Oliver is a five-year-old boy with a stage III Wilms tumor who is receiving chemotherapy at the cancer center following his surgery. Ben is Oliver’s usual infusion room nurse; he and Oliver share a love of Pokemon Go and often roam the halls looking for particular Pokemon. Oliver’s mom, Claudia, is divorced, and Ben has mentioned that he is single as well. One evening, Ben receives a Facebook friend request from Claudia. 

What Would You Do?

“OSNs (online social networks) . . . may present both opportunities and problems for patient-doctor communication. OSNs provide a forum within which a new form of purported professional indiscretions may take place,” Bosslet, Torke, Hickman, Terry, & Helft said.

Ben makes arrangements to speak with his nurse manager before his shift starts the next day. He learns that the hospital has clear policies regarding online social networking. He realizes that this is for Oliver and Claudia’s privacy and safety, as well as his own.

“Communicating with patients on social media sites can cross professional-patient boundaries, risking patient confidentiality, exposing patients to inappropriate details of physicians’ personal lives, and jeopardizing therapeutic relationships. Connecting with patients through online venues can also pose risks to providers’ reputations, safety, privacy, and work-life balance. Physician organizations and institutions should consider progressive policies on professional and ethical responses to patient friend requests and the use of social media for work-related issues to keep both patients and physicians as productive and protected as possible,” Wiener, Crum, Grady, & Merchant said.

The next time Oliver comes into the infusion room, Ben has another nurse sit with him while he speaks to Claudia privately. 

“I’d be happy to communicate with you through other means (here in the infusion room, after or before your appointments with the doctor), but I have a personal policy not to communicate with patients using Facebook. I really care about you and Oliver, and I hope you understand.”

Claudia asks if Ben will still be their nurse when they come to the infusion room, and Ben, feeling grateful that Claudia has understood, agrees. 

It’s sometimes hard to know the boundaries between ourselves and our patients, especially when they are young and friendly. But Ben realizes that by setting boundaries, even though it is uncomfortable, he is setting and maintaining a healthy work-life balance. 

“Maintaining a healthy work-life balance may be difficult when physicians continue communication with patients and families outside of the work environment. Over time, this could contribute to job burnout or compassion fatigue, a term used to describe a state of tension and preoccupation with the patient’s suffering and depletion of the practitioner’s emotional and physical energy toward work. Readily available contact information or current whereabouts may even facilitate cyber or physical stalking,” according to Wiener et al.