Don't Let Friends 'Friend' Patients on Facebook

BOSTON – Before hanging out a shingle on Facebook or other social networking sites, mental health providers should be aware of the pitfalls of TMI – too much information – warned a psychiatrist at the annual meeting of the American Academy of Psychiatry and the Law.

Roughly half of all medical students who posted on Facebook without thought to their privacy settings revealed personal information that did not reflect well on them, including profanity, intoxication, and discriminatory language, and more than a third posted sexually suggestive messages or images, reported Dr. Helen M. Farrell, a staff psychiatrist at Beth Israel Deaconess Medical Center in Boston.

In addition, indiscriminate postings can run afoul of HIPAA rules and leave clinicians liable to malpractice actions, Dr. Farrell cautioned.

Facebook can be useful for marketing a practice, but it can also be a professional and ethical minefield when used improperly, she noted in a poster presentation and an interview.

"If psychiatrists are contacted by patients on Facebook, they should not ‘friend’ the patients or establish any communication with them. They can also block patients from seeing their profiles and that would be recommended," she said.

She quoted a 2009 article in Entertainment Weekly which asked, "How on earth did we stalk our exes, remember our coworkers’ birthdays, bug our friends, and play a rousing game of Scrabulous before Facebook?"

Dr. Farrell did a PubMed search for articles on professionalism and Facebook, and found 12 studies that looked at how medical students and residents used the social medium.

"If psychiatrists are contacted by patients on Facebook, they should not ‘friend’ ... or establish any communication with them."

For example, a survey of Vanderbilt surgery residents and faculty found that 64% of the residents and 22% of the faculty had Facebook pages, and that 31% had publicly accessible sites with work-related comments posted (J. Surg. Educ. 2010;67:381-6). Of those comments, 14% made reference to patient care or to specific patient situations.

In a another study, investigators from the Wellington School of Medicine and Health Sciences in New Zealand, conducted a cross-sectional survey of Facebook use by recent medical graduates (Med. Educ. 2010;44:805-13).

They found that 37% of the 220 graduates who had Facebook accounts had publicly available profiles, more than one-third of which (37%) revealed the poster’s sexual orientation, 46% showed them using alcohol, and 10% showed them being intoxicated.

It’s also unwise for clinicians to accept "friending" requests from patients. The patient may be exposed to possible unprofessional or embarrassing content that could tarnish the doctor-patient relationship, and there are concerns about boundary issues and potential liability, Dr. Farrell said.

The flip side of the Facebook coin is its promotional value, which can be used to market a school’s curriculum and share information about clinical and academic departments, schedules, etc.

In addition, public profiles that patients post can provide clues about their mental states, such as histrionic or narcissistic personality traits, antisocial moods, or behaviors such as the use of hostile language, libel, or cyberbullying.

The way in which patients react to Facebook also might provide clues to their thought processes or content. For example, patients who frequently, repeatedly check their Facebook accounts might have obsessive/compulsive traits, whereas postings by the patient might reveal psychosis or homicidal or suicidal ideation. Postings also may provide clues to patients’ perceptual disturbances, insight, and judgment, Dr. Farrell noted.

She recommends that Facebook users choose the highest privacy settings allowed, and that "e-professionalism" become part of the formal curriculum at professional schools and organizations.

The study was internally funded. Dr. Farrell reported that she had no relevant conflicts of interests.

BOSTON – Before hanging out a shingle on Facebook or other social networking sites, mental health providers should be aware of the pitfalls of TMI – too much information – warned a psychiatrist at the annual meeting of the American Academy of Psychiatry and the Law.

Roughly half of all medical students who posted on Facebook without thought to their privacy settings revealed personal information that did not reflect well on them, including profanity, intoxication, and discriminatory language, and more than a third posted sexually suggestive messages or images, reported Dr. Helen M. Farrell, a staff psychiatrist at Beth Israel Deaconess Medical Center in Boston.

In addition, indiscriminate postings can run afoul of HIPAA rules and leave clinicians liable to malpractice actions, Dr. Farrell cautioned.

Facebook can be useful for marketing a practice, but it can also be a professional and ethical minefield when used improperly, she noted in a poster presentation and an interview.

"If psychiatrists are contacted by patients on Facebook, they should not ‘friend’ the patients or establish any communication with them. They can also block patients from seeing their profiles and that would be recommended," she said.

She quoted a 2009 article in Entertainment Weekly which asked, "How on earth did we stalk our exes, remember our coworkers’ birthdays, bug our friends, and play a rousing game of Scrabulous before Facebook?"

Dr. Farrell did a PubMed search for articles on professionalism and Facebook, and found 12 studies that looked at how medical students and residents used the social medium.

"If psychiatrists are contacted by patients on Facebook, they should not ‘friend’ ... or establish any communication with them."

For example, a survey of Vanderbilt surgery residents and faculty found that 64% of the residents and 22% of the faculty had Facebook pages, and that 31% had publicly accessible sites with work-related comments posted (J. Surg. Educ. 2010;67:381-6). Of those comments, 14% made reference to patient care or to specific patient situations.

