So what happens when patients talk to doctors online?

It will happen—requests for medical advice on Facebook or Twitter will happen. The more public you become, the more people you will meet. The network grows, and friends of friends will learn about what you do. Every physician needs to think about how they will handle these encounters.

The problem with casual advice in public places

So Junior has a little pain and shows up at the local ER where the CT shows thickening of the ileum. Someone suggests that the family message you on Facebook.

Your availability in public raises the likelihood that someone will want to tap your expertise. The culture of social health favors sharing and open dialogue.

Here’s the problem: there’s more to this than digital correspondence will allow. 

While the reality is that this child’s radiographic finding likely represents a little edema from a virus, the differential is precarious: Crohn’s disease, lymphoma, tuberculous ileitis, eosinophilic enteropathy.

Children are complicated creatures. Parents are more complicated. Loose, off-the-cuff advice based on information delivered in short form shortchanges both parties.

Of course, the easiest response to these regular queries is that my employer, malpractice carrier, and the Texas Medical Board preclude offering medical advice without an established relationship or medical record. Everybody understands legalese. Few, however, understand the complexity of a properly executed medical encounter.

So avoid the temptation to offer casual advice in public places. 

How to respond when patients reach out online

So what’s a public physician to do? Just as you’ll be approached on occasion in the frozen food section of your local grocery store, there will be the occasional patient who will reach out in cyberspace to ask something about their personal situation. You need an action plan for when that happens.

Here’s what I do when approached by established patients:

1. Take the conversation off-line. Tell them that you can’t have this patient-specific conversation on Facebook or Twitter, but that you’d be happy to call them.
2. Handle their problem. Remember that they reached out to you for a reason, so address their issue. There’s a tendency to blame the patient for trying to use social channels to get their problem addressed, but for a millennial patient, using Facebook to communicate is second nature.
3. Tell them why you can’t discuss cases in public. Explain to them why you can’t handle their problems on Facebook. It helps to frame the discussion in the context of privacy and documentation. One approach might include, “I’d like to do this but I can get in a lot of trouble.” As part of this conversation, it may be helpful to mention why the airing of their personal health details may not necessarily be the best thing for them as a patient. Offer an alternate, privacy-protected means of contact and finish by reminding them that you’d like to keep the conversation going—just without patient specifics.
4. Create a phone note. Create a phone note in their electronic health record. Document what happened and make a point of mentioning that it was the patient who initiated the contact. It’s important for your institution to understand that despite your visibility, you’re not soliciting dialogue but responding in a way that’s reasonable, helpful, and above the law.

This brings up an important point. It used to be that the only way to reach a doctor was through the office landline, but now there are a number of fragmented ways for us to communicate. Clinics and physician groups should preemptively share with patients how they want to be reached (e.g., email, office phone, etc.) as part of new patient information. This can also be included in the after visit summary.

How to respond when non-established patients reach out online

So what if you’re approached by someone you don’t know?

It’s important to understand that, just like with your established patients, dialogue about non-specific medical issues is fine. It’s the patient-specific questions that represent medical advice and have the potential to create problems. 

• Okay to answer: When does reflux typically go away in a baby?
• Not okay to answer: Why hasn’t my baby’s reflux gone away?

See the difference?

If someone asks you for specific input or advice, I usually respond with something like this:

I’d love to help but I’m prohibited by my state medical board and malpractice carrier from dispensing advice without an established relationship. I’d suggest you chat with your doctor about this.

As a student, your response might look something like this:

I’d love to help but I’m prohibited by my medical school from dispensing advice. I’d suggest you talk to your doctor about this.

People understand this.

As a Doctor You’re Probably Less Important Than You Think You Are

The idea of being in the same place as patients (social networks) has created anxiety (and excuses) for some doctors. One concern is that public visibility means they’ll be ‘attacked’ with patient requests and solicitations for help and information.

To avoid this, the strategy for some doctors has involved hiding under their exam room tables—because when no one can see you, no one can talk to you. And when no one can talk to you, you can’t get in trouble.

Some of the anxiety over our public visibility stems from what we don’t understand about the physician’s changing role in the Information Age. There was a time when doctors were the sole source of information for patients. We were defined by our unique and restricted access to medical information and knowledge. Not so much anymore. Information is now free, and patients have sources beyond the man or woman in the white coat. By nature of this ubiquitous access to knowledge, doctors may be less individually important to patients than they were before the Information Age. This is why none of us are inundated with questions during our everyday sharing and talking.

Of course, patients will want to talk to doctors online, but our presence in public may not be as big of a deal as you think.

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!