A well-established medical blogger Dr. Bryan Vartabedian (aka @Doctor_V, a fellow gastroenterologist whom I recently had the pleasure of meeting at DDW 2011 #DDW11) seemed to ignite a firestorm this week amongst #hcsm tweeps with his post about a specific incident he saw on Twitter. He was (is) of the opinion that:
- Physicians who maintain a professional presence in the Social Media space (Twitter, Facebook, blogosphere), should not do so anonymously.
- Professionalism and respect for patients should be maintained in this space in a manner similar to the non-internet space.
I read the blog and was sure that most people would be of the same opinion. With only a few exceptions, most of the doctors I have encountered on Twitter have maintained a professional attitude, with a few notable exceptions, as documented in a recent JAMA Letter to the Editor. I was definitely not expecting the eruption of sentiment from several others.
What transpired felt like a political debate between conservatives and liberals. As a moderate I found it intriguing to listen to both sides and take it in, like an argument between the Dems and GOP on the appropriate way to decrease the deficit. Let’s at least agree that those who have differing opinions are not going to agree, and neither side is truly “correct” or “incorrect”.
To explain the basic themes of those that espouse the opposite view of Dr. Vartabedian:
- Physicians do not have a responsibility to maintain an online “level of professionalism” that reflects our profession.
- This space is a social, not a professional, space.
- Physicians have every right to be anonymous.
- Our freedom of expression, even as physicians, is protected, and one person should not be the sole arbiter of morality.
- Public condemnation of individual physicians may be just as unprofessional as the actions being condemned.
- Since there were no actual HIPAA violations, there was no direct harm.
I am going to limit the remainder of this discussion to Point #1, professionalism. Do we have a responsibility to maintain a certain level of decorum in every aspect of our lives, or just certain aspects? If just certain aspects, in which ones are we permitted to let loose? Is the Social Media space the appropriate place to drop our guard?
This is a matter of fervent discussion among medical educators and ethicists. In a recent article in the Annals of Internal Medicine, Drs. Mostaghimi and Crotty said “social networks may be considered the new millenium’s elevator”. We all know of doctors that do not keep quiet in the elevator no matter how often they are reminded of the issue of patient privacy. The same can be said for online personae.
I have recently become more interested in the issue of medical professionalism after attending talks at the recent GI Training Directors workshop as well as a seminar series led by Drs. Sylvia and Richard Cruess from McMaster, who are leaders in this area. They stressed that there is a gradient of professionalism and a learning curve that occurs over the years of education, training, and practice.
Two attributes of professional behavior are are germane to the discussion at hand: Morality/Ethical behavior, and Responsibility to Profession. The fact that the internet and social media are new does not excuse the behavior, which was clearly less moral or ethical than optimal, nor does the novelty of the space eliminate the Responsibility to Profession that all who are physicians should maintain. But just like there are some physicians whose medical knowledge, patient care, or interpersonal communication skills are less than optimal, we must realize that there are some doctors whose professionalism is so as well.
For those of us who enjoy educating, it behooves us to try to engender excellence among all of our colleagues. We have a long way to go, but let’s keep working at it.
As a post-script, I applaud @mommy_doctor for reflecting on her actions that led to the post, as noted by her tweets that came out subsequent to Bryan’s blog (“will think about my response”; “First of all, I did cross the line with a tweet or two so I apologize”). Such personal reflection is just as important as the discussion on #hcsm chat on Tuesday night and has continued through Wednesday.