Breaking the Physician-Patient Boundaries on Facebook?

McLean Hospital psychiatrist addresses ethical questions and provides guidelines to online social networking

March 2, 2010

Facebook and other social networking websites are posing new ethical issues for doctor-patient relationships, according to researchers from Harvard-affiliated McLean Hospital. Do patients’ “friending”—the act of initiating an online relationship on a social networking site—doctors violate doctor-patient confidentiality? Should physicians include information obtained via social networking in a patient’s medical record?

David H. Brendel, MD, PhD, chair of McLean Hospital’s Institutional Review Board, addressed these and other issues in an article in the Journal of Medical Ethics. “We tried to think through each step in the “friending” process to devise ways to safeguard the patient-doctor relationship while preventing ethics breaches,” said Brendel, the senior author.

The article offers physicians four guidelines for online networking: Address a patient’s online invitation immediately and in person to avoid any damage to the therapeutic relationship. Do not enter information obtained on social networking sites into a patient’s medical record without his/her consent. Use discretion when posting personal information. “I would discourage doctors from participating in any form of social networking, but if they do, I would encourage them to privatize their information,” said Brendel. Understand a site’s privacy settings to assess the risk of privileged information becoming public.

Brendel, who teaches medical ethics and professionalism at Harvard Medical School, was inspired to author the article by his first-year medical students, who produced a fictional vignette about a doctor who uses Facebook to obtain patient information. While the students thoughtfully addressed the issue of what to do with this information, Brendel said he was concerned that many of his students saw no problem with researching a patient on Facebook in the first place. Nearly two-thirds of medical students use Facebook regularly, according to a study cited in Brendel’s article.

Brendel is also the senior author of a forthcoming article in the Harvard Review of Psychiatry that delves further into the changing landscape of online medical information, including the ethics of doctors’ searching online for patient information (“patient-targeted googling”).

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