Can a patient be a ‘friend’?

Not best advised according to new BMA guidance for doctors using online social media

Be it Facebook, Twitter, blogging or internet forums – there is no doubt that the rise of social media has led to a blurring of the personal and professional and this brings risks for anyone engaging in our brave new digital world. But for doctors the risks can be much more serious and far-reaching.

In July the BMA issued guidance advising doctors and medical students not to accept Facebook ‘friend’ requests from current or former patients. Using social media: practical and ethical guidance for doctors and medical students also urges doctors and medical students to consider adopting conservative privacy settings and to be aware that not all information can be protected on the web.

The Chairman of the BMA’s Medical Ethics Committee (MEC), Dr Tony Calland, said: "Research has shown that while most doctors would not accept Facebook friend requests from patients, a minority said they would consider doing so. Yet accepting Facebook friends presents doctors with difficult ethical issues."

One obvious risk area is in maintaining appropriate professional boundaries with patients. The GMC provides no specific advice regarding social media but the same principles apply in doctor–patient relationships regardless if interactions are on-line or face-to-face.

MDDUS senior medical adviser Dr Jim Rodger, said: "Doctors are bound by guidance from the General Medical Council which states that they must maintain professional boundaries with patients.

"Any doctor pursuing a non-professional exchange with a patient via social media – no matter how innocent it may seem – runs the risk of falling foul of the GMC. So it’s best not to go there.

"The GMC further states that if a patient displays inappropriate or sexualised behaviour – be it actions or words – the doctor should wherever possible treat them politely and considerately and try to re-establish a professional boundary."

Just what is meant by professional boundaries can be widely interpreted and it is important to understand that the GMC may still question a doctor’s fitness to practise even if a relationship seems entirely open and consensual with no obvious adverse consequences for the patient. Such a relationship need not be long-term or even sexual in nature to attract censure. Exchanging personal details with a patient such as those commonly posted on sites like Facebook can increase the likelihood of ethical difficulties.

"For example doctors could become aware of information about their patients that has not been disclosed as part of a clinical consultation," explains Dr Calland.

So what should you do if sent a friend request by a patient or former patient on Facebook? Some doctors might feel that simply to ignore such a request would be rude. The BMA recommends that doctors and medical students should politely refuse with an explanation of the reasons why it would be inappropriate to accept the request.

Doctors should also be careful not to invite unwanted attention from patients in first place. The BMA says that although doctors often "choose to divulge personal information about themselves during face-to-face consultations with patients, they are able to control the extent and type of this self-disclosure. The accessibility of content on social media however raises the possibility that patients may have unrestricted access to their doctor’s personal information and this can cause problems within the doctor-patient relationship".

Taking care with private details can be as much a matter of personal security. In 2009 the University of Birmingham issued guidance to students on Facebook after it emerged that former patients had contacted two medical students via the website.

The BMA warns: "Some social media sites, such as Twitter and Facebook, have privacy settings that allow users to control and put restrictions on who has access to their personal information. The default settings for both sites however permit various types of content to be shared beyond an individual’s network of friends.

"On Twitter for example, the default setting for accounts is 'public', allowing anyone to search for and access a user’s profile page, while the recommended settings on Facebook allow ‘'everyone’' to access status updates, photos and posts. Users therefore actively need to change the privacy controls to ensure their content is protected to the extent they would like."

ACTION  Take steps to ensure that the risk of inappropriate patient contact - online or otherwise - is kept to a minimum. Consult the BMA’s Using social media: practical and ethical guidance for doctors and medical students

Jim Killgore, publications editor at MDDUS

This article appears in issue 07 of FYi