A safe ground to take for facebook activity of residents and fellows

Bing H Tang, MD, MPH

Research & Ethics

Danville, California, U S

I read with interest Facebook activity of residents and fellows and its impact on the doctor-patient relationship (J Med Ethics jme.2010.036293Published Online First: 15 December 2010 doi:10.1136/jme).

Basically, facebook is a way of making oneself known to another, and,in so doing, asking the other person to make him/herself known to you.

The "primitive" yet VERY personal Facebook method, one known to me since my boyhood in the Far East, is to offer my Calling card on which basic data about myself are contained, to the person I have just met. As I say my name, out of my pocket comes the little card on which my "face" is revealed: name, address, title, and all degrees I earned, telephone, telegram, and what not. The "primitive" is, as well, the very personal way. It appears to be inconvenient as following: on meeting a stranger, one does not have one's calling card handy and give it to the "stranger".

Facebook, today has expanded globally. It's the mechanized system of exchanging your personality and whatever else you want to add to the world. Once you are on Facebook, millions of people, potentially, can find you. The big question for someone, would be, "How much do you want to reveal.

Facebook, in fact, is YOU-dominated platform, therefore you decide what privacy you want to keep, as well, what you want to reveal.

If one doest not use it as a device to find friends, as well, not for playing games do not etc either, nor can I see any risk of using it.

If one uses the New high technique and also very cautious to keep reminding oneself to refrain from what not to be used, it will be little risk involved.

As to the question of whether or not Facebook is "ethical", I think "ethical" in this connection has little or nothing to do with Facebook.

If doctors only want to discuss a case, all personal information of this particular patient could be codified that nobody over the web can identify the patient's identity, and still achieve the objective of discussing a case. Doctors should know the risk over the web, and try to wear the patient's shoes on going facebook talking about his patient. Not do onto others that you don't like people do onto you, or even one more step further, do onto others that you wish people did onto you, as Christ taught.

References

[1] Wilson S, Johnston J, More trouble with Facebook. Privacy Law Bulletin 2010;7.2:25-8.

[2] Michael Zimmer blog, Facebook's Zuckerberg: "Having two identities for yourself is an example of a lack of integrity" 14 May 2010 http://michaelzimmer.org/2010/05/14/facebooks-zuckerberg-having-two- identities-for-yourself-is-an-example-of-a-lack-of-integrity.

[3] Facebook activity of residents and fellows and its impact on the doctor-patient relationship Ghassan Moubarak, Aur?lie Guiot, Ygal Benhamou, Alexandra Benhamou, Sarah Hariri J Med Ethics jme.2010.036293Published Online First: 15 December 2010 doi:10.1136/jme.2010.036293

Conflict of Interest:

None declared

Moubarak et al conclude that "Residents and fellows frequently use Facebook and display personal information on their profiles. Insufficient privacy protection might have an impact the doctor-patient relationship". I agree strongly; users of Online Social Networking sites clearly need to take care with their postings, and exercise the same sort of social graces, including inhibition, as we do in the real world.

Yet I caution that the medical profession should worry about more than incidental privacy breaches by doctors who might in effect simply 'forget where they are'. There are more serious systemic risks that can automatically identify select patients of doctors and make that information public.

The "find friends" feature of Facebook surreptitiously imports members' web mail address books in their entirety. The feature's overt purpose is to allow Facebook to find individuals that are common to pairs of people, so that those pairs can be suggested as potential friends. The "find friends" process is not clearly explained to users; in particular, Facebook does not mention that the entire address book is uploaded and retained [1].

I want to raise a new and distinct privacy risk for doctors and their patients: if doctors on Facebook happen to have patients in their web mail address books, and they use "find friends", then it is possible for associations between individuals and their doctors to inadvertently become public. For doctors working in mental health, sexual health, family planning, substance abuse and so on, naming their patients could have catastrophic consequences.

"Find friends" operates through an automatic web interface provided by Facebook to participating web mail services, such as Gmail, Hotmail and Yahoo. How likely is it that a patient might appear in their doctor's web mail address book? E-mail increasingly figures in the way many healthcare professionals interact with their patients. More and more patients are pressing their doctors to make use of e-mail and other online media, since they are routine now in so many walks of life.

Usually, doctors will have a specific workplace e-mail account, but some don't have the option. Many allied health professionals, counsellors, specialists and the like run their sole practices as small businesses. They don't have a major investment in IT, nor a deep understanding of the technology. Many such medicos do use web mail with patients. Further, web mail is being re-branded in the market as a "cloud" service, offered to businesses as a cost-effective alternative to managing their own e-mail domains (I note that the e-mail address for correspondence with the authors of the paper in question is a Gmail address). So the line may blur between private and workplace e-mail usage. Chillingly, Facebook CEO Mark Zuckerberg has shown a degree of contempt for people who feel the need to operate separate digital identities [2].

One way or another, including simply by accident, patient contact details will inevitably appear in some doctors' web mail address books. As a result, if a doctor signs up to Facebook and innocently allows "find friends" then Facebook will import e-mail addresses, some of which may be for patients. Note carefully that these individuals never have the chance to consent to being imported; they don't even know it's happening. Subsequently, others on Facebook will come automatically to learn that individuals are associated with doctors, indicating they may be patients of those doctors.

In conclusion, healthcare professionals using web mail should be warned against the risks to patient privacy should they join Facebook and use "find friends". Wherever possible, providers should use separate professional and personal e-mail accounts, but because this may not always be possible, and because accidental crossover may occur, the warning about "find friends" remains important.

[1] Wilson S, Johnston J, More trouble with Facebook. Privacy Law Bulletin 2010;7.2:25-8.

[2] Michael Zimmer blog, Facebook's Zuckerberg: "Having two identities for yourself is an example of a lack of integrity" 14 May 2010 http://michaelzimmer.org/2010/05/14/facebooks-zuckerberg-having-two- identities-for-yourself-is-an-example-of-a-lack-of-integrity (accessed 18 Dec 2010).

Conflict of Interest:

None declared