{"id":177,"date":"2009-09-09T12:14:17","date_gmt":"2009-09-09T11:14:17","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=177"},"modified":"2009-09-09T12:15:01","modified_gmt":"2009-09-09T11:15:01","slug":"physicians-on-facebook","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2009\/09\/09\/physicians-on-facebook\/","title":{"rendered":"Physicians on Facebook"},"content":{"rendered":"

There’s a short piece in the latest JME<\/em> about the use of social networking sites<\/a> by medics that’s got me thinking. \u00a0In it, Guseh, Brendel and Brendel suggest that physicians need to be especially careful about accepting, say, a Facebook friend request from patients because of the nature of social networking sites and the possibility that normal privacy rules may be violated.\u00a0 (For the rest of this post, I’ll talk mainly about Facebook, but that’s just for convenience.\u00a0 The points will stand in relation to any social networking site.)<\/p>\n

I can see something of the motivation for the worry here, but I’m not sure I share it. \u00a0The reason for this is that I have yet to be convinced that the online world presents us with any new problems: all it does is re-manifest old ones. \u00a0For that reason, there’s nothing about which we need to get all that excited.\u00a0 Nor is there anything special about physicians, as opposed to anyone else, on FB.<\/p>\n

Let’s start with the first area of dispute: is there anything special about online social networking?\u00a0 The paper hints that there might be.\u00a0 For example,<\/p>\n

if a psychiatrist were to become an online friend with a patient and discuss aspects of the treatment on the website, other online friends could learn potentially compromising information about the patient.<\/p><\/blockquote>\n

This is probably true – but I wonder whether there’s anything special about online communities here. \u00a0Facebook is like a bus. \u00a0Its users know that what you wouldn’t say on a bus, you shouldn’t say online; if a psychiatrist were to meet a patient on the top deck and start talking about treatment, other people in earshot could learn something compromising.\u00a0 This is a fairly trivial point, though. \u00a0If an HCP of any stripe needed this pointing out, I’d worry that he was missing something important anyway.<\/p>\n

Of course, the net gives us the capacity actively to search for information in a way that we couldn’t otherwise.\u00a0 But Smith searching for Jones or information about him online is really no different from following him home, sweet-talking his friends,\u00a0or rummaging through his bins.\u00a0 Finally, using facts that one may accidentally learn online in the context of a consultation doesn’t seem to be so different, morally, from using facts that one may accidentally learn in any other situation; and carelessly propagating information online isn\u2019t, by the same token, all that different from carelessly propagating it anywhere else.<\/p>\n

Nor are the boundaries of propriety in relationships all that different online; all the problems that one might cite here are problems that one might equally well cite in relation to offline social interactions.\u00a0 For example, a doctor who tried to “friend” a patient online would perhaps have violated some kind of expectation about behaviour – but the same applies to a doctor who gets too chummy with a patient whom he happens to see at a pub; we’d expect doctors, like anyone\u00a0else,\u00a0to follow certain rules of (for want of\u00a0a better word) decorum.\u00a0 And the same applies to patients:\u00a0a patient who tries to friend a doctor, or who is chummy in the pub, is a bit odd, too. \u00a0(Transference and countertransference, anyone?)\u00a0\u00a0So there’s nothing special about Facebook or other social networking sites there.\u00a0 On the other hand, a doctor might form a friendship with a patient or ex-patient in the normal course of affairs: there’s nothing to say that a medic and his patients have to maintain glacial relations if the situation naturally could sustain something else (for example, if they happened both to go to the same social functions or have mutual friends); and, again, the same applies online.<\/p>\n

Social networking, at least in this respect, isn’t all that interesting.<\/p>\n

Move now to the second area of dispute: the claim implicit in the paper that there’s something particularly noteworthy about physicians.\u00a0 <\/span>There\u2019s a hint of what one might call \u201cmedical exceptionalism\u201d in the paper, and it generates the recommendation of restraint in the use of sites like FB:<\/p>\n

[P]hysicians might choose to become Facebook users but populate their site only with professional information, such as area of speciality, office address, academic affiliation and contact information.<\/p><\/blockquote>\n

But – and this was tacit in the last couple of paragraphs – it’s not entirely clear why this might be: why, that is, physicians have, or ought to have, special rules that don’t apply to anyone else.\u00a0 Of course, a person may choose to place all kinds of limits on what they do or don’t say online, but there’s nothing special about physicians here, and it’s not self-evident that any of this amounts to an obligation. \u00a0We wouldn’t, I don’t think, expect bank managers or\u00a0teachers to take special precautions beyond what we’d expect of anyone else, so I’m not sure why doctors are different.<\/p>\n

