Can We Be Facebook Friends?

An issue that has been been discussed in other venues is whether doctors and their patients should be “Facebook friends”.  There have been various posts on other sites, but last night’s #HCSM chat brought it up.  The quick consensus, especially from the medical folks, was that this would be a bad idea.  Too many potential conflicts and too many possible lines can be crossed–at least on a personal/private Facebook page.  I expressed my concerns–I consider Facebook a private space: I interact with friends and family, people I know.  I consider Twitter a different creature altogether: I am throwing my comments, thoughts and opinions into the public forum and allowing the public to decide if they listen or not.  Facebook is, for me, a much calmer arena.  A place where my nieces can tell me what they’re up to for the weekend, or where my friends can invite each other to barbecues.  I don’t consider any of these to be public issues.  As a result, I’ve done my best to lock down my Facebook profile so that only my “approved” friends can see postings and activities on the account.

There are potential serious concerns as well, such as unprofessional behavior that may show up on Facebook pages (an issue seen in a recent study of medical students’ social media presence) or breaches of patient confidentiality (as seen in California, where medical staff posted pictures of a seriously injured patient directly on Facebook).  There are clearly limits which we all agree must not be crossed, but there are others that fall into a more difficultly-defined gray area.

The answer, for many professionals, is to have two different Facebook pages: one personal for friends and family, and another public page that can be the official and professional contact site for patients to interact with their doctor.  This allows patients to have a way to interact with their physician in a less-official capacity.

Not all were in agreement.  Some participants felt that that physicians and other medical professionals should be willing and able to be completely open on the web.  They raised the issue of whether anything should be posted online if one does not want it to be seen, and noted that patients hire their physicians as much as physicians opt to work with patients.  There was also a sense of frustration: patients clearly want to have a more direct (and a more personable, if not personal) relationship with their health care provider.  Current medical practice does not easily allow the necessary time for patients and doctors to develop a therapeutic bond easily; Facebook (or other) interactions could allow patients and doctors to have a stronger connection.

The issue can also be complicated when a friend becomes a patient: how does that change the doctor/patient relationship, Facebook sharing, etc.  My thoughts are different in that situation: if you were already a friend, someone I’ve known in real life, then you likely know much about my family, my other friends, etc.  We already trust each other, and we already communicate outside of our professional doctor/patient relationship.  To me, this is very different from accepting friend requests from patients–that is the situation where I feel uncomfortable becoming “Facebook friends”.

The conversation did open a theme that is sometimes lost in the discussion of health care and social media.  It is clear to me that there is a strong need for patients to connect with and interact with their physicians, and to form the necessary therapeutic bond.  Conversations and interactions allow us to form the relationships that humanize us and that humanize health care systems.  Health care providers’ Facebook personal pages may not be the best option, but it seems evident that there must be some other way to meaningfully extend doctor/patient interactions.

How can we leverage social media techniques and platforms to encourage productive communication and interaction between health care providers and patients?  Can we use professional Facebook pages more effectively?  Is Twitter a better means of interaction, given that the short posts and updates limit the amount of information that can be transmitted–is that a positive or a negative?  How can technology effectively personalize health care?

13 Responses to Can We Be Facebook Friends?

  1. DrV says:

    Huge issue that I struggle with daily. I avoid these relationships but some have slipped through the back door. I think that a personal page and a professional ‘fan’ page seems like the most sensible solution. Too much to talk about. You’ve instigated a post in my mind. Keep your eyes peeled.

    Of note, I’m finishing The Facebook Effect. Its the story of Mark Z and FB. Amazing story and frightening to hear his early thoughts on privacy.

  2. Prajesh says:

    This is a very timely and important discussion to have, as I mentioned in my earlier comments it raises questions on both ends of the relationship.

    You could ask yourself
    1) As an independent Dr why would you want to have a Facebook page that is linked to your professional name which would be different to you as a private person? In essence what value is being added by you or your patient by using Facebook or any other open social network site to communicate with patients?

    Which would be different for a practice to have a fan page or for certain intervention to have a fan place, which would be a way that the doctors can use the page to a way of communicating with people undergoing specific programs.

    At the end of the day there needs to be a system that will add benefit to both the patient and the doctor otherwise it will be a waste of resources.

    We also have to factor in that in some cases individuals do not want to befriend their doctors, lawyers, accounts etc on social network sites.

    Prajesh
    @Zimbarama

  3. Great post. I acknowledge that this issue is important but unfortunately I think it is a “wedge” issue that distracts from the overall benefits of doctor/patient social media engagement. At Macarthur Obgyn we have a very active Facebook Fan Page http://www.facebook.com/#!/macobgyn?ref=ts and Twitter handle (@macobgyn). This represents the professional life of myself and my partners. Links off our website direct patients to the fan page not our peronsal pages. We try to create value for our patients through our posts which hopefully encourages them to interact with our page frequently. We believe this increases patient education about Obgyn issues and promotes a more personal doctor patient relationship.

    Occassionally, I wil have a patient find me personally on FB and request to be friends. I will accept them, but I add them to a FB created list called “patients” in which I have certain privacy settings arranged. This allows me to protect my personal life while still giving the patient the feeling of connection to me. I hope that doctors are not avoiding diving into the social media world out of fear. Technology can be used the right way to help create a better doctor/patient relationship.

