Abstract
Keywords: Facebook, social media, ethics, professionalism, British Medical Association.
Citation: Grajales FJ III. One step forward, two steps back: why can’t we protect doctors who put patients first? J Participat Med. 2011 Aug 8; 3:e36.
Published: August 8, 2011.
Competing Interests: The author has declared that no competing interests exist.
To the Editors:
I am a patient, researcher, and medical professional. I have worked with the World Health Organization and the World Bank as an “expert” in social media. I believe that we can use social media to humanize medicine and empower patients. Recently, I was shocked to receive an email from my doc. He had to “unfriend” me from Facebook because of a new hospital policy.
Last May, the British Medical Association (BMA) issued a statement condemning patient relationships on Facebook. Their rationale is that social technologies “increase the potential of clinical exploitation” because a physician may gain access to information that was not disclosed during a clinical encounter.[1]
At the core of this issue is our expectation of privacy. My doc and I, whom I haven’t named to protect his identity, had a mutual agreement. Our “friendship” outside the clinical space would serve to complement rapport, and the Facebook platform would not be used for medical purposes.
At last, I had found a positively deviant doctor. He put patients first.
It took less than two months for the system condemn our behavior.
In case you are wondering, I fully supported and understood my doctor “unfriending” me. However, when are we going to protect those doctors who want to go above and beyond the standard of care? Perhaps the BMA will not sanction our connection through a Google + circle in the future or perhaps the system will never change.
References
- British Medical Association. Using social media: practical and ethical guidance for doctors and medical students. Available at: http://www.webcitation.org/60JqjvpTe. Accessed July 21, 2011. ↩
Copyright: © 2011 Francisco J. Grajales III. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.
This seems unnecessarily harsh. The guidance as linked simply points out the liability of inappropriate use of information, from both patients and physicians. It is not a condemnation of social media, but a cautionary tale.
I would much rather my physician un-friend me (full disclosure: I don’t use Facebook anyway) than a situation arise where I overheard a condescending remark about myself or someone I knew. Likewise, I understand that patients might not truly want to be honest with their doctor, regardless of the potential risk (that’s just realistic, I don’t think it’s the correct way to communicate with your physician), and might be offended/taken aback if their physician was aware of some behavior that affected their health, which they had not actively shared in a clinical setting.
All in all, it all boils down to people in every position, physician, patient, etc. controlling their social behavior. If it’s inappropriate, don’t say it, write it, tweet it, post it, whatever. Control your communication, and this is a non-issue.
Thank you very much for your comment Jon. Indeed, they BMA does not condemn the use of social media; however, their rules have not yet adapted to the realities of contemporary computer-mediated-communication. In particular, “the BMA recommends that doctors and medical students who receive friend requests from current or former patients should politely refuse and explain to the patient the reasons why it would be inappropriate for them to accept the request;” it would be unethical for them to do so.
I agree with you Jon, in that it is best for a physician to un-friend their patient, than to have problems with the College. However, the point here was that there was an agreement and full transparency between both parties and it was hospital policy that took over his desire to keep a more coherent doctor-patient relationship.
Excellent point brought by the author. Medicine should adapt to modern technology whilst maintaining ethics principles, including patient record privacy.
Social media is taking important part of our modern life now, and science. Medicine must take advantage high tech resources like social media to enrich medical practice.
Thanks and keep on doing social media research.
F G Burguete.
Although I believe that for the most part relationships between doctors and patients belong confined to secure web locations, this issue is a slippery slope that is not so much to me a question of privacy but a question of sanctions on choice. Physicians should be free to choose how and where they interact with their patients. As long as they are completely professional and observe the privacy laws of their governing entity, they should have the right to converse with their patients on and off line on whatever forum they and the patient agree upon.
Thank you Nancy. I agree with you wholeheartedly and wish that the Colleges, Medical Associations (American, British, and Canadian), and Medical Schools were able to make policies that follow the principles you have mentioned.
Was it the doctor’s personal Facebook profile? I fail to understand why the rules of engagement for social media are so different from other social environments. Would the physician be allowed to attend the same dinner party as one of his patients? Could they talk on the telephone? It seems that adults ought to be able to associate (at least in the US where that’s constitutionally protected behavior) using whatever method best suits them.
I’m just not sure what I’m overlooking that makes Facebook so different from a neighborhood cookout where people might friend each other.
If I liked my doctor, I’d do the same as Francisco and gladly overlook it all.
Thank you Kelly for your comment. I believe that part of the problem why the rules of engagement for social media is that many of the decision makers within large medical organizations are risk averse and seldom understand the tactical and operational nature of social technologies. Of course, in medicine we should do what is best for the patient, and being risk adverse is essential; however, running into your physician at a social (either positively or negatively deviant) gathering is no different on the web, as it is in real life.