We live in an increasingly social and connected world. As such, doctor-patient online communication will become more common. As I noted in my last column, many physicians see online communication as a minefield of potential patient privacy violations, and they are reluctant to use it. Rather than avoid it for fear of committing a privacy violation, I hope all physicians will educate themselves on how to communicate online safely and effectively. To this end, I’m providing some examples of online questions you will likely encounter, with sample responses.
• A nonpatient asks you to make a diagnosis online. As a dermatologist who is active in social media, I often have nonpatients send me photos of their skin conditions requesting a diagnosis.
Sample question: "I’ve attached a photo of a mole on my leg. Does it look OK to you, Doc? Could it be cancerous?"
Sample response: "Thank you for sending me the picture. Without an established doctor-patient relationship, I’m unable to provide a diagnosis. I recommend you make an appointment with your dermatologist. If you don’t have one, here’s a link to the American Academy of Dermatology website where you can enter your ZIP code to find a dermatologist near you."
• A nonpatient asks your opinion about symptoms he is experiencing.
Sample question: "I’ve been experiencing bouts of diarrhea and stomach cramping and think I have celiac disease. I’m going to stop eating gluten. Do you think that’s a good idea?"
Sample response: "I’m sorry you’ve been unwell. Unfortunately, I cannot provide medical advice to you since we don’t have an established doctor-patient relationship. I can tell you, however, that diarrhea and cramping can be symptomatic of many conditions including, but not limited to celiac disease, irritable bowel syndrome, and lactose intolerance. I recommend you make an appointment with your primary care doctor so he or she can help you with your actual diagnosis and treatment."
• A patient of yours asks you a clinical question in an open forum such as Facebook or Twitter.
Sample question: "Hi, Doc. The birth control pills you gave me aren’t helping. I’ve been on them for 2 months, and I’m still having all the symptoms I had originally – mood swings, spotting, difficulty sleeping, and my acne’s not better. I think I need a different pill. Can you prescribe me one?"
Sample response: "I’m sorry to hear that. I’m happy to discuss this with you, but let’s do so privately. Please use our secure office e-mail to contact me, or call me during office hours and we can talk about what’s happening and what to do next. Hope to hear from you soon."
• Someone asks for specific product recommendations.
Sample question: "My doctor wants me to buy the sunscreen he sells in his office. He says it’s better than drug store brands, but it’s expensive. Is he telling the truth?"
Sample response: "I can’t speak specifically to your doctor’s sunscreen. But in general, you should look for a sunscreen that is labeled "broad spectrum," which protects against both UVA and UVB rays and has an SPF of 30-50. Most often, price doesn’t correlate with effectiveness. So, just because a sunscreen is more expensive doesn’t necessarily mean it’s more effective."
• Someone criticizes his current doctor or medical provider.
Sample question: "I’ve been going to my dermatologist for 6 months now and my acne hasn’t gotten any better. He put me on antibiotics and topical creams, and I still have acne. He obviously doesn’t know what he’s doing. Can you tell me what to do?"
Sample reply: "I’m sorry to hear that. I know how frustrating it can be. Acne can be very difficult to treat and can take a long time. Be sure that you’re communicating with your doctor about your situation so he can help you. Also, remember that you can always request a second opinion."
• You want to blog about a patient’s condition. How do you do it without violating the patient’s privacy while ensuring that he cannot be identified? One option is to obtain the patient’s written consent. Another option is to create a composite: Use real facts with fictional patients. For example, your actual patient is a 30-year-old UPS driver with severe hand eczema. You want to write about connections between hand eczema and occupational exposure. You create a fictional patient who is a 40-year-old female mail carrier. You discuss the symptoms of your actual patient in a way that maintains his privacy yet allows you to educate patients online.