    As doctors move into social media we create a problem. We are basically telling the patients to go online and interact via FB and Twitter. On the other hand we are saying HIPAA does not allow the exchange of personal health information via social media or nonsecure email. The problem here is we say “go online” but “you can’t communicate with me personally in a legal way.” It is crucial to have a patient portal or a secure messaging system in place to complete the circle. Portals allows online doctor/patient communication in a legal way….but that is another topic for hopefully another post.

  4. Howard Luks says:

    I share Bryan’s comments, and likely, his frustration and concern.

    This is a timely and very important discussion. Social media and health care is a potential minefield for physicians and health care providers to navigate… There are an enormous number of reasons for us to figure out the boundaries and allow physicians to actively participate in #hcsm topics and engage patients in various venues… Some gov guidance would be useful. Until then, HIPAA is HIPAA and patient privacy is paramount.

    David Harlow offered some very useful advice on a guest post on my blog a short while ago and is a worthy read… http://goo.gl/IYus
    /h

  5. Amanda Changuris says:

    I don’t think having two presences on Facebook (or any other SM site) is necessarily a bad thing, provided you’re true to yourself in both (or all) cases.

    For example, I have a personal page on Facebook where I post all kinds of stuff (mostly vacation pictures and snapshots of my cat). I’m also responsible for managing the Facebook presence of the healthcare system where I work. It wouldn’t make sense to ask people to seek me out by name in connection with my employer — it just wouldn’t happen.

    I think the same general rule can apply to physicians. Just because you’re a doctor doesn’t mean you have to give up all of your privacy. I think as long as you are genuinely YOU through both accounts, having a personal Facebook page and a “Page” for your business identity is perfectly acceptable.

    Sure, some people probably abuse this dichotomy, but they won’t hold much credibility for long.

    As an aside, I don’t hide the fact that I’m behind my employer’s accounts. It’s not something I mention a great deal because I think (in general) people don’t care who I am, they just want health information and local tidbits. I don’t recall anyone asking me anything personal (or even specific to me in any way) through the hospital site, but if they did I’d probably just answer — you know, like a human being.🙂

    Just my two cents! Great discussion!

  6. […] Given that Twitter is much simpler than Facebook, I wonder what trend we’ll see in terms of use by healthcare professionals. Mark Ryan (@RichmondDoc) raises some good questions about Twitter versus Facebook which you can read here. […]

  7. I always seem to be contrary when I join in these conversations! Thank you for summarising the discussion. Personally, I think that efforts at developing a therapeutic bond should be made with the patient present through the process of care. I can’t see how any contact through Facebook could enhance that.
    I have not had friend requests from patients but if I had I would say no. In all honesty, I don’t even think they would ask. All of use present different faces to friends or family or patients or colleagues. This is part of being human. It isn’t deceitful or bad.
    Caring of patients, helping them understand their illness, knowing that I am happy to just be with them in times when I can’t do anything else, that is what a therapeutic bond is about. I honestly can’t see how seeing my holiday snaps could have any relationship to this.
    I’ve been a patient too. I wouldn’t want to be Facebook friends with my doctors either.

  8. richmonddoc says:

    Thanks for the discussion, everyone. I’m still hoping that there are some other contributors waiting to chime in…

    My personal bias is to keep my private life as private as possible. When I worked in a small town, I lived 30 minutes away and kept to myself. Not because I don’t like people–after all, my career puts me in contact with people all the time. I did this because I feel, as Anne Marie said, that all of us have a need for privacy.

    As SocMed expands, and as wireless and portable devices become more common, the chances one could be constantly in the public eye increase. To me, this means keeping a private/personal Facebook page private and personal. Jeff has found a way around this by careful use of privacy controls and by emphasizing the practice’s official page, though I wonder if he has run into problems with patients trying to push boundaries beyond those he has set.

    Jeff: have you had problems with patients trying to move past the connections you’re comfortable with? And would you be willing to write more about portals in a future post?

    • Very rarely will patients in my practice do something that I feel like crosses the line via social media. In a few years I have only deleted three post on our practice FB wall that I felt were potentially inappropriate or revealed too much personal health info. Our page gets 500-600 hits a week so I consider that a good track record. Occasionally, a patient will say hi via FB chat which I dont really like and dont feel is appropriate. Usually, that is one of my teen patients and they are very innocently just saying hello. While I understand what they are doing I think that violates the spirit of doctor patient online communication. Overall I am quite happy with the privacy I am able to maintain and feel like we are creating a stronger therapeutic bond with our online presence.

      I can talk about practice portals all day long. Yes I would love to discuss in a future post.

      • richmonddoc says:

        So it sounds as though you’ve been very successful at making professional and (my interpretation) fairly well-controlled connections via Facebook. I think that’s a great paradigm and your track record reflects that.

        This next thought might also merit its own post, but I was wondering how you feel about Facebook vs Twitter in terms of use, patient interactions, etc. They strike me as very different tools and am curious what you think.

  9. […] This post was mentioned on Twitter by P. F. Anderson, AnneMarie Cunningham. AnneMarie Cunningham said: Next question about Facebook.. could it help the doctor-patient relationship? Again, I think not. http://is.gd/enUMz […]

  10. […] F. Anderson Can We Be Facebook Friends? « Social Media Healthcare – https://smhcop.wordpress.com/2010… 5 hours […]

  11. […] Marie Cunningham Can We Be Facebook Friends? « Social Media Healthcare – https://smhcop.wordpress.com/2010… 2 hours […]

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