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Doctors are urged to think twice before they price that "post" button on Facebook, or that "Accept" friend request from a patient, a new report said Thursday.

A report published online today in the Annals of Internal Medicine. by the American College of Physicians and the Federation of State Medical Boards suggests doctors should remember that the boundaries of the physician-patient relationship apply online as much as they do in an exam room.

The report urges doctor to not "friend" patients, only text them with "extreme caution" and should use e-mail only with patients who understand the risks of lost privacy, says the latest set of guidelines to help doctors navigate the online world.

According to Dr. Humayun Chaudhry, president and CEO of the Federation of State Medical Boards, the main thing that doctors should bear in mind is to separate their personal and professional lives and to help them maintain a professional distance from their patients. 

"We're not telling people what to say, we're just asking people to think before they hit 'send,'" he said during a press conference Thursday morning at the American College of Physicians' Internal Medicine conference in San Francisco, according to Healthline.

The new paper recommends using only digital forms of communication, such as e-mail, for patients with whom doctors have a preexisting relationship and to avoid any kind of communication that could violate patient confidentiality laws.

The advice is sound, but the truth is that many physicians already are too timid about using online communication,

According to Kevin Pho, an internist who practices in Nashua, N.H., and is well known for his blog KevinMD said the advice is good, but in reality, doctors are too busy or too timid to use online communication.

Pho did not work on the guidelines but is co-author of a new book, Establishing, Managing, and Protecting Your Online Reputation: A Social Media guide for Physicians and Medical Practices.