Many decades ago, a town would consider itself extremely lucky to have its own doctor living on-site. Despite the dramatic limitations of medical care in these earlier times, the people of the town still felt far safer having a doctor around. One of the most important  characteristics of such a doctor was that he or she knew the members of the town intimately. For some people, it was the same doctor who had delivered them, who was now treating them for their fever, or for their arthritis much later in life.

The advantage of having this social connection to the townspeople, was that the doctor did not need to begin from scratch every time a patient would show up. The townsperson’s history was already known to the doctor. In fact, the doctor also new that the particular patient was a farmer, had four children, had experienced the loss of a spouse, was having difficulty due to the last drought and so on. In other words, the doctor of the town knew the entire social environment in which the patient lived. Sometimes, treatment would be guided by this awareness of the individual’s social environment. Even today, a great deal of primary care has to do with the mental state of the patient. So, when a patient would present to a doctor a 100 years ago, the doctor could still diagnose depression based on negative recent events in the patient’s life.

Should doctors have a professional presence on a social media site like Facebook and accept their patients as Facebook friends? This question has been debated amongst individual doctors as well as in the  professional literature. The positives seem clear. If a patient wishes to discuss a medical issue with their doctor, rather than wait for the next available appointment, the patient can directly share a comment with the physician. Since such comments are open on Facebook, other patients could chime in and share their personal perspectives, even before the doctor has a chance to respond.

There are a number of problems with this scenario. Firstly, there really is no privacy for the patient. One could easily argue that by virtue of posting a personal comment on Facebook, the patient has effectively allowed for publication of this comment to anyone else on Facebook. The patient may very well not care that others will know he or she has high blood pressure. For this loss of privacy, the patient will benefit from near immediate access to their doctor. As such, many people may feel that the trade-off is worthwhile.

From the doctor’s perspective, having a social media presence gives the impression that the doctor is available 24/7. If the patient posts a comment but the doctor does not respond for days, the patient may very well feel slighted. More importantly, if the patient posts a comment that clearly indicates a pending medical disaster, the patient could die before the doctor responds. Rather than make a same-day appointment or go to the emergency room, the patient may mistakenly think that the doctor “must have seen” what was written, and chose not to respond because the complaint  was not serious.

A doctor with a presence on a social media site might also find it difficult to take off a few days for a vacation. The doctor could easily find him or herself bombarded with comments asking when he will return and whether the patient can wait until his return. Clearly, this would make it far more difficult for the doctor to have some downtime. And patients must realize the doctors are human and need to sleep, eat, spend time with their families and take vacations.

There is also the critical matter of responsibility. Is a doctor responsible medically for a comment that was made on their social media site? If a doctor misdiagnoses a patient based on a Facebook comment, is this considered malpractice? And, you cannot discuss such issues without raising the legal repercussions. Can a doctor be sued for not responding to a patient via a social media site?

Some of the same issues arise when a doctor offers patients the option to send an email. In these cases, the doctor often formally states that the purpose of the email should never be to raise and/or discuss an active medical illness. As such, the email is appropriate for asking for a refill on medication, or perhaps asking for some general advice related to travel  abroad. But the email should never be used for stating that the patient is having on and off chest pain since the early morning. In such a case, the patient must seek immediate medical care. In some practices, the doctors hire a dedicated person to handle email. Or, the doctors will ask their nurse to begin his or her day with a review of emails from the previous day. The nurse has sufficient medical training to spot suspicious comments, and knows enough to answer certain medical questions or to ask the physician before answering. But even in this case, you can definitely imagine a scenario where the nurse, even after consulting with the physician, makes an honest and very human mistake due to a subtlety in the patient’s language. At this point, the physician will need to deal with the repercussions and complications of this misunderstanding. In some cases, such an event can be so unnerving, that the doctor cancels the email option.

If social media is problematic, at least for the doctor, does it mean that the medical community must abandon all forms of online communication with patients? Some doctors will simply state that they would embrace online care if they could reliably assess a patient via the Internet.  There are tremendous advances in this area of medical care, many of them based on technologies that provide for “remote presence”. This will likely be a critical new area in healthcare across the entire world in the years to come. And, I will discuss this in more detail in my next blog entry.

Thanks for listening.