"I’m a child psychiatrist. We tend to have a lot of folks involved in the care of any individual patient. The efficiency with which we’re able as a treatment team to stay in touch with each other is much enhanced by the use of e-mail," she said.
She said she asks adolescent patients to show her their Facebook sites as part of the therapeutic session, or talk about what might be found if someone searched online for the patient’s name.
In many ways, boundary issues raised by e-mail are similar to boundary issues related to use of the telephone; they’re just in a different form, several participants noted. Psychiatrists have little control over Internet searches and the information they turn up, except for setting search engine alerts to be notified whenever their name is mentioned and perhaps hiring a company to scour erroneous information from the Web.
It’s the use of social networking sites like Facebook, LinkedIn, and others that seems to create the greatest ambiguity, some said. One doctor noted that even if you set the highest privacy settings and refuse to "friend" patients on Facebook, nonfriends can "see" you in other ways. "I have to caution family members about posting photos" that include him, he said.
New curricula are available from the American Association of Directors of Psychiatry Residency Training to inform trainees about the ramifications of electronic and social media.
One participant summed it up by saying, "We have to accept that this is the digital age."
Dr. Gray, Dr. Gabbard, and Dr. DeJong said they have no relevant financial disclosures. Dr. DeJong is a paid contributor to a nonprofit website, Children’s Emotional Health Link.