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The repercussions of declining Facebook friend requests from patients

At the end of a long day at my medical practice, I am sitting at my computer catching up with friends via Facebook. Suddenly, a notification pops up: one of the patients I saw today has sent me a friend request. I know that the ACP, AMA and every other physician organization recommends strongly that doctors not connect with patients via social media, so I quickly click to decline the invitation. I spend the rest of the evening imagining the awkward conversation when the patient next comes to see me, where I have to explain why I had to decline the request. I know that digital communication with patients can lead to blurring of personal and professional boundaries, miscommunications and confidentiality breaches. But I wonder whether the dangers really outweigh the benefits. I have limited time available to see each patient in the office and an out-of-office communication channel such as Facebook could allow me to be more accessible to patients. I would be available to answer non-urgent questions in my free time and I could also take advantage of my social networks to send out public health announcements and advocate for important health causes.

Are Doctors Blurring Professional Lines with Social Media?

But what of that blurring of personal and professional? This is a question that goes far beyond the issue of social media. Doctors are constantly faced with the dilemma of how much to share of their own personal lives. Can empathy help a patient suffering from an ailment the doctor has experienced himself? Can a personal story make the patient feel closer to the physician and instill confidence in her? Numerous studies show that a positive relationship with the doctor promotes confidence, encourages compliance with treatment, and aids healing. I have occasionally shared a personal anecdote when it seemed to be in the patient’s best interests. My personal problems are of course not the concern of the patients, and they need to feel that I am giving them 100% of my energy. But on the other hand, I don’t want to be one dimensional and inaccessible. A small amount of sharing can go a long way in sending a patient home with a spring in his step and the hope that he will be healed.

Digital Communication Can Supplement, not Replace, Personal Attention

Miscommunications can happen through social media, but they can happen in short office visits as well. Social networking is not a short-lived trend; a whole generation has grown up communicating in a digital format. Patients are coming to see the doctor after they have Googled their symptoms and compiled a list of possible diagnoses. This being the case, a social network where the doctor can respond and explain has distinct advantages over the anonymous and often inaccurate information available on the Internet. Digital communication is obviously not a substitute for in-person medical exams, but can serve as a helpful supplement. Confidentiality breaches are a real issue but can be solved with strict guidelines regarding which types of content are appropriate for digital sharing and using technology to ensure safe communication.

A Glimpse Behind the White Coat

I think the strongest argument for the use of social media for patient-doctor communication is the sheer number of Facebook requests I have declined over the last few years. Patients are reaching out to doctors, wanting to have a direct line of communication without feeling they are intruding on their personal time with a phone call. They are telling us with each friend request that they want a glimpse into the real person behind the white coat. They are saying that they want to be more proactive and involved in their own care, letting their doctors know about their progress in between clinic visits. What kind of message does it send to our patients when they reach out and we take a step backwards? Perhaps some entrepreneurial, tech savvy person can develop a separate social network to handle patient requests, but until that happens we must decide how we'll deal with the networks as they exist, and the inevitable requests that come our way. MD Capsule Nathalie Majorek is co-founder, MDCapsule and can be reached on Twitter and LinkedIn. Note: This post originally ran on