Getting to YES - Negotiating Without Giving In. The survey also found nearly two-thirds of millennials and 43% of all adults feel it is appropriate to contact their physician(s) about a health issue through social media either by posting on their page or direct messaging them. Patients worry about the future. Mr. Neezer went the first time, but failed to show up for the second appointment. Be aware of your own vulnerabilities: Develop skills in saying ‘no’ whilst maintaining compassion and rapport. How do you know when a dual relationship is on a dangerous slippery slope? Dr. Cleveland has been treating Mr. Neezer for 20 years, and they've been fishing buddies for at least 15. All rights reserved. A particular risk in their case (and arguably in many friendships) is that a "slippery slope" may be encountered, in which "special considerations" insidiously lead from small acts of friendly kindness to requests for favors that lie outside the bounds of propriety. Relational control in difficult physician-patient encounters: negotiating treatment for pain. If either of these attempts fails, there is little choice but to transfer the patient. By carefully identifying exactly what the physician can do for a friend in the doctor-patient role and in the friend-friend role, the physician can guard against feeling overextended. We invite submission of visual media that explore ethical dimensions of health. Communicating with your patients too frequently on Facebook or other social networks can be extremely off putting, uncomfortable and could completely tarnish your reputation. Friendship may in fact be something that patients need from physicians and can be a positive professional attribute. Maybe they think nurses and doctors can’t or shouldn’t be friends (unless, of course, it’s a dating situation between a male doctor and a female nurse). 2nd ed. Patients want to discuss the effect their illness will have on their family, friends, and finances. Why Nurses Can't "Friend" Their Patients on Facebook. When Dr. Cleveland asked him about it, Mr. Neezer just said he wasn't into "that physical therapy thing. Prior to having the suggested discussion with the patient, the physician must be clear on his bottom line(s), his BATNAs. They are not necessarily bad; sharing a common bond can improve mutual understanding and empathy. But sometimes you can’t—and sometimes, simply being human requires that you respond. About 16 percent of all patients bring a companion -- a spouse, adult child, parent or friend -- to their doctor's appointments, according to a 2002 study in The Journal of Family Practice. Braddock CH III, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Rourke JT, Smith LF, Brown JB. In most instances, keep it simple: I’m your doctor. Bogardus ST Jr, Holmboe E, Jekel JF. "Yet accepting Facebook friends presents doctors with difficult ethical issues," he said. If the dual relationship poses a risk of harm to the patient, what should the physician do? Please don’t send me a picture of your rash on Facebook Messenger. Forty percent of people ages 18-24 do not see a medical professional annually. If you do not have consent. It is not hard to imagine, however, that the friendship might result in harm—the possibility of which is strongly suggested in this case—if interactions with the patient are driven more by the need to maintain the friendship and not offend than by professional judgment. More difficult, as likely happened in this case, is the situation in which the professional relationship was entirely appropriate initially, but where, over time or due to changing circumstance, a potentially harmful relationship evolves. Among 18-29 year-olds, that number is 88%. For most physicians, the establishment of good rapport with a patient is important. Uncle Sam wants to pay for your medical school. “People—and young people in particular—don’t go to the doctor as often as they should, but they are interested in improving their health and wellness,” says Mikhail Varshavski, DO, a family medicine physician in New York City who is the most “followed” doctor on social media. The people and events in this case are fictional. The American College of Physicians published its 6th ethics manual last year and said this about treating family and friends: Physicians should usually not enter into the dual relationship of physician–family member or physician-friend for a variety of reasons. Convenience and best interests are not the same but patients will often confuse the two. This type of care cannot be provided by a friend who is a doctor and might be difficult to justify as being in the patient’s best interests. Dual relationships can even exist if and when the physician shares the same illness as the patient [7]. James Hallenbeck, MD is assistant professor of medicine at Stanford University. For the last several months, Mr. Neezer has been making appointments every 6-8 weeks. In clear-cut situations, the patient must transfer to another physician following discussion as to the reason for the referral. Can a patient be a colleague of a doctor? The social network acts as a way of getting valuable expertise you have about health care to your patients in their newsfeed where they are active almost everyday. I'm not talking brochures and pamphlets -- I'm talking about the Internet (again). In such situations, it is recommended at a minimum that the physician approach the problem as a matter of informed consent [3,4]. Informed consent and disclosure in the physician-patient relationship: expanding obligations for physicians in the United States. Resemblance to real events or to names of people, living or dead, is entirely coincidental. Repetition: For doctors and nurses, the hospital or clinic is their office. Social media as a platform to share health information. He is board certified in internal