Tips for Maintaining Your Professionalism on Facebook

Advances in communication technology in the last two decades are stunning. Twenty years ago we were just learning about email and the Internet, and now we can Tweet with friends and celebrities, Skype with family members who are overseas, see just about anything we want on YouTube, and navigate the Internet to access information on topics as diverse as the Human Genome Project, the latest CDC epidemiological data about Zika, and the 10 best recipes for flourless chocolate cake.

With these advances comes more time in front of a screen instead of face-to-face interaction, more accessibility to our medical records database with accompanying expectations that we will continue working via computer at any time of day or night, and a continuous acceleration of the pace of work. We adapt to each new technological advance, but sometimes the adaptation process is hindered by the fact that we can’t possibly anticipate all the implications associated with the new technology.

This article is the first in a series designed to facilitate our adaptation to modern digital media by helping us maintain our professionalism and boundaries as we venture into these new social territories. Specifically, this article addresses ethical concerns when using Facebook, a social networking site launched in 2004 with over a billion daily active users as of April.

There is a generational difference in approaches to online social media. Medical students, residents, and early career psychiatrists grew up in the digital age and may have different expectations about privacy than those of us who were already in practice a dozen or more years ago. There may be no reasonable expectation of privacy when using online sites such as Facebook, and that may bother some of us more than others. Posting something online is like using a can of shaving cream: easy to get it out there, really difficult to get it back in. Regardless of our comfort with sharing elements of our lives online, we must be mindful of preserving an appearance of professionalism.

Professionalism is the combination of technical skill, good judgment, and polite behavior that helps to maintain the public’s trust in a particular occupational group. Doctors are held to a higher standard of professionalism than most other groups, with the possible exception of Supreme Court justices. What we do in our free time reflects on our personal reputation and our profession’s reputation.

Facebook may blur the line between personal and professional personas and may erode an appearance of professionalism. Images of doctors imbibing at parties don’t improve patients’ confidence in our skills. Family photos or descriptions of recent vacations offer up more personal information than psychiatrists usually share with patients. These disclosures can be mitigated by choosing the most stringent privacy settings on your Facebook page, but keep in mind that those settings automatically revert to the lowest privacy settings each time you load Facebook onto a new device.

Beyond compromising our privacy and professional image, having a Facebook page introduces the ethical dilemma of how to respond if you receive a friend request from a patient. If you accept the friend request, you may help to strengthen the alliance with the patient, but you also risk blurring boundaries about the nature of your relationship with the patient and the extent of your clinical availability. Is this person a patient or a friend? If the individual asks you a clinical question in a Facebook message, have you inadvertently extended your clinical space to social media? Accepting a friend request also places you at risk for a breach of confidentiality if the patient discloses on your page that you are his or her doctor. If you ignore or delete the friend request, you may hurt the patient’s feelings, harming the alliance, but you also protect your professionalism and confirm your commitment to maintaining appropriate professional boundaries.

In addition to being mindful of the effect of our online profiles on our patients, we must remain vigilant to the image we are projecting to other entities that are interested in our professionalism. Online profiles have been used to vet applicants for residencies and jobs, suspend trainees, and fire employees. These consequences may arise from disclosing patient information in a Facebook post; griping about a clinical encounter, institution, or supervisor; or posting inappropriate images.

If you want to use Facebook, here are a few tips for maintaining your professionalism on the site: