Apparently I’m not the only one whose been pondering the question of doctors and Facebook.  Asks Danielle Ofri over at the NY Times:

Should Your Doctor Be on Facebook?

I can’t really answer that question without asking another one first — is your doctor an idiot?  If so, your doctor shouldn’t be on Facebook.  (Also, you should find another doctor.)

From the article:

For doctors like me who have waded into social media, however gingerly, many questions arise. Is posting a medical musing or details of a recent party on Twitter or Facebook the same as chatting with colleagues while walking down the hall of the hospital? Do the same rules of etiquette and liability apply to this extremely public environment?

An article in The Journal of General Internal Medicine highlights some of the hazards of the murky mixing of personal and professional selves that occurs in the online world. In one example, a doctor had posted photos of himself and his colleagues partying on his Facebook page. These were aid doctors providing medical care in Haiti, and the unprofessional images of drinking, carousing and posing with guns cast a poor light on what by all accounts was exemplary medical work.

I was curious about those photos of partying while on the aid trip, so I clicked through.  It seems that Dr. Ofri is eliding some important details.  From the linked CNN article:

Some of the photos, which were posted on the social networking site Facebook, show smiling doctors holding guns or toasting each other, bottles of scotch or other alcohol in their hands. Others show medical personnel in what appears to be a clinic, grinning as they attend to patients. Another shows a quake victim on a hospital bed, naked from the waist down except for a thin strip of cloth covering the genitals.

Holy cats! I don’t think anyone would have cared about relatively innocent pictures of drinking (although I’m wondering about the guns) were it not for the much worse pictures of naked quake victims!  Guys!  Don’t post pictures of patients on the Internet without their consent.  Especially if they’re naked!! Physicians who lack the common sense to know this without being told prrrrrrrobably should avoid Facebook.

When I was in practice in a smaller area, the issue of Facebook was a bit more complicated for me.  There was more overlap between patients/families and friends, and I knew people from different contexts.  I ended up “friending” (a tedious new verb that drains the original noun of meaning) many of my patient’s parents, thus giving them access to the whole lot of what was in my profile.  There’s nothing there that would be worrisome if anyone saw it, though there’s plenty that doesn’t redound to my gravitas either.  (I work every year at a camp for chronically ill kids and families, and plenty of my time is spent acting like a lunatic for their entertainment, as documented photographically.)  It wasn’t entirely comfortable, and I avoided any kind of clinical communication using Facebook messaging, but I side-stepped any problems by posting only anodyne material.

My current practice has a strict policy forbidding any social media contact between patients and staff.  Given all the problems that can surround confidentiality, how to document communication, and the potential for blurry professional/personal relationships, I think this is prudent.  Different providers may have different levels of comfort.  However, the same rules of propriety and professionalism must remain in place, wherever medical practitioners draw the line.