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Since the early 2000s, new ways of communicating have been developing over the Internet; initially, discussion forums and blogs, followed by social networking sites like Facebook, Myspace, LinkedIn and Twitter. According to a 2010 Pew Internet survey (1
), 95% of Americans aged 18 to 33 years are online, 83% use social networking sites and 43% read blogs. Over the past two years, an increasing use of social media has been noted for all age groups. A similar increase in usage has been noted in the medical profession. A Canadian Medical Association (CMA) survey (2
) demonstrated that 51% of physicians use Facebook, 26% participate in social networking sites for physicians and 14% have a practice website. The extent of use of these new forms of communication in paediatrics is not known, but it is assumed to follow these general trends.
A recent CMA guideline outlines various social media uses, debates their advantages and disadvantages, and recommends that Canadian physicians be aware of their impact on professional practice (3
). A frequently cited Canadian Paediatric Society practice point offers practical suggestions for the professional use of e-mail communication in paediatrics (4
). Many of its recommendations also apply to social media use, but newer platforms also have specific characteristics that may be impacting the traditional doctor-patient relationship differently than e-mail communication. For example, these platforms are designed so that information can spread globally and very rapidly (eg, by ‘going viral’). Known as the ‘Facebook effect’ (5
), this feature allows the instant sharing of data by people interested in the same topics. The downside of public information dissemination is that it is also accessible by persons who are not necessarily the intended recipients. Information posted on social media sites has the inherent potential to reach a much larger audience than targeted e-mail communications. Thus, any material posted on such sites should be assumed to be public. In addition, ‘footprints’ (6
), meaning information that is left behind even after an initial thread is deleted, are difficult, if not impossible, to remove from the public domain. The permanent record left by temporary postings on these platforms can have far-reaching effects.
The present practice point reviews three Internet applications with particular relevance for the traditional doctor-patient relationship: patients’ blogs, physician websites and social networking platforms like Facebook. Pertinent ethical issues include privacy, patient confidentiality and medical professionalism. A distinction is made between professional versus personal use of social networking media. Blogs written by medical students, health care professionals and physicians are not discussed because they were addressed in the practice point cited above (4