I received a message from physician friend about how I handle medical questions on Facebook or Twitter. This is a common concern for doctors and it’s often used as an excuse for avoiding a public presence. My ideas about doctor-patient communication are evolving and may well change as technology evolves.
Here are a few thoughts.
People have always asked questions. The social web doesn’t change human curiosity, it just gives it a new avenue. What’s different is that:
- It’s easier to approach experts in today’s media climate.
- Dialog is potentially retrievable.
- The always-on nature of social media creates public expectations that engaged physicians are ready and willing to be their personal advisor.
Social media has lead us to believe that health assessment may easier than it really is. But answering questions, be it at the grocery store or on Twitter, is trickier than you think. Questions require attention, time, focus, and some kind of relationship. And when you give advice based on a 140 character history you put yourself at risk of doing a disservice to the person asking for advice. They have no idea that you’re doing them a disservice. They just want a quick answer. It’s how you think when you’re sick and you want an answer.
So how do I handle myself specifically?
I never answer patient-specific questions.
There are two types of questions that physicians may encounter in public spaces: patient-specific and patient non-specific. I answer patient non-specific questions without reservation. Those involving someone’s specific health issues spell trouble. While there isn’t much precedent in this area, you could be construed as having a relationship with the patient in question …. Um, I mean the person with the question. Where there is a relationship there is risk.
How I approach things depends on my specific relationship with the person asking the question.
There are three categories of people that reach out to me on social media.
I. People I don’t know. This is easy. I tell them that I can’t offer advice to those who are not established patients. I offer two clear reasons: It’s a mandate of my state medical board that interactions must involve clear documentation in a medical record. Also, my involvement isn’t covered under my institution’s malpractice policy. I’ve never encountered someone who didn’t understand these two points.
II. Patients. Every once in a while an established patient will reach out to me on Twitter. Here’s how I handle it:
1) I take the dialog off line. I usually do this by at messaging back that I’d be happy to talk to them by phone.
2) I address the problem. They reached out for a reason and I try to address their problem.
3) I discuss why it isn’t a good idea for either of us to have our dialog in public. This typically involves a discussion of how I can get in trouble but includes potential issues related to their disclosures. It’s interesting that many patients I speak to don’t really understand the privacy settings of the site they used to reach me.
4) I document the encounter. I document the conversation in a phone note making it clear that it was the patient who initiated the contact in public.
How you want to be contacted by patients should probably be part of your new patient information. Remember that social applications like Facebook represent some of the most commonly used communication platforms and we shouldn’t blame patients for using them if they haven’t been instructed otherwise.
III. People I loosely know. These are the hardest to handle because often I have an easy, conversational relationship with the person but this unfortunately doesn’t extrapolate to my willingness to invest significant bandwidth (see the next paragraph) on their issue. I can’t help but feel as though I’m letting them down. But the bottom line is that I treat these just the same as for people I don’t know. I simply tell them I can’t do it.
What about my own family and very close friends? They’re different. In cases where I think I can offer help, I’ll arrange phone time in the evening, close the door to the study and spend 45 minutes getting all the facts so that I can come close to offering some direction. That’s how long it takes. Good input can only come when you have good information. I work really hard to help support the established relationship that the person has with their doctor.
While many may not see it this way, my avoidance of loose advice is ultimately an act of advocacy for those who approach me. Remember that reliable health input involves attention, time, focus and a great relationship. The fast flowing, real-time dialog of today’s social environment doesn’t allow for all of these elements.