I can’t tell you whether you should connect with patients as friends online. And I’m not sure there’s anyone who can. That sounds like a bad way to start. So let’s unpack the issue.

The policy reality

With the rise of social media, institutions have responded by creating policies about public engagement by hospital staff. And those who write policies and guidelines have ideas about whether you should or should not have any kind of dialog with patients outside of clinic. I know this because I’ve been on both sides, as someone who has both created and lived within limits of these policies. 

The problem is the belief that we can help doctors manage their public presence with black-and-white language. To say that you shouldn’t talk to a patient in public is wrong. To suggest that you can and should engage with your patients as freely as you see fit is equally problematic. How we define the middle ground represents a challenge that has yet to be cracked. 

But whether we like it or not, we are beholden to the policies defined by the institutions that employ us. And you, as a public physician, will have to live within the constraints of your organization. It is important, however, that you serve as an advocate for policies that are reality-based and representative of your needs as a digital citizen.

Relationships should not be defined by a social media platform

One of the problems with restrictive social media policies is the way relationships are defined.

Health organizations have fallen into the trap of defining our relationships with terms created by Silicon Valley insiders. I witnessed an argument not long ago that centered on the idea that following a patient might be okay, but friending was something very different and very wrong. We all make assumptions about what these indiscriminate terms mean, and they all mean different things to different people

As an example, I use Twitter primarily as an information-filtering tool. It’s less a social toy than it is a critical funnel for information. There are lots of people in my sphere of influence who collect and share amazing information that I find useful. Some of these people may be coworkers, superiors, medical students, or mothers of patients. My follow is for information—not winking, nudging, or sharing party pictures.

But many who are empowered with writing the policies and guidelines about how I should be using social tools have never used Twitter. They heard somewhere that it’s for sharing what you had for lunch. Or winking and nudging. This level of misunderstanding by those responsible for shaping policy will be something that we will continue to confront as we all become more public and communication platforms evolve.

Just as there’s no way to prevent my running into patients at the grocery store, there is no policy that can keep you from having some contact with patients in public. And I have yet to see a policy that will help you understand a practical approach to a patient when they want to talk.

If it isn’t explicitly outlined by your employer, you are ultimately going to have to decide how and where you will engage with patients beyond the exam room.

What I do with regard to relationships with patients

In general, I tend to follow the advice on this site. I like to think that I engage with patients on social sites just as I do in real life. I never entertain or engage in any type of patient-specific or care-related dialogue in public. 

I don’t typically friend patients on Facebook. While I understand that what I put there is relatively public, I consider it a loosely personal space. While I am a heavy Twitter user, I don’t follow parents unless there’s something specific or uniquely useful to what they share. I do, however, have many parents who follow my Twitter feed, and while it has nothing to do with children’s digestive health, lots of patients read my blog.

I will add that my personal boundaries in public have been and will continue to be a moving target.

How to handle the patient who wants to connect

It’s not a matter of if, but when. It’s important to understand that solicitations for connection on public channels will happen. The only way to avoid this is to avoid putting yourself anywhere you can be seen. As we have 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 patients, you can be approached on Instagram, Pinterest, Goodreads or even the next great social network.

Here are a few things to keep in mind:

They’ll get over you. If your personal boundaries dictate that you are not interested in sharing Facebook with your patients, you will need to confront the issue of friend requests. Many of us live with the distorted view that connection requests are rude or awkward to reject. A lot of doctors have concerns that their patients are going to be angry or upset with the rejection, but most patients in this situation 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 with them there. If you have a patient-focused blog, your comment area may be a place to interact and have dialogue.

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. Many physicians open up their personal world to their patients. They feel that it enriches the relationship they share and represents the most honest, transparent means of operating in the networked world.  

You have to decide what works for you. Again, your institution may shape the decision for you.  

Remember that the right kind of contact can be enriching for both a provider and patient. Many policies are driven by the fear that there may be care-specific dialogue taking place that can’t be monitored. 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.

Things might be different for students, residents and trainees. Students and residents should take the most conservative posture with regard to public 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. If, for example, a young mother friends you during your pediatrics rotation, you’re best bet is to simply explain that you don’t connect with patients (or patients’ parents).

Once you are evolved in your career, you will be better able to make decisions regarding the kinds of relationships you want and where.

This page is part of a bigger project: The Public Physician, a field guide for life online. To read more check out the Public Physician landing page. Happy reading!