Say yes and accept Farrah's friend request as he is confident that he doesn't have any inappropriate content on his Facebook pages?
Dr Sam Walker is a doctor in training who works in an accident and emergency department of a hospital. Dr Walker has to decide whether it's appropriate to accept a Facebook friend request from a vulnerable patient. Later, Sam examines whether he should change the way he uses Twitter.
Farrah is a 15 year old student, who has been admitted to the accident and emergency department of a hospital after collapsing at school. She has a history of eating disorders and her case notes suggest that these disorders began following an intensive period of bullying at school over the last three years.
She is conscious and recovering in A&E where she is being given hydration. Farrah's parents have been delayed on their way to the hospital, and she is waiting for them to pick her up.
Sam treated Farrah when she first came in, and he is checking up on her again. Farrah is using her smart-phone to access her Facebook account while she waits.
Hello again Farrah... oh, I'm afraid you're going to have to leave Facebook for now and turn off your mobile phone while you're in A&E.
[starts to cry] Oh, sorry. I didn't know.
There's no need to cry, its fine Farrah. And the good news is that you'll get the rest of the day off school. Your mum and dad are on their way, and once they get here we have a chat about how we can get you "LOL"-ing again.
[laughs] So are you gonna be my doctor from now on?
I'm your doctor right now in A&E, but once your parents get here we'll talk about who else might be able to help you - maybe find someone you can talk to every week or so about how stressed you've been feeling at school.
But don't worry about that now - just think about what you're going to do with the rest of the day off. You can spend the whole afternoon on Facebook if you like!
[smiling] You've been so kind, doctor. No-one has really taken me seriously about what's going on at school before...I'd really like to keep in touch. Are you on Facebook doctor?
Of course, isn't everyone? I've been hooked on it since I was at school too.
Well... can I 'friend' you?
Dr Walker decided against accepting Farrah's friend request because he wanted to maintain the professional boundary between them.
However, he was concerned that Farrah, being vulnerable, may see this as a rejection, which could be damaging for her. So he sensitively explained that even if he was unlikely to treat Farrah again, it wouldn't be appropriate for him to be Facebook friends with a patient.
When Farrah's parents arrived at the hospital, Dr Walker sat down with them and Farrah to discuss the next steps for helping her. Dr Walker recommended that he refer Farrah to the local Child and Adolescent Mental Health Service for an appointment which she could attend with or without her parents, to chat about the difficulties she's been having with eating and the bullying at school.
Dr Walker also suggested that, as Farrah was already online, she may want to look at the website for the charity B-EAT (Beating Eating Disorders) which has an online forum for young people who have a lot in common with Farrah, as well as pages her parents might find useful too.
Using social media also creates risks, particularly where social and professional boundaries become unclear.
If a patient contacts you about their care or other professional matters, through your private profile, you should indicate that you can't mix social and professional relationships and, where appropriate, direct them to your professional profile.
(Doctors' use of social media paragraphs 10-11)
You must consider the potential risks involved in using social media and the impact that inappropriate use could have on your patients' trust in you and society's trust in the medical profession. Social media can blur the boundaries between a doctor's personal and professional lives and may change the nature of the relationship between a doctor and a patient.
(Doctors' use of social media paragraph 14)