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Friend me?

March 2009

Recently, I invited my pediatric hospitalist colleagues to join a growing online community: the pediatric hospital medicine group on Facebook.

As you know, Facebook, MySpace, Ning and others are social networking sites that typically feature individuals. But as membership in these networks grows, the inevitable has happened: People with common interests have aggregated within online groups.

So what are the consequences?

Questions have cropped up about medical professionals participating in these sites. As Lindsay A. Thompson et al discussed in the July 2008 issue of the Journal of General Internal Medicine, there’s a growing concern about how these sites are being used by medical students and trainees, specifically in regards to medical professionalism.

The authors looked at the online profiles of medical students and residents at the University of Florida and found that the majority of them listed at least one form of personally identifiable information–such as a screenshot or home address–and that only a third of these profiles were private. (In the world of Facebook, “private” means that a person has to add your name to his or her friends’ list for you to access private details.)

They also found that some accounts displayed potentially unprofessional material like photographs of hosts with alcohol or remarks implying excess drinking, foul language or overt sexuality. The authors recommended that medical trainees get “instruction on the intersection of personal and professional identities.”

Let’s face it. Most of us join these sites to interact with new acquaintances and reconnect with old friends. We share our likes and dislikes and put up pictures of recent events, be they as insignificant as a photograph of falling leaves or as important as a wedding or a graduation. We post jokes, we play games. And yes, my current profile picture shows me holding a champagne flute. (It was New Year’s Eve!)

What we include in our profiles is up to us, but sometimes our friends pipe in and take it upon themselves to reveal personal aspects on a public wall or post pictures that might be considered “embarrassing.” (Please, don’t look at my college pictures. That pink shirt is long gone). Granted, we can control how much “friends” or casual “lurkers” can see of our profiles, but the reality is that we put a lot of private information on these sites and not all of it will remain private.

How does that affect professionalism? Sometimes, the intersection that Thompson et al mentioned just feels too close. Recently, a patient’s mom tried to become my Facebook friend. I looked at her picture and didn’t recognize her, but in her request, she posted this message: “I can’t believe you have a Facebook account! You helped take care of my daughter!” I denied her friendship request because I didn’t feel comfortable with this person looking at my children’s birthday photos.

Here’s another request I recently turned down: that of a recruiter who likewise wanted to be a “friend.” That also felt like a breach of protocol–but maybe, that’s the future…

So far, the pediatric hospital medicine group in Facebook is just a venue for re-publishing this blog and announcing upcoming conferences. But what are the ground rules when, say, someone wants to discuss a patient’s condition or is looking for a job?

Should people feel comfortable posting questions or queries in such a public domain? Would collegial interaction flourish with the openness exhibited by network members? Or will members actually abstain from interacting with colleagues because it is such an open forum?

Is it OK to ask to be friends with a colleague with whom you have no other relationship except professional affiliation? Do online communities blur the line between personal and professional interaction–and is that necessarily a bad thing? Or should physicians keep their Facebook accounts strictly personal and use a site like a Sermo, an online community of physicians designed specifically for medically related interactions like case discussions, research, and yes, networking?

In other words, when you’re in one of the social networking sites, are you there as your Mr./Ms. “You,” or are you there as Dr. “You”? Is it possible to be there as both and switch from one to the other?

I think these sites can foster valuable interactions between medical colleagues in a non-stressful, “relaxed” environment. If Sermo and some of the listserves are the equivalent of conferences, Facebook and MySpace can be the hotel bar or bookstore where you share ideas with colleagues in a more informal setting. These sites can help build connections with physicians who share an interest in, say, hospital medicine, without the fuss of talking to someone in a crowded conference or battling institutional e-mail filters or firewalls.

I’m enjoying being on Facebook, keeping in touch with friends from all over and, yes, “meeting” new colleagues. From an ethical and legal standpoint, it’s clear that we have to err on the side of caution when discussing particular medical cases to preserve the patient privacy.

That said, it is up to each of us to police his or her own page and what can be seen of a profile. Your presence on such a social networking site entails a certain degree of openness regarding who you are. But it seems to me that privacy is becoming more about controlling the flow of information than the actual details of our personal lives–and that the line between personal and professional conduct seems to blur more each and every day.