Friday, September 11, 2009

Should Doctors Use Facebook with Patients?


When it comes to Facebook, I will offer full disclosure, a policy I’ve advocated in my medical ethics postings; I am neither a friend nor a fan of this godfather of social media. In my 7 member nuclear family, 6 of us use Facebook as a portal into their personal worlds. Once again, I am the outlier. I just don’t have the time to create and maintain another universe in my life. It would eliminate the scant discretionary time that is still available to me.

Bloggers at the American College of Physicians and KevinMD and have mused about physicians using Facebook to communicate with patients. Earlier this year, Sachin Jain, M.D. wrote a commentary in The New England Journal of Medicine discussing his ambivalance to ‘friend’ a prior patient. While the public might be receptive to ‘friending’ doctors, most physicians won’t be in a hurry to use social media with their patients. 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’. Conversely, do we physicians really want to enter our patients’ Facebook worlds? I think that this would corrode the patient-physician relationship. There should 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. We are their physicians, not their pals. In fact, it is challenging when folks choose physicians who are within their social circle. While some doctors I know welcome this, I try to avoid having friends as patients. My objectivity would be diminished. In addition, depending upon the medical circumstances and outcome, the friendship may be at risk, which could have consequences that extend far beyond the exam room.

Physicians have always been strict guardians of confidentiality and patients’ privacy. Indeed, when I have performed a colonoscopy on a real friend (not a cyber pseudofriend), not even my wife knows that this occurred, unless the patient himself relates it to her. Could physicians who become a patient’s Facebook ‘friend’ maintain confidentiality? The doctor, of course, could make no Facebook reference to the professional relationship. Other ‘friends’, however, might recognize the medical identity of the doctor, which might lead to a line of questioning or speculation that could be problematic.

“Hey, I see that MDWhistleblower is your ‘friend’ now. Isn’t he a gastroenterologist? Are your hemorrhoids acting up again?”

I know that Facebook is a social media empire. It’s being used by tens of millions of individuals, marketing organizations, politicians, government agencies and corporations across the country. It is a powerful tool for personal and business networking. But, it lacks the intimacy of human contact, the mother’s milk of the doctor-patient relationship. Physicians and patients don’t need Facebook time; we need more face time. Is anyone else a ‘fan’ of this?

16 comments:

Anonymous said...

Can I share this on my facebook page?

Anonymous said...

I am a physician and have accepted a patient as a friend on Facebook which makes me uncomfortable. After reading your blog, I will change Faceebook controls for my patient to decrease access to my personal information and avoid potentially embarassing situations.
AK

Anonymous said...

I agree with Dr. Kirsch. Privacy is a very important issue. Also, I think that misinformation obtained through facebook or even email interaction between patients and doctors can be harmful. What patients and doctors need is more face-to-face time! Unfortunately,the structure of our medical system and our busy lifestyles don't foster this kind of interaction. iz

Evinx said...

I think you are right. Facebook could lead to all sorts of uncomfortable and awkward complications.

I wonder though if the younger generation of MDs, now leaving Med School and Residency Programs, who have grown up with Facebook, will think the same way. I suspect they will not as privacy does not seem to matter much with the 20 + even early 30 somethings.

Anonymous said...

Please! If you want to be friends with someone who you provide your service to, go ahead, no one is holding a gun to your head. If you don't want to, don't.

The entire post about facebook said a lot about nothing. It really did.

And if you are apt to complain you don't have time for facebook? Whose fault is that? Are you a slave? Did anyone coerce you to work so much?

Anonymous said...

Oh and he's got time to write a blog!

Dr. George said...

If a doctor wants to have a Facebook page for his patients he can have a separate personal page. This avoids any uncomfortable feelings about what a patient has access to.

Anonymous said...

You may not be aware of this ... but blogs are very public sites. I just typed in "doctors on facebook" into Google, and your post was the 3rd or 4th result. If you want to maintain a low profile, why do you have a blog?

Anonymous said...

There is something about the doctor patient wording in itself that is troublesome. Possibly the wording itself creates imbalance. I think doctors are to assist people with their health. People search for someone with more knowledge in an area to help solve health issues. Some health problems are more complex than others. Too often what people think, feel or just instinct about their own health gets lost in an imbalance. There are ways to explain circumstances to many people so they understand what they are signing up for, such as informed consent. Informed consent, another legal sound wording but very important and often determined a failure after the fact. I think of informed consent as a sort of teaching of the issue. People come to someone with more knowledge to LEARN as much as possible and know all options so they have more intellectual insight quickly to put with their instinct and feelings about their own health. By leaving out options or lack in teach or expain skills, people can't make the best use of their survival skills. Maybe doctors take on too many people to give each the best care? There is something to be said for quality over numbers, at least judging from the receiving end.

I think facebook comes across sort of too much of a random socializing for me in any respect.

KL said...

Dr. Kirsch and respondants, I am a 30-year healthcare professional and an experienced Facebook user, and submit you all may be missing the point about the value of the Facebook model to a more effective, holistic approach to personalized medicine.

I do agree that the Facebook platform as it stands today is too general purpose and not secure enough to support doctor-patient communications. I struggle just with having "friends", "family" and some "coworkers" mixed in my friend list and find myself censoring some of my communications. I prefer to use Facebook for friends/family and LinkedIn for my professional social persona, albeit updating multiple social portals presents other time management challenges as was noted above.

