Over the past 5 years, social-networking sites have evolved from a preoccupation of high-school and college students to a mainstream form of social interaction that spans divisions of age, profession, and socioeconomic status. At the hospital where I'm in training, medical students, nurses, residents, fellows, attending physicians, and service chiefs can all be found linked to one another as active members of social-networking sites. The technology facilitates communication, with personal Web pages that permit users to post information about events in their lives, advertise social activities, and share photographs. Users are prompted by Facebook to carve out a digital identity by disclosing their political affiliations, sexual orientation, and relationship status. Those who do so can readily communicate and associate with other users who have similar interests — a feature of these sites that facilitates collective action across spans of geography and time. In the 2008 presidential campaign, the group Doctors for Obama used Facebook to rapidly mobilize thousands of doctors to communicate their views on health policy to the Obama headquarters. This group of physicians continues to have a voice in the Obama administration, largely on the strength of its Facebook-created network of members. Similarly, Facebook networking groups have been created with a focus on specific medical specialties or diseases. Doctors or patients can interact with one another in groups such as "Diabetes Daily" and "I Support Cystic Fibrosis Research and Awareness!," each of which boasts thousands of Facebook members. Hundreds of thousands of philanthropic dollars can be traced back to initiatives publicized on social-networking sites.
By creating a new environment for individual and group interaction, social-networking sites also create new challenges for those who work in clinical settings. Take, for example, the MICU nurse who blogs about her experiences in dealing with a difficult patient, forgetting that one of the patient's family members — a recent addition to her network of friends — has access to her blog. Or the dermatology resident who is asked on a date by a clinic patient after he learns from her online profile that she is single — information that he would have hesitated to draw out of her in person. Or the medical attending whose clinical judgment is questioned because of photographs posted online, showing him in progressive stages of apparent inebriation at a department holiday party. Although many Web sites allow users to choose higher privacy settings and to control which personal content is available to whom, it is clear that there is no longer a professional remove between many clinicians and their patients.
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