What Does Caring Mean When It Comes To Social Media in Medicine?

This original version of this post was first published on the The AMS Phoenix Project blog in February 2015. It’s appearance prompted #hcsmca to invite Dr. Karen Devon to host a chat on the same topic Wednesday, June 24 at 9pm ET (time zone converter). Chat questions and additional reading have been added.

By Karen Devon (@specialkdmd)

Karen Devon

Imagine that your surgical resident approaches you about the patient you are meant to operate on tomorrow. “I know that being a smoker makes this operation much more likely to fail and I just found out that Mrs. SB smokes”. “Really? How do you know” you ask. “Um, well, Facebook. She’s um, well, my friend’s friend’s friend’s mom…”

This is the type of case that sparks debate as I found out on a recent ethics panel at the American Surgical Congress. It really brings us back to the question of caring for our patients. Is caring for our patients letting them make potentially medically unsound decisions and keeping all information they wish private in the name of autonomy? Or does it mean digging deeper into this issue and sharing with our patients what we found and how, with the end result of potentially delaying the procedure to ensure adequate healing?

Furthermore, if indeed searchable information provides a lot of additional information that would allow us to better treat patients, do we have an obligation to do so as part of the medical history? Unfortunately the issue isn’t quite so simple and will require some thoughtful consideration in this new age of social media.

What can be said about accuracy of information found during online public searches? If information that is public is posted by people other than the person involved, is it really considered public in the moral, rather than the legal sense?

Patients are weighing in as well, with several communications and blogs out recently in which they ask whether their doctor should be allowed to Google them. While many of us can see the potential utility in such a practice and think of emergency situations where this might be extremely beneficial, there are certainly concerns.

We must maintain our doctor-patient relationships, which are built on honest communications and trust. For instance, if my life partner felt it was necessary to Google me for more information, that would certainly affect the question of trust between us. If they did so and were unable to express their intent in such a search, things might get even more tense and lead to breakdown. On the other hand, if a search was intended to help or protect me, on an issue where I needed or desired help, I might feel differently.

Social media is stimulating many more questions about what caring really is. It has been called the new house call – allowing practitioners to respond to patients’ needs in the place that the patient is seeking assistance. In fact, while many see technologies as creating a physical distance between providers and patients, I can also see the technology as bridging a gap, perhaps as the telephone did many years ago at its inception.

When I give a patient the ability to connect with me online, I become accessible to them in a way that may not have been possible in recent years. And I hope that I am becoming accessible in more than only the physical way. My participation on Twitter is a part of my personal and professional life that I hope has humanized me, “the surgeon,” in a way that is positive and engenders confidence.

Finally, how can we begin to deal with the exponential increase in knowledge, but also in misinformation if, as a profession, we do not engage? For example, anti-medical social media campaigns have contributed to resurgent epidemics in infectious disease. If we extend our definition of caring to public health advocacy, do we then have a moral obligation to care by tweeting the new Facebook link to organ donation registries around the world? I’m not sure that is the case currently, but I do envision a future where active participation in social media is a requirement of professionalism and an important part of the #newandimproveddoctorpatientrelationship.

There remain more questions than answers. For the #hcsmca chat on Wednesday, June 24 9pm ET (time zone converter) we’ll use the following questions to guide the discussion. 

• T1: Have you ever searched for a patient online
  a. What were you looking for ?
  b. How would you assess information for accuracy?
• T2: Do you have concerns about searching for publicly available information about patients?
  a. How would you feel about this as a patient?
  b. Would you disclose to patient?
• T3:Is it ever within professional boundaries to “google” a patient?
  a. What would be good reasons? (ie. duty to warn, concern about safety or suicide, discrepancies in history and patient claims)
  b. When is it inappropriate? (ie. Voyeurism, interest in personal life)

Additional reading

Baker MJ, George DR, Kauffman GL Jr. Navigating the Google blind spot: an emerging need for professional guidelines to address patient-targeted googling. J Gen Intern Med. 2015 Jan;30(1):6-7. doi: 10.1007/s11606-014-3030-7. Accessed June 18, 2015

Goldman, Brian. Doctors Who ‘Google’ Their Patients. White Coat, Black Art blog. CBC Radio. Accessed June 18, 2015.