This isn’t to deny that your role might influence what you do online.\u00a0\u00a0For example, I think my own FB page is public, but although I’ve accepted FB friend requests from students and ex-students,\u00a0they have been\u00a0(in the main) only from people whom I’ve taught face-to-face. \u00a0I purged my distance learning students because it occurred to me that, never having met me, they might not quite appreciate some of the banter between me and my friends; I’m more confident that campus-based students’ll know how I tick: we have, after all, know each other a while and been out for a curry on occasion. \u00a0(Sorry about that Peter and Robert: I’m sure you’re lovely people, but I just don’t know you well enough.) \u00a0But this has to do with fairly workaday concerns about managing my public profile; it’s not that I think I have any obligations<\/em> in particular – not in any strong sense, at any rate.\u00a0\u00a0I don’t think\u00a0that I have any responsibility to tone things down because of my job; nor do I think anyone else does – I’m just aware that some of the jokes I and my friends enjoy are a bit near the knuckle at times, and could be misconstrued.\u00a0 Thus I’m not going to have them clog up the news feeds of people whom I’m not sure will get them.<\/p>\n

So as well as social networking being none-too-interesting, I think the same applies to medics; what we can say about them, we can say about anyone.<\/p>\n

There’re other considerations as well.<\/p>\n

Guseh et al<\/em> point to the privacy aspect of social networking, but I think that what they don’t question – and what is worthy of question – is what “privacy” actually means in the context of online social networking. \u00a0There’s a steady stream of examples of people saying waaaay too much on their Facebook page – this is a quite marvellous example<\/a> – but, again, I don’t really see how privacy has<\/em> to be seen as being all that big a deal.\u00a0 If you don’t want to have something accessible, don’t put it online: pace<\/span><\/em> the example in the link, most people get that, and, again, it’s really no different from offline prudence.\u00a0 At the other end, it’s probably a bit off to go trawling for information – just as it’s a bit off actively to keep tabs on someone offline.\u00a0 Again, so far, social networking doesn’t obviously offer anything new to cause us to worry.<\/p>\n

On the other hand – and I’m speculating wildly here – it might be that the evolution of electronic social networking is of philosophical and ethological interest.\u00a0 One might wonder, for example, whether the age of mass and electronic media is one in which “privacy” means what it used to.\u00a0 It’s possible that Facebook does<\/span><\/em> undermine traditional boundaries – but it’s also possible that it’s only a success because of the fact that people are willing to publicise themselves in a way that either they wouldn’t, or couldn’t, a generation ago.\u00a0 (Here’s one for the counterfactual historians: had Facebook and webcams existed 50 or a hundred years ago, would they have been as popular as they are now?\u00a0 I kinda suspect that they would.\u00a0 Moralise all you like, but some people are self-publicists, and some people like watching ’em.)\u00a0 Call it a Debordian “spectacular society” if you want, or a general pervasive vulgarisation, or – and this is my preferred option – shrug and note that something interesting might be happening but equally well might not.<\/p>\n

The point would stand, though: if “privacy” has mutated, then proposing guidelines to protect it on the old lines mightn’t be much more than a thumb in the dike.\u00a0 And it’s equally true that most people are pretty savvy about privacy and have adapted perfectly happily to the online world.\u00a0 The context of privacy has perhaps changed: but I suspect that that’s all<\/p>\n

The most we can say is that it might be prudent to keep certain things offline just in case someone does something with that information that we would prefer them not to – but, by this token, we should be more careful about what we put in the bin just in case someone chooses to rifle through it, notwithstanding that in this case it’s the bin-rifler who’s causing the problem. \u00a0As long as we’re not gratuitously silly in the things we put online – the equivalent of putting a box clearly labelled “my bank and medical records” in a public bin, we shouldn’t have to worry. \u00a0The point is that professionalism has nothing to do with it.<\/p>\n

\u00a0<\/span><\/p>\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

There’s a short piece in the latest JME about the use of social networking sites by medics that’s got me thinking. \u00a0In it, Guseh, Brendel and Brendel suggest that physicians need to be especially careful about accepting, say, a Facebook friend request from patients because of the nature of social networking sites and the possibility […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[443,472],"tags":[],"class_list":["post-177","post","type-post","status-publish","format-standard","hentry","category-jme","category-thinking-aloud"],"yoast_head":"\nPhysicians on Facebook - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2009\/09\/09\/physicians-on-facebook\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Physicians on Facebook - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"There’s a short piece in the latest JME about the use of social networking sites by medics that’s got me thinking. \u00a0In it, Guseh, Brendel and Brendel suggest that physicians need to be especially careful about accepting, say, a Facebook friend request from patients because of the nature of social networking sites and the possibility [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2009\/09\/09\/physicians-on-facebook\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2009-09-09T11:14:17+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2009-09-09T11:15:01+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"8 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/09\\\/09\\\/physicians-on-facebook\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/09\\\/09\\\/physicians-on-facebook\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Physicians on Facebook\",\"datePublished\":\"2009-09-09T11:14:17+00:00\",\"dateModified\":\"2009-09-09T11:15:01+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/09\\\/09\\\/physicians-on-facebook\\\/\"},\"wordCount\":1643,\"commentCount\":2,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"JME\",\"Thinking Aloud\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/09\\\/09\\\/physicians-on-facebook\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/09\\\/09\\\/physicians-on-facebook\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2009\\\/09\\\/09\\\/physicians-on-facebook\\\/\",\"name\":\"Physicians on Facebook - 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