Online physician professionalism, a medical student opinion

Recently we saw a flurry of discussions about online physician professionalism, the merits of being anonymous, and teachable moments. As a newbie I’m trying to figure this out. But I need to be more mindful of the filter bubble – a self-imposed bias by preferentially linking to people and things we agree with, thus unwittingly trivializing reasonable alternatives.

I’ve just had 3 “Uh-oh” moments:

  1. Right after the #hcsm Twitter chat on 5/24, something didn’t sit right in my gut. A single topic – one physician’s controversial tweet – ended up dominating the whole session. The chat was pretty one-sided (I too sang in that choir) with few new voices. Unfortunately, I suspect its only legacy was that the physician who sent the tweets in question quit Twitter.
  2. I got this comment on my last post from a physician: “Thanks for your boldness and willingness to police the profession. Blog On!” … I appreciate the applause but I’m just a first-year med student. If I gave the impression that I’m “policing” anything, I’ve gone wrong somewhere. Which dovetails into the next one:
  3. Posting a single view is a classic way to spark dialogue. I count on that dialogue to refine or correct my views. If I change my mind about something, my old view must have been flawed. But if I’ve published it already, I feel it’s dishonest to go back and delete/change what I’ve said. When I wrote about how med students can cultivate their online profiles, I thought social media profiles are either business or pleasure, and that it’s bad to mix the two. I now realize there’s a vast gray in between where physicians and nurses blog anonymously, exchanging lessons, humor, support and inspiration. It’s tricky to paint such diverse contexts with one broad brush.

On point #1, any physician’s demise is a net loss for our online community: we can’t grow from something that scares more of us away. The fallout illustrates the human-nature pitfalls of social media: excessive crowd-reactivity, and conformity of thought that often befalls a grassroots club. This isn’t the doing of any one person or blog post, it’s just mass effect (not a video game reference) and we should keep an eye out.

We’re like goalies at World Cup Soccer. We can catch 9/10 shots, miss 1, and the crowd boos and the death mail pours in. Any one thing we do in public can affect our community rapport. Not a question of fairness, but it comes with the territory.Friends of mommy_doc on Twitter defended her as a witty, competent and compassionate MD. I don’t doubt them. An ill-fated remark does not a bad doctor make. We’re human, but we try not to end up in places that require us (or friends) to explain our character.

On points #2 & 3, there’s lots of gray areas. Some push for moral consensus and accountability. Others vigorously defend the ethical no-man’s land where we are free to vent, entertain, and share anonymously. I’m skeptical of the latter’s value proposition, since there’s a potential for conflict of interests: one’s desire to tell a story vs. duty to the patient’s dignity that goes far beyond HIPAA.

A snapshot of this moment reminds me of a pendulum: in any one cycle, the weight is more likely to be found at either ends than in the middle. People seem polarized by different motives/forces. But while the back-and-forth never truly stops, in time, I hope the weight approaches middle, due to the uniform pull of – not gravity – wanting what’s best for our patients.

Still, it’s hard to imagine a bunch of physicians willing to go halfsies on their beliefs like school kids swapping lunch meat. I’ve heard that “getting any number of physicians to achieve consensus is like herding cats.” We’re addicted to heirarchy, guidelines and criteria, yet we scoff at compromise. Is there any way out?

We can start with a bit of introspection. Some of the more senior med blogs may have found their own ethical steadiness. For as long as we call ourselves “Dr. so-and-so” online, it’s only fair that we prepare by thinking through the following:

  • What’s my reason for tweeting/blogging? Is there a redeeming quality?
  • Am I effective at managing others’ expectations of my online persona?
  • If I let a friend secretly guest-post in my name, what would I ask of him/her?
  • If a patient recognized himself in my remarks (never mind HIPAA), how might he/she take it?
  • Which remarks could be taken the wrong way, and what type and magnitude of reactions can I expect?

The many flavors of med-blogs are characterized by different sets of risks, roles, and audience expectations. If each of us can keep our own answers straight on these questions, the world might feel less confused about what’s acceptable for physicians in their various online incarnations.

Jin Packard is a medical student who blogs at Fresh White Coat.

 

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  • http://www.nickdawson.net Nick Dawson

    Jin, thanks for the thought provoking post!

