Tuesday, July 17, 2012

Facebook Good Samaritan

Like most of the civilized world now, I am on facebook.  At first it was fun and exciting, now it mainly acts as a time suck while waiting around at the hospital.  My news feed consists mainly of lovely updates of what my friends from third grade had for dinner or more recently many pictures of car thermometers in Oklahoma.   I, of course, only post extremely interesting things, like cute quotes from my kids or pictures of the XM radio in my car. Obviously everyone wants to know what song I'm listening to.

I do my best to avoid the usual internet arguments.  I skim past  the anti vaccine or homebirth conversations.  The is definitely no “poli-booking’ for me (discussing politics on FB). I’m not ‘friends’ with patients and try to make sure my behavior is ethical online.

Despite these precautions, I have found some grey areas in social media.

What do you do when people are making obvious bad medical decisions online? What is our responsibility as doctors?

A girl I went to elementary school with was recently pregnant. She lives several states away from me and I haven’t seen her since 4th grade.  Every minor detail of her pregnancy was posted in her status updates. Many of these would definitely fall in the “TMI’ category (ie: hemorrhoids ).

Near the end of her pregnancy she began having swelling, and she would post daily pictures of her 'c-ankles.'

One night she posted a status that made my obstetrician’s heart skip a beat, “I have the worst headache of my life, and I’m seeing little squiggly lines.  I just checked my blood pressure and it’s 170/95”

This update, received several ‘helpful’ comments from friends, family and other third grade classmates, such as “take a relaxing bath” or “try Tylenol”.

I quickly sent her a private message recommending she proceed to the hospital.  These symptoms met the criteria for severe pre-eclampsia. She replied that she had called her doctor and her doctor wasn’t concerned.

Now this was a dilemma. Is she lying? Is her doctor an idiot?  What is my responsibility here?  

I tried to go to sleep, but every time I closed my eyes I kept picturing her having an eclamptic seizure.

I posted a comment or her update, encouraging her to go to the hospital that I was worried she had a serious life threatening condition.

She did not respond.

Two days later she posted that she was going to her doctor.  She was promptly delivered.

Luckily she and her baby were fine, but since this incident (which is entirely true) I have been left wondering, what if she had seized?  Did I do enough to just tell her to go?  Should I have tried to track down her phone number and call her?  Should I have ignored the comment all together?   

Technology had introduced many grey areas in our ethics.  Since we have a social media expert in our midst and many of you are bloggers, immersed in the internet, I thought I would toss this out there and see what you think.


  1. Agreed! This is so difficult. I joined a moms' group that has a facebook forum. People are constantly posting photos of various baby rashes and asking for advice. Some that have been pronounced by the group as "teething rashes" actually look suspicious for impetigo. Or "my baby has a high temp again today, what should I do?" I'm not about to go dishing out peds advice based on my one rotation in medical school years ago, but I keep reiterating "GO SEE YOUR DOCTOR"... what more can you do? If it were coming from someone I knew better or was closer friends with, I would probably call them up if I felt it was urgent/emergent. In the end, we have to hope that common sense prevails to others, too.

  2. There is nothing more you could have done. You are not her doctor - at the end of the day, she was not your responsibility. She is an adult and chose to ignore your warning - you cant make her do what you think is best. Even if she was your patient, you couldn't make her do what you want - you would make recommendations and hope that she heeds them.

    What if you saw an obese person walking down the street eating a big Mac? Would you stop them and tell them they shouldn't eat that because they may have a heart attack? Probably not. This is similar.

  3. This is such a very difficult topic for me, too! Case in point - I had a similar situation, but instead of a friend, it was a family member... mother of said family member asked me for advice regarding her daughter's decision to do a home birth. I gave her my complete and honest opinion about the topic. Without my permission, she forwarded my e-mail to her daughter, and things got awkward between me and her. I never messaged the daughter or commented directly on her Facebook about her pregnancy choices, but did end up taking the whole passive aggressive route instead (posting HB warning articles and the like), in the hopes that she would see them. I don't feel proud about doing that, but I was very worried about her and what she had set her mind to before doing her research and learning both sides of the story. I think, if a similar situation pops up, I may just keep my mouth shut in a non-emergent situation because it's impossible to know the whole clinical picture based solely on a person's FB status... but it sure is a tricky spot to be in :-/

  4. I've learned to keep my mouth shut for the most part. Frankly, I think people must misrepresent things on the internet. I was involved in a situation similar to yours: I was in an online pregnancy community where a woman posted that she had one leg that was very swollen and painful. Red lights for DVT went off in my head, but after I warned her, she said that her doctor "wasn't concerned." I've realized giving online medical advice is frustrating and pointless.

  5. I also generally stay out of it, however, when its really serious/life-threatening-ish I try gentle encouragement of the importance of seeing a doctor in person. I'm on an online mommy site where a mom posted about her newborn baby's frequent bilious vomiting and she was getting ridic advice like - just keep breasfeeding him because breastmilk cures everything. I stepped in and said I was a doc and recommended she have her pedi eval him just to make sure everything was okay since none of us on the forum could really see what was happening and better to be safe. The baby was okay, she did end up taking him to the pedi and he was dehydrated and needed some fluid. I also have a hard time with this.

  6. Not a Dr (FNP), but I have encountered similar situations over the years. I quickly learned that most people just want attention for their :: insert medical condition::: and not real advice. I do not interfere unless it is an emergency situation like the one you described. A number of years ago I did interfere in a "I can't breathe while I am lying down and I am so swollen (8 months pregnant)" post on an internet board. I sent a PM, briefly addressed the concern for PPCM and then promptly heard nothing for a month until I got an email from the lady's husband. She had seen my message and they had gone straight to the hospital with a printout of my email. Turns out they were in a rural hospital in China, the physician read the email, agreed with my internet assessment and promptly sent the patient to a larger hospital where she delivered her daughter and then went into cardiac arrest on the table. Fortunately they were able to take care of her appropriately, she lived, her EF of 15% was correctly diagnosed as PPCM and she recovered. So sometimes it DOES pay to interfere!

  7. RH+, I think you did the right thing. Most times, we do not have enough information to give specific advice (nor do we want to because that would imply a physician-patient relationship and make providers potentially liable for subsequent events) but urging someone to seek medical attention for a possible emergent situation is an ethical obligation, it seems. Other things that could help is providing good sources of medical information (like reputable websites with guidelines, symptoms, etc).

  8. I agree, this is a very sticky situation. Your reference to "good samaritan" alludes to another issue. Could we be held legally liable for any mishap related to giving medical advice via social media? Does this constitute establishment of a physician-patient relationship?

    I usually keep quiet about medical posts on FB, etc with the exception of suggesting a visit to their doctor for anything that sounds serious.


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