Health Information Compliance Alert

Friending patients on Facebook may lead to privacy violation issues, say experts.

Should patients and doctors "friend" each other on social networking sites? Steer clear unless you're prepared to delve into very murky privacy waters, warn healthcare professionals.

In his article, Practicing Medicine in the Age of Facebook posted on www.nejm.org, Sachin H. Jain, M.D., says how in his second week of medical internship he received a "friend request" from an Erica Baxter (name changed). Two years earlier, as a medical student, Sachin had participated in the delivery of Erica's baby and now she wanted to get back in touch.

Jain writes he clicked "Confirm" and accepted the request even though initially he had reservations.

Although Jain accepted this request because he was curious to know about the progress of the baby girl he'd helped deliver, his reservations about the appropriateness of this online relationship were well founded. There was no way he could've been sure whether Ms Baxter was simply a grateful patient or had other motives. In accepting her friend request, he was merging his professional and personal lives, which is definitely not advisable in Jain's opinion.

Sachin further says in his article that unlike five years ago, social networking sites are no longer just a preoccupation of high-school and college students but are now also a mainstream form of social interaction that span divisions of age, profession, and socioeconomic status. At the hospital where he's in training, medical students, nurses, residents, fellows, and attending physicians, can all be found linked to one another as active members of social networking sites.

There are many Facebook networking groups that have been created with a focus on specific medical specialties or diseases. Two such examples are "Diabetes Daily" and "I Support Cystic Fibrosis Research and Awareness!," each of which boasts thousands of Facebook members. Hundreds of thousands of philanthropic dollars can be traced back to initiatives publicized on social-networking sites.

But the healthcare segment is well aware that there is another side of this coin also, and physicians, medical centers, and medical schools are trying to keep pace with the potential effects of such networking on clinical practice. In an e-mail to students and faculty of Harvard Medical School, Dean for Medical Education Jules Dienstag, wrote: "Caution is recommended . . . in using social networking sites such as Facebook or MySpace. Items that represent unprofessional behavior that are posted by you on such networking sites reflect poorly on you and the medical profession. Such items may become public and could subject you to unintended exposure and consequences."

Similarly, Washington, DC, physician Katherine Chretian -- an expert on Facebook-medicine intersection -- is quoted in a www.getbetterhealth.com blog as saying: "Having a so-called dual relationship with a patient -- that is, a financial, social or professional relationship in addition to the therapeutic relationship -- can lead to serious ethical issues and potentially impair professional judgment. We need professional boundaries to do our job well."

Jain says during medical training, the importance of maintaining professional distance -- however much one desires to have a close, meaningful relationship with one's patients -- is taught by educators and reinforced by the use of beepers and paging services meant to shield physicians from their patients.

Simply becoming Facebook friends with patients can infringe upon their HIPAA privacy rights also, according to Chretian.

For example, if a patient posts "Not feeling well today," a reply from their physician "don't forget to take your meds," would likely be a violation of privacy and confidentiality. In addition, all online communication must be secure.

In another post on www.kevinmd.com, internal medicine physician Matthew Mintz quotes his friend and colleague Chretien as saying, "the thought of opening up our personal pages filled with family photos, off-the-cuff remarks and potentially, relationship status and political and/or religious views, to our patients gives us the heebie-jeebies."

There are currently no national guidelines for social media use by physicians and, as mentioned above, confidentiality and boundary issues are difficult and controlling one's own privacy may not be easy for many physicians, Mintz says in his post.However, he says most of the barriers that scare people today can be worked around and he doesn't see any reason why physicians can't be "friends" with their patients on Facebook as long as they use extreme caution.

On the other hand, Katherine Chretian is of the opinion that Facebook pages -- which many doctors and practices have -- are not the best way for physicians to interact with patients. Physicians should definitely keep their professional and personal lives separate, she says.

(Editor's note: Sachin Jain's article can be read at: http://www.nejm.org/doi/full/10.1056/NEJMp0901277. And the other articles that have been referenced can be read at: http://getbetterhealth.com/patient-doctor-facebook-friends-could-be-a-hipaa-violation/2010.06.21 and http://www.kevinmd.com/blog/2010/07/facebook-friend-issues-doctor-patient.html.)