It comes as no surprise, to me anyway, that doctors would be catching on to the value of social networking on Facebook for marketing of their practices. But what are the ethical bounds of using social networks for the existing patients under a doctor’s care?

According to a recent study by Harvard researcher David Brendel, the “friending” process between doctors and patients was explored to find an ethical way for the physician-patient relationship to remain intact via social networking. Here is what he came up with, according to his own press release:

• 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.

Quite frankly, I have not read a less well thought out set of recommendations in a very long time. The potential for privacy violations on both sides (for doctor AND patient) are so serious here that I can hardly believe that this study was published. If anyone knows anything about how Facebook works, one can only imagine how this would be a complete and total disaster.

Let’s imagine just one scenario: a patient goes online and says he/she wants to connect with Doctor Doe on Facebook. How long is too long for Doctor Doe to wait before “damage to the therapeutic relationship” begins? A day? Two days? A week? Of course, this is totally dependent upon how frequently the “requester” uses Facebook. The patient might be on Facebook every hour, while Doctor Doe might be a weekly user. Already there is the potential for the inadvertent snub.

Moreover, most patients are likely to friend doctors right before office visits because they are on their minds or for rapport-building or for hopes of longer than the average 7 minute encounter. So what happens when Doctor Doe wasn’t online last night and Patient Paul comes into the exam room and says, “Hey Doc, why didn’t you accept my friend invitation on Facebook?” Isn’t the patient relationship inherently already damaged?

As for Brendel’s second recommendation, it might seem obvious, but it would be all too easy if one were monitoring a patients Facebook page to say, “I noticed last Tuesday you said you were really tired and running a fever and didn’t go to work. What was going on?” Those kinds of invasions of privacy that we now think of as being routine on Facebook would be almost unavoidable for doctors and would be inevitably in one’s subconsious, whether or not they ever made it to the chart.

Brendel’s third recommendation would require making patients a separate group of people in their Facebook lives and making only certain information available to them. But that begs the question, what kind of information is okay to share with patients? That Doc Doe went sailing last Saturday or that he likes Dr. Pepper but not who his other friends are? Drawing those boundaries are incredibly complex and I’m not sure anyone, least of all the medical profession has thought through where the boundaries of information sharing with patients should be drawn, especially when it can reach through to friends of friends of friends.

The same holds true for Brendel’s last point. Which leads me to conclude that the friending of Doctors on Facebook and the connecting of patients on all kinds of social networking sites is simply not a good idea, or is at least premature. While social networking is great for marketing and outreach, it in this case creates so many privacy concerns that have been so poorly thought out that it should not be done until someone comes up with concrete and clear guidance for patients and physicians for how networking can proceed so both sides of the interaction can be respected.

But it is a problem that cannot wait and must be resolved quickly, as Brendel’s press release notes, 2/3rds of medical students are on Facebook. This means nearly all doctors in the future will be on Facebook. Moreover, we know patients want to have access to doctors and to be able to communicate with them. I’m confident though that Facebook is not the medium through which to do it.

Summer Johnson