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Posted on 11.13.2012

Dual Relationships and Social Media: The personal and professional risks of being “friends”

I have to admit, I'm fairly fond of Facebook. I'm your average mid-40s, working Mom who's really enjoyed rekindling friendships with friends from childhood and college.

I've also enjoyed staying in touch - on a personal level - with colleagues and even clients from other parts of the country. We post photos of our families, share the occasional recipe or one-liner, and celebrate those rare nights when we get out on the town with girlfriends or go off on a well-deserved vacation. Innocent stuff, really.

But for professionals in other lines of business, particularly in the field of healthcare, the need to be discrete and thoughtful about what you post and with whom you connect on social media is much greater.

Many professional organizations for clinicians and other allied health professionals offer social media guidelines to help members discern what is and is not considered appropriate social media content. Those same organizations often advise their members to steer clear of boundary violations and "dual relationships" - situations in which the relationship between a provider (physician, counselor, therapist, social worker, etc.) and a patient may be impacted by a second relationship, such as a business or financial relationship, romantic involvement, employment arrangement, blood or marital relatedness, etc.

But does the act of connecting with a patient online - even just with the acceptance of a LinkedIn request or an invitation to become friends on Facebook - constitute a dual relationship in and of itself?

Think about what you share on social media: your personal likes and dislikes, photos of loved ones, information about places you've been and things you've done, indications of who your friends are, insights into your political and religious preferences, etc. Through our posts, comments, likes and group memberships, even low-activity Facebook users reveal a lot about themselves.

When we accept a friend request, we effectively volunteer to share a lot of that kind of information. Unless we're in the tiny minority of Facebook users who carefully manicure privacy settings according to relationship, we effectively invite "friends" into our virtual home, we pull out all our photo albums (some of which contain 20+ year old photos that our college roommates thought were funny to share), we talk about our most recent vacations and major life experiences, and we introduce them to most everyone we know.

Though the healthcare provider - or educator, or social worker, or anyone from whom dual relationships pose a professional risk - may not intend it, "friending" someone on social media clearly extends a relationship beyond the clinic or classroom and into the homes of both parties.

Is it damaging to the therapeutic relationship? Maybe.

Could it be damaging? Absolutely.

Could it appear to be damaging? You bet - perhaps 100% of the time. And that appearance could be plainly evident to anyone with a computer or smart phone - including not just patients, but potential patients, employers, referrers, regulators and licensing organizations.

With those kinds of odds, does it make sense to connect with a patient on social media? I'm not a healthcare provider and I'm not professionally licensed, so I don't have skin in the game. But I know what my advice would be if I was asked.

What do you think?

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