There is no clear, accepted standard on how to use social media in a patient–physician relationship. The Sixth Edition of the American College of Physicians Ethics Manual warns physicians who use online media about the potential to blur social and professional boundaries and recommends that physicians record any patient–physician interactions.4 Additionally, the mere existence of an online patient–physician relationship could, in some cases, represent a violation of the Health Insurance Portability and Accountability Act of 1996.
How can we ensure the security and privacy of messages sent to and from patients? How can physicians ensure that patients are conscientious about the issue of privacy? Although patients’ information belongs to them, physicians who engage in social media may have a role in educating patients to ensure they know that a message they think is personal may be seen by the whole network of the person to whom it was directed, depending on the privacy settings and policies of the social media platform.
The absence of a face-to-face relationship may also create a false sense of anonymity, and this misapprehension has led to many abuses and misuses of social media by healthcare professionals and medical students.5 Patients may feel they can obtain medical advice from their physicians through social media, when in fact, their physicians may not be legally able, or willing, to give advice online without seeing them in person. On the other hand, if a physician sees a patient abusing alcohol on social media, how much of this information should be used to make management decisions, such as starting methotrexate?