Social Media in Medicine: Do Your Patients 'Like' You?

The Federation of State Medical Boards (FSMB) recently issued guidelines for the use of social media and social networking in medical practice. You could read the entire 17-page document (About PDFs) for yourself or I can paraphrase their recommendations in one tweet-sized blurb: Physicians should never interact with patients on social media websites. Ever.

Meanwhile, PricewaterhouseCoopers recently released an exhaustive report on health care and social media that revealed some interesting tidbits about what patients want from their physicians relative to social media:

So, how do we reconcile these conflicting pieces of information? Patients want, and in some cases expect, us to be available on social media. At the same time, we are being cautioned by medical organizations about how to use social media -- if we dare to use it, that is.

I started using Facebook about five years ago as part of a project for the Kansas AFP, recruiting medical students to family medicine. It wasn't long before my patients noticed I was on Facebook and started sending me friend requests.

I could see right away this was one more way for people to reach me, and I'm comfortable with that. My number is listed in the phone book in our small town, and people know where I live.

My urban colleagues are shocked when I tell them my patients "friend" me on Facebook, but my standard response is that in a community of 2,000, if I don't let my friends be my patients, or my patients be my friends, I either won't like my patients or won't have any friends.

I love talking to people, but I never initiate a medical conversation with a patient online. If a patient brings a question to me, however, there are ways to answer it without violating the patient's privacy. A patient might see that I'm on Facebook and send me a message that says, "Hey, what's the Tylenol dose for my kid?" Or, "Susie has an earache. Do we need to go to the ER?"

These are the same kind of questions that small town docs have been answering in grocery stores (or wherever patients might run into us) for years. The key is how and where we answer. If a patient asks me a question that's not patient-specific and the answer could be easily found on the Internet -- like that proper dose of Tylenol -- I can respond with a link from a manufacturer's website. That's not a Health Insurance Portability and Accountability Act (HIPAA) issue.

If someone sends me a long, complicated question on Facebook, I copy and paste it into their chart and ask them to sign up for our patient portal. More than 90 percent of them will.

If a patient asks a sensitive or urgent question, I take the conversation off social media and respond with a phone call or a secure portal message, as appropriate. I have even been known to text with a few patients if that seems the best way to communicate.

For example, I had a family leave my practice a few years ago when they moved out of the area. They had not yet established care in their new town when one of the children became ill, so they took her to an urgent care facility.

As part of her evaluation, a urinalysis showed glucose in her urine, and a follow-up finger-stick blood test revealed that her blood sugar was 400. The health care professional there instructed the parents to take the child to an emergency room, but they didn't do so because of financial concerns. Clearly, they didn't understand the severity of the situation.

I was not close friends with the mother, but she had friended me on Facebook before the family moved. She did not feel comfortable calling me directly, but I had delivered her babies and cared for her family, and she trusted me enough to send me a message on Facebook that basically said, "Is this a big deal? Do we need to go the hospital?"

A blood sugar of 400? Yes, that is a very big deal.

Now, I agree with the FSMB to a point. And that point is that you can't have a social media discussion with a patient or parent that would violate HIPAA regulations. So I called the mother in response to her Facebook message, and we discussed her daughter's health on the phone.

I was able to get her in to see a family physician friend of mine in her city the same day, sparing the family the expense of an ER visit and avoiding a possible bad outcome. The child received needed care in a timely manner, and it wouldn't have happened without social media.

The key to using social media with patients is being professional and respecting both their privacy and your own. I don't post anything from my own life that could embarrass me or my practice. I have used information gained from social media to check on patients, however. Someone with depression who posts that their mother passed away probably needs a personal call from me or my staff, for example.

Privacy issues aside, some physicians are wary of social media for the same reason they shy away from telemedicine or e-visits: They can't get paid for it. For my practice, our availability and accessibility has proven worth the time and effort.

A few years ago, we started a blog on our website to keep patients up-to-date with our practice. Topics included things like practice surveys, a patient-centered medical home initiative, new staff members and seasonal issues, as well as reminders for things like flu shots and using sunscreen.

Nobody cared.

Later, we started professional Facebook pages for both of our clinic locations. Patients noticed and "liked" our pages. We posted links to new blog posts, and suddenly people started reading them. It was a new way to reach our patients with important information.

Not only that, it was a new way to draw patients into the office.

Last fall, we posted a blog promoting school sports physicals for $25 cash and linked to it on our Facebook pages. We saw a spike in the number of physicals we did compared with previous years. It wouldn't have happened without the Facebook links.

Similarly, one of our nurses offers regular foot care clinics for patients with conditions such as osteoarthritis and diabetes. We introduced her to patients in a blog post that included details about the clinic. Again, more people showed up for her clinics after that post.

I now have more than 800 Facebook friends, and probably a few hundred of them are patients. Obviously, that approach isn't going to work for physicians who prefer not to be connected to patients in their lives outside the exam room. But one option for physicians who feel more comfortable keeping a solid barrier up between their personal lives and their patients is a professional Facebook page, which can provide patients with information they need, raise the profile of your practice in your community and bring more people into your office.

To sum it up, let's make it tweetable (You need a Twitter account to view this link): Patients and docs have spoken: #socialmedia in medicine is here to stay. How will you use it? http://bit.ly/MUN1HH #fmrevolution #AAFP