Defining the Patient–Physician Relationship in the Era of Facebook

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“Friend requests” by patients are becoming increasingly common on social networking Web sites such as Facebook. We physicians are usually not trained to deal with this aspect of the patient–physician relationship and are unsure and often uncomfortable with it. The implications of “confirming” versus “ignoring” such requests provoke a level of uneasiness and anxiety within many of us. On the one hand, we want to accept the request and check to see whether the patient is seeking clinical help, but on the other hand, we become worried that patients could go online and learn about aspects of our personal lives such as marital status, friend lists, photographs, and blogs posted by others in our spaces. Similarly, we can be exposed to a variety of our patients' personal information.
We physicians must develop strategies to deal with this new and expanding aspect of our relationship with patients. An important part of such strategies will be to comply with institutional guidelines on such matters. Medical centers advise physicians to adopt appropriate caution in using social networking Web sites. And where there is no institutional guidance, we must try to develop our own sets of rules to deal with social media. For example, for our current patients, we should attempt to reach them by phone or see them in person and not encourage communication through social media. We should remind them that online social networking is not a means to share protected health information and that such communication is risky for their privacy as well as for our practices. For those who approach us as an experts in the field, the best way is to help them arrange appropriate face-to-face consultations.
Last, we must always remember that the interests of patients are paramount. Expanding social media has already or is likely to intersect with clinical care for most of us in the near future. It remains within the art of medicine to develop our relationships with patients to foster mutual respect for each other's spaces without compromising the patient's needs.
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