Rebuff patient Facebook friend overtures, British Medical Assn. advises

A Facebook friend request from a patient lands in your inbox. What should you do?

"Politely refuse," according to new guidance issued by the British Medical Assn.

Many medical associations in the United States, including the American Medical Association, have approached the concerns about social media with guidance that avoids steadfast rules but rather advises physicians to exercise caution.

But the BMA's guidance, issued in mid-July, has received a lot of attention internationally because of its clear-cut recommendations that physicians not accept Facebook friend requests at all. That's because of the increased likelihood that the relationship could become inappropriate, according to the BMA. The advice was part of a booklet the BMA produced about physicians and social media conduct.

"Given the greater accessibility of personal information, entering into informal relationships with patients on sites like Facebook can increase the likelihood of inappropriate boundary transgressions, particularly where previously there existed only a professional relationship between a doctor and patient," according to the BMA.

"Difficult ethical issues can arise if, for example, doctors become party to information about their patients that is not disclosed as part of a clinical consultation. The BMA recommends that doctors and medical students who receive friend requests from current or former patients should politely refuse and explain to the patient the reasons why it would be inappropriate for them to accept the request."

The Ohio State Medical Assn. issued guidance to members more than a year ago after it received several requests from doctors who wanted advice on how to handle unsolicited social media friend requests from patients.

Jason Koma, director of communications and marketing for the OSMA, said the association recognized the importance of physicians using social media to connect with patients professionally. Therefore, "To not utilize social media at all was not the intent of our guidance," he said.

Similar to policy adopted by the AMA, the guidance issued by the OSMA encourages physicians to consider the ethical and legal boundaries that have the potential of being crossed by each online relationship. One recommendation is to create separate profiles for personal and professional use.

Koma said that, especially in rural areas where physicians are more likely to have relationships with patients outside the physician-patient sphere, social media can be considered an extension of what has been going on for decades. Using the same judgment that would be used in face-to-face social interactions, physicians must adhere to professional boundaries, he said.

In November 2010, the AMA adopted policy acknowledging that social networking websites can be an effective and efficient way to communicate with patients, but advising doctors to maintain an appropriate physician-patient relationship.

Koma said the OSMA plans to revisit the issue in coming months to revise its guidance to include warnings to medical students and residents to keep their personal profile pages clear of content that could be deemed unprofessional to potential employers. As the BMA guidance warns, privacy settings go only so far in protecting online content.

"Although the way medical professionals use social media in their private lives is a matter for their own personal judgment, doctors and medical students should consider whether the content they upload onto the Internet could compromise public confidence in the medical professional," the BMA guidance says.

The BMA acknowledged that it appears few physicians are accepting patients' Facebook friend requests. It cited a survey, posted online Dec. 15, 2010, by the Journal of Medical Ethics, that found medical residents and fellows in France were very unlikely to accept a patient's friend request, fearing it would alter the doctor-patient relationship.

However, the same survey of 202 residents and fellows found that those concerns didn't extend to the doctors refusing to post personal information about themselves on Facebook.