Social media changing patient-MD relationship

No "absolutely correct" answer to some questions

Social media provides both significant opportunities and risks in medical practice, says David H. Brendel, MD, PhD, a Belmont, MA-based psychiatrist who writes extensively about the ethics of online technology use in clinical practice. Brendel is the recipient of an award for teaching medical ethics in 2011 from the Academy at Harvard Medical School.

"In the absence of clear medico-legal guidance about physician use of social media and best practices on whether and how to interact with patients using these technologies, careful ethical deliberation is essential," he says. "A pragmatic weighing of risks versus benefits is generally the best approach." Clinical ethicists who are knowledgeable about the dilemmas involving social media usage can help physicians think through these challenging new questions affecting their practice.

One important question is whether physicians should learn information about their patients by conducting searches using patients’ names on Google or LinkedIn, by reading patients’ online blogs, or by following them on Twitter. "My research and published articles have suggested that there is no absolutely correct answer to these questions in the absence of thoughtful, nuanced consideration of the pros and cons," Brendel says.

If this type of physician usage of social media reveals potentially life-saving information, such as reading a patient’s blog describing an imminent suicidal or homicidal plan, then online searching for patient information could be ethically permissible or even required in some limited situations. "On the other hand, if physician usage of online technologies is likely to result in compromising patient privacy or other core values, then it must be avoided and prohibited," says Brendel.

Related questions arise as to whether physicians should obtain informed consent before conducting an online search for patient information, and whether the information should be disclosed to the patient and/or entered in the medical record. Brendel says the most prudent approach is to avoid conducting these kinds of online searches unless careful deliberation, possibly including consultation with peers or an ethics committee, reveals that potential benefits to clinical care far outweigh risks to patient privacy and to the public’s trust in the medical profession as a whole.

"Physicians should be aware of the learning opportunities — and the serious privacy risks — that have been generated by the escalating availability of social media technologies," he cautions.

More informed patients

The degree of connectivity provided by current technology, when used incorrectly or carelessly, can threaten the relationship between physician and patient, warns Jeanne M. Farnan, MD, MHPE, assistant professor in the section of hospital medicine at The University of Chicago (IL) Pritzker School of Medicine.

Social media has provided patients immediate access to information and advice that has never before been available, and this is informing the therapeutic relationship. "Patients use of social media is consistently on the rise, with many accessing the Web for health concerns, often finding communities with which to share experience and stories," says Farnan. "This results in a more informed patient, with which physicians have the potential to have a higher level conversation about care and decision-making."

However, social media has taken the doctor-patient relationship out of the physical structure of the office and into a world where professional and personal boundaries are quite indistinct. "Several ethical concerns and considerations plague physician use of social media, specifically to use in interactions with patients," says Farnan.

Examples of inappropriate behaviors include inappropriate patient-physician relationships, sharing information that threatens confidentiality, and physicians displaying questionable behaviors online. In April 2013, the American College of Physicians and the Federation of State Medical Boards jointly issued a policy statement on online medical professionalism. (To view the policy statement, go to http://bit.ly/ZR5Xvt.)

"Suggestions include maintaining personal and professional interactions by establishing clear guidelines for when and how communication can take place, being aware of the digital image that is presented by the physician in all digital behaviors, and cognizance of representation of self and the profession," says Farnan.

Bioethicists can provide guidance to medical students and practicing physicians on the ethical implications of digital behavior on the physician-patient relationship. "In addition, they can lead the discussion of what conduct is becoming of a physician in this new environment, and explore what exactly is professional behavior in the new digital realm," Farnan says.

SOURCES

• David H. Brendel, MD, PhD, Belmont, MA. Phone: (617) 932-1548. E-mail: david@drdavidbrendel.com.
• Jeanne M. Farnan, MD, MHPE, Assistant Professor, Section of Hospital Medicine, The University of Chicago (IL) Pritzker School of Medicine. Phone: (773) 834-3401. E-mail: jfarnan@medicine.bsd.uchicago.edu.