Doctors’ practices are increasingly trying to reach their patients online. But don’t expect your doctor to “friend” you on Facebook – at least, not just yet.

Physicians generally draw a line: Public professional pages – focused on medicine, similar to those other businesses offer – are catching on. Some might email with patients. But doctors aren’t ready to share vacation photos and other more intimate details with patients, or even to advise them on medication or treatment options via private chats. They’re hesitant to blur the lines between personal lives and professional work and nervous about the privacy issues that could arise in discussing specific medical concerns on most Internet platforms.

Some of that may eventually change. One group, the American College of Obstetricians and Gynecologists, broke new ground this year in its latest social media guidelines. It declined to advise members against becoming Facebook friends, instead leaving it to physicians to decide.

“If the physician or health care provider trusts the relationships enough … we didn’t feel like it was appropriate to really try to outlaw that,” said Nathaniel DeNicola, an OB-GYN and clinical associate at the University of Pennsylvania, who helped write the ACOG guidelines.

But even the use of these professional pages raises questions: How secure are these forums for talking about often sensitive health information? When does using one complicate the doctor-patient relationship? Where should boundaries be drawn?

For patients, connecting with a physician’s office or group practice on Facebook can be a simple way to keep up with basic health news. It’s not unlike following a favorite sports team, your child’s middle school or the local grocery store.

One Texas-based obstetrics and gynecology practice, for instance, uses a public Facebook page to share tips about pregnancy and childcare, with posts ranging from suggestions on how to stay cool in the summer to new research on effective exercise for post-birth weight gain. Practices have also been known to share healthy recipes, medical research news, and scheduling details for the flu shot season.

“I have people come up to me and say, ‘I follow you on Facebook — thank you for posting this particular article. It helped me and my husband and my family,’ ” said Lisa Shaver, a primary care physician based in Portland, Ore.

But unless they’re already friends, she won’t add patients to her personal account, where, she said, she posts less health information and more cat videos.

Historically, professional groups including the American College of Physicians and American Academy of Family Physicians have advised against communicating through personal Facebook pages. The American Medical Association notes social media can be a valuable way to spread health information, but urged doctors in its 2010 guidelines to separate their personal and professional online identities to “maintain professional boundaries.”

Finding ways to use Facebook and other forms of social media to connect with patients — even if it may just be through professional pages — fits a trend in which patients seek more equal footing with their doctors, said Zack Berger, an assistant professor of medicine at the Johns Hopkins School of Medicine who studies patient-doctor relationships and social media.

It also follows what James Colbert, a hospitalist at Massachusetts-based Newton Wellesley Hospital, described as the growing consumer approach to medicine, including the notion that patients should be able to reach their physicians at all hours. Colbert is also an instructor at Harvard Medical School who researches how patients want to fit social technology into their health care.

Email can be a particularly convenient method, though it isn’t without concerns. Eva Schweber, 44, emails her doctor from a personal account and sends messages through an online portal — a more digitally secure system that is being adopted by a growing number of practices. The portal, she said, is for discussing complex, specific information. She’ll email her doctor from her personal email for less private concerns: scheduling, filling prescriptions and asking if certain symptoms might warrant a checkup.

“The unsecure email is easier, in that I can do it from my phone, my tablet, whatever,” said Schweber, of Portland, Ore.

In a recent study published in the Journal of General Internal Medicine, almost 20 percent of patient respondents reported trying to contact doctors through Facebook, and almost 40 percent through email. “Patients want to communicate with doctors [in whatever way] is convenient,” said Joy Lee, a postdoctoral research fellow at the Johns Hopkins Bloomberg School of Public Health, and the study’s lead author.

Doctors don’t yet seem to share that enthusiasm, Colbert said.

Meanwhile, security questions persist.

Social networking platforms aren’t usually digitally encrypted, increasing the odds they could get hacked or shared with third parties. The same worries hold true for other, casual forms of online communication such as email and text-messaging.

