Doctor-patient boundaries
Example 3:
You get a friend request on a social networking site from someone whose name sounds very familiar, but they have a photo of a dog as their profile picture. You accept the request. After looking through their profile page, you realise that it is actually one of your previous patients. The patient sends you a message to let you know that they cannot make their next clinic appointment, but would like to know their histology results from a test ordered while the patient was in hospital. The patient also throws in a cheeky comment about some photos they saw of you wearing swimmers at the beach.
A power imbalance exists between doctors and patients, and the maintenance of clear professional boundaries protects patients from exploitation.12 Doctors who allow patients to access their entire ‘profile’ (or similar) introduce them to details about their personal lives well beyond what would normally occur as part of the usual doctor-patient relationship, which may be a violation of professional boundaries. In general, it is wise to avoid online relationships with current or former patients. Boundary violations can occur very easily online, and serious indiscretions may result in disciplinary action against the doctor.
If a patient does request you as a friend on a social networking site, a polite message informing them that it is your policy not to establish online friendships with patients is appropriate. Another mechanism used by some doctors, who often work privately, is to create an online profile that is maintained as their professional page only, or to join a professional social networking site.13 Patients can become friends or fans of this professional page, which only provides information relevant to the professional practice of that doctor. It is also possible to pay companies to manage social networking profiles.
Other boundaries
Example 4:
In September 2008, a Junior Medical Officer in the UK was suspended from work for six weeks after describing a senior colleague as a ‘f***ing s***’ on an online social networking forum. Another colleague, who happened to be friends with the JMO and the senior colleague, saw the posting and made a complaint about the comments to the JMO’s employer. The complainant said she felt compelled to complain after seeing the ‘scatological’ language used in the posting. The JMO apologised for the comments and organised for their removal from the website.14
Other professional relationships may also become problematic on social networking sites. Think very carefully before allowing others (including employers, other doctors, nurses, allied health professionals, clerks, ancillary staff, students, or tutors) to access personal information.
Colleagues’ online conduct
Inevitably, many people choose to interact with colleagues via social media. While you need to be aware of what they see you doing, you may also notice colleagues posting information online or behaving inappropriately. Looking after colleagues is an integral element of professional conduct, so if you feel that a friend or workmate has posted information online that could be damaging for them, consider letting them know in a discreet way (such as a personal email, text message, or phone call).
References
12 Ibid
13 Ibid 10.
14 Graham N, Moore P. The Dangers of Facebook. Stud BMJ 2008;8(10):354-355