In a another study, investigators from the Wellington School of Medicine and Health Sciences in New Zealand, conducted a cross-sectional survey of Facebook use by recent medical graduates (Med. Educ. 2010;44:805-13).

They found that 37% of the 220 graduates who had Facebook accounts had publicly available profiles, more than one-third of which (37%) revealed the poster’s sexual orientation, 46% showed them using alcohol, and 10% showed them being intoxicated.

It’s also unwise for clinicians to accept "friending" requests from patients. The patient may be exposed to possible unprofessional or embarrassing content that could tarnish the doctor-patient relationship, and there are concerns about boundary issues and potential liability, Dr. Farrell said.

The flip side of the Facebook coin is its promotional value, which can be used to market a school’s curriculum and share information about clinical and academic departments, schedules, etc.

In addition, public profiles that patients post can provide clues about their mental states, such as histrionic or narcissistic personality traits, antisocial moods, or behaviors such as the use of hostile language, libel, or cyberbullying.

The way in which patients react to Facebook also might provide clues to their thought processes or content. For example, patients who frequently, repeatedly check their Facebook accounts might have obsessive/compulsive traits, whereas postings by the patient might reveal psychosis or homicidal or suicidal ideation. Postings also may provide clues to patients’ perceptual disturbances, insight, and judgment, Dr. Farrell noted.

She recommends that Facebook users choose the highest privacy settings allowed, and that "e-professionalism" become part of the formal curriculum at professional schools and organizations.

The study was internally funded. Dr. Farrell reported that she had no relevant conflicts of interests.

BOSTON – Before hanging out a shingle on Facebook or other social networking sites, mental health providers should be aware of the pitfalls of TMI – too much information – warned a psychiatrist at the annual meeting of the American Academy of Psychiatry and the Law.

Roughly half of all medical students who posted on Facebook without thought to their privacy settings revealed personal information that did not reflect well on them, including profanity, intoxication, and discriminatory language, and more than a third posted sexually suggestive messages or images, reported Dr. Helen M. Farrell, a staff psychiatrist at Beth Israel Deaconess Medical Center in Boston.

In addition, indiscriminate postings can run afoul of HIPAA rules and leave clinicians liable to malpractice actions, Dr. Farrell cautioned.

Facebook can be useful for marketing a practice, but it can also be a professional and ethical minefield when used improperly, she noted in a poster presentation and an interview.

"If psychiatrists are contacted by patients on Facebook, they should not ‘friend’ the patients or establish any communication with them. They can also block patients from seeing their profiles and that would be recommended," she said.

She quoted a 2009 article in Entertainment Weekly which asked, "How on earth did we stalk our exes, remember our coworkers’ birthdays, bug our friends, and play a rousing game of Scrabulous before Facebook?"

Dr. Farrell did a PubMed search for articles on professionalism and Facebook, and found 12 studies that looked at how medical students and residents used the social medium.

"If psychiatrists are contacted by patients on Facebook, they should not ‘friend’ ... or establish any communication with them."

For example, a survey of Vanderbilt surgery residents and faculty found that 64% of the residents and 22% of the faculty had Facebook pages, and that 31% had publicly accessible sites with work-related comments posted (J. Surg. Educ. 2010;67:381-6). Of those comments, 14% made reference to patient care or to specific patient situations.

In a another study, investigators from the Wellington School of Medicine and Health Sciences in New Zealand, conducted a cross-sectional survey of Facebook use by recent medical graduates (Med. Educ. 2010;44:805-13).

They found that 37% of the 220 graduates who had Facebook accounts had publicly available profiles, more than one-third of which (37%) revealed the poster’s sexual orientation, 46% showed them using alcohol, and 10% showed them being intoxicated.

It’s also unwise for clinicians to accept "friending" requests from patients. The patient may be exposed to possible unprofessional or embarrassing content that could tarnish the doctor-patient relationship, and there are concerns about boundary issues and potential liability, Dr. Farrell said.

The flip side of the Facebook coin is its promotional value, which can be used to market a school’s curriculum and share information about clinical and academic departments, schedules, etc.

In addition, public profiles that patients post can provide clues about their mental states, such as histrionic or narcissistic personality traits, antisocial moods, or behaviors such as the use of hostile language, libel, or cyberbullying.

The way in which patients react to Facebook also might provide clues to their thought processes or content. For example, patients who frequently, repeatedly check their Facebook accounts might have obsessive/compulsive traits, whereas postings by the patient might reveal psychosis or homicidal or suicidal ideation. Postings also may provide clues to patients’ perceptual disturbances, insight, and judgment, Dr. Farrell noted.

She recommends that Facebook users choose the highest privacy settings allowed, and that "e-professionalism" become part of the formal curriculum at professional schools and organizations.

The study was internally funded. Dr. Farrell reported that she had no relevant conflicts of interests.