Set aside the reimbursement model for just a minute... and imagine a separate, secure system modeled after Facebook that had the capabilities and functionality of Facebook - where the patient's "friends" were their network of caregivers, providers, and health facilities where they have been. The only information accessible to the patient is all the information about that patient and attributes of the facilities they have been to and the tests they have had done or are scheduled there. The "Wall" would be the patients' medical record with different tabs. The patient could broadcasst a status message for all their caregivers to see in their news feeds. Test results would appear in physicians' news feeds...caregivers could comment on the patient's wall and see each other's comments almost immediately without the need for scheduling a phone consult. It's a brilliantly holistic and efficient model for facilitating the collective thought process, aiding in diagnosis and treatment planning...much more efficient than point to point email communications where it is easy to forget to cc: someone who needs a piece of key information. Since using Facebook I spend LESS time on email - with those who are also on FB - the catch is the more people on it the more efficient you become. I have become an evangelist of FB to my personal connections because it saves me so much time updating friends/family on our lives.

This is the publish/subscribe model of communication and it works! You choose what to see, what to reveal, and whether or not to go further and push messages from the system to your email or mobile device.

I challenge any of the physicians here to reconsider your position on Facebook because you have not allowed yourself the opportunity to understand how it works.

As a consumer, I would subscribe to a Facebook-like service who offered the opportunity to get all of my caregivers and my insurance company on the same platform. The technical challenge is the disparate platforms fueled by all the competing interests and profit motives in our healthcare system today. Standards are emerging but very slowly. A catalyst is greatly needed to support a patient-centric model that would work at a global level, as we live today in a global world without borders.

Michael Kirsch, M.D. said...

Appreciate thoughtful and reasoned comments from KL. The concept of a cyber 'medical home' is intriguing. Once electronic medical records(EMR)becomes the routine standard, it may be that many of the functions that KL highlighted could be incorporated into these systems. I don't think physicians will want to be participating in EMR and various other social media. For some of us it will take all of our psychic energy just to convert to EMR!

Marie said...

I agree with Dr. Kirsch that, as it stands now, it would not be appropriate to 'friend' my physicians on Facebook.

I want my doctor's to take me seriously. I have to admit, even at the age of 55, my friends and I can be very silly indeed. I don't want my providers seeing my posts about being a rabid Bruce fan who has been to three concerts in the past 2 weeks. Or that my one of my best friends and I call each other Mrs. Oppenheimer (long story). And occasionally (horrors!) I use bad language. :)

We all have a more playful side, but it is one I prefer to keep separate from my engagement with my providers. While the relationships do involve personal care, and in my case I am particularly fortunate that I receive extremely compassionate care, it is essentially a business relationship. I have MS, so I have an entire team of providers. I want to be respected as a mature health care professional, not a total goof ball.

I do find KL's idea to be a wonderful one. That kind of social media could really benefit the doctor/patient relationship, especially for someone like me with multiple health issues.

Re. anonymous above and the incredible vitriol of their comments: holy mackerel!!! Did you have a colonoscopy that went horribly wrong?! You appear to be incensed way out of proportion to the subject.

Great blog Dr. too-much-time-on-your-hands Kirsch. lol Time well spent indeed. :)

Anonymous said...

I joined FB at the urging of a friend and rarely log on. I really don't get the fascination with this venue. I like a more personal approach with friends. For that reason, I don't text unless it's to say someting impersonal such as "I'm running late." That being said, I would not want anyone on my FB account that has seen me in a paper gown. I guess I liken it to what I allow my co-workers/boss to see. I keep my personal life totally separate from my work.

I can only speak for myself but I am very uncomfortable around physicians as it relates to my health. If something happens, I go but I limit my visits to taking care of an issue that comes up and keep discussions limited to the purpose of my visit. I do not have a PCP and have not had one in over 20 years. My last visit to a doctor was due to a dog bite I received from a stray dog and it eventually needed looking at. Because I do not have a PCP, I went to urgent care. I think my own personal 'uncomfortableness' is due to the impersonal (but necessary) nature of a patient/doctor relationship. If the physician is to be effective in managing someone's overall health, they need to know very personal information about their patient. Loaded with that information, I would not want them on my FB having interaction with my personal life. Fortunately I am very healthy and have not had much of a need for medical care.

This is my view from a patient point of view (albeit probably not popular). I am sure there are valid reasons why a physician would not want contact outside the office with a patient.

In any event, I agree with your view of FB contact but I'm looking at it from different perspective than a physician.

~tishrei

Anonymous said...

I have a very complex health history and need frequent communication with my PCP. Email is the least time-consuming for both of us. I'd gladly pay a subscription fee for the service, but I get it for free.

I do have the option of an online "visit" for a fee. But if I need a visit, I'd rather it be face-to-face than a text chat--even though the online option is equal to a co-pay.

We've been together many years, my doc and I. We have a friendship of sorts, but our personal lives don't mix. I don't need her to come to my bar-b-ques (though I'm sure it would be a hoot). She doesn't invite me to her son's bar mitzvah. Those are things personal friends do. We are professional friends who would never have met outside of her office. We like it that way. We need it that way. It allows me to be candid with her about my health and allows her to remain objective about it. Win-win, that.

So long as we have email, we can pass information between us. We don't need FaceBook or Twitter.

Anonymous said...

Kepping up with people on facebook can be a full-time job. I don't think a doctor would have the time. Also people may request a kind of intimacy that could be troublesome. A doctor should not be on Facebook or any other social networking site.

Anonymous said...

Dr. Kirsch,

I very much so enjoy reading your blog--its refreshing to hear from a physician himself. But I was so glad I came across this particular article...because I am currently going through an issue of the same sort with my primary physician. I would love to have your input on my situation, and I think that you can truly help me work everything out..and see what this doctor is really up to...let's just say his ethics are quite blurred when it comes to some patients. Is there a way to share my information privately? I want to remain anonymous. Thank You

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