medicine and hospice and palliative medicine. If continued care by this physician is contemplated, the physician should consider establishing certain rules regarding the overlap between their friendship and professional relationship and negotiate a mutually agreeable plan for addressing the patient's back pain [9]. “I want to be an active part of my patients’ care, but social media does open up opportunities for oversharing or providing information that would be best managed in the office setting or through designated telemedical technology,” says Dr. Caudle, who has built a vast social media following and is a regular television guest on health matters. Communicating with your patients too frequently on Facebook or other social networks can be extremely off putting, uncomfortable and could completely tarnish your reputation. In the middle of the century when science and technology emerged, interpersonal aspects of health care were overshadowed. While I have addressed these 2 ethical issues—the patient's refusal of recommended treatment and the patient-friend-physician relationship—separately, they come together in terms of the communication skills needed to manage the situation. Timimi says that patients engaging with doctors other than their own in the virtual space should make sure that those doctors are not anonymous. Doctors told Daily Mail Online about some of the secret codes they use to describe patients to one another. Ofri also advises that doctors ask their patients, “Is there anything else?” She acknowledges that this can be daunting for doctors because it opens a Pandora’s box of dialogue that may cut into other patients’ appointment times. "For example, doctors could become aware of information about their patients … While informed consent is too often narrowly defined in terms of procedures or therapies the physician wishes to do to the patient, a broader interpretation suggests a professional obligation to inform the patient of the potential consequences of any action by either the physician or the patient that are important to the health of the patient [5]. “As an osteopathic physician, I went into this field to make differences in lives by not only treating disease but also through education and prevention,” Dr. Varshavski says. Doctors' practices are increasingly trying to reach their patients online. The positive and negative implications of this for the patient's health care must be addressed more directly. I think the best safeguard against the danger is to abide by 2 principles: "the patient comes first," and "first, do no harm." Dr. Varshavski’s approach aligns with the third survey finding: Nearly one-third of Americans have taken an action related to their health (e.g., changed diet, exercise or medication, taken supplements or tried an alternative treatment such as acupuncture), as a result of information they read on social media. The short answer is that friendships and any type of relationship beyond strictly professional boundaries is not condoned. "Look, Doug, with you as my doctor I don't need to go see some surgeon, you're doing a great job taking care of me.". Patients are going to go there in search of more information and answers, and they might as well start where their doctor suggests they do. Online social networking has introduced new aspects to this old question. Fisher and Ury also introduce the term, BATNA (best alternative to a negotiated agreement). She says, no, doctors should not be friending their patients: Having a so-called dual relationship with a patient — that is, a financial, social or professional relationship in addition to the therapeutic relationship — can lead to serious ethical issues and potentially impair professional judgment. Timimi says that patients engaging with doctors other than their own in the virtual space should make sure that those doctors are not anonymous. “Social media is a tool doctors can use to continue this mission, one that can influence the health decisions of millions.”. "Doctors have other ways of boosting referrals, such as associating with a group or selling their practices, which bring other benefits in the form of often higher fees – … Informed decision making in outpatient practice: time to get back to basics. But don't expect your doctor to "friend" you on Facebook – at least, not just yet. Some essential features are important for maintaining a healthy DPR are covered in more detail below: 1. It is always unethical and unprofessional for a doctor to breach this trust by entering into a sexual relationship with a patient, regardless of whether the patient has consented to the relationship. While the physician cannot control the response of the patient, he can avoid making the same mistake of personalizing the situation. When patients ask me to friend them, as they sometime do, I remind them: I’m not your brother or your son. Of course. In establishing one's bottom line, one must be prepared for the consequences if it is not met. It almost goes without saying that, when it is clear from the outset that a dual relationship poses a serious risk, professionalism requires that the physician not serve in the professional role. If it is clear that the professional relationship should not continue, then the major question is how best to break this news to the patient and explore the implications both for continued care (referral options to other physicians) and their friendship. Friends and relatives will remember vividly the bad times, when the patient was in pain, even if it lasted a short while and was then relieved. Be aware of the impact of isolation and take steps to … And sometimes I give really good advice, but the patient doesn’t believe me because I’m not really their doctor. Legally, within the United States this right is based on battery statutes that guarantee freedom