Web-based Social Networking Sites: Not a Private Conversation

Two recent provocative newspaper articles and an editorial that appeared in a major medical journal serve as an excellent introduction to this brief commentary on the currently underappreciated and potentially serious implications for the medical community regarding the rapidly expanding arena of Internet-based social networking. The first news item involved Chris Bell, a former congressman and candidate for governor of Texas, who wrote to “apologize” to his “more than 4000 Facebook friends” who had corresponded with him since he established a presence on this social networking site while running for governor in 2006.¹ Mr. Bell noted this activity “has led to an extraordinary sense of guilt and shame. People would tell me they had sent me e-mails via Facebook or saw me on Facebook, and I would have to hang my head and mumble, ‘Well, that’s really not me.’ Or like yesterday when my friend assumed I knew about something because I must have seen it on Facebook, but of course I had no idea what she was talking about.” Why was Mr. Bell so unaware? Because someone else had done all of the communicating for him.

The second news item highlighted the potentially negative impact of social networking sites on personal relationships.² The article noted that “couples are finding that old flames and flirty friends on social networking sites have a unique ability to stir up suspicion.” An individual cited in the story had researched the topic and commented that “part of the issue with information on Facebook is that it lacks certain context, so there could be things posted on your partner’s wall that you really don’t know what it means.”²

How many lives have been or will be impacted by information, whether true, false, or somewhere “in between,” posted on one of the many available social networking sites? The impact of this still poorly understood but rapidly expanding method of communication is summed up quite nicely in the conclusion of the aforementioned newspaper article. The author writes: “In one case...a young woman learned that her boyfriend had broken up with her when she noticed he had changed his relationship status to single.”² This information may have provoked minor annoyance, or perhaps even relief, but one can easily imagine other very personal and distressing information being conveyed in this very impersonal manner that may have far more serious consequences.

Finally, a commentary from a physician describes a “friend request” on Facebook from a woman whose baby he helped deliver several years earlier while he was a medical student.³ A major point of the commentary was the issue of the “appropriateness of interactions” between physicians and patients through social networking sites. While physicians, like all members of society, should absolutely have the opportunity to freely communicate with others, the unique nature of these sites raises the specific questions of what is being said, who is receiving the message, and what exactly is the potential for this information to be widely disseminated in a manner that was not intended, resulting in unanticipated and unintentional harm. Consider, for instance, the example of “the MICU nurse who blogs about her experience in dealing with a diffi cult patient, forgetting that one of the patient’s family members, a recent addition to her network of friends, has access to her blog.”³

While nothing in this commentary is meant to dissuade members of the medical community or their staffs from participating in and fully enjoying the rapidly evolving world of high-tech communication, it is absolutely critical to remember that the availability and use of innovative technology does not change the potentially profound impact, either short or long-term, of spoken or written words or visual images posted on what must be acknowledged to be a rather public forum.³

Maurie Markman, MD, is Editor-in-Chief of Oncology Net Guide and Vice President of Clinical Research for University of Texas MD Anderson Cancer Center in Houston, Texas.

References

1. Chris Bell. “Fessing up to faux Facebook account” West University

(Texas) Examiner, August 13, 2009; page 4A.

2. Hill M. Who’s that girl? Facebook entries trigger jealousy. Houston

Chronicle, August 16, 2009; page A16.

3. Jain SH. Practicing medicine in the age of Facebook. N Engl J Med

2009; 361:649-651.