“Friending” Facebook?

Abstract

Sir: Plastic surgery, particularly aesthetics, is a business that requires as much economic acumen as surgical skill to remain financially viable.1 Given today's intensely competitive cosmetic surgery landscape that has been exacerbated both by uncertified physicians participating in aesthetic rejuvenation and by the country's recent 12 percent decline in cosmetic procedures, aesthetic plastic surgeons and residents in-training face increased pressure to recruit patients to clinics.2 To this end, many have turned to social media outlets such as Facebook to market themselves through online presence. Although this seems to be a reasonable idea, certain ethical issues are beginning to present themselves, especially from the resident cosmetic clinic angle, that deserve consideration. To be sure, Facebook creates tremendous value in terms of one's outreach potential, with Microsoft Corp. (Redmond, Wash.) spending $240 million for a mere 1.6 percent ownership stake.3 Facebook's unique ability to align seemingly diverse individuals of differing age, sex, profession, sexual orientation, and race for a certain cause or interest enables it to be a powerful marketing tool, from selling plastic surgery CME podcasts to resident tummy tucks. Admittedly, although the majority of residents tended to join Facebook for the social phenomenon (i.e., to reconnect with old friends, keep in touch with current colleagues, and to find new ones when entering a new city), many are capitalizing on the site's business benefits. For example, we now use our Facebook pages to acquire donations for Cents of Relief, a nonprofit organization aiming to provide health care for victims of human trafficking. Others, particularly in academics, can use the site to send out surveys related to research initiatives to assess public opinion on medical or surgical interventions. The uses of Facebook are boundless, making it an almost indispensable tool for all, including plastic surgeons. To keep a broad base of support, privacy settings cannot be too limited to engage potential supporters or clients for the initiative at hand. Regardless, privacy options tend to be ignored in the medical community, with one study highlighting that among over 300 physicians using Facebook surveyed, 25 percent failed to establish privacy parameters, permitting the public access to personal information.4 This can permit individuals originally “friended” for solely business purposes intimate access to residents, including viewing their party pictures, asking them on a dinner date, or requesting online cosmetic consultation. Consider the innocuous move of advertising a cleft mission charity gala on Facebook that ends up not only with donors but also cosmetic patients unable to be seen because of overbooked clinics seeking a discounted consultation. Or, drawing from primary author's personal experience, performing a rectal examination on a wheelchair-bound patient only to find out days later the same patient “friending” him on Facebook with a message asking to grab drinks. Dealing with each of these encounters mandates weighing the pros and cons, as the cosmetic patient may turn out to be extremely philanthropic, and the patient whom you decline as a friend may turn into one requiring long-term treatment for nonhealing pressure ulcers. Physicians and residents must remain cognizant of the ethical issues posed by the intertwining of personal life and professional career on Facebook. The overlap between business and play can jeopardize the doctor-patient relationship. Currently, the American Society of Plastic Surgeons does not regulate board-certified plastic surgeons with regard to using social media outlets, and it may never choose to, as this delves into personal matters. Thus, the onus falls on plastic surgeons and residents to remain very cautious when using Facebook as a business and recruiting tool because of unforeseen consequences stemming from the social realm. If used correctly, Facebook can be a plastic surgeon's friend rather than foe, allowing communication with colleagues, survey-based academic research projects, increased patient volume, and other avenues of the Internet yet to be innovated.5 Anup Patel, M.D., M.B.A. Niclas Broer, M.D. Shitel Patel, M.D. Antonio Forte, M.D. Devinder Singh, M.D. Section of Plastic and Reconstructive Surgery Yale University School of Medicine New Haven, Conn.