Manners For The Digital Age

Twitter Therapy (Transcript)

Is it appropriate to follow my psychiatrist on social media?

Farhad Manjoo:  I wonder if it’s possible to have Dr. Smith tweet my prescription to the corner pharmacy.

Emily Yoffe:  I’m Emily Yoffe, Slate’s Dear Prudence advice columnist.

Farhad:  I’m Slate’s technology columnist, Farhad Manjoo.  And this is Manners for the Digital Age.

This week’s question comes from a daughter whose mother is taking her psychotherapy into cyberspace. She writes, “Dear Farhad and Emily, recently my mother created a Twitter account for her new business. When she followed me, I went to her profile to see who else she was following. One of the people she follows is her psychiatrist. My psychiatrist also has a Twitter account, although I do not follow him. What is the etiquette surrounding this? Can I follow my shrink on Twitter? Would it be appropriate for him to follow me back? What if I wanted to follow my mother’s psychiatrist? Does HIPAA have anything to say about all this?” Signed, Twitter Therapy.

For the reader’s question about HIPAA, our producer, Melonyce McAfee, talked to an expert on HIPAA law. What did you find out, Melonyce?

Emily:  Let’s explain what HIPAA is, first of all.

Melonyce:  That’s the federal law that governs the electronic transfer of medical information. It restricts how doctors can handle your medical information, who they can release it to, and how they handle it within their office.

HIPAA, as it relates to social media, is a little bit murky and it’s sort of a battle ground area for law and for regulators right now. HIPAA doesn’t specifically mention social media, but it’s thought to encompass social media within its tenets.

Doctors can’t just discuss your personal medical information on Twitter with the world. They can’t say, “Hey, did you take your meds today?” They can’t release your specific medical records to family members. Certainly, they wouldn’t want to do that on Twitter or Facebook, but they can’t do that without your expressed permission.

Farhad:  So can they follow you? That wouldn’t release any information about you, but it might suggest. If a doctor follows me and other people see he’s a doctor, it might suggest that he’s my doctor which might be some kind of privacy violation.

Melonyce:   I don’t think it’s considered a privacy violation for you to follow a doctor or for a doctor to follow you. That could be interpreted by the public as just a business relationship or as a social connection. The expert that I spoke to said, “Sure, you could follow your doctor or your doctor could follow you with no problem. The problem comes when you start transmitting information back and forth.”

Or if your doctor describes a patient interaction and uses some characteristics of your condition or your personality, someone might be able to track that back and determine that your doctor is talking about you.

From a lawyer’s point of view, advising a doctor, he would say, “No don’t reveal any information about a patient on Twitter. You can follow your patient for the purposes of, say, tracking their mood or tracking what they’re talking about if you have disclosed what you’re going to do.” You need to explicitly have that conversation if you’re a doctor.

As a patient, you want to be fully informed about how your doctor is going to use the information that he or she has access to on Twitter. Patients always sign a HIPAA disclosure form, and nowadays doctors are including social media information in that HIPAA form oftentimes if they do have social media relationships with their patients.

Farhad:  One of the things you mentioned is a psychiatrist might want to follow a patient to peek into their mood or see what they’re doing online. I don’t know much about psychiatry, but it strikes me that the amount of time that people spend on online and the amount of information they disclose could be a really good source – a way to track your patients and the way they behave in the real world (or an approximation of the real world) that comes from something beyond what they say. It seems like it could be pretty valuable for a doctor.

Emily: Also, a pain if now you feel, “Gee, I should be following my patient’s posts.” The New York Times had a story a few weeks ago about colleges, students on Facebook, and the psychological services at colleges which dealt with some of this. They did a study tracking students’ moods and they found 25-30% of kids were posting rather alarming things about their moods that could indicate depression and possible suicidal thoughts.

The problem with all of that is you’re dealing particularly with melodramatic college students, so sorting through “I’m going to kill myself because of this exam” and “I’m going to kill myself” is a big problem. But it did say one dorm advisor friended all the students in her dorm and did keep track that way and saw that someone appeared to be having an alcohol problem and found this person passed out in her room.

The one big thing they said is it’s one thing to look at all this stuff, but you don’t then deal back and forth on Facebook. You go face-to-face.

I think we’ve dealt with the larger legal question, but should this person follow her shrink or follow her mother’s shrink? What do you think, Farhad?

Farhad:  Following her mother’s shrink is really weird. I don’t understand why she would want to do that. Would this be a way to get an insight into her mother’s personality in some odd way? I don’t understand that.

But in telling so much to a psychiatrist, you probably get very curious about your psychiatrist and that probably accounts for why you would want to follow that person.

I think it’s fine. I don’t see anything wrong with it. It’s fine to follow them, but you might learn stuff about your psychiatrist that might put off your psychiatry session. There’s a funny episode of “Curb Your Enthusiasm” where Larry David sees his shrink at the beach in a thong and can’t go back to him after seeing him in a thong.

Emily:  Well, that occurred to me, too. First of all, I’m wondering what are all these psychiatrists tweeting? “I had two oral fixations and a body dysmorphia today.” I think this professional has to be very careful about his or her tweets and Facebook posts. And I think you’re right – it probably is more of a benefit to the patient in some ways than the psychiatrist.

Traditionally, your therapist has been fairly opaque to you, but now you can find out. What if your therapist is saying, “Gosh, I hate the way social conservatives have taken over the republication party,” but you’re a social conservative? That’s going to have a serious effect on your therapy, and you might or might not bring that up. I think all those are something to consider.

The other thing is the letter writer says, “Should my psychiatrist follow me back?” If the psychiatrist does, are you going to get charged for the psychiatrist reading your tweets? I think a psychiatrist should not follow back.

Farhad:  My bottom line is I think there’s no etiquette problem in following your shrink, but it might not be great for your therapy, so don’t do it.

Emily:  I agree. I think your therapist is not supposed to have a social relationship with you, and labeling yourselves friends of each other creates questions. I think you can do it and you can discuss it in therapy while you’re following your shrink, but these are issues that should be addressed within the therapy session, and I think it’s really important not to let that relationship spill over into social media.

Send us your questions about shifting etiquette in the online age. Our address is

Farhad:  You can also join our Facebook page where we carry on the conversation throughout the week. Go to

Emily:  And we’ll talk to you next time on Manners for the Digital Age.

Correction, April 13, 2012: This article originally used an incorrect acronym for the Health Insurance Portability and Accountability Act. The correct acronym is HIPAA.