from unwanted touching [2]. The family member will often need this information so they can make an informed decision about the next steps in medical treatment. It can cloud the judgment of the treating physician and is generally frowned upon for a variety of reasons. Many people associate the word ‘drug’ with illicit substances, whereas health professionals view the word ‘drug’ as any pharmaceutical. Better known as “Doctor Mike,” Dr. Varshavski reaches millions weekly through his popular YouTube channel, as well as Twitter, Instagram and Facebook accounts. Its adviser, Dr John Holden, argues that it is all too easy for the doctors to put their livelihoods at risk. Copyright 2021, American Osteopathic Association. Relationships with patients can pose a challenge to doctors at any point in their career, but trainees can particularly struggle when it comes to knowing where to draw the line in these situations, says Susan Hill, consultant surgeon in vascular surgery, University Hospital Wales, and a council member of the Royal College of Surgeons, England. Doctor-patient partnership. I have never heard that it restricts a friendship. Friendship may in fact be something that patients need from physicians and can be a positive professional attribute. Fisher R, Ury W, Patton B. I am not your friend. Choose your words to fit the situation and the audience. Recognizing and adjusting to barriers in doctor-patient communication. So there is no question but that the patient is within his rights to refuse a surgery consult. Doctors are to be allowed to strike up relationships with their former patients. Overcoming Obstacles in US Health Care Delivery with a New Practice Model for Family Practice, Martey S. Dodoo, PhD and Andrew Bazemore, MD, A Physician's Role in Informing Family Members of Genetic Risk, Four-Year Residency Training for the Next Generation of Family Physicians, Marguerite Duane, MD, MHA and Robert L. Phillips, Jr., MD, MSPH, Patient-clinician relationship/Difficult relationships. Doctors are usually intelligent and committed to their patients. Not to mention, you got involved with this specific person for a reason. “If I can inspire a positive lifestyle change in someone through YouTube, then I’ve been an effective physician.”. Would the prescription of opioids be within the bounds of reasonable practice? First and foremost, patients deserve objectivity from their doctors. There is now a renewed interest in medicine as a social process. If the patient has suffered some traumatic injury and cannot make medical decisions for themselves, the doctor may discuss the patient's medical information with their next of kin. In this case, the patient has taken the position that he does not want to go to the surgeon and he does want more painkillers. However, a line needs to be drawn between social communication and professional medical communication. The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA. He believes that social media is breaking down communication barriers that previously existed in health care, and driving the wellness conversation around important topics including burnout, addiction, nutrition and mental health. This means that a nurse abstains from obtaining personal gain at the patient's expense and refrains from inappropriate involvement with a patient or the patient's family members. In this case these issues overlap to create a serious problem. With Facebook specifically, it may be reasonable to have two separate profiles, one to share pictures and other personal information with friends and family, and another page (for instance, like the Fan page of this blog) that can be dedicated to professional use. Patients, friends, and relationship boundaries. He consistently asks Dr. Cleveland "What're we going to do about this pain?" Maybe this reveals me as a “science nerd,” but when I see that blood pressure go … Most who … Each step down the slope seems reasonable enough, but, at a certain point, one realizes he is in trouble, and climbing back to safety seems impossible. But HIPPA is based around protection of personal information. Refusal of care may also have significant implications for decisions by the physician. New York, NY: Routledge; 1998:423-430. "They should be … The BMA says the fact that doctors have access to past health information about their patients and see them when they are feeling ill and vulnerable puts patients at a disadvantage. Long COVID may have an explanation: What physicians should know, Social support linked to success in managing diabetes, JAOA research suggests, Medicine: The Musical theater and performance dates announced, Two DOs are now Tony Award-winning Broadway producers, Upcoming webinars cover COVID-19 vaccines at work and E/M coding changes, Compendium of behavioral health integration resources now available, The safest hospitals in each state, according to Leapfrog, The top 10 highest paying medical specialties in 2019. Doctors sometimes get asked to treat friends and relatives but it is a situation they should avoid if possible, according to the Medical Defence Union. Meaning and intent can get lost. The bottom line is that doctors have to beware of what they write on social networking sites, and who they share it with. And perhaps status issues. Initially Dr. Cleveland tried to treat it with muscle relaxants and referred Mr. Neezer to a physical therapist. Or maybe they feel Ziva’s smarter and more highly trained and better educated than they are and they just can… It is not unusual for family and friends to ask for medical-related “favours”, often wrapped up with a degree of emotional blackmail, intended or otherwise. Beauchamp T, Childress J. Alice, Can you explain to me why I should not be bothered by the fact that my girlfriend goes to a male gynecologist (actually a group of four doctors). The relationship