By Sarah Gabriele
Doctors are now using social media platforms to spread medical knowledge and to interact with the communities that they are actively building.
This trend poses new ethical questions for physicians who want to create and engage with their communities on social media.
A recent survey showed that almost 1 in 5 Americans now turn to TikTok before their doctor for health advice. To name just a few so-called “TikTok doctors,” Dr. Leslie has almost 1 million followers to whom she gives daily recommendations, and Dr. Emeka Okorocha is a London-based physician with over 250k followers to whom he offers advice on topics including smoking cessation. Like Dr. Leslie and Dr. Emeka, hundreds of other physicians use social media to share recommendations and bits of advice. As these accounts proliferate, the line between the roles of doctor and influencer becomes blurred.
Needless to say, the relationship between a doctor and a patient is different from the relationship between an influencer and their followers. Influencers do not know each individual person they interact with, but rather use their social media profiles to engage with many people, who, collectively, form their community. On the other hand, doctors personally know their patients and are entrusted with the task of evaluating their health case by case.
According to the American Medical Association (AMA), a clinician-patient relationship is generally formed when a physician affirmatively acts in a patient’s case by examining, diagnosing, treating, or agreeing to do so. The existence of these requirements, and more specifically, the necessity for a doctor to take some active steps toward the care of a patient to fully form such a relationship, has historically required some type of in-person activity from both doctors and patients, due to a lack of other means for interactions.
This picture rapidly changed with the COVID-19 pandemic and the increased use of telemedicine, creating the necessity to revisit the classic standard for establishing a doctor-patient relationship. Consequently, professional associations, like the AMA, updated their practice guideline to cover and regulate these “new” virtual clinical spaces. In this respect, AMA Code now states that a physician’s fundamental ethical responsibilities to patients do not change in the context of care delivered via telemedicine.
Yet, although telemedicine might have normalized the use of virtual means for receiving health care, the interactions of doctors and patients in telemedicine are still fundamentally different from the relationship between TikTok doctors and their community.
Indeed, while doctors can simulate the same interaction that would otherwise occur inside a doctor’s office through telemedicine, social media has created a completely different way of delivering care. TikTok doctors use their accounts to talk to a larger audience, without particularly referring to the specific case any individual patient. The lack of identification of one patient to whom medical advice is referred has been considered in the past as the deciding factor for the lack of a doctor-patient relationship. For example, doctors who became television celebrities have been deemed exempt from any responsibility for their recommendations, due to the lack of a doctor-patient relationship.
However, although the relationship between clinicians and patients is not fully formed, the interactions between TikTok doctors and their communities are strong and long-lasting, and should not be dismissed because they do not fall within the narrowly defined category of doctor-patient relationship. Instead, we should consider that there are other kinds of relationships that are similarly deserving of moral attention among doctors and people who are seeking their advice.
The existence of a special relationship between doctors and their social media communities has not gone unnoticed. Professional organizations are becoming increasingly aware of this phenomenon and have started to issue guidelines for best practices on social media. For example, the American Academy of Family Physicians has specifically recommended not to offer medical advice, but rather to offer educational tips, protect users from misinformation, and avoid conflicts of interest that might arise through paid partnerships. These guidelines further show how, although no doctor-patient relationship is established, there is a concern over the duty of care that medical influencers owe to their followers.