How is Facebook Affecting Medical Ethics and Malpractice Liability?

nejmlogoShould doctors on Facebook be wary of sharing too much information with patients, colleagues, or representatives of insurance companies?

An article in the latest issue of the New England Journal of Medicine by Dr. Sachin H. Jain explores how Facebook is changing the nature of the doctor-patient relationship and the difficulties of balancing a personal and professional persona in social networking.

Facebook is quickly evolving into much more than a “social networking” site, with more and more people using the site to cultivate a variety of professional connections. But conflicts can arise when your professional and personal worlds intersect, especially when dealing with health and medicine.

When a former patient sent Dr. Jain a Facebook friend request, he accepted it with some hesitation. He was unsure of the patient’s motives, but felt Facebook offered a way to learn a little more about the woman’s daughter, whom Dr. Jain had delivered. However, Jain says he had reservations about inviting a patient into his personal life, as there were some potential ethical and legal repercussions to the online interaction.

“In confirming this patient as my ‘friend’ on Facebook, I was merging my professional and personal lives. From my Facebook page, Ms. Baxter could identify and reach anyone in my network of friends, view an extensive collection of personal photographs, read my personal blog, and review notations that others had left on my ‘wall,'” Jain says. “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.”

It turned out that the patient was seeking some advice, as she was considering entering medical school. Dr. Jain was relieved that the interaction was indeed somewhat professional, but the entire situation showed him how Facebook can break down the barriers put in place to help keep doctors at a safe distance from their patients so as to remain impartial.

For doctors, are also the issues that apply to every professional with a public Facebook profile, including a patient/client having access to photos or posts that could be detrimental to the professional’s image. While it’s always wise to police what you share on Facebook, it can be especially damaging for medical professionals to post questionable material. Should a patient with access to a doctor’s or nurse’s Facebook profile find something that breaches doctor-patient confidentiality, there could be potential legal issues. We might even theoretically see insurance companies trolling doctors’ personal pages for incriminating evidence, and the wrong content could affect the already high price of malpractice insurance.

Dr. Jain was fortunate that his former patient was only seeking advice, but he was cautious and advices others to be careful.

“The issues raised by access to online media are in many ways similar to issues that physicians and medical institutions have dealt with for generations. Physicians, after all, are members of real-life communities and might be observed in public behaving in ways that are discordant with their professional personas,” Jain says. “What is different about the online arena is the potential size of the community and the still-evolving rules of etiquette.”