Doctors and “Friends”

Key Definitions:

Personal Profile / User Account: for individual person to connect with their friends and share information about their interests. Friends connect with other users / profiles by “friending” them. “Friending” involves an invitation, and requires clicking an “Accept” button to make the connection.

Facebook Page: Pages are for organizations, businesses, celebrities, and brands to distribute information to their fans in an official, public manner. Fans “like” Pages. More simply stated, people or users “like” professional Pages. “Liking” an organization’s Page is simply a statement of interest or appreciation, requiring no active button-clicking by the “liked” organization or business to accept it.

Administrator: A page administrator, or admin, controls the content and settings of a group, and administers the page via a personal profile.

Wall: The Wall is the central location on Facebook for recent information posted by you and about you. It’s where you keep your up-to-date content, and where your friends or Fans can contribute.

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Facebook and Physicians

Over 1/3rd of the population of the US is now on Facebook. Right now, chances are there a patients in your waiting room who are commenting on their Facebook "wall," tweeting on their Twitter account, or leaving a comment on someone's blog. 

Any physician who is present and active on social networks will encounter patients on those networks. After all, that is one of the reasons for physicians to participate on social networks – to interact, to engage with their patient community. 

In general, such engagement is a positive:

• That engagement continues the conversation beyond the exit door of the clinic.
• It helps educate and inform your patients and their families.
• It helps establish your expertise in your area of practice.
• It allows for patient advocacy.

But, there can be instances where this engagement poses a unique risk for the physician.

One of those is the situation where a patient requests to “friend” a physician on Facebook. Should a physician accept a “friend” request from a patient on their Facebook personal profile?

The short answer is “NO”.

Liability

There are several ways that this may pose a liability for the physician:

• Simply accepting a “friend” request on Facebook may acknowledge a physician-patient relationship. And does so in a public space. It is publicly disclosed, displayed. 
  The request, and the physician’s acceptance of that request, may NOT constitute adequate consent for public disclosure of that relationship. That is, according to some legal experts, accepting a “friend” request on Facebook from a patient may represent a HIPAA violation.
• Accepting a “friend” request from a patient on a physician’s personal Facebook account may allow that patient to identify and contact anyone in the physician’s network, to access personal, family photographs, to view personal comments left on the physician’s “wall”, and to view the physician’s personal comments.  
• There are ways to limit this access, but the majority of Facebook users do not understand how to manage those security settings. Furthermore, Facebook has a history of changing these privacy settings without notice to users.
• Studies have found that physicians and others in healthcare are preferred targets for stalkers. Thus, many physicians are careful to protect their families and friends from their professional lives, and are wary of sharing their personal information with patients and the general public.

Regardless, a personal profile on Facebook is probably not the best place for physicians to connect with patients.

The question remains: how DOES a physician, or practice, or hospital, interact with their patient community on Facebook?

Are we limited to a single-dimensional, Web 1.0 means of communicating? That is, are we able to do more than simply broadcast information on this platform?

Can we interact?

Can we hold a meaningful conversation?

Some Solutions

• One solution is for physicians who participate on social networks to maintain separate personal and professional accounts in an attempt to keep these worlds from mixing. In this scenario, they do not accept “friend” invitations to their personal profiles from patients. See note on “business Page” below.
• Alternatively, on some social platforms, such as Facebook, there are ways to separate various “groups” or lists of friends or contacts – keeping family separate from friends or colleagues, as examples. 
  Savvy management of these security settings can allow commenting and posting family photos for limited family viewing only, for example, without broadcasting them for all friends and colleagues.
• A physician, as a professional practice, or a hospital can establish a business “Page” onFacebook. Other users can then “like” that page instead of “friending” it as they would connect to a personal profile. Of all the options, this one is perhaps the safest, although it does require a bit more effort to maintain the bidirectional nature of communication using a Page than it does using a personal profile / wall.

Make no mistake: The effort required will return benefits for your patients, and for your practice and hospital.  

It IS worth the effort. 

Disclaimer

A professional Facebook Page for a medical practice, clinic, or hospital should display a link to their privacy policy, and disclaimer that clarifies the purpose of the page. This disclaimer must also clarify the fact that interaction on the Facebook platform does NOT constitute medical advice, and does not constitute a physician-patient relationship.

If you want to have a more direct connection with a patient, take the conversation offline. If you ever feel that an interaction online is approaching a HIPAA violation, or you are uncomfortable with it for any reason, request that the patient call your practice for follow up. Telephone is acceptable. Face-to-face is optimal.

The Facebook History:

Facebook is a special case with regard to privacy issues. More than any other popular social network platform, Facebook has established a precedent of capriciously changing their privacy rules, without asking – or even notifying – their users. Facebook users are therefore cautioned to regularly check their privacy, security settings.

The safest solution is to NEVER discuss ANY identifiable patient information on digital media. This applies to Facebook, and all other social networks.  

Never Practice Medicine Online

NEVER offer specific medical advice, other than generic or hypothetical generalizations, on social networks. That is, a physician can describe specific treatment modalities for specific disease states, but may NOT advise specific treatments for specific patients. Doing so may constitute establishment of a physician-patient relationship. This poses obvious liability, and represents offering treatment advice without a detailed history and physical exam – something that a physician would never consider in the clinic setting.

Furthermore, the social network is global. Offering medical advice on such networks poses the particular risk of practicing medicine across state lines – your license may be at risk by offering medical advice for someone in a state in which you are not licensed to practice medicine!  You may lose your license to practice. Don’t do it!

Establish a Social Media Policy

Finally, your practice or hospital can minimize liability by establishing a Social Media Policy. Be certain that you have posted links to your policy on all of your social networking platforms. 

Our whitepaper, "Write a Social Media Policy Manual for Your Hospital or Practice", is a free 3-step guide you can reference.

Resources:

http://www.bakerdaniels.com/newsandevents/news/detail.aspx?id=8D07A5EA708045D4B0CD4DC02D12BA85

http://www.kevinmd.com/blog/2010/06/facebook-friends-patients-violate-hipaa-privacy-laws.html

http://www.nejm.org/doi/full/10.1056/NEJMp0901277

http://mentalhealth.about.com/cs/womensmentalhealth/a/stalkers.htm

http://www.mja.com.au/public/issues/176_07_010402/pat10750_fm.html