The word “friend” has taken on new meaning these days, thanks mostly to the influence of Facebook. The definition has become so broad that it’s not unusual to find Facebook users boasting upwards of 500 friends.

Of course, it’s unlikely anyone has 500 individuals they can truly call friends, and that broad-based definition can become problematic — especially in the case of physicians who are increasingly being sought after to use social media to stay in better touch with patients.

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Doctors, it should be noted, in fact on Facebook. According to Jeff Tangney, chief executive officer of Doximity, the largest online network helping physicians connect with their colleagues, approximately 70% of physicians are Facebook users. The caveat, however, is that most of them do so using a pseudonym.

“They have to [use a pseudonym],” Tangney says. “There have been a number of cases, mainly young doctors, who have been fired for friending a patient. The mere establishment of the existence of that friend relationship can be a HIPAA violation.”

Don’t friend patients

Tangney explains that if a psychiatrist becomes a Facebook friend with a patient who doesn’t want others to know that he or she is seeing a psychiatrist, even if the patient initiated the friendship, it still constitutes a breach of doctor-patient confidentiality. Likewise, any social media messages the doctor receives from or sends to the patient are not encrypted, therefore they’re not HIPAA compliant, which can lead to further violations.

Case in point: Tangney recalls that a doctor in Rhode Island was fined and fired for posting a photo of a patient’s body part.

“You couldn’t see the patient at all, it didn’t mention the patient’s name, so a lot of docs would look at that and say well, that’s not a HIPAA violation,” he says. “But it didn’t matter. That patient knew it was them, and they could reasonably claim that someone might be able to figure out it was them knowing who that doctor saw that day. Which is really tenuous, if you ask me, but it doesn’t matter. At the end of the day anything that’s out in such a public forum is a risk for doctors.”

Privacy violations are only one part of the equation. Tangney says that there are considerable liability concerns as well. He explains that it’s easy for email messages to be misinterpreted.

“It takes a while to write an email that’s fully understood, whereas in a verbal discussion there are many other cues,” he says. “Seventy percent of communication is nonverbal; it’s the body language. You don’t have that in email.”

Don’t friend staff

A social media relationship with patients is only one line that physicians should not cross. Friending members of the medical practice staff is another.

“It’s a different type of potential lawsuit, and it’s also not professional,” Tangney says.

Teachers have learned through painful experience not to become “friends” with students. Teachers’ and students’ lives intersect in the classroom, where an appropriate mentor and mentee relationship develops. Crossing that line breaches the relationship. If a teacher sees a student post comments about having attended a wild party, and then that student performs poorly on an exam or fails to show up for class the next day, rightly or wrongly, that student will now be judged in a different light.

The same is true in the physician-staff relationship. If a physician becomes social friends with a staff member who then performs poorly in the office and is subsequently reprimanded by the physician, it wouldn’t be unusual for the staff member to feel betrayed because he or she is “friends” with the physician; because that line has been crossed.

Antisocial or anti-doctor

Tangney says that there’s a tendency to say in the U.S. that physicians are antisocial because they don’t want to connect as much with patients over email.

“I would actually say it’s not that doctors are antisocial, it’s that social media is anti-doctor,” he explains. “Almost one-third of all malpractice cases today include some sort of HIPAA claim. It may not be the main problem, but it’s just another thing for an attorney to pry into.”

That’s where Doximity can help. The online network is currently used by approximately 8% of U.S. physicians, enabling the secure transmission of email. Even the remaining 92% of the physician population can be reached via the network simply by entering a name, specialty or location.

“We send more than 1,000 faxes a day to and from doctors,” Tangney says. “You can just take a photo on your iPhone, we’ll enhance the image of the lab test, and then click the send button and it gets set to another doctor. It may sound like a really outdated thing to do, but the doctors love it.”