That means doctors who discuss specific health concerns with patients through those could break the Health Insurance Portability and Accountability Act, the patient privacy law.

“Those concerns are always going to be there,” said David Fleming, past president of the American College of Physicians. “How private is it when we share, when we talk to people? … Once I’ve written it or once I’ve emailed it, it’s gone, and I have no control.”

But because HIPAA was written before email and social media’s ascent, it may not address patient preferences or behavior, Colbert said. With more patients becoming comfortable using personal accounts for health needs, he said, the law perhaps deserves another look.

“Should we allow patients to be able to share or send messages without going through these privacy safeguards if they’re willing to do so? Or do we say that that’s not safe and even if patients don’t care about privacy we need to protect them,” he said. “That’s an open question.”

That public nature is a real worry for patients like Katie Cardenas, 45, who lives in Garner, N.C. She doesn’t think Facebook is secure enough for personal medical details. For sensitive information, she’ll usually send messages through a patient portal, the more secure website her doctor’s practice has set up.

Doctors could address that, several said, by using social media in other ways. These include maintaining active Twitter presences and professional Facebook pages for less-tailored health tips. That way, patients can get useful information and a sense of their doctors as people, but privacy stays intact and physicians maintain distance.

At the Minnesota-based St. Cloud Medical Group, patients can follow a public page. Doctors who are part of the practice post updates with safety tips and seasonal health reminders, or use the page to coordinate and publicize small projects, such as a week-long initiative geared to reducing children’s screen time.

Julie Anderson, a family physician who is also part of the practice, sees the value in this option, but doesn’t personally befriend patients on Facebook. Beyond patient privacy, she said, she fears blurring her personal and professional lives, or patients using that access to seek extra care when she’s off the clock.

“I’ve known colleagues that have friended somebody and have had inappropriate questions asked online, in terms of kind of abusing service,” she said. “Or abusing that … Facebook friendship, where they’re asking medical advice and you’re not even their physician.”

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.

Download

Attorney Ermence Parent stands on the porch of her New Orleans home. Two hip replacements eased Parent’s pain and got her exercising again, she says. A doctor at one of the city’s newly renovated clinics made the diagnosis. Edmund D. Fountain for NPR hide caption

itoggle caption Edmund D. Fountain for NPR

Five years ago, New Orleans attorney Ermence Parent was struggling to find out what was wrong with her leg. She was 58 years old, and her right leg hurt so much that she needed a cane. That was not only painful, but frustrating for a woman who routinely exercised and enjoyed it. Parent sought advice from several doctors and a chiropractor, but got no diagnosis.

Then she made an appointment at the newly renovated St. Thomas Community Health Center, a primary care clinic dedicated to providing quality care for people regardless of insurance status. Most patients, including Parent, are on Medicaid or Medicare. Some pay on a sliding scale. Parent saw internist Dr. Mary Abell, who is now medical director of the clinic.

Abell took a careful medical history, looked at Parent’s X-rays and watched as she walked up and down the hallway

“‘Baby, your hips are going,’ ” the doctor told Parent. The attorney had “bone-on-bone” arthritis. Without surgery, the doctor said, “‘in about six months you’re going to be in a wheelchair.’ “

Instead, about a month later, Parent received her first hip replacement, and nine months later, her second.

Today, she’s back to exercising, has lost weight and sleeps more soundly. “You know, changing those two hips just rejuvenated me; it gave me years back on my life,” Parent says.

The shuttered main entrance of New Orleans’ Charity Hospital (left), after storm and flood damage (right) from Hurricane Katrina closed it down in 2005. Robyn Beck/AFP/Getty Images; Don Ryan/AP hide caption

itoggle caption Robyn Beck/AFP/Getty Images; Don Ryan/AP

When Katrina hit in 2005, many health facilities were destroyed or otherwise shut down, including urgent care centers, nursing homes, pharmacies and hospitals. The renowned and beloved Charity Hospital, a public facility that had served the city’s poor for centuries, was forced to close.

Many said the loss of the hospital was devastating. Charity represented a precious connection to health from childhood through old age.

