Question: I’m not sure how to respond when a patient sends me a “friend request” on a social networking website. Are there ethical concerns with using such sites to communicate with patients?
Answer: There are no specific ethical concerns under the rules of the Academy’s Code of Ethics regarding the use of social networking sites to communicate with patients. However, from a practical standpoint, this issue is analogous to the general taboo of establishing a therapeutic relationship with friends or family. In both situations, boundaries between personal and professional relationships can become indistinct. Usually, such relationships are problematic enough that physicians generally avoid them. The AMA expressly recommends avoiding treatment of family, as do many state licensing boards specific to prescribing.
Seeing patients socially is also potentially problematic, but clearly will depend on the specifics (i.e., whether the social link is a distant acquaintance, a friendship, a business interest, etc.).
A problem unique to networking sites is that when one approaches another with a friend request, the response must be binary—either yes or no. This does not allow the latitude of conventional social interactions, in which we take advantage of infinite shades of acquaintanceship that can be calibrated to the situation. Such shading is not conveniently available in the way networking sites are structured, except perhaps by granting access to more or less of one’s information.
A physician need not abstain from a presence on such sites but might consider a policy of not befriending patients in order to keep social life and patient care separate, and to minimize potential complexities.
Alternatively, a separate online persona could be developed for professional interactions, though this has all of the problems inherent in electronic communications with patients. These problems include protection of confidentiality, giving medical advice without examination, inability to bill for such services and a substantial investment in time for these activities.
For more information or to submit a question for this column, contact the Ethics Committee staff at ethics@aao.org.