Wanting to connect is natural—but the patient-provider relationship has important boundaries.
I’ve said a lot about how social media can help us connect with, understand and help our patients better. Outside of our social media policy, though, I haven’t mentioned the habit many in health care have of connecting directly with patients, like when we friend them on Facebook.
But you said we should reach out to them.
Here’s the thing. We care a great deal for our patients and their families. We share amazing bonds with them during some of the most important moments of their live
s. I know that many of you work with some of your patients for weeks, months, sometimes years. It’s natural to want to continue that relationship, especially when the patient is entering the uncharted waters of life outside our care.
Friends with a patient? Any of these could happen to you.
One of your coworker-friends posts a drunken selfie of the two of you—and now your patient has seen it too.
You see a photo of your patient drinking, which she’s denied doing because her condition makes it dangerous. Would you feel obligated to confront her? What if she saw a photo of you doing the same thing? Even if you were off-duty, you’ll still look like less of a role model—and odds are, you’ll never know she saw it.
Your patient complains to you about one of your colleagues. (You’re friends, after all.) What do you say to the patient? Or your coworker?
Your patient complains about her care. Now your coworker-friends can see it.
On the flip side, what about the behavior of all of your coworkers? What would your patient find if she started exploring those timelines?
But as much as we care, this is our job. We already have boundaries that, in real life, we hold sacred. Social media is real life; to fool ourselves into thinking otherwise is to do our patients a great disservice.
When we’re in the office with our patients, we listen. The more they can tell us about their lives, the better we can help them. But do we then turn around and go into the same amount of detail about our own lives? No. Of course not. Would you mention your political or religious views in the office? No. But Facebook will do it for you if you accept that friend request.
Friending patients opens the floodgate to your uncensored life (and anything your other friends do). You can’t anticipate how that information may be seen through the eyes of a patient or parent who’s:
- dealing with disease or trauma
- facing the end of life or contemplating suicide
- battling with addiction, abuse, or another issue that they’re gathering the courage to mention when they come back.
It’s so easy for our own friends to take our words out of context. What might the consequences be if it were one of your patients?
I don’t want to insult my patient by refusing the request.
I get that. I wouldn’t want to either. It’s entirely fair to explain why we have the boundaries we do, and they aren’t personal. They include:
- Privacy. To protect our patients, we must follow very stringent HIPAA laws, as do all health care providers in this country.
- Policy. Dartmouth-Hitchcock requires all its employees to abide by its social media policy. This applies to connections on all social media platforms, not just Facebook.
If you get such a request and need help with a reply, contact me.
The patient perspective
As a patient myself, I sometimes wish things were different. The midwife who saw me through an immensely difficult pregnancy and birth—and several equally hard early months of motherhood—will always hold a sacred place in my and my daughter’s life. I would love to be well-connected with her online, and there’s a lot I’d share with her. She’s really special to me.
But early on, she let me know that she doesn’t interact with her patients online at all, partly because she wants to hear a patient’s voice when she speaks with her (a useful diagnostic tool) and partly because she knows her own limits. Given how many families she affects every year, she’d have thousands of contacts in no time—and no time in which to consume the daily avalanche of emotion that would come her way.
I see her point. And I respect it.
Remember, how we present ourselves in the social sphere is just another aspect of how we present ourselves in the real world. If a patient wants to connect with you, it’s because of that professional bond I mentioned earlier. They don’t want to know that, like everyone else, we can be total idiots sometimes.
So how do I interact with my patients online?
“My patients only get 20 minutes with me each year. It is my ethical obligation to be online.” —Wendy Sue Swanson, MD, who blogs and tweets as SeattleMamaDoc
We can make a difference in people’s lives without crossing that line.
- Contact me if you keep answering the same questions over and over every day and wish you could get your message out to a wider audience. That’s why I’m here. Let’s find a way that works for you.
- Encourage your patients to join the conversations that are already happening on our existing social channels and in online patient communities relevant to them.
- Engage in those patient communities in your area of expertise. That’s where patients are already very active. If you want more information about broadening your online presence, contact me.
- And guess what! You don’t have to be a clinician to be a valuable member of our social media team. You work here. Your perspective is just as important as anyone else’s. I want to hear from you.
Talk back!
- Have you received a friend request via Facebook, Twitter, LinkedIn or another medium from a patient or family? How did you handle it? You can reach me on Twitter @susannafrench. Join the conversation on all our social platforms at d-h.org/social.
Susanna French is Dartmouth-Hitchcock’s social media specialist. She thinks “selfie” should be banned from the English language, chopped into a million pieces and thrown into the fires of Mordor.
About The Feed
The Feed is my regular column for employees of the Dartmouth-Hitchcock health system about how the synthesis of health care and social media affects all of us—employees, patients and the community—for the better.
