By Katherine Hobson

Accepting Facebook friend requests from current or former patients is a lousy idea, the British Medical Association is telling physicians.

The group’s new social media guidance notes that “because of the power imbalance that can exist in any doctor-patient relationship,” it’s important to establish a professional boundary. And that can be tough to do given all the personal information a Facebook status-update stream can deliver.

The BMA writes:

Given the greater accessibility of personal information, entering into informal relationships with patients on sites like Facebook can increase the likelihood of inappropriate boundary transgressions, particularly where previously there existed only a professional relationship between a doctor and patient. Difficult ethical issues can arise if, for example, doctors become party to information about their patients that is not disclosed as part of a clinical consultation. The BMA recommends that doctors and medical students who receive friend requests from current or former patients should politely refuse and explain to the patient the reasons why it would be inappropriate for them to accept the request.

You can imagine a scenario, for example, where a doctor sees pictures posted on Facebook of a patient he knows to be three months pregnant at a party, with a cigarette in one hand and a beer in the other. Is it ethical to bring it up at the next visit, even if she doesn’t?

The new guidance also includes advice that doctors consider adopting conservative privacy settings on their online profiles and warnings to respect patient confidentiality and declare conflicts of interest.

The American Medical Association’s social-media policy doesn’t explicitly recommend against friending patients. It does say that if doctors interact with patients online, they should “maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context.” And physicians “should consider separating personal and professional content online.”

The Mayo Clinic recently put together a video to help spark discussions about how medical residents can negotiate the social-media terrain.