The past was a time when patients and I would exchange a warm but formal handshake, when we all were intent on maintaining the doctor–patient relationship, and we kept an elusive distance in our relationships. However in the age of e-mail, text messaging, Facebook, blogs, and Twitter, how have our interactions with our patients changed? Is it essential to maintain those barriers from the past, that strict professionalism, or is it OK to have patients become “friends” on Facebook and have my patients follow me on Twitter?
In reality, many of our patients do become our friends. Patients have shared with me the most troubling and intimate details of their lives. I do think about them and worry about some of them even when I am home with my family. As physicians, we share in their joys, their promotions and births and weddings, and mourn together deaths of parents and spouses, lost jobs, and sick children. Often the favor is returned. My patients know when I am having a bad day, struggling with lack of sleep, too much work, or a sick child, and they commiserate and cheer me along on my path.
Is it essential to maintain those barriers from the past, that strict professionalism, or is it OK to have patients become “friends” on Facebook and have my patients follow me on Twitter?
In 2005 I moved from the relative safety and comfort of my practice in the suburbs of Boston to Dubai in the United Arab Emirates. Among the many challenges awaiting me was the absence of a proper answering service and patients having difficulty getting hold of me to ask questions or leave messages. Initially they had my cell phone number and could text message me. It then seemed like a natural extension of our close communication with patients and families that they were given my e-mail address and asked to e-mail questions, rather than call. This step then sees me answering patients’ questions from the middle of a seventh-century medina in Marrakech or a museum in Cairo during family vacations, much to the consternation of family and friends, and mostly thanks to the extensive BlackBerry network. Then patients wanted to “BBM.” In the “old days,” BM only meant bowel movement to me. Now BBM stands for BlackBerry Messenger, an instant, urgent means of communication that is not required for most routine patient queries.
Then came Facebook. It seemed initially like a good idea to keep in touch with my scattered family and many friends across the world. Slowly, I added patients to my network, and they started becoming familiar with the escapades of my children or where my next vacation was. What was I to do then when the chat box would open up at midnight and out would pop a lengthy consultation about some newly appeared symptom? Also, there is the constant concern about the security of e-mail and confidentiality issues on Facebook, and all of these have to be discussed with patients. What they may gain in easier access to the doctor may come with a price if confidentiality is breached. In an age of information overload where patients can get their information from online forums and blogs, I feel it is still best that they can access their doctor to get their information filtered and verified.
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Setting Limits
What follows each new means of communication is a process of patient education on appropriate uses of this form of technology. I would give patients my mobile number with instructions “not to call me”—or, more precisely, to call only in an emergency. For nonemergent questions, they were to text me or e-mail. Facebook friendships are fine, but I do not do Facebook consults, just like I do not like to answer medical questions at a birthday party or grocery store. There will always be the extremely distressed person and, if a few words from me can set something in their life right—whether it is by e-mail, Facebook chat, or text message—I will make these exceptions. Although the new forms are communication are valuable, I really do not want to answer questions like this from a teenage patient of mine: “doc wat de med name? Plz tell m hom shd I go to? I jus heard dat de symptom…” Please, I have to tell my patients, I can answer questions only in a proper form of the language—and yes, I have drawn the line at Twittering!
What is next? I see a virtual “avatar” of myself taking online queries while I am on vacation on the planet Pandora! My computer-age almost-teenage sons, in the meantime, dream of growing limbs for people in petri dishes, replacing doctors with robots, and eliminating completely the process of speech as a form of communication.
Dr. Badsha is a rheumatologist trained at the University of California, Los Angeles and was a rheumatologist in Dedham, Mass., prior to moving to Dubai in 2005. She runs a rheumatology service as part of a musculoskeletal clinic and also blogs at Arthritis Dubai (http://humeirabadsha.blogspot.com).
