The position paper from the American College of Physicians and the Federation of State Medical Boards, is a humbling reminder of the challenges that today’s physicians face when entering the online space.

Their recommendations for online medical professionalism, written by ethics committees for the two organizations, “provides recommendations about the influence of social media on the patient–physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician–physician communication that preserve confidentiality while best using these technologies” — no small amount of territory to summarize.

But given the tenure of their document, I should probably hang up this blog right now.  After all, why risk being vulnerable in the online world?  While well-meaning on one hand, we should appreciate that physicians have officially been put on notice on how to behave online.

To be fair, I agree with most of what they say.   All the things about patient confidentiality are appropriate.  All the things about respect for persons, better still.

But to me, the part of the document that wanders off into the “influence of social media on the patient-physician relationship” and the influence of social media on the “public perception of physician behaviors,” is more difficult to gauge in its benefit or detriment to the public discourse.

After all, perception is in the eye of the beholder.  When central health care planners muddle the ethics of patient safety by facilitating the deployment and mandating use of untested electronic medical records, should doctors sit quietly and act “professional” as the age-old ethics of research and study are cast aside in the name of the “public good?”   Taking it a step further: should doctors, in the interest of political correctness, cower in our newly constructed cubicles and tow the corporate party line, even though it harms our patients, lest we run afoul of corporate social media gag clauses?

Yes, dear doctor, according to the guidelines, you should.

Don’t harm the profession. Be polite.  Be respectful.  Don’t stir the waters, or if you do, stir them very gently.  Stick with medical issues and don’t wander into the political or the social mire.  Instruct.  Speak of the many wonders of medicine.  Don’t raise red flags for they may affect public perception of not just doctors, but the institutions that employ them.  Tread very, very lightly, and if you can’t play nice, don’t play at all.  To do otherwise, dear doctor, might affect our growth strategy.

This is the challenge that doctors must face online these days.  It’s not just about being ethical, for the lines of ethics is being blurred by others’ perceptions of what we should be now, but rather it is being true to ourselves and our patients.  Doctors increasingly work for large, soon-to-be accountable care organizations (ACOs) where ethical standards for an organization’s success can conflict with the ethical requirements for the autonomous patient.   With whom should we side, the patient or the organization?

The academic elite with little or no real experience with the nuance and complexities of this online world have little realization of the complexities of behavior online and even less appreciation how their position papers of online professionalism can come back to haunt those who delve into this space to tell our story.

“Doctor, we want to talk to you in the front office about your blog.  Do you remember that ethics document from the American College of Physicians and the Federation of State Medical Boards?”

Yes, perhaps I’m an alarmist, but we should appreciate the gravity of these seemingly well-intentioned documents to online physicians who strive to be patient advocates in an era of ACO employment of physicians.

This is our new professional calling.

Respectfully and ethically, of course.

Wes Fisher is a cardiologist who blogs at Dr. Wes.