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When A Patient Contacts A Doctor On Twitter

When perusing my Twitter feed [one] morning, I stumbled onto this post directed to me:

Patients reaching me in public social spaces is becoming a regular thing. I’ve discussed this in the past, but I think it bears repeating. So here’s what I did:

I understood the mom’s needs. Patients resort to “nontraditional” means of communication when the traditional channels fail to meet their needs. Recognize that these patients (or parents in my case) are simply advocating for themselves. My specialty struggles with a shortage of physicians, so we’re dependent upon phone triage to sort out the really sick from the less-than-sick. It’s an imperfect system and consequently parents find themselves having to speak up when the gravity of their child’s condition hasn’t been properly appreciated.

I took the conversation offline. I don’t discuss patient problems in places where others can see, so my first order of business in this case was to get the conversation to a place where it can be private. I called the mom, found out what was going on, and rearranged her appointment to a time appropriate to the child’s problem.

I dicsussed why public dialog of health related issues may not be a good idea. Of course it’s the right of any patient to discuss their issues anywhere they like. The difference is that once you engage in a relationship with a doctor, you then have to consider the interests, needs, or concerns of the treating physician. And I’m not comfortable with public discussion of patient-specific issues, even if okay with the patient.

The biggest concern stems from the fact that platforms like Twitter severely limit the extent of the dialog. Details get lost and it’s hard to tell if the patient really understands what you’re saying. Then there’s the issue of documentation. My peers and colleagues need to see what happened between us. Twitter and Epic don’t talk.

And many patients aren’t aware that direct @ messages and DMs are not private. Many people can access this information. Depending upon the nature of the problem, patients may not want this information released into the public space.

In this case specifically, the mother was not aware that her message was public. We discussed this at length, and she was excited that this case and her tweet could be used as an example.

I documented the encounter. I created a phone note and documented the nature of encounter, including the fact that the parent had initiated public contact. I also noted that I discussed the issues with public dialog and brought the patient up to speed on how I prefer to be reached.

Again, all of this is done in a way that respects the intent and needs of the patient.

Interestingly, this is exactly what I do when I bump into someone in the grocery store or cocktail party who wants to talk personal issues. Beyond something really simple, I encourage that we pick it up in a place where I can give them the attention that they deserve and where all of it can be documented in the medical record.

If you’re a socially-active doctor, what do you do when patients make public contact with specific health-related issues?

*This blog post was originally published at 33 Charts*

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One Response to “When A Patient Contacts A Doctor On Twitter”

  1. Be prepared to spend way more time on Twitter, doc!

    In fact, even re-telling this story may mean you’ve just given many more parents a great idea about ploughing through the wall of scheduling delays at their doctor’s front desk!

    If you or any doctor are participating in social media of any kind (and the jury’s still out on how appropriate it is for physicians to be “friending” their patients on Facebook) you’d best expect this kind of contact to increase – especially since you’ve now documented how easily my far-off medical appointment can be “rearranged” to my satisfaction just by tweeting my doc.

    There’s a great scene in the old movie Terms of Endearment where Shirley MacLaine goes screeching out into the hospital corridor yelling at the top of her lungs “HELP!!! MY DAUGHTER’S IN PAIN!” Mothers will do this for our babies (yes, even our grown-up babies) even when we would never make such a fuss over ourselves.

    If it were my daughter, and I were this mother, and if we were your patients, you can bet that I’d do exactly what she did on your Twitter account, private or not, appropriate or not, as long my efforts got my child in sooner.

    This seems less an issue about “to Tweet or not to Tweet”, but one of what timely patient care could and should look like.

    Carolyn Thomas

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