Doctors and Facebook: The Fine Line

The latest scandal to grip Pakistan (because domestic violence, rape, honor killing aren’t enough, it seems) is a strange one. It was reported that Sharmeen Obaid Chinoy, the Oscar-winning filmmaker, had a doctor fired for sending her sister a Facebook friend request after having treated her in the emergency room of the Aga Khan Hospital.

Social media quickly ignited over this incident, which Chinoy tweeted about before it blew up. The ensuing conversation about what constitutes harassment, whether or not a doctor can or should send a “simple” friend request, and whether Chinoy should have “abused” her power, has been rather frustrating for its lack of understanding of the issues.

First of all, let’s examine the doctor-patient relationship in the case of a male doctor treating a female patient in the ER. In normal circumstances this is a very sensitive relationship, because it has to do with privacy and confidentiality. The doctor is privileged with the patient’s information, and keeps them in medical records that are also meant to be confidential.

In a trip to the ER, these factors double and triple. Suddenly you have a patient with whom you have no long-standing relationship, trusting you with her body and her life. She is in physical danger (you have to assume this as a doctor), stressed out, vulnerable and frightened. She trusts you to help her, and you took a Hippocratic oath to do this, and do no harm.

If the outcome of treatment is successful, and the patient is discharged, you have done your job.  Let’s say you look up your patient’s name from her records so that you can find her on Facebook. Suppose you corroborate the name with some more of her information, like her telephone number and email address, to make sure it’s really her (you saw hundreds of patients in the last week and want to make sure you have the right woman). If you follow that up with a Facebook friend request, you have breached a code of ethics, possibly violated the hospital’s policies of patient confidentiality, and possibly violated the patient’s trust and regard for you and the institution you represent.

It is not a doctor’s place to become Facebook friends with his patients. This cannot even be considered an error in judgment, an innocent request for friendship, or a mistake. This goes against everything a doctor has been trained to respect, and it brings a terrible name to the institution he/she works for. Patients do not go to doctors to become their friends, but to become their patients. The lines should not be blurred in this manner, especially in a country as sensitive as Pakistan, where gender interactions are highly charged and accusations of improper behavior can result in death for women.

Perhaps what makes people so uncomfortable when the tables are turned is that men have never had to pay the price for these improper interactions. Certainly there are isolated cases where men have been murdered in “honor killings” along with the women. But in the everyday experience of Pakistani working life, men are able to get away with just about every infraction under the sun, from a simple case of unwanted attention towards a woman, to inappropriate comments at work, to coercing a woman into sexual activity in the guise of helping her with her career (or not firing her outright). All of this falls into the category of harassment.

That Pakistanis are calling this an overreaction is not testament to the willfulness of the Obaid family, or that she is abusing her power. It is testament to the fact that sexual harassment is so common, so everyday, and so part of the fabric of our lives, that we find it odd and uncomfortable when someone actually calls it out. Any ordinary woman would have ignored the request, many not even realizing it was inappropriate. Others may have found it intrusive or embarrassing — he gave me a physical examination, now he wants to be my “friend”? — but decided to say nothing because “nothing will happen” if she complains. Most will think this is the price you pay for being a woman in Pakistan.

We are trained to think of male doctors as all-powerful, all-knowing. They are not. But the doctor-patient relationship is considered sacred, and every doctor, male or female, is trained from the start to know that. The onus of respecting it is on the doctor. In this case, the Obaid family complained; the hospital investigated, and made their decision. The doctor is free to go to court to appeal it on a legal level. But every man in Pakistan should know: you may find your future wife in the workplace, but if your workplace is an emergency room, you should err on the side of caution and concentrate on your job, or suffer the consequences.

(Here are guidelines from the United Kingdom about doctors and social media, if you want to educate yourself more about this – with thanks to Dr. Anne Murphy, who informs me that this kind of misbehavior is likely to get you “struck off” the register – ie your license to practice will get taken away. At the very least you would be called up in front of the general medical council and investigated.)

And no man likes to be told there are consequences for his “need for friendship” — to put it politely. The real phrase for this is “sexual misconduct”. Because we all know that had the doctor’s patient been male, this FB friend request would have never come through at all.

 

UPDATE: Courtesy Ambareen Kazim Thompson….”I was called by a senior AKU board member who asked me to share this: the doctor so valiantly being defended was under investigation and warning but continued his unethical behaviour as is the pattern of arrogant predators.

“OTHER women patients and staff ARE NOT as willing to become fodder for the public or come out publically. They were dealing with it internally. The Chinoys have the confidence to do otherwise. AKU cannot release confidential information of his victims ……. please feel free now to do the right thing or not…….”

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