The American College of Physicians and the Federation of State Medical Boards have some suggestions for your online doctor-patient relationships online, and they’re fairly restrictive.
 
This “position paper,” created by the American College of Physicians (ACP) Ethics, Professionalism, and Human Rights Committee, the ACP Council of Associates, and the Federation of State Medical Boards (FSMB) Special Committee on Ethics and Professionalism, appears in the latest Annals of Internal Medicine.
 
The paper raises the expected issues about privacy vs. responsiveness, and the authors advise conformity with applicable HIPAA regulations, including thorough, proper storage of electronic patient interactions as medical records.
 
But some of their suggestions go beyond the usual privacy and security concerns. For example:
  • Patient emails “should only be used by physicians in an established patient–physician relationship and with patient consent”; also, they can supplement face-to-face encounters but not replace them. (In a related graph, they counsel “reserve[ing] digital communications only for patients who maintain face-to-face follow up.”)
  • Social media interaction with patients. “Physicians should not ‘friend’ or contact patients through personal social media,” the authors advise. Similar caution applies to trainee–faculty relationships.
  • Text messaging. “Because of its abbreviated format and the greater possibility of missed messages,” text message communication is not recommended “for even established patients except with extreme caution and with patient consent.”
  • Googling patients for medical reasons.  While observation of online behaviors “may be helpful in the care of that patient,” say the authors, “physicians should be sensitive to the source,” and take care lest their online observations descend into “curiosity, voyeurism and habit.”
  • Recommending online health information to patients. The authors generally approve, so long as the materials come from “peer-reviewed media and Web sites where the quality control of information can be checked.”
  • Online behavior and identities. The authors counsel physicians against “airing of frustrations and ‘venting’” in online forums. “Poor judgment,” they caution, “reflects not only on the individual physician but also on the profession.”
They also endorse an AMA social media guideline that “strongly suggests divorcing public and professional digital identities, specifically maintaining separate online sites or identities for the separate roles” so as not to “blur social and professional boundaries.”