Many of Facebook's 500 million users treat the social networking site as a place to kick back and share funny moments from the workday, even party pictures snapped in the wee hours.
Not Dr. Jeannine Del Pizzo.
Del Pizzo, 31, is among the many doctors and other medical professionals who recognize that for them, a Facebook or Twitter post about their day at the office might violate patient privacy laws. A photo showing them sipping a beer at the beach or lighting a friend's cigarette at a party might shake patients' confidence and raise colleagues' eyebrows.
"I don't write curses, and you won't find pictures of me in bathing suits," says Del Pizzo, chief resident in pediatrics for the University of South Florida. "It can take away from your professionalism."
It can also cost doctors their jobs.
Rhode Island physician Alexandra Thran posted information about a trauma patient — not even the name, but enough about the condition to be considered a violation of privacy laws. She was fired by her hospital last year and disciplined by her state medical board a few weeks ago.
Incidents like that have led medical schools, industry groups and hospitals here and across the United States to spell out what is and isn't acceptable in social media. But it's also the latest example of how the Internet is changing the doctor-patient relationship by putting the latest — and not always greatest — information within easy reach of Web-savvy patients.
And when it comes to social networking sites like Facebook and Twitter, doctors are not like everyone else.
"(Doctors) are going to be held to a higher standard," said Dr. Lindsay Thompson, an assistant professor of general pediatrics at the University of Florida, who has studied the use of social media by medical students and helped craft the school's social media policy.
The advice Thompson gives future doctors: "Whatever you put up, make it something that would make your grandmother proud."
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Many guidelines remind doctors that patient privacy protections included in the federal Health Insurance Portability and Accountability Act, or HIPAA, apply in cyberspace. Doctors and other medical personnel are not allowed to share information about patients without their permission, and as Thran learned, just withholding a name isn't always enough.
When the University of Florida began studying the Facebook habits of its medical students and residents in 2007, it found a dozen instances in which students and residents posted photographs on their Facebook pages of themselves caring for patients.
The photos were taken during medical mission trips outside the United States, so HIPAA rules did not apply. But findings like that prompted discussions, and eventually led to a medical school policy on the use of social media that specifically says not to post health information about any patients, Thompson said.
Besides upholding patient privacy rules, many policies — including one from the American Medical Association — stress the importance of keeping social media profiles private, or viewable only by trusted "friends."
Thompson says it's a simple thing to forbid health workers from posting about patients. What's tougher is defining what health care professionals can safely post about themselves.
The UF research found that more than half of medical students with Facebook pages included information about their sexual orientation, relationship status and political opinions. It also found numerous photographs showing medical students consuming alcohol.
Thompson found other things that troubled her, including the occasional use of off-color or sexist humor by students and residents.
"That clouded my opinion of them, knocked them down a couple notches," she said.
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But everyone has different standards, making it tough to set firm rules.
"If you're holding a glass of wine, is that bad? Or if you're in front of a keg stand?" asked Del Pizzo. "You don't know where the line is."
Thompson wondered what would happen if plaintiff's lawyers pursuing a malpractice case over a botched surgery discovered a Facebook photo of the doctor drinking a beer the night before the procedure.
"If I was a juror I might not think kindly about it," she said.
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The Internet is full of health information, though its quality varies wildly. People can get free medical advice, shop for health insurance or check their doctor's credentials and patient ratings.
Increasingly, health consumers are using social media. The Breast Cancer Awareness page on Facebook and the Centers for Disease Control and Prevention account on Twitter each have more than 1 million fans or followers.
So when a patient finds his doctor on Facebook, why wouldn't he ask to "friend'' him so that he can have access to the doctor's online profile and everything he posts?
But many doctors find that a bit too close for comfort.
Every week, Dr. M. Christopher MacLaren, a Tampa orthopedic surgeon, gets patients asking to be his Facebook friend. He says he declines them all.
"It's really odd to me. I'm their doctor. For me, patient-doctor is a very special relationship, one based on trust and professionalism."
And accepting a friend request puts that relationship out on public display, even if only one's own "friends.''
Thompson said MacLaren is smart to turn down patient requests, but acknowledges some doctors do accept requests, they just are very careful about what they post. Some maintain separate Facebook profiles for patients and for their personal circle.
"Everybody handles it differently," said Thompson, who cautions medical students and residents to think more than twice before accepting such a request. "You should try to maintain some boundaries."
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The American Medical Association's policy notes that social media can be a good way for doctors to promote their practices or help disseminate public health messages.
All Children's Hospital in St. Petersburg encourages employees and medical staff to use social media to communicate within the hospital and outside it. The hospital uses its Facebook page to post news releases and information about events it sponsors. It used Twitter to update the community about its 2010 move to a new hospital building.
Dr. Katarzyna Ostrzenska keeps two Facebook profiles: one that's personal and the other to promote her St. Petersburg internal medicine practice, and the Zumba classes she teaches there. She also responds to general medical questions, and posts items such as: "Get your B12 injections! I personally love them."
She also counts patients and former patients among her Facebook friends.
"But,'' said the doctor who works out with her patients, "my practice is a little different than most.''
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330.