Costs of communication on email, Facebook and Twitter

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in Social media

by Alex Lickerman, MD

Email, Twitter, Facebook, MySpace, YouTube, Delicious, Digg, LinkedIn, blogs (of course), and scores of others—all part of the new and wonderful ways we can now connect with one another electronically, each with its own culture and unique set of rules.

In one sense, the planet has never been more interconnected. And yet, this interconnectedness, while wonderful, hasn’t come without cost.

Isolation

Much has been written about the dangers of Internet addiction. From pornography to merely surfing the web, the Internet is clearly the television of the 21st century, an electronic drug that often yanks us away from the physical world. Like any addiction, the real cost, for those of us who are truly addicted, is to the number and quality of our relationships with others.

We may enjoy online relationships using social media sites like Facebook or Twitter, for example, but the difference between these kinds of interactions and interactions with people in the physical world is clearly vast. As long as we expect no more from these online relationships than they can give, no good reason exists why we can’t enjoy the power of social media sites to connect us efficiently to people we’d otherwise not touch.

The problem, however, comes when we find ourselves subtly substituting electronic relationships for physical ones or mistaking our electronic relationships for physical ones. We may feel we’re connecting effectively with others via the Internet, but too much electronic-relating paradoxically engenders a sense of social isolation.

Dangers

Making our meaning clear electronically presents extra challenges. For example, we write things like “LOL” and “LMOA” to describe our laughter, but they’re no real substitute for hearing people laugh, which has real power to lift our spirits when we’re feeling low.

I’ve also observed people using electronic media to make confrontation easier and have seen more than one relationship falter as a result. People are often uncomfortable with face-to-face confrontation, so it’s easy to understand why they’d choose to use the Internet. Precisely because electronic media transmit emotion so poorly compared to in-person interaction, many view it as the perfect way to send difficult messages: it blocks us from registering the negative emotional responses such messages engender, which provides us the illusion we’re not really doing harm.  Unfortunately, this also usually means we don’t transmit these messages with as much empathy, and often find ourselves sending a different message than we intended and breeding more confusion than we realize.

As a result, I’ve made it a rule of thumb to limit my email communications as much as possible to factual information only. If I need to work something out with someone that feels difficult, uncomfortable, or unpleasant, I make myself communicate in person. In-person interactions, though more difficult, are more likely to result in positive outcomes and provide opportunities for personal growth. Whenever I hear stories of romantic break-ups, firings, or even arguments going on electronically, I cringe. We find ourselves tempted to communicate that way because it feels easier—but the outcome is often worse.

Etiquette

For transferring information efficiently, the Internet is excellent. For transacting emotionally sensitive or satisfying connections, it’s not. My wife and I joke that we use email messaging when we’re sitting back-to-back in our home office, but we use it to keep a record of our schedule. When we have a conflict, we turn our chairs around and talk.

Even when we’re all careful to use the Internet only to exchange information, problems can still arise. People tend to delay answering emails when they don’t have what they consider to be good answers or when they want to avoid whatever responsibility the email demands of them. But this is like being asked a question in person and rather than responding, “I don’t know” or “I’ll have to think about it,” turning on your heels and walking away in silence. It’s far easier to ignore an email sender’s request than a request from someone made in person because an email sender’s hope to get a response or frustration in not receiving one remains mostly invisible. But it’s every bit as rude.

Our “emotional invisibility” on the Internet perhaps also explains so much of the vitriol we see on so many websites. People clearly have a penchant for saying things in the electronic world they’d never say to people in person because the person to whom they’re saying it isn’t physically present to display their emotional reaction. It’s as if the part of our nervous system that registers the feelings of others has been paralyzed or removed when we’re communicating electronically, as if we’re drunk and don’t realize or don’t care that our words are hurting others.

Social media websites are wonderful tools but are often abused. A few common sense rules for the electronic world apply:

1. Don’t say anything on email you’d feel uncomfortable saying to someone in person. If it needs saying but feels awkward, do it in person. Look upon it as practice for handling confrontation maturely. Consider yourself drunk every time you get online so that you take steps to monitor yourself carefully. If you find yourself tempted to behave like a boor, step away from your keyboard (you wouldn’t drive drunk, would you?).

2. Don’t delay your response to messages you’d rather avoid. If someone has reached out to you, they care about your response. I’m sometimes guilty of this one myself, but I’m working on it.

3. Relationships are affected by online communication. It’s much easier to injure friendships online than in person because of the ease of creating creating misunderstandings electronically. Non-verbal communication, after all, (argued by to some to represent up to 40% of our in-person communication) is completely absent. Be careful how you word every electronic message you send, in whatever context. Remember that every Internet message you send becomes a permanent part of your brand (whether you’re trying to market something or not).

4. Balance time on the Internet with time spent with friends and family. It may seem too obvious to mention, but it feels qualitatively different to go out to dinner with friends than to spend several days engaged in back-and-forth email exchanges. So much communication and meaning is lost in the latter. And our effect on one another is much more intense when we meet in person. When a friend is going through a rough time, nothing substitutes for in-person communication. A gentle smile or a heartfelt hug has far more power than the cleverest emoticon to lift another person’s spirits.

Conclusion

The Internet is an amazing tool. But even as it’s shrunk the world and brought us closer together, it’s threatened to push us further apart. Like any useful tool, to make technology serve us well requires the exercise of good judgment. For whatever reason, the restraints that stop most of us from blurting out things in public we know we shouldn’t seem far weaker when our mode of communication is typing.

