Drs. Douglas Mossman and Helen M. Farrell’s article on the social networking Web site Facebook (“Facebook: Social networking meets professional duty,” Malpractice Rx, Current Psychiatry , March 2012, p. 34-37; http://bit.ly/1JFSxP3) deserves some expansion.
We shouldn’t give Facebook more credit than it deserves, nor our patients less just because they are mentally ill. Even severely mentally disturbed patients often possess a fair degree of knowledge when it comes to social media. Most patients can and often do obtain information about us from Internet searches without ever having to “friend” us on Facebook. What psychiatrist hasn’t seen patients who say they “found us on the Internet”?
Drs. Mossman and Farrell are correct that there are Web sites that provide our academic, personal, family, legal, and military information with the click of a mouse; patients don’t have to go to Facebook. Because Facebook has a number of security and privacy settings, anyone who does not take the time to learn about these settings shouldn’t be on Facebook.
Handling a Facebook friend request can be a tool to educate or exploit. A psychiatrist might have a Facebook presence that has nothing to do with mental health, but devoted to his or her hobby. A patient may have the same hobby; however, a friend request such as this cannot be honored because it is a personal/boundary issue.
We’ve all seen patients at gas stations, supermarkets, post offices, banks, movie theaters, and libraries. We don’t change banks, gas stations, or supermarkets just because a patient patronizes the same business we do. We don’t refuse to be interviewed for newspaper or magazine articles, radio programs, or television shows just because a patient might read, listen, or watch. We treat these unintended encounters as a natural by-product of our chosen discipline with respect and integrity that maintains the therapeutic relationship without crossing professional boundaries, or having to completely alter one’s lifestyle. Should we react differently if a patient is on Facebook or Twitter? Until the American Psychiatric Association makes a definitive ruling on this issue, it is an individual matter of cautious judgment.
Roland S. Jefferson, MD
Private Practice
Los Angeles, CA