Yesterday, I received a LinkedIn invitation from a former patient. It happens once in a while. Of course, I can't accept the invitation because doing so potentially exposes the identity of a patient to my other connections. Even though the former patient sought the connection, I'm still ethically and legally bound to protect his/her privacy. Although a LinkedIn connection doesn't, in and of itself, identify connections as patients, it could lead to speculation among my other connections, especially if some of those other connections are themselves current or former patients.
At a recent electronic ethics program I attended, an attorney-psychologist who is a pioneer in the area of ethics in electronic practice, recommended against using LinkedIn, even if we don't link to patients. When he set up his own LinkedIn account, he was troubled to learn that LinkedIn was recommending connections to patients and friends of patients, even though he hadn't connected to his patients via LinkedIn. What surprised me is that this expert was still puzzled about how this troubling turn came about.
Evidently, he didn't realize that one of the permissions you grant when you sign up for LinkedIn is permission to access your email contacts. So if you have email contact with patients, and you sign up for LinkedIn using the address you use with patients, LinkedIn has names and email addresses of your patients. LinkedIn will then encourage your patients and other email contacts to connect with one another. Obviously that's a problem. Imagine the conversation: "Hi there. How do you know Dr. X?"
The solution to this problem with LinkedIn is simple. When opening a LinkedIn account, begin with a virgin email account that has no contacts and no history. Use the account only for LinkedIn activities, and never let that email account be used for any other activities. That's what I did, and I've encountered no problems.
Detour: Another precaution you can and should take is to set up an email account that is used exclusively for your practice. I have a practice domain and set up a practice email account with Hushmail, which is an encrypted platform. I do not use that email address for anything but contact with patients, and I only allow use of email for exchange of logistical information such as addresses, phone numbers and scheduling. No other patient data is ever exchanged via email.
By the way, I also have a signed BAA (Business Associate Agreement) with Hushmail. The BAA contractually extends HIPAA regulation to the contractor, in this case, Hushmail, while immunizing the health care provider from legal responsibility for privacy compromises on the contractor side of the relationship. If Hushmail somehow breaches privacy of patient emails, the BAA legally protects me from the fallout, per HIPAA. You need to show these BAAs if the gubmint ever audits your practice for HIPAA compliance. Fines for failure to comply are as high as $50k, so it's no small matter for a solo practitioner or a small group practice. /detour
Returning to LinkedIn, when I set up my LinkedIn account, it was intended only to function as a first-page placeholder for Google searches, but I made a few connections with other other psychologists who have asked to connect. Since maintaining my own privacy matters, I don't even allow family or friends connect with me.
So, as you can see, in the electronic world, it's all about erecting Chinese walls around practice information and professional activity. There's a lot more to protecting patient privacy and confidentiality than this, but this discussion is only intended to cover participation in LinkedIn and, more broadly, social media.
About that former patient who asked to connect via LinkedIn, I must say I was surprised. The patient has a rather distinctive name that I recognized, but couldn't place at first. A little digging determined that I saw this person for less than ten sessions over a decade ago. The patient has few connections, so I'm especially surprised by the effort to connect. Perhaps this person is considering a return to therapy.