Dear YO Info:
I recently received a “friend” request from a patient on social media on my personal (not professional) page. I do know the patient, but I’m not sure how to respond since I’m not exactly a friend. Are there ethical concerns with using social media to communicate with patients?
Confused About “Friends” vs. Patients
Dear Confused:
I can see why you’re confused. Boundaries between personal and professional relationships can become blurred and you need to tread carefully.
Let’s start by thinking about it the opposite way: establishing therapeutic relationships with friends and family. Since it’s difficult to maintain your objectivity, the American Medical Association expressly recommends avoiding treating family, as do many state licensing boards specific to prescribing.
On social media, the problem is unique in that when someone approaches you with a "friend" request to your personal account, the response must be binary — either yes or no. This is not the way conventional social interactions work (when we can work in the infinite shades of acquaintance) when seeing a patient in public — you can be friendly, but not be “friends.”
You don’t have to stay off social media, however. Personally, I have chosen to have two separate accounts on Instagram, one public profile with my professional posts where anyone can follow me; and a second private account for true friends and family.
Once, I had a patient contact me on my @esilversteinMD Instagram account to get an appointment because they couldn’t get in touch with my office. Fortunately, I received the call information in my electronic health record (EHR) system at the same time and called them from my work phone and documented the call in the EHR.
It is essential to keep patient care off of social media. Some people have slid into my direct messages (DMs) asking for medical advice. I make a point to not provide advice but refer them to my office number to make an appointment or the patient information pages on aao.org or aapos.org. When thinking about online interactions, I ask myself a few questions: 1) What would I say to a stranger on the street?; 2) What would I want to be broadcasted to the world? Your DMs are not private and can be copied or pasted anywhere at any time.
I have a strict policy on keeping my Facebook profile “locked down” and will not communicate with patients on this platform. Consider a similar policy of not befriending patients on your private accounts in order to keep your social life and patient care separate and to minimize potential complexities.
For help see “Code of Ethics, Principle 2: An Ophthalmologist's Responsibility.” It is the responsibility of an ophthalmologist to always act in the best interest of the patient. In addition, check out the AAO’s Redmond Ethics Center for more advice in ethics.
Evan Silverstein, MD
Chair, YO Info Editorial Board
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