Addressing an upset patient and negative Facebook postings

Q. An obstetrician called regarding a patient who recently lost her baby during the 31st week of pregnancy, due to an unanticipated placental abruption.   According to the physician, the patient blames the OBGYN for this outcome. She has been posting untrue and highly critical comments about the OB on Facebook on which the OB is also active.  The patient is scheduled for her 6 weeks postpartum visit this week.  Although the physician is sympathetic to the patient’s loss of her pregnancy, the physician is also concerned that these negative postings are visible to many of his active patients.  The situation has totally unnerved the physician. He requested guidance about responding to the Facebook postings and the patient’s upcoming post-partum visit.

A. It is important to remember that healthcare providers are severely limited with how or even if they can respond to negative social media postings.  Even an innocuous reply that does not identify a patient by name but provides sufficient detail to identify the individual as a patient of the provider and/or practice can constitute a violation of HIPAA. The physician must resist the temptation to respond directly to the patient on social media. However, the physician can call or write to the patient directly and ask the patient to contact him to discuss the anger and anguish she feels. The physician should also recommend appropriate counselling about the loss of her pregnancy.

Even though the Facebook postings may be egregious, the patient may still keep her postpartum visit. If so, we recommend that the OBGYN see the patient for this upcoming appointment.  The Facebook postings could be indicative of a post-partum depression. Therefore, it is important to fully evaluate the patient’s physical as well as emotional status at that visit if the patient keeps the appointment. However, he should not confront the patient about the negative online posts.

The provider should also be prepared to appropriately respond to the patient’s failure to keep her post-partum appointment. Should this occur, which is very likely, the provider should notify the patient of the importance of having a post-partum visit, and the risks/dangers associated with non-compliance.  These efforts should be meticulously documented in the patient’s medical record.

Finally, if the patient does come to the post-partum appointment, and the provider feels that the patient’s condition requires no further follow up, the provider can then initiate the patient discharge process from the entire practice, because of a serious disruption in the Dr-patient relationship. If the patient does not keep the postpartum appointment the physician should also discharge the patient from the entire practice or if the patient has so indicated, confirm discharge by the patient.