Can Your Patient Be Your Facebook Friend?

Robyn Hart is director of Child Life Services at Rush University Medical Center, where she focuses on the emotional and developmental well-being of hospitalized children and their families. She recently spoke about social media — “Should You Be Friends with Your Patients?” — at a conference of child life directors. Rush’s Jody Lempa talked to Hart about her views on social media in health care.

What are some of the major issues regarding the use of social media?

This is a day and age when people are communicating much more through social media, and a lot of the medical team is young and grew up with this, but they don’t often see how problematic this can be. Just the word “friend” by definition means that it is not a professional relationship. However, other people will counter that in the context of Facebook they are really not all of your friends; rather it is a network where they are trying to get as many people on their network as they can because it looks good. But the problem is that this is a network. So, for example if you communicate something that was possibly OK to say to one person, but now it has gone viral, it could have a devastating effect both emotionally, if a person feels that their privacy has been violated, and now legally. …

You are going off a slippery slope by having these relationships. Sometimes there are pictures that are appropriate for your family and friends to see, but it does not project the professional image you prefer. So now when a patient or family sees a picture of you at a party getting wild, silly or drinking, it diminishes the professional ranking and status they hold you in and puts you in a more difficult position to impact them in a professional manner.

Do you think it is appropriate for medical personnel to link up with patients?

I think only if social media is being used for something nonsocial. If it is being used for communicating information, and that is the most effective way, then OK. But it is not OK for staff to become friends with patients. I think that boundary issues are very important to maintain in an individual’s professional and social lives.

It is also important to consider what happens when a staff member moves on to another job. What if they want you to go to their birthday party or be their best friend, but it is more than what you want or more than you are able to meet. Do you want to have to tell that child that you do not want to be their friend anymore or that you can no longer maintain that friendship, both of which are hurtful? There is a potential to really hurt someone’s feelings when you think you are just being friendly. There is no way to predict when something like that is going to happen. So I feel very strongly to not get into these situations.

One of the other problems with Facebook is that you can have someone who is not your friend view your profile. For example, there was a situation in which a nurse wrote about the difficult day she had at the hospital, and while she was not friends with her patients, they were friends with her friends. The patient’s family saw her posting (which did not include names), and the nurse didn’t think it was her fault because she considered her Facebook page private. But it is not private because you cannot control who is reading it. It is never private on the World Wide Web.

In what capacity do you think you can become friends with patients?

You can’t. You have to maintain a professional relationship, and really the first thing you learn in child life, social work, or psychology courses is that you cannot be friends with your patients. And really this is an extension of that, in my opinion. While some of these things may seem common sense to some people, it needs to be stated clearly for others to truly understand the boundary issues.

Would you suggest any recommendations to be cautious of or warn against when using social media?

If you really need to, I would suggest that people create two Facebook pages — one under an alias as your personal page, and one that is very generic, in which you will not post any pictures or personal information on. That way if you choose to communicate with patients in that manner, it is a separate, protected area that you can somewhat control the information on. Because remember, your friends can post comments on your page, which can be then viewed by your patients, but they do not know that they need to edit their comments appropriately for a child or patient that might be reading it.

What I am really advocating for is that discussions of this and the boundary issues in general, start happening at the student level in nursing and medical school, so that people can understand the theoretical foundation behind these rules. When you enter the hospital setting, there is a long list of rules and regulations that need to be learned and followed. So unless you had a discussion, it is quite difficult for some people to understand what could be wrong or bad about becoming friends with patients and growing close to them. It seems counterintuitive that it would be negative in some ways; so it needs to be a conversation, not just one of the rules on a list.

The discussion of the use of social media needs to be involved in ethics and legal courses so that students understand that even if you don’t use names, there are other indicators of identity that are covered by HIPAA. Hospitals can lose accreditation and Medicare reimbursements for HIPAA violations. The consequences are not only to the individual and their own personal career, but potentially to the hospital, both of which are enormous. People need to be educated that this is not a private capacity.

Robyn, can you tell me about the conference you recently attended and the topics on which you presented?

I presented with another child life director from the University of Chicago. This was a child life directors conference, in which the audience was made up of all child life directors from the United States and Canada, and the topic of the presentation was “Should You Be Friends with Your Patients?” The presentation was aimed at discussing staff use of social media, both directly in terms of becoming friends on Facebook or staff becoming friends with students, or becoming friends with patient’s families, and the issues that this poses for professional relationships.

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