But the attachment people felt to the old institution may have been based more in sentiment than fact, says Abell, especially when it came to primary care. She says patients had to rely on a trip to the emergency room if they didn’t have health insurance and had ongoing chronic problems.

“Before Katrina, there was no primary care or preventive medicine — really, truthfully — for patients,” Abell says. “None. Zero.”

Back then, a patient with a medical problem that wasn’t acute often had to wait months to schedule an appointment, she says. And once they showed up for the appointment, they might have to wait all day — or even end up with the wrong clinic or with the wrong physician. Abell says the situation was “very disrespectful” to patients.

Today is a “different day,” Abell says. In recent years, a network of renovated and newly built primary care health clinics has opened, which she and New Orleans residents hope will bring a new degree of stability to the health care that the city’s low-income residents get.

Katrina was devastating, Abell says, but after its ruin, New Orleans received a dramatic infusion of cash from the state and federal governments, and from private foundations. The funds resulted in new hospitals, new clinics and an enormous state-of-the-art facility that replaced the old Charity Hospital.

University Medical Center New Orleans on Aug. 1, when the $1 billion facility welcomed its first patients. Brett Duke/The Times-Picayune/Landov hide caption

itoggle caption Brett Duke/The Times-Picayune/Landov

University Medical Center New Orleans, which opened this month, is just a few blocks from the shuttered hospital. The new facility’s gleaming buildings, hundreds of patient beds and high-tech specialty care, stand in startling contrast to the old institution.

Abell has high hopes the new medical center will provide timely, excellent care for both acute and chronic needs. And her biggest praise is for the new network of primary care clinics.

“Today, a patient can call and get same-day primary care,” Abell says, an improvement that Ermence Parent attests to, as well. A few months ago, when Parent’s leg became swollen, she called the clinic and was seen right away.

In a recent poll of New Orleans residents by NPR and the Kaiser Family Foundation, 72 percent of adults agreed that progress has been made in the availability of medical facilities and services in the city. But the majority of residents — 64 percent — also said more needs to be done to provide care for people who are uninsured and have low incomes.

And among African-Americans, nearly half said they’re very worried that health care services may not be available when they need them. Only 13 percent of white adults said they are very worried in that way.

According to Abell, one of the biggest remaining weaknesses in the current system in New Orleans is timely access to specialty care like orthopedics, neurology and cardiology.

It’s a problem, she says, “when you can’t get your patient in to be seen for an issue that’s evolving, and you know that some specialty advice would be helpful.” She says she’s had to rely on personal connections ­— and 30-plus years of experience working in the city — to help her poorer patients gain timely access to specialty care. She’s anticipating that the new University Medical Center will help remedy that.

That hope extends to mental health care, as well. Rashain Carriere-Williams, who directs program operations at Boys Town Louisiana, a community organization that helps troubled families and children, says the need for mental health treatment in the city is huge.

After Katrina, psychiatrists fled New Orleans, along with many other people. Unfortunately, Carriere-Williams says, most psychiatrists never came back. In the entire city, there are now only two or three psychiatrists who accept Medicaid and are willing to see her patients and their families, Carriere-Williams says.

“A lot of times it’s easier to get them in to see a psychologist, because there are more of those,” she says. But psychologists can’t prescribe the medication some patients need.

Although the new hospital has some beds dedicated to patients in need of mental health treatment, the number of beds isn’t nearly high enough, she says.

She’s been faced with heartbreaking situations — including one New Orleans boy who recently threatened suicide and had to be placed on suicide watch. The only facility with an inpatient bed was a six-hour drive from the city. The family drove their child there for a 72-hour hold, and the child temporarily got the needed care, says Carriere-Williams. But the experience was grueling, at a time when the family was extremely fragile.

Carriere-Williams says she’s hopeful the new clinics and hospitals will begin to fill the big gaps in the community’s mental health needs. But, based on Louisiana’s and New Orleans’ history in that regard, she says, she’s skeptical.

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.