[I’m creating some physician teaching material and I could use some input on doctor-patient connections on social sites.  What am I missing? What have I overstated]

Should you friend your patients on Facebook, or other social sites?  Or if you’re a medical student on your pediatrics rotation and a young mother friends you, how should you respond?

Here are few things to consider:

It’s not a matter of if, but when.  It’s important to understand that solicitations for connection on public social channels will happen.  The only way to avoid this is to avoid putting yourself anywhere where you can be seen.  This isn’t an option.  At some point you’ll have to face the issue of who you are willing to talk to and when.  Remember that while Facebook may be the most frequently accessed network by millennial moms, you’ll can be approached on Instagram, Pinterest, Goodreads and any number of others.

Here’s what I do.  I’ve chosen to restrict Facebook to generally personal information for friends and close colleagues.  Most of what I share there is from my personal life so when patients make a friend request, I decline.  While there’s nothing there that I have a problem with my patients viewing, they just don’t know me well enough to gain from pictures of my vacation or Christmas morning.

You must get to the idea of how and with whom you see yourself using different applications for dialog.  You must decide where you are going to draw the line with certain people in your life.

It’s important to understand that despite my individual ‘no patient policy’ I still see my Facebook page as very public.  I don’t live under any kind of illusion that this area is a walled off garden for my dark side or hard-edged opinions on politics.  I understand that every picture or comment that I make is one screen grab from my next employer.

I do have a number of patients who follow me on Twitter.  I have no problem with them seeing what I share in technology and doctoring (what my Twitter feed is about).  In fact, my Twitter feed is a type of public curation where I share things.  I have little in the way of public exchange and when it happens, its really transient.  Since few patients curate content and links surrounding technology and the emerging role of the doctor, I follow few, if any, patients.

Honestly, they’ll get over you.  Many of us live with the distorted view that friend requests are rude or awkward to reject.  A lot of doctors I’ve spoken to have concerns that their patients are going to be angry or upset with the rejection.  My experience with patients in this situation is that they completely understand.  Even if they don’t, you have to define what you’re comfortable with and those around you are going to have to accept it.

Think about where you might be able to engage them.  When you tell patients that you’re not willing to connect with them on your personal Facebook page, think where you might be able to engage them.  Remind them, for example, that your practice has a page and you would love to share stuff there.  If you have a patient-focused blog, your comment area may be a place to interact and have dialog.

So rather than planting a flat rejection on the patient who wants to connect, offer them a place to have some interaction with you.

Plenty of doctors let their patients in.  It’s important to understand that you don’t have to restrict your conversations.  I have colleagues who open up their personal world to their patients.  They find that it enriches the relationship they share and feel that it represents the most honest, transparent means of operating in the networked world.  You have to decide what works for you.  Avoid the temptation to do just as I do.

Your institution may make the decision for you.  Many institutions or hospitals have policies that prohibit doctor-patient contact on public networks.  I think that these are problematic since, like the grocery store encounter, it may be difficult to avoid contact in certain circumstances.  I also think that the right kind of contact can be enriching for both a provider and patient.  Most of these policies are driven by the fear that there may be care-specific dialog taking place that can’t be monitored.  While this is a reasonable concern, it can be handled with basic education and training surrounding conversations and context.  There’s no reason why doctors and patients shouldn’t have certain conversations in public, be it at the soccer field or on Twitter.  But, unfortunately, you’re unlikely to change minds anytime soon.  Check with institutional policies and be smart.

Things might be different for students, residents and trainees.  For trainees I would recommend the most conservative posture and avoid relationships.  Remember that when it comes to your deans and program leadership, perception trumps reality.  Even the most appropriate conversations clipped out of context may be perceived as problematic.  Once you are evolved in your career you will be better able to make decisions regarding the kinds of relationships you want and where.  Concerning the young mother who friends you during your pediatrics rotation, simply explain the situation that you don’t connect with patients (or parents).  My experience has been that they always understand.