Dr. Markham wanted to convey several important objectives in her talk. Firstly, physicians need to recognize that patients are communicating with each other and with physicians online, and this is only going to expand. Secondly, it is important to understand that professional guidelines exist to guide physician-patient online communication, and they should be adhered to. Lastly, she would focus on developing a strategy for how to communicate safely with patients on social media.
We have significantly progressed from the time where patients only communicated with their doctors in the examination room. Nowadays, patients have 24/7 excess to their electronic charts, they can see the results of their tests, schedule an appointment, refill or request a prescription, view their account statement and pay their bills, and even send a message to any one in their care team.
Modern communications also includes and involves social media such as twitter, Facebook, and other dedicated health platforms such as cancer community support (www.wellnesshouse.org/Cancer-Support), “patients like me” (https://www.patientslikeme.com), “Inspire” (https://www.inspire.com/), “Smart patients” (https://www.smartpatients.com/), and more.
Dr. Markham then discussed the important question of whether physicians should be friends with their patients on a platform like Facebook. She presented some statistics on this topic, including a survey of 1500 Australian physicians, showing that 1 in every 5 physicians received a friend request from a patient.  Furthermore, a survey of US and Canadian academic physicians in 2011 demonstrated that 4 out of 5 physicians felt it was never or rarely appropriate to become social networking friends with patients. 
Next, Dr. Markham discussed the Pros and Cons of physician-patient communication online. She began with the cons which include potential violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which is a United States legislation that provides data privacy and security provisions for safeguarding medical information. Additionally, this kind of relationship is unprofessional, with a potential to make the physician always available to the patients, due to the high accessibility of these platforms. Lastly, this kind of digital online relationship can cause unwanted blurring of physician-patient boundaries.
In contrast, the advantages of this kind of online communication include the fact that it can provide education with reliable information, and an ability to correct misinformation. Furthermore, it can raise awareness and advocacy of different topics. It also enables the physician to publicly demonstrate compassion, expertise, and passion. Finally, it enhances the understanding of patient experience on the one hand, and trust in the medical profession on the other hand.
Dr. Markham then showed the position of various guidelines on this important topic. The American Medical Association (AMA) states that doctors must maintain appropriate boundaries of the physician-patient relationship. Furthermore, doctors need to consider separating personal and professional content online. The Federation of State Medical Boards (FSMB) states that physicians should not friend or contact patients through personal social media. More liberal recommendations come from the American College of obstetricians and gynecologists (ACOG), stating that the social media profile is a powerful tool with low risk when maintained with close surveillance. Furthermore, ACOG state that how physicians should interact with patient personal digital and social profiles remains unsettled. Importantly, the ACOG declines to recommend against it.
Dr. Markham then gave 10 tips for use of social media by physicians:
1. Get involved – take advantage of the greatest opportunity to disseminate credible information and influence both peers and patients
2. Engage often – To increase your profile, provide input, respond to others and create new content
3. Always identify yourself – anonymity is a myth
4. Protect patient confidentiality and privacy
5. Contextualize your activities
6. Avoid impropriety – ensure that any potential conflict of interests are readily disclosed
7. Give credit where credit is due
8. Professionalism is critical
9. Separate the personal from the professional – Maintain professional distance between you and the patients
10. Be aware of your institutional guidelines on social media – If you have questions, seek guidance
Dr. Markham reiterated that if social media is to be used by physician, it must be done in a safe manner, while adhering to institutional guidelines. Additionally, one must separate personal from professional content in online activities. Lastly, physicians need to create professional profiles and always act professionally.
Dr. Markham concluded her great talk saying that it important to always be authentic in online activities and gave a quote by Dr. Amy Caruso Brown from the JAMA journal, summarizing her own view on social media: “The ethical complexity of this new world does not change the simple truth of my experience: I am a more mindful and compassionate physician because, against all I had been taught, I accepted a friend request.”
Presented by: Merry Markham, MD
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter:@GoldbergHanan at the 2018 ASCO Annual Meeting - June 1-5, 2018 – Chicago, IL USA
 Brown et al. JMIR 2014; 16(12):e267
 Chretien et al. Acad Med. 2011; 86(12) 1545
 Amy Caruso Brown JAMA 2017;317(24)