August 14, 2014

Should doctors or hospitals follow their patients on Twitter?

By Lee Aase, Director, Mayo Clinic Social Media Network

Brave New World: Your Doctor, Your Private Parts, Twitter And You

That's the underlying question Hinda Mandell, Ph.D. raised Tuesday in a post on the Boston Public Radio site, "Brave New World: Your Doctor, Your Private Parts, Twitter And You."

My gynecologist just followed my vagina on Twitter.  At least, that’s how it felt when I received email notification that I had a new Twitter follower.To be fair, maybe it wasn't my gynecologist who hit the “follow” button, but an employee at her practice. Does it matter? Because my ob/gyn’s name and Twitter handle are the same, and her Twitter avatar is her practice’s logo of a mother and child, entwined. Now she — or whoever her office’s social media manager is — knows my political views, sees the photos I take of my crafting projects and reads the recipes I plan to cook. It sounds innocuous, but it doesn’t feel so innocent.

Ms. Mandell refers to the 12-word social media policy published by our Mayo Clinic Center for Social Media Medical Director, Farris Timimi, M.D. (which is how I came across her post.) Dr. Timimi's personal policy is, in some ways, a distillation of our official Social Media Guidelines for Mayo Clinic Employees. The relevant point from our guidelines is this:

Mayo Clinic strongly discourages “friending” of patients on social media websites. Staff in patient care roles generally should not initiate or accept friend requests except in unusual circumstances such as the situation where an in-person friendship pre-dates the treatment relationship.

Does the different nature of "Friending" on Facebook as compared with following on Twitter make the latter less problematic? I think it does, to some extent. As Ms. Mandell says later in the piece:

What I find most confusing is my own reaction. It does feel unseemly, slightly freaky and certainly uninvited for the physician who helped bring my daughter into the world 13 months ago to know the Twitter version of myself.But why?

After all, I know on a conscious, logical level that my tweets are public and can be seen by anyone. I mean, isn't that the reason I use Twitter, to broadcast my ideas and opinions to a wider audience and to share the online content I find of interest? And if I already have a confidential, private relationship with a medical professional, who cares if she sees my very public tweets about the hottest Parisian beauty balms or chefs who have discontinued favorite dishes in New York restaurants?

She goes on to say that she does care and it makes her feel uncomfortable, and I  encourage you to read the whole thing.

In her doctor's defense, Ms. Mandell writes frequently on a public radio blog and has interesting things to say. To that extent, she's something of a public figure. Maybe the physician-patient relationship trumps that, but wanting to follow interesting and lively public commentary would at least be a reasonable explanation.

Which brings me to the main question, I think:

Why would you as a doctor, or as a hospital representative,
want to follow a patient on Twitter?

At @MayoClinic, the main reason we would follow a patient or employee is to enable private messaging.

In the early days of our Twitter experience in 2008 we weren't following anyone, but that seemed kind of...well...anti-social. Then we started following those who had followed @MayoClinic and who were real people and not spambots, until I got a message from a Mayo employee expressing some of the same angst at Ms. Mandell: "Why are you following me?" Felt we might be big-brotherish, I guess.

After that we moved to (generally) only following those who asked to be followed. If someone mentions @MayoClinic on Twitter, particularly with a service concern, we may attempt to connect by sending a private direct message. The NSA we're not.

What do you think?
Should providers following patients on Twitter be out-of-bounds?
What reasons for following might be justified?

I'm speaking next week at a Mayo Clinic CME event, Professionalism Today and Tomorrow: Sustaining Trust in a Technology-Driven Health Care World, and I would like to share the community thoughts on this, so would appreciate your perspective in the comments box below.

Updated (8/15/14): Dr. Bryan Vartabedian, a member of our MCCSM External Advisory Board, has posted on the topic this morning on his blog. Great stuff. Check it out!

Lee Aase is the Director of the Mayo Clinic Center for Social Media.

Choose a message to share 
Should caregivers following patients on Twitter be out-of-bounds?
Following your patients on Twitter sounds innocuous, but it doesn’t feel so innocent.
Does a doctor following a patient on Twitter violate the patient-physician relationship?

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