Most Facebook users debate about whether they should "friend" a co-worker or boss, but what about a doctor? While social networking and e-mail may offer easy access to a doctor who is typically hard to reach, getting too cozy online could carry some serious ramifications -- for both the patient and the doctor.
"While the public might be receptive to 'friending' doctors, most physicians won't be in a hurry to use social media with their patients," says Dr. Michael Kirsch, a gastroenterologist who writes the blog MD Whistleblower. "Physician Facebookers would not want patients to have access to their vacation photos and personal vignettes, many of which are private for a reason. Reading comments on a doctor's Facebook wall might show how that the physician is really 'off the wall.'"
Kirsch also doesn't think doctors should enter a patient's Facebook world. "There should be a line between patients and their physicians. While this barrier is not inviolable, I don't see how blurring or eliminating this separation enhances their health care, which is our designated role."
The Pew Internet and American Life Project found that "Despite the increasing popularity of social network sites and status update services, few people are using them to gather and share health information."
But it will likely be only a matter of time before social networks will become a bigger tool for Internet-savvy patients and their doctors. Medical schools like Drexel University are already warning students that what they post on social networking pages could impact their ability to get job or be accepted for further graduate training.
Dr. Sachin Jain, who now works in Obama's Health Information Technology office, warned doctors and med students against friending patients on Facebook last summer. He describes the anxiety he felt as a medical student when he accepted a former patient's friend request. While the decision didn't turn out to be detrimental -- the former patient was seeking advice about whether or not to go to medical school -- Jain realized the pitfalls of giving a patient access to his personal world.
"The anxiety I felt about crossing boundaries is an old problem in clinical medicine, but it has taken a different shape as it has migrated to this new medium," Jain wrote in the New England Journal of Medicine last August. (Dr. Jain was unavailable for comment.)
A study done at the University of Florida showed that many medical students share too much. Many of the university's medical students and residents were publicizing personal information that they would never want their patients to see, the report concluded. More than half of the 362 students they found with Facebook pages gave information about sexual orientation, 58% talked about personal relationships and about half gave information about their political opinions or positions.
Striking a Social Networking Balance
Yet, some doctors say that they have managed to incorporate Facebook into their interactions with patients without crossing the line. Dr. Edward Ramirez, an infertility specialist in Monterey, Calif., who uses Twitter, Facebook and MySpace and writes a blog, claims he always keeps in mind "it's a public forum" and keeps "any answers posted to Facebook in general terms not specific to a patient question." He also has his office manager screens comments he needs to handle personally.
Two other medical practices, Fertility Partnership and Atlanta Women's Specialists, say they use Facebook to create patient support networks. "[Social networking has] helped our patients feel supported by us and their fellow patients," says Dr. Kathryn Jamboretz.
Wayne Miller, who specializes in Health Insurance Portability and Accountability Act (HIPAA) privacy law, says doctors must be careful when they friend a patient. "Just the fact that a patient is a friend could lead someone to suspect he is a patient and that would be the release of protected health information," he says. Miller suggests doctors who have Facebook pages put a waiver at the top of the page to alert patients who post that they are giving up certain privacy rights.
Lita Epstein has written more than 25 books including The Complete Idiot's Guide to Social Security and Medicare and the Pocket Idiot's Guide to Medicare Part D.
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