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As patients and clinicians find themselves increasingly on sites such as Twitter and Facebook, more and more are asking whether they should be talking to one another using social networking outlets.

If so, how much? And on what level?

An American Medical News article points out that there is little professional guidance to help physicians navigate connections with patients. So, what one doctor may be comfortable with, another may not be. Some hospitals and medical school have policies to direct physicians, medical students and other health professionals on how to use social media properly, but formal ethical guidance to help physicians maintain professional standards online is limited.

It’s a discussion that continues to appear in conversation over conversation among those actively engaged in health care communications and social media.

This week, two of the three topics during the weekly Health Communications and Social Media (#HCSM) tweet chat focused on doctors’ engagement. The first, “You are talking to an MD about SM. MD days “Why SM? I don’t want to talk to people. I don’t need to.” How do you respond?” And second, “Do MDs who don’t adopt SM ‘policies’ or engage in any way risk becoming obsolete?”

There are many questions left to be answered besides should there be a dialogue or not. Would more doctors engage online with patients if there was training? There is code of conduct that governs physician-patient interactions in a face-to-face setting. But does that apply to online interactions? Should they be different?

And if doctors move beyond that, what role do they play in the use of social media with their patients and the community? Can platforms such as Facebook be used to help advance their patients’ health?