When perusing my Twitter feed this morning I stumbled on this post directed to me.  Patients reaching me in public social spaces is becoming a regular thing.  I’ve discussed this in the past but I think it bears repeating.

So here’s what I did:

I understood mom’s needs.  Patients resort to ‘nontraditional’ means of communication when the traditional channels fail to meet their needs.  Recognize that these patients (or parents in my case) are simply advocating for themselves.  My specialty struggles with a shortage of physicians.  So we’re dependent upon phone triage to sort out the really sick from the less-than-sick.  It’s an imperfect system and consequently parents find themselves having to speak up when the gravity of their child’s condition hasn’t been properly appreciated.

I took the conversation offline. I don’t discuss patient problems in places where others can see.  So my first order of business in this case was to get the conversation to a place where it can be private.  I called mom, found out what was going on and rearranged her appointment to a time appropriate to the child’s problem.

I dicsussed why public dialog of health related issues may not be a good idea. Of course it’s the right of any patient to discuss their issues anywhere they like.  The difference is that once you engage in a relationship with a doctor you then have to consider the interests, needs of concerns of the treating physician.  And I’m not comfortable with public discussion of patient-specific issues, even if okay with the patient.

The biggest concern stems from the fact that platforms like Twitter severely limit the extent of the dialog.  Details get lost and its hard to tell if the patient really understands what you’re saying.  Then there’s the issue of documentation.  My peers and colleagues need to see what happened between us.  Twitter and Epic don’t talk.

And many patients aren’t aware that direct @ messages and DMs are not private.  Many people can access this information.  Depending upon the nature of the problem patients may not want this information released into the public space.

In this case specifically, the mother was not aware that her message was public.  We discussed this at length and she was excited that this case and her tweet could be used as an example.

I documented the encounter.  I created a phone note and documented the nature of encounter including the fact that the parent had initiated public contact.  I also note that I discussed the issues with public dialog and brought the patient up to speed on how I prefer to be reached.

Again, all of this is done in a way that respects the intent and needs of the patient.

Interestingly this is exactly what I do when I bump into someone in the grocery store or cocktail party who wants to talk personal issues.  Beyond something really simple I encourage that we pick it up in a place where I can give them the attention that they deserve and where all of it can be documented in the medical record.

If you’re a socially active doctor, what do you do when patients make public contact with specific health-related issues?