Most social media guidelines for physicians, most recently from the American College of Physicians and Federation of State Medical Boards, suggest that doctors separate their personal and professional identity.

Until physicians are better educated on how best to act professionally on social networks, keeping their online personal lives private is more likely to keep them out of trouble.

But is it time for that recommendation to be revised?

In a recent JAMA perspective piece, bioethicists from Johns Hopkins argue against separating physician personal and professional identities:

We contend that this is operationally impossible, lacking in agreement among active physician social media users, inconsistent with the concept of professional identity, and potentially harmful to physicians and patients. A simpler approach that avoids these pitfalls asks physicians not whether potential social media content is personal or professional but whether it is appropriate for a public space.

Instead, they argue that physicians are held to a higher standard of behavior than the public, and shouldn’t frame social media as personal versus professional. Instead they should ask themselves before posting on a social media site, “Is this appropriate for a physician in a public space?”

“Is this appropriate” is a question doctors should ask themselves before posting anything on a social media site. And while this model works well for public social media spaces like Twitter or Google+, I wonder about Facebook.

Without separating identities, how do the JAMA authors suggest handling Facebook friend requests from patients?

35% of physicians receive friend requests from patients.  Every physician social media guideline I’ve read says to reject them.

Facebook too easily blurs that line between one’s personal and professional life.  My personal Facebook profile doesn’t cross any professional boundaries, and would be appropriate in a public space.  But I wouldn’t be comfortable sharing those updates, which can include vacation pictures or stories of my kids, with patients.  That’s one reason why my Facebook profile is closed to both the public and my patients.

Yet Facebook has tremendous potential as a platform for patient education.  But unless physicians friend patients, they can only do so with a Facebook page.  In other words, a separate, professional identity.

(And yes, I’m aware that Facebook and Google+ allows you to group friends onto lists and circles respectively, where you can control the stream of information you broadcast to. But isn’t that just another way of separating your identity?)

Here’s my bottom line, which is more nuanced than both the JAMA perspective piece and current social media physician guidelines.

On public social networks like Twitter or Google+, separating identities isn’t often feasible. I have a single persona on these platforms, where as a physician, I accept the expectation of being held to a higher public standard of behavior.

However, the personal nature of Facebook presents a greater professionalism risk for doctors. I continue to recommend that if physicians want to use that platform to educate patients, they do so with a page separate from their personal profile.

Kevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on Facebook, Twitter, and LinkedIn.