The Perils and Pitfalls of Social Networks (Series 3 of 5)

The Downside to Social Media

Among key concerns about medical professionals’ use of online social forums is the lack of guaranteed security, with the possibility of unwitting transmission of sensitive materials despite the use of privacy settings. For example, Facebook users may “tag” or label another Facebook user (pictures or text) by name without the knowledge or consent of the individual involved. A blog leaves a permanent imprint on the Internet because most blogs are searchable by date, name, or keywords, and a blog entry from long ago can quickly be accessed.

There is a considerable bioethical literature base concerning sexual, financial, and gift-giving boundaries within the patient-doctor relationship. Engaging in friendships with patients has not been a customary part of the relationship. Online friendships are particularly problematic because they do not prioritize the therapeutic interest of the patient and are associated with potentially inappropriate clinician self-disclosure, problems that can be magnified to the detriment of the therapeutic relationship in a mental health encounter. Therapists also note that the healthcare provider may become privy to patient information not intended for them through social media sites, such as patient smoking, alcohol ingestion, or dating behaviors. This information has the potential to change the framework of the therapeutic relationship.

Searching for information online without the patient’s knowledge may itself violate patient autonomy and dignity, infringing on the trust integral to the relationship. On the other hand, patients are now able to Google their providers and gather data that may well include inaccurate or false information. Healthcare professionals have to rethink the presumption of anonymity now that their private lives are within the reach of their patients, subject to intensification through images and other highly personal content. The traditional information asymmetry between provider and patient is likely to be increasingly equalized, with escalating information access by patients.

Some examples of unintended consequences of online participation in networking sites could include:

1. A patient loses his life insurance because his primary care provider documents information in the medical record about his lifestyle behaviors obtained through his Facebook account.
2. A nurse practitioner is approached for a date by a male patient on a dating site on which she has a profile.
3. A well-known psychiatrist’s online venting about “drug-seeking patients” is widely disseminated through a “friend” who shares it with his friends.
4. A surgeon shares concerns about technical errors he made in a case on a physician blog and becomes the subject of a lawsuit from the patient.

Venting or debriefing are strategies informally adopted by health professionals to relieve stress. While conversations in closed hospital settings and in-person, face-to-face remarks are short-lived and lend some protection to practitioners, the content of blogs and social networks do not afford privacy and are presumed to be a permanent record. Examples of online violations of patient privacy leading to unintended consequences are widely available in the lay press. A recent particularly shocking example, as reported by The Boston Globe,occurred in April 2011 when an emergency room physician was fired for posting photos of a patient on her Facebook page.