    This topic already reminds me of an op-ed in Modern Healthcare almost three years ago. The article’s author admonished medical students against using facebook; suggesting discussions about personal life were tarnishing the profession.

    I’m conflicted on the point. As a patient (we’re all patients!) and consumer of healthcare, my immediate reaction was to disagree with the op-ed. Please – let me see the real person. If, as the author suggested, posts involving parties and overindulgence in alcohol show up, at least I know it and can make a more educated decision about where my care comes from.

    Put another way, stopping the posting doesn’t change the behavior.

    In the example of the physician tweet heard round the world, whats worse, the fundamental character flaw or that it was posted online? That’s not rethorical, its a legitimate question.

    Taking the conversation in a slightly different direction… online social “gurus” (as defined by those with pre-2008 twitter accounts?) tout the idea of “personal brand”. The idea is we are a mix of our professions, personal life, hobbies, friends, etc. Successful online socialites know how to properly mix those things. Those successful folks might suggest there is an effective way to encapsulate being both a professional and a relitivly normal human (arn’t most doctors normal humans still?).

    To me, all of this raises the question of where the profession of practice medicine has inherent differences and standards. Clearly there is a societal expectation around physician morality and behavior which we expect to extend well beyond the clinic’s walls.

    Conversely, what we are seeing from millennials and the online social savvy crowd is a relaxation of the barrier between professional and personal life. Millennials were discouraged from having college party pictures online and now HR hiring managers tell me it just comes with the territory; they consider those things less in a hiring decision than they did a few years ago.

    Regardless of where the line in the sand is today for physicians, are we seeing a shift? And, if that is the case, does that help consumers identify with the more personal side of their physicians or does it determinately deteriorate a long held professional image?

    • http://www.freshwhitecoat.com Jin Packard

      Nick,

      You alluded to one of the positive aspects of physicians blogging, which is that it humanizes us. It provides the reading public a more humane (even raw/honest) context in which to view physicians. That, of course, also means from time to time our faults show through in our posts/tweets. But as long as our missteps are not egregious, I think we’d be forgiven, even appreciated, for our efforts to give non-physicians a peek into our lives.

      Not just us physicians, but our patient base is also going through a shift in social norms, and as the facebook generation begins to fill the higher age brackets of our patient base, we will see a demand – not in the strict economic sense, but more in terms of social norms and nuance – that physicians be willing to keep up with how they feel people should connect and communicate.

      Going forward, I expect these discussions and self-reflections to continue. Out of that, I’m hoping we would all come out with a way of looking at blogging and patient communication that is more rooted in duty and critical thought, rather than fear and legalese.

  • http://www.nickdawson.net Nick Dawson

    drat, really must proof before posting comments.
    Would prefer to have said:
    “the PURPORTED fundamental character flaw or that it was posted online? ”

    Didn’t intend to offer so much judgment in that sentence.

  • http://blogs.dal.ca/distmeded DistMedEd

    Jin,
    I enjoyed reading your post. You’re on the right track by spending time and effort on reflecting about the intersection between social media, professionalism, and the internet in general. I hope you will continue to explore these topics.

    The act of writing a single post, a series of posts, or even several tweet, provides an opportunity to compose your thoughts and fix them in writing. The self-reflective aspect of blogging and micro-blogging by student has the potential to truly revolutionize medical education. Yet, along the way, as you point out – there needs to be some guidelines or online manners, to ensure the dialogue promotes discussion.

    Great work – keep it up!

  • http://www.thenerdynurse.com The Nerdy Nurse

    In blogging, med and personal alike, there is room for everyone!

    Blogging is an extension of who we are and some of us choose to integrate our professional lives into that as well. And just as in the medical field, errors can and do occur. To er is human, and until we have robots and machines doing everything for us, then we are going to encounter some ‘ers’ every now and then. Social media is no different.

    The benefits of using social media as a healthcare provider far outway the risks. I have gained so much personally and professional from being involved in healthcare social media and it’s unfortunate that sometimes people are singled out for errors in judgment. We are all human and we all deserve some understanding.

    If you’d think that you can be both human with a sense of humor and be professional at the same time, they you are exactly who I want to connect with on twitter!
    http://twitter.com/thenerdynurse