Social networking etiquette: Making virtual acquaintances

Social networking, once the domain of teenagers, is attracting physicians who want to connect with other people online for reasons from professional contact to dating.

Although Internet interactions can be freewheeling, certain rules of etiquette apply. As with most technology, early adopters tend to set the standards, and latecomers learn to adapt. So "netiquette" does vary, depending on the type of site -- general versus physician-specific, personal versus professional.

And there are a plethora of sites. Social networking no longer involves just a handful of general sites, such as Facebook and MySpace, but includes a network of sites specific to health care, physicians and even specialties.

The first step to social networking, experts say, is to decide what audiences you want to connect with, choose the most appropriate site for each purpose, and set clear boundaries between each one. But even if you opt for purely social networking, a stranger there potentially can become your employer, patient or colleague, and an etiquette blunder could be career-killing.

"There's no way people aren't going to Google a new contact," said Rusty Weston, chief blogger of the networking site My Global Career. "You have to be careful."

A recent survey conducted by Erika S. Fishman, director of research and client services for Manhattan Research, a marketing and research firm for health care and pharmaceutical companies, found nearly half of all physicians feel it is important to have a professional presence online.

According to Fishman, physicians were slower to jump online than other professionals, but have recently recognized this form of networking as an important piece of professional development.

"People who are online expect everyone else to be online," said Kim Gregson, an assistant professor who incorporates social networking into her curriculum at New York's Ithaca College School of Communication. "You have to be where the people are."

Many physicians consider it most useful to be where other physicians are, said Dr. Subrahmanyam Karuturi, who developed DoctorsHangout.com, an international social networking site for physicians.

Sermo creator Daniel Palestrant, MD, agreed. He said he created the physicians-only social networking site after he started to notice that he and his colleagues were discussing topics weeks and months before the mainstream media picked up the stories. He thought it would be interesting to hear from other doctors across the country and find out what they were discussing. (Sermo has an arrangement with the AMA that allows the Association and its members access to the board, and gives the AMA the ability to pose questions and get feedback from Sermo physician posters.)

Physician-specific sites, which can be regional as well as specialty-specific, are a newer phenomenon, Fishman said. Many physicians who started out using sites like LinkedIn, a general professional networking site, have since turned to physician-specific sites. Her survey, "Taking the Pulse v8.0," released in April, found more than one-quarter of physicians visited Sermo in the prior three months.

Often, experts say, physicians will go to sites for advice on difficult cases or to vent to people who understand. But often research partnerships are formed, fellowships are found, and professional contacts are established.

More mainstream social networks can provide a way for physicians to attract new patients and connect with current ones, or keep in touch with family and friends.

Sites such as Facebook and MySpace are indexed by Google, so a search can place your social network page high in the results, said Mari Smith, a San Diego-based relationship marketing specialist. That's great news if you want potential patients to find you, bad news if your page portrays you in a nonprofessional way.

Separate business and pleasure

Gregson recommends physicians keep personal sites and professional sites separate. Most of the general sites have privacy settings that can limit visits to friends and family. But privacy settings can only protect you so much, experts warn.

"What stays in Vegas shows up on the Internet the rest of your life," Gregson warns.

One young psychiatrist learned that the hard way when Van Allen, founder of TimeLine Recruiting, based in Columbia, Mo., discovered MySpace pictures of her topless and drinking from beer bongs.

The doctor had already finished her residency and established herself as a qualified psychiatrist when Allen found the pictures. The event they depicted had happened more than eight years earlier, but the embarrassment was current.

Setting parameters for your sites will not only delineate professional and personal networking, and protect against embarrassment, but also help alleviate the burden of managing the sites.

You gotta have friends (or not)

Nearly everyone on social networking sites faces the dilemma of trying to expand his or her network while maintaining a professional persona. Smith likens her choices to living in a gated community. "You decide who gets the code."

The expectation of who you will accept as a friend or link partner should be established, Gregson said. A note on your main profile page explaining the purpose of your site can help deter inappropriate friendship requests. You also could opt to say up front you won't be accepting any friend requests, but will be posting relevant information for your patients. But unsolicited and unwanted friend requests are bound to happen.

If the unwanted requestor is someone you know but don't want to connect with online, a short note of explanation can help alleviate hard feelings, Gregson said. The note should also refer back to your established guidelines.

Similar guidelines can apply to friend requests you do want to accept. Smith said she gets about 20 friend requests per day and accepts about 95% of them. She generally sends a personal note to the requestors she knows, but she doesn't do the same for strangers.

There is also etiquette involved in asking someone to be your friend or link partner.

Experts suggest you initiate your overtures of friendship with an introduction from a mutual friend, or a personal note that explains who you are, how you know of this person, or why you want to join his or her network.

If your friend request goes ignored, one follow-up e-mail might be appropriate. If that one is ignored, experts say it's best to move on.

The same rule applies to unanswered questions posted in forums. Dr. Karuturi said it is rude to repeatedly post the same question or to post it in multiple forums.

Online friends who wear out their welcome can be deleted discreetly and quietly.

Smith said she routinely deletes friends who send junk or spam and rarely gets inquiries afterwards. If pressed for a reason, you can always fall back on your site's established guidelines.

The quickest way to get yourself deleted from someone else's friends list is by engaging in flame wars, experts say. These feisty exchanges generally start with inappropriate or inflammatory comments posted just to get a rise out of other posters.

Many of the physician-specific sites vet members, so if you tarnish your name, you can't just create a new profile, Dr. Palestrant said.

Once you know the postings and behavior that are appropriate to a specific network, experts advise taking that knowledge and running with it. People who use social networking sites to connect with others appreciate those who participate. Even if time doesn't allow you to respond to each message, your site should at least appear active.

One easy way to do this, Gregson said, is by sharing links. "You are surfing anyway. You see an article about flu season and you share it."

When time does allow, answering a poster's questions with professionalism can help establish you as an expert, said Dr. Karuturi.

Posting personal tidbits can pay off. Allen said he has seen candidates get a competitive edge because they share an interest with an employer.

Just be judicious about what you share. Allen said one doctor lost out on a job because her online activities revealed an interest in witchcraft.

Beyond using basic common sense, the biggest piece of advice experts have is to just get involved, even if you start with only one site.

"This is something that I hope doctors will experiment with for a lot of reasons, but not the least of which is seeing what their patients are interested in, or what the next generation of doctors is interested in," Weston said. "Even if you don't use it to advance your career, it's something you should be adept at to be well-rounded."