Unfortunately, typed messages often wound even more gravely, while electronic messages of remorse paradoxically have little power to heal. Perhaps we just don’t think such messages have the same power to harm as when we we say them in person. Perhaps in the heat of the moment without another’s physical presence to hold us back, we just don’t care. Whatever the reason, it’s clearly far easier for us to be meaner to one another online. Let’s try not to be.

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.

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{ 7 comments }

1 Jeff J. July 23, 2010 at 10:07 am

Thanks for your thoughtful post. I am interested in seeing how our future generations engage in face to face interactions considering how today it can hard to reach even smart phone owners.

One would think it would be quite relatively easy to contact a person who has access to voice, text and email.

2 Paula Johnson July 23, 2010 at 3:29 pm

The Good Doctor is right. I think people are often less sensitive (or simply more bold) when they don’t face the person to whom they are communicating. This, like all issues of communication, must be handled through education.

The issue of written tone I think can easily work itself out. Look at the new products being released that allow you to send voice messages as email (TrulyMail, Google Voice, etc.) and you can see that you can communicate with tone more clearly.

We know that most information during face-to-face communication is communicated non-verbally (body language) but I think the spoken word can still be used with today’s technology to get more meaning across (someone typing in ALL CAPS might not be shouting).

3 IVF-MD July 23, 2010 at 3:30 pm

So true. I know spouses who IM each other from nearby rooms in the same house.

4 W July 24, 2010 at 5:48 am

I remind my staff at work as well that they should always assume their e-mail will be forwarded places they never intended and write it accordingly (and to doublecheck the “To” field before sending). E-mail is never private. I don’t think I’d ever want to discuss confidential medical matters using the medium, nor would I think any less of a physician disinclined to do so. Has worked out pretty well for setting up appts, but beyond that…no thanks.

5 twicker July 24, 2010 at 3:54 pm

I agree with your assertion that everyone should assume that e-mail will be forwarded (the old rule is to never write anything in an e-mail that you wouldn’t want to see on the front page of the NY Times).

As for the not discussing medical matters: from a patient standpoint, being able to discuss certain medical matters via e-mail can help tremendously.

For example: I and my sisters all have healthcare power of attorney for our elderly mother. I live in the same town as my mom; one sister lives a 2.5-hour drive away, and another lives on the other side of the Atlantic. E-mail allows all of us to be kept informed as to what’s currently happening with my mom’s condition and what the doctor’s response (if any) is to the information.

Sometimes, it’s simply one of us e-mailing her doctor prior to an appointment to mention issue(s) of concern; sometimes, we have what we feel to be a small concern (something that might be able to be handled over e-mail) and we just want a check on what’s happening. If the doctor feels that something requires a visit, or if he is not comfortable responding over e-mail, he lets us know; this allows us to separate the levels of attention Mom needs.

IMHO, one of the largest problems (mentioned here @ KevinMD.com many, many times before) is that it’s hard to bill for this time. We have some solutions, but we need more implementation of these solutions. Until then, I would recommend that all docs be willing to use e-mail, even for some HIPAA-confidential medical information (and only with appropriate, vetted HIPAA-compliant policies in place) — but carefully.

6 W July 24, 2010 at 11:55 am

Your example makes a good point. Thanks.

7 Alice July 25, 2010 at 6:24 pm

As for the not discussing medical matters: from a patient standpoint, being able to discuss certain medical matters via e-mail can help tremendously. [end quote]

I agree with Twicker (on two different threads…..I’m impressed)! When the radiation took a toll on our daughter I wrote to two doctors. The second doctor got involved and I got a response from both of them (the second doctor was kind and caring and it was really healing to receive his e-mail). We switched doctors and the lack of response to e-mail was one reason we changed. The new doctor writes back thoroughly, and uploads test results. It makes a world of difference, but he did say few patients write to him. That will change. A recent poll said that people over (I think) 35 years old don’t mind holding on the phone for a doctor, while those between something like 25 and 35 years old like e-mail, and the younger ones are so used to instantaneous texts they could drive a doctor crazy if they had his cell phone number. We are products of the technology of our generation. E-mail would seem to be so much easier than the phone, so I often wonder if a doctor’s preferences aren’t based on age and what they are comfortable with. I, personally, wish all doctors would answer their e-mails because patients will admit to things in e-mails they would never admit to in an office visit. It helps with diagnosis for the doctor, and it helps the patient feel cared for. Realizing some articles will bring up the lack of payment for those e-mails. My doctors are salaried, so they answer most e-mails at work (but sometimes will write on the weekend….but I would not expect that). One of our doctors does video conferencing with a few patients in a test program. I understand the patients love it. It would seem a bit strange, but it would certainly keep everyone on their toes when there is a record of the complete visit. If patients forget almost 70% of a visit, having their visit logged would be helpful.

Once I found myself wondering if Kevin has stats on the average age of his posters, or a categorizing of what those age groups are interested in as far as articles go. I realize he doesn’t ask for our ages, but it would be of interest to me. There is so much anonymity here though I guess those stats aren’t going to be forthcoming. I link to my Twitter page, so I am findable, and so are the author’s of articles (and I tend to think some of them post anonymously too. Sometimes you pick up on a type of rhythm contained in the writings). Just thinking aloud…….it’s the strength and weakness of social media.

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