are currently seeing).

For physicians, the relationship can be a little fuzzier. Doctors don’t have ethics classes about forming “dual relationships,” and in many small towns, you may not help but be in a social circle that includes the town’s doctor.

Nevertheless, doctors should carefully consider such “friending” requests from their patients before accepting them. The survey noted that “the reasons given for accepting a patient as a friend included feeling an affinity with them and fear of embarrassing or losing that patient if they declined.” Those are not reasons sufficient to override the ethical obligation of physicians to keep their doctor-patient relationship professional. A request to be someone’s “friend” on Facebook doesn’t typically fall into the definition of a “professional relationship” (especially since many don’t understand that the word “friend” on Facebook doesn’t mean friend).

Because Facebook relies on a person’s name as their personal identity, patient privacy is immediately compromised when this “friend” relationship is established between a doctor and patient. That may be fine if both parties are aware of the compromise and agree to it. However, many times, one or both parties are not aware of the implications of sharing this connection in a public manner.

There are, of course, exceptions to the rule. Two people may indeed be both friends and doctor-patient, but these are rare exceptions — most doctors should be aware of that.

The study’s findings may also not hold up to the way American doctors interact with Facebook (since it was done only on French doctors). And the fact that the survey respondents were trainee doctors might also impact the results in ways that can’t be predicted. For instance, older doctors may be more aware and sensitive to the privacy and confidentiality issues associated with Facebook use. Or not.

Facebook is a great tool that helps hundreds of millions of people stay in touch and communicate with others. If used responsibly, I think it can also be used an ethical and appropriate manner by both physicians and therapists alike. But health professionals must be aware of the ethical issues involved in using these types of social media to engage with their patients.

Read the full article: Doctors and Their Patients on Facebook