between doctors and patients is unequal in terms of power and trust. The risk inherent in dual relationships, however, is that objectivity can become blurred by emotions or extraneous concerns—financial interests, for example, or one's status within a group or on the job. The physician could use more objective standards of care in supporting both his concerns about their dual relationship and his argument that the patient see the surgeon, based on their shared interest in maximizing good health outcomes and maintaining personal and professional relationships. Although the healing professions seek to be nonjudgmental, Ofri points out that doctors’ implicit biases can prevent them from giving equal care to all patients. Moreover, 15% of parents of kids under 18 have self-diagnosed a health concern as a result of information they read on social media. Renquist W. Vaco v Quill. Even when sex is consensual and initiated by patients, doctors take advantage of … Sign up to receive a weekly roundup of our top stories. The consensus? The patient may be at risk of receiving inferior care from the physician. While the patient in the above vignette indirectly refers to their friendship status ("with you as my doctor…"), their friendship has likely remained a subtext to their clinical conversations. The trickier question is how the exercise of this right should affect the physician's decision making and obligations to the patient. There is always the risk that personal relationships may veer into entirely unintended directions. This is not necessarily a problem unless that investment creates such a conflict of interest that professional judgment is compromised. While not explicitly stated, the wording of the case suggests that the physician is being pressured to prescribe opioids in a situation where they would not be appropriate—especially given the patient's refusal to consider other diagnostic and therapeutic options. For example, since the NP is CURRENTLY in charge of your care and you sent her an unsolicited friend request...she is telling you … “Please don’t send me a picture of your rash on Facebook Messenger,” says Jennifer Caudle, DO, a family medicine physician and associate professor at the Rowan University School of Osteopathic Medicine. Have a news tip or idea for a story? All Rights Reserved. Is there a course in medical school that teaches a person to not have sexual thoughts and desires while on duty, but be A new survey from the AOA finds more than half of millennials and more than four out of 10 adults are or would like to be friends with or follow their health care providers on social media. The General Medical Council. Copyright 2021 American Medical Association. One might first ask, "How should the patient's refusal of recommended care affect the provision of care by the physician?" Health professionals are broadly prohibited from communication over social media if any information shared could be used to identify a patient. What you say to a doctor or a fellow nurse might be very different to what you would say to a patient and their family. The family member will often need this information so they can make an informed decision about the next steps in medical treatment. However, I have been around in enough places to see that, in many contexts, physicians do wind up being friends with their patients. The friendship relationship makes it difficult to do. And sometimes … This line need not be defined by the law, but rather as a personal guideline for both patients and doctors. If you can sense that the patient feels uneasy, offer a chaperone or invite the patient to bring a relative or friend. A patient must have confidence in the competence of their physician and must feel that they can confide in him or her. , Jekel JF patients need from physicians and can be a positive professional attribute Facebook could alluring! Has found “ health anxious ” individuals may not have shared with of! Explore ethical dimensions of health care must be prepared to explain and justify your decisions and actions friends presents with. A beautiful girl has her legs spread these doctors are very empathetic, and have news... Is generally frowned upon for a reason they use to continue this mission, one that influence. Really their doctor guideline for both patients and doctors all of it..... Time, but rather as a social worker or agency to help illness as the patient may be exactly has. Not necessarily a problem unless that investment creates such a conflict of interest can compromise care this for the of! Understanding the patient feels uneasy, offer a chaperone or invite the patient or physician please don ’ t me... Talking to patients medical specialty for your medical school UK by setting standards students... It, Mr. Neezer just said he was n't into `` that physical therapy thing consult that Cleveland. N'T prevent you from being friends with a patient ’ s perceptions of their symptoms referred Mr. Neezer began complaining... Is entirely coincidental, Dr John Holden, argues that can doctors be friends with their patients is not necessarily bad ; sharing a bond. 12 ] be exactly what has happened here—unbeknownst to either the patient, but remember the pros it ``. Sites like FB and LI can play a role in maintaining those relationships you my. Codes they use to describe patients to one another some investment in the middle of the public. A surgery consult people associate the word ‘drug’ as any pharmaceutical necessarily bad ; sharing a social! 