How doctors should professionally behave on Twitter

How doctors should professionally behave on TwitterAccording to one of the  the guidelines set forth by the AMA about professionalism in social media, “When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions.”

With that in mind, Bryan Vartabedian, who blogs as DrV at 33 Charts, publicly illustrated a Twitter stream that he deemed unprofessional.

I won’t recap it here, but instead go over to the thread and read about the controversy, as well as the comments, now numbering over 130.

Was it actually unprofessional?  Some doctors think not.  Emergency physician Shadowfax, for instance, notes the subjective nature of professionalism, and says,

if you look at the actual conversation nothing more was disclosed beyond the diagnosis, lack of risk factors, and the duration of symptoms. That’s hardly a lot of detail. I should also point out that she expresses significant empathy for the patient which is to her credit.

But, as others have have noted, did it pass the proverbial “elevator test?”  Meaning, if a physician verbalized the offending tweets in a crowded hospital elevator, would it be unprofessional?

A physician openly discussing an anonymous patient’s penile condition doesn’t pass such an elevator test, in my opinion, and is inappropriate.  I agree with Wendy Sue Swanson when she says, doctors “need to aim above HIPAA.”

So, although the content may not have technically breached patient privacy, physicians need to behave at a higher standard online.  Unfair? Perhaps, but that comes with the territory of being a doctor with an online persona, especially when the boundaries of professional social media etiquette are so unsettled.

And finally, does such a Tweet benefit the patient at all?  I’d say no.  Physicians should weigh that above all else when deciding to “blow off steam,” or express to the world what’s on their mind at a particular moment.

Some have asked me, “How would you have handled it?”

I probably would have reached out to the offending physician privately, rather than in a public forum.  No one likes to be called out.  The physician in question has been clearly affected, and has even lost sleep over this episode.  But I understand that DrV doesn’t generally engage anonymous online entities, and I respect that.

There are certainly benefits to conducting the dialogue publicly.  It’s hit a nerve, and the discourse has been instructive.

If this episode moves us one step closer to better defining how doctors should behave professionally on Twitter, I’d say that’s a good thing.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitterGoogle+, and LinkedIn.

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  • Ryan Madanick, MD

    Thanks for another balancing view. No one was clearly 100% right or wrong here, as is usually the case. This has spurred great discussion and is a learning point for all of us.

    Anonymity and Professionalism on Twitter: Room to Educate (

  • Bradley Jobling

    As more and more people go online for everything I think it’s important that physicians and the medial field adapt. Those who don’t, do so at their own peril. Apologies for the link, but I wrote this post a few weeks back and think it fits in with is being said in your post. Thanks for being a leader in this field Dr. Pho.

  • Martin Young

    Spot on, Kevin!

    I see two issues here, anonymity (1) allowing bad behavior(2). Both have their problems, but the combination is doubly dangerous.

  • Dr Sam Girgis

    Doctors are held to a higher standard than the rest of society. This should also apply online and in social media platforms. Facebook and Twitter are places were there is a lot of informality. As doctors, we should carry ourselves in a formal manner when using these website. In addtion, I also agree with Wendy Sue Swanson, we should aim to be above HIPAA especially on social media platforms.

    Dr Sam Girgis

  • medstudent

    I thought an outrageous letter regarding “The Girl With Unexplained Hair Loss” had been published on The New York Times.

    I wrote a blog post, tweeted it, but didn’t receive any comments.

    I am curious to know if doctors think that was unprofessional

    Thank you for your attention

  • Juliet K. Mavromatis, MD

    Interesting example. I don’t have a problem with a doctor alluding to penises as a general category on Twitter. However, alluding to a particular patient’s penis problem, though anonymous, seems to cross the line. Let’s hope that this patient is not able to identify himself with the escalation of this Tweet. This type of conversation in a public forum seems as though it might make one’s male patients feel uncomfortable. Many of us, however, have experimented with similar humor–sometimes with regret. I think that it’s through learning from these types of errors that one establishes a firmer sense of personal professional identity.

  • Nate Osit

    I participated in the chat on this topic, and I think it touched a nerve on the relationship between doctors and patients on twitter. Doctors who primarily interact with other physicians online seem to forget that patients are always listening, and that they need to remember to be respectful. It’s important to discuss these issues when they come up.

    That said, I feel as though a blame-game discussion is not as productive as a collective examination of online conduct. I think we realized that during the chat, and what people came away with was an increased awareness of the need to exhibit compassion and respect for patients at all times, especially in public forums.

  • The Nerdy Nurse

    I agree that someone should have spoke with the MD directly and discussed the issue. If they then choose to be arrogant and felt that it wasn’t an error, then a discussion may be merited.

    We are all human, and sometimes we say things, on twitter even, that we may not have thought through fully.

  • Sara Stein MD

    There was no redeeming social or educational value in that conversation other than the exhibitionist shock jock factor. How many times can you say the word penis and describe its appearance in public and get a reaction. I would have expected Howard Stern to be making those comments.

    Further, the rationale about empathy is nonsense in the twitterverse, where each comment exists existentially on its own. It’s not Facebook with a stringed thought-line that can be viewed all at once.

    No way around it. It was locker room doctor talk. We’ve all done it outside the locker room out of habit, we’ve all regretted it. Most of us never do it again. Live and learn.

  • Penny

    I must say that doctors are coming across as being more unprofessional all the time, and the more this happens, the more they will be sued. I was particularly shocked by the site put up by the Colorectal Association of Canada.
    The ads on the radio were even worse.
    It appears that the main goal of this site is is not to encourage colorectal testing, but to prove how interested they are in the sizes and looks of women’s butts and underwear. It makes women see doctors increasingly as perverts, especially when given the go ahead by such a large organization.
    While the creators of this web site are obviously talented in imagination, a skilled web site designer should keep his main goal in focus and not just write a lot of article on colorectal testing to cover up his chief interest which is obviously focusing on pornography. What good is talent when it’s used to it highly undermine the professionalism of a group it pretends to be promoting? While no woman is stupid enough to believe her doctor isn’t interested in such things, women don’t want to be reminded of it either.

    Sites like this, that teach women that doctors have more of a pornographic interest in their bodies than medical, encourage women to distrust their doctors ever more and launch lawsuits against them for the slightest suspicion of inappropriate touching. Is that the type of impression most doctors would really like to convey?

    Same with twitter. Surely there are professional sites they can discuss their problems on without the need for world wide viewing. What’s stopping them from going there?

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