Abstract
Then I received another request, this one from Kathy, an 18-year-old with a new diagnosis of osteosarcoma. Then it was Mike, a 17-year-old with Hodgkin's lymphoma, followed by Rachael, a 20-year-old with glioblastoma multiforme. More requests kept coming from more patients.
I stopped visiting my Facebook site. I did not know what to do. I was in a dilemma, “to simply not visit the site” or “completely close my account.”
What did Bob want from me? I am his doctor. I am not his friend. But he is a young person combating death early in his life. Is he going to ask questions about his treatment and prognosis or my personal life? Will he be hurt if I decline his request to be my friend? I did not want to upset him, but how can I accept him? How do I be his friendly doctor? These were the thoughts running through my mind. Unlike my residency in internal medicine or pediatrics, I realized that I saw my oncology patients more often, some of them every day, and became a part of their life at least for a short period of time.
It was then I recognized that oncologists form true therapeutic relationships with patients. My patients, especially adolescents and young adults, are more comfortable with fellows in training and younger faculty than older faculty or their parents. (An interesting personal observation. I may be biased). Being in a similar age group they want to “naturally” be friends.
Networking sites like Facebook are a part of their daily lives (our lives too). It is where they meet friends, their teachers, and coworkers. Politicians use it everyday to express their views, successfully campaign, and even raise money. Authors use it to promote books. In the modern age we carry iPhones and Blackberries more than pagers for sending and receiving messages. We can instantly connect/network to anyone and everyone though these modern “gizmos” and gadgets.
The current era of online social networks like Facebook creates both challenges and opportunities for the oncology community. 1 The challenge is to maintain the doctor–patient relationship and uphold the ethical and moral standards that are unique to the profession.
The opportunity lies in organizing groups especially for rare cancers among patients', doctors, researchers, and between doctor and patients. It can be used as a medium, if effectively designed and regulated, for creating awareness, disseminating knowledge, instant peer review, and advancing research.
Because of the sudden explosion of such social networking sites, there has not been enough time for the medical community to establish guidelines for the online behavior of physicians and the exchange of ideas. It is absolutely essential to keep our personal and professional lives separate. The main point would be to figure out how best to let both communities interact professionally.
The medical community will need to address this at a national level and define a set of new ethical codes of conduct—“physician netiquettes,” pertaining to the use of online networks in a way that will help promote the wellness of the patients, and enhance the knowledge of the medical profession without changing the professional dynamics of the doctor–patient relationship.
Bob died with his friend request unfulfilled. As far as the rest of them, I still ignore their requests to be my friends.
What happens to their online profile when they die? I found out that some sites memorialize the virtual person after they die. 2
It is now more than a year after Bob died. Should I at least write something on his online epitaph? I still do not know.