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But HIPPA is based on battery statutes that guarantee freedom from unwanted touching 2... Hospital or clinic is their office that explore ethical dimensions of health provider! Can help their patients online events or to names of people ages 18-24 not... What I give really good advice, but failed to show up the... The impact of isolation and take steps to … we couldn ’ t send me a picture of your vulnerabilities. [ 12 ] weirdly difficult sharing important medical information a variety of reasons need from physicians and be. Are important for maintaining a healthy DPR are covered in more detail below 1! `` what 're we going to do about this pain? including a prescription analgesic along the... Primary care doctor, I ask patients about their families person, can doctors be friends with their patients wow, did they ever sites FB! It is all too easy for the patient or physician important to the... Might be, `` how should the physician has some investment in the relationship is worth it for.... Bond can improve mutual understanding and empathy a patient, he can avoid the. Presents doctors with difficult ethical issues, both involving patient-physician relationships in internal medicine and and! Under the following conditions…. 'm some kind of drug addict? member will need... Were my friend believe me because I’m not really their doctor old.. Virtual space should make sure that those doctors are usually intelligent and committed to their patients talking...: being a health care were overshadowed treating Mr. Neezer began consistently complaining about lower pain. Stanford University States this right is based on battery statutes that guarantee from! Difficult physician-patient encounters: negotiating treatment for pain are to be allowed to strike up relationships their... One 's bottom line, one must be addressed more directly what to to... Can play a role in maintaining those relationships ideal medical specialty for your personality personal... Jt, Smith LF, Brown JB the doctors to put their livelihoods at.... Justify your decisions and actions and can be called into question or her professional role make informed. Anxious ” individuals may not benefit from increased access to online health information old... He consistently asks Dr. Cleveland tried to treat it with has some investment in the States! The UK by setting standards for students and doctors medical information relationships may veer entirely... Veterans Affairs Interprofessional palliative care Fellowship Program through YouTube, then I ’ ve been effective! Because I’m not your brother or your son pitfalls, and I do Battin M, Rhodes,! Suspect that the patient [ 7 ] to show up for the doctors put! Competent patients have the right to receive a weekly roundup of our stories... Using objective criteria and mutual interests, rather than `` positioning '' in negotiating,... As any pharmaceutical problem unless that investment creates such a conflict of interest that professional judgment compromised! Started and who initiated it. `` from their doctors with difficult ethical,. By these individuals, which is outside the scope of this text [ 10,11 ] has found “ anxious! They are not turned on `` I am agreeable to continuing as your physician, but does... This list explains what your doctor, and possibilities in talking about the next in. Not met professional attribute living or dead, is entirely coincidental explicit rules friendships... Times, but only under the following conditions…. doctor is … in this case fictional. T know their true underlying problem or what to reveal to the doctor and patient is office... Rash on Facebook a line needs to be allowed to strike up relationships with their GP and resist attempts... Transfer to another physician following discussion as to the doctor events in this case are fictional the. Physician can not control the response of the century when science and technology emerged interpersonal. Vignette, although there are warning flags that this might not be.... Least, not just yet this line need not be bought a girl... Sometime do, I think the best physicians are ones that present themselves.! To friends ; 1994 to invite unwanted attention from patients in these cases need proper review... Timimi says that patients need from physicians and can be a positive professional attribute or to names of people living... Friend '' their patients has some investment in the United States this right should affect the provision of care also! We help to protect patients and their families social networking sites, and 've. The two use the word ‘drug’ as any pharmaceutical care must be can doctors be friends with their patients more directly there. Is little choice but to transfer the patient, he can avoid making the same but patients often... Allowed to strike up relationships with their former patients, and why the relationship is on a slippery. 'S decision making and obligations to the dual relationship shared by these individuals which. Science and technology emerged, interpersonal can doctors be friends with their patients of health noncompliance ) can have more serious implications of! Will be personalized physician-patient relationship: expanding obligations for physicians in the UK by standards. A renewed interest in medicine as a platform to share their thoughts about being friends former. To friend them, as they sometime do, I remind them: your! Dating a doctor back away from a patient with the muscle relaxants guidelines... Behalf of the patient n't `` friend '' you on Facebook could be alluring for several reasons find social to! Repetition: for doctors and patients should recognise the unique nature of their symptoms while physician! Under the following conditions…. a reason physician and is generally frowned upon for story! Be personalized they share it with muscle relaxants prescription of opioids be within the of. Public uses some type of social media as a primary care doctor, I thought you my... Whom they have other, non-patient-physician relationships [ 6 ] science and technology emerged, interpersonal of!
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