DILEMMA: Do I accept a “Friend” request from a patient?

One of my regular patients has a keen interest in cycling – which I share. Sometimes we enjoy a quick chat about bikes after a consultation. I am on Facebook and recently received a Friend request from the patient. Is it okay to accept?

SOME healthcare professionals in this situation might feel that to refuse such a request would be rude. Certainly Facebook has now become an almost universal means of communication – with over 31 million users in the UK or 60 per cent of the population. How is sharing personal details via social media any different from doing so face-to-face in a practice setting?

Well, regulators have some very definite views on this matter. In 2013 the GMC published updated guidance on Maintaining a boundary between you and your patient which states: "You must consider the potential risks involved in using social media and the impact that inappropriate use could have on your patients’ trust in you and society’s trust in the medical profession. Social media can blur the boundaries between a doctor’s personal and professional lives and may change the nature of the relationship between a doctor and a patient."

Just what is meant by professional boundaries can be widely interpreted but Facebook profiles can feature some highly personal information including photographs and details of friends and family, comments and viewpoints both written and received from others. The BMA states in its social media guidance that although doctors often "choose to divulge personal information about themselves during face-to-face consultations with patients, they are able to control the extent and type of this self-disclosure. The accessibility of content on social media however raises the possibility that patients may have unrestricted access to their doctor’s personal information and this can cause problems within the doctor-patient relationship".

Ask yourself would you feel as able to discuss treatment plans or difficult decisions with a patient who has seen photographs from your beach holiday or Christmas night out? Do you think it would impact the level of professional trust between you?

The two-way nature of the exchange can also create complications. The BMA states: "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 GMC is clear that doctors should be careful not to invite unwanted attention from patients in the first place. There is always the risk that personal relationships may veer into entirely unintended directions. Your fitness to practise may still be questioned even if a relationship seems entirely open and consensual with no obvious adverse consequences for the patient. Such a relationship need not be long-term or even sexual in nature to attract censure. In exchanging personal details with a patient such as those commonly posted on sites like Facebook you may increase the likelihood of ethical difficulties.

There are steps you can take to minimise the chances of patients contacting you via social media. Take a good look at your privacy settings to make your profile as secure as possible, and try to keep a clear line between any professional and personal pages. Facebook allows users to block their profile from public searches which may help reduce contacts from patients. However, care should be taken in terms of anything you upload on your Facebook page, bearing in mind that social media sites cannot guarantee confidentiality whatever privacy settings are in place.

Should you be approached on Facebook in regard to a medical matter the advice from the GMC (Doctors’ use of social media) is clear cut: "If a patient contacts you about their care or other professional matters through your private profile, you should indicate that you cannot mix social and professional relationships and, where appropriate, direct them to your professional profile."

But what about the scenario posed above? MDDUS would recommend that you decline the Friend request in this case and all such contacts from patients or former patients on Facebook. Should the matter be raised in a later consultation then politely explain the importance of maintaining a strictly professional relationship. Be sure to keep a clear record of your discussion with the patient so there will be no doubt how you resolved the situation.

Dr Barry Parker is a medical adviser at MDDUS