Is Facebook healthy for the doctor-patient relationship?

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If you’re on Facebook, you’ve likely faced this dilemma: Someone you know through your work has asked to become your online friend. You don’t want to be rude and say no, but you’re also a bit queasy about giving professional acquaintances full access to your personal life online. What should you do?

Dr. Sachin H. Jain encountered this problem in his second week of internship, when a woman whose baby he helped deliver as a medical student asked to become his Facebook friend. As he writes in this week’s New England Journal of Medicine, he was wary of allowing his former patient to see his list of friends, view his photos or read his personal blog. On the other hand, he didn’t want to be a jerk.

“The anxiety I felt about crossing boundaries is an old problem in clinical medicine, but it has taken a different shape as it has migrated to this new medium,” he writes.

What could go wrong? Plenty, he speculates.

Patients could call a doctor’s medical judgment into question after viewing Facebook photos of a festive holiday party that involved a bit too much spiked eggnog. Or a physician who lists herself as “single” on her Facebook profile could find herself being asked out by patients who probably wouldn’t have inquired about her relationship status in person. Or a nurse might blow off steam by blogging about a difficult patient without remembering that she had friended one of the patient’s relatives, who would have access to all the gory details. These are some of the reasons medical schools now advise students to think twice about what they post on social networking sites such as Facebook and MySpace.

But without Facebook, a grassroots group called Doctors for Obama might not have persuaded thousands of physicians to flood Barack Obama’s campaign with their ideas about health policy during the 2008 presidential election. “This group of physicians continues to have a voice in the Obama administration, largely on the strength of its Facebook-created network of members,” Jain writes.

So how did he handle his patient’s request? He accepted, partly because he was curious to see how her baby was doing.

It turned out the patient did have an ulterior motive – she was thinking about applying to med school herself. Jain said he was happy to dispense advice, because that was in keeping with the doctor-patient relationship. Among his suggestions: Be careful about how you manage your online identity.

The article is also available via the New England Journal of Medicine’s own Facebook page.

-- Karen Kaplan