Case 13 Doctors On Social Media

DOCTORS ON SOCIAL MEDIA
CLINICAL CASE *
Dr. Núñez, a third-year resident, is on duty in the emergency room. During his shift,
Isabel- a medical graduate comes into the ER for a panic attack, which she explains is
because she is nervous about taking the MIR exam in less than a month. Dr. Núñez
introduces himself to Isabel and asks her to call him Alberto to build a bond and be more
familiar. He notes that the patient’s vital signs are normal, as well as the neurological
examination. After ascertaining that there are no signs of urgent pathology, he spends
some time calmly speaking with her, emphasizing active listening. He explains that he
understands her nervousness and empathizes with Isabel. Dr. Núñez, who has gone
through the same process, understands the importance of the exam and knows several
friends who had to take some anxiolytics in the weeks prior to the exam. The patient
feels understood and finds that Alberto has been very understanding and friendly with
her.
While the resident writes the discharge report, Isabel looks up Dr. Nuñez on social media
and sends him a message via Instagram asking if he minds if she “follows” him. Before
delivering the discharge, Dr. Nuñez takes a 10-minute coffee break and while checking
his social media platforms sees Isabel’s message. The patient seems very nice to him,
but he does not know if it is appropriate to answer. On the other hand, he thinks that if
he does not respond, he may generate more negativity at a difficult time for Isabel.
Should Alberto accept Isabel’s request to connect and follow him on Instagram?
* Based on a question from the 2016 MIR.
ETHICAL ANALYSIS OF THE CASE
In recent years, the doctor-patient relationship has been facing a new paradigm due to
the use of new technologies, giving rise to new ethical conflicts. Several publications and
the recent 2022 Spanish Code of Medical Ethics have analyzed these dilemmas. Manuals
of good practice (including social media) for physicians have also been produced, such
as the one made by the “Organización Médico Colegial: Manual De Estilo Para Médicos
Y Estudiantes De Medicina” (Code of Conduct Manual for Doctors and Medical
Students). However, so far, no publication has addressed how to act in cases of patient
contact via social networks, as is the case with Alberto.
In this case, an ethical conflict arises because the resident does not know whether to
indulge his patient’s desire for close communication or, on the other hand, to maintain
a professional social distance to facilitate a mutually respectful clinical relationship. It is
the physician’s responsibility to preserve trust and respect. This commitment to the
patient is a good thing because maintaining an appropriate clinical relationship is
positive and even therapeutic for the patient. If the physician accepts the patient’s
request for contact through any social network, he or she puts their credibility as a
professional at risk. Physicians must not forget that mutual respect and patient trust are
essential in their healthcare activities.
COURSE OF POSSIBLE ACTIONS
⮚ Accept the request and invite her to contact him via Instagram if she becomes
nervous about the exam again.
⮚ Accept the request to follow you (so that Isabel does not feel bad), but don’t directly
engage with her through social media (to mark a professional distance from the
patient).
⮚ Look over the patient’s Instagram profile before assessing whether to accept the
request or not.
⮚ Explain to Isabel why he should not accept the invitation: physicians should maintain
a proper and professional relationship with their patients, based on mutual respect,
and trust.
⮚ Block the patient on social media.
⮚ Notify a colleague so that he/she can be the one to discharge Isabel, and thus not
come into contact with her again.
RECOMMENDED COURSE OF ACTION
⮚ Dr. Nuñez must personally approach Isabel to deliver the discharge report and must
invest time in clarifying, with respect, the limits of the clinical relationship, making
the patient understand why they are necessary. This communication has to be done
carefully, so that the patient, who has come into the ER during a moment of stress
and anxiety, does not feel harmed.
⮚ At no time should the patient be neglected. Dr. Nuñez must insist that, although he
cannot accept the Instagram request, he can offer on a professional level the
possibility for the patient to return to the ER in case of a new episode of anxiety. You
should also give her the option of seeing her family physician or a mental health
specialist if you feel she needs follow-up during the exam preparation period.
⮚ In the event of the patient having a bad reaction or if a conflict arises that prevents
Dr. Nuñez from continuing to be her physician, she should be offered the possibility
of being treated by other professionals if needed.
DISCUSSION
A good doctor-patient relationship is fundamental in healthcare the foundation of which
is trust and mutual respect. Communication with patients and family members/relatives
requires active listening, empathy, and accessibility. However, healthcare professionals
must also maintain a certain distance from their patients. Otherwise, the professional
relationship could be jeopardized, because the patient may no longer see the physician
as a qualified professional to confide in.
The availability of the physician and the closeness the patient might feel, therefore,
should not be confused with “collegiality” nor should it imply a loss of professionalism.
Both the health professional and the patient must maintain their relationship with
integrity. If the lines of friendliness and professionalism are crossed, the distance and
objectivity necessary for a fruitful and therefore therapeutic clinical relationship may be
lost. The physician should not lose this perspective and, in cases such as the one
mentioned above, the physician has the responsibility to explain it to the patient with
due care while trying to preserve a good professional relationship with the patient.
Sgd.: ASISA-Lavinia Bioethics and Health Law Committee
April 2023