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Ethics, Medicolegal, social media

Doctors, Twitter, the AMA, and professionalism

The American Medical Association (AMA) appears to have appointed itself as Ministry of Morality in response to the ever growing numbers of physicians embracing social media.

You may recall (you may not, but that’s why I’m here, to help you remember this kind of trivia) a recent letter in JAMA indicating that, “3% of physician tweets contain unprofessional content.” Unprofessional content on Twitter is also discussed in this in this article from a recent edition of the AMA News reporting on doctors and social media.

The article mentions a doctor who lost her privelages for violating HIPAA. A worthy point. PHI should never be disclosed anywhere, but HIPAA violations are not really the purvey of the AMA.  The Health Insurance Portability and Accountability Act of 1996 Privacy and Security Rules are enforced by The Office for Civil Rights not the Ministry of Morality AMA. But fair enough for the AMA to stress the point and offer a reminder.

The article also suggests that anonymous postings might seem liberating, but could in fact be dangerous because physicians might feel emboldened to cross HIPAA lines because they are shrouded by the thin veil of anonymity offered by a fake name and a cartoon avatar. I have to say, I have never read any PHI on Twitter from either self- identified doctors (or nurses or pharamcists) or from those tweeting anonymously. One example of an anonymous doctor tweeting about a patient with priapism was held out as an example. The suggestion was this particular doctor went too far, although whether she tweeted a real case or a fabricated one is not known. If indeed the case transpired exactly as tweeted, someone aware of that particular patient’s problem could have potentially read the tweets and put two and two together. I don’t think that’s a HIPAA violation, but it might make some people feel sad/mad/angry. Then again, how different is it for an anesthesiologist to tweet about a priapism than for an OB/GYN to tweet they just delivered a beautiful baby girl? That’s about the same amount of general information, the only real difference being that a priapism is not a blessed event.

But for me, the most concerning part of the AMA News article is the concern over “profane” language. Swearing apparently earns one (and by one, I certainly mean me) a big fat scarlet A. The AMA News couldn’t even quote some of the tweets because they were so “profane.” I didn’t know the AMA News was read by impressionable 12 year olds, then again, I’m not privy to their circulation statistics. Perhaps the AMA News is in stiff competition with junior high newspapers across the county and can’t print the language that you can hear in just about every PG-13 movie.

So here’s the thing. Tweets are not medical advice and Twitter/Google +/Facebook are certainly NOT medical offices. If swearing on Twitter is unprofessional, then swearing walking down the street must be unprofessional too. Or maybe swearing when you stub your toe (although maybe not, because there is evidence based medicine to suggest that swearing helps reduce pain). What about swearing during sex? What if you go to an R-rated move and a patient sees you? Or, heaven forbid, a XXX movie? When I was a medical student it was considered unprofessional for the guys to not wear a tie and for a girl to wear a mini skirt. Yes, I wore mini skirts anyway.

Who decides what language is right and what constitutes moral behavior outside of the office and within the boundaries of the law? The AMA certainly doesn’t speak for me. If fact, they don’t speak for most doctors. At last count, only 15% of American doctors in practice were members.

With social media you choose who you follow. If what someone has to say offends you, then you stop following them. It’s not Clockwork Orange and no one is going to bring out the eye speculums and force you to read offensive tweet after offensive tweet. Grown ups are supposed to change the channel when they don’t like what they see.

In my opinion getting all hot and bothered about swear words smacks of insincerity, because if morality in medicine was the real issue, the AMA would be getting a lot more worked up about doctors receiving $1,500 a pop for drug dinners or $50,000 a year to sponsor a book tour (complete with promoted tweets). Studies tell us Big Pharma money affects prescribing, yet somehow that’s not unprofessional behavior but swearing is?

If the AMA really cared about medicine and how we deliver care they would be less concerned with the words doctors use in social media and worry a lot more about bad medical care, like opioid naive patients getting 400 OxyContin tablets (I read about that in a tweet!) and the asshats who write those prescriptions. Most non-medical people I asked don’t think a doctor swearing outside of the office is of any concern. One of my tweeps put it most eloquently when she said, “It means they’re real.”

Maybe the AMA is afraid of new technology. Less than a hundred years ago doctors were warned about using the telephone because it was impossible to deliver care without the “laying on of the hands.” I guess doctors who used the telephone were unprofessional. We’ve also worried a lot about e-mail in medicine, but many doctors use it quite effectively. I’m not saying social media is necessarily a platform for delivering care, I’m just pointing out that a lot of new technology that at first seemed to have sprung from the loins of the devil himself has actually proven to be quite useful. Perhaps the AMA forgets that medicine and innovation go hand in hand, and if you drop an f-bomb along the way, well, so be it.

What do you think? Should the AMA care about profanity in tweets?

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Discussion

15 thoughts on “Doctors, Twitter, the AMA, and professionalism

  1. When I think of the AMA, I think of a bunch of stodgy old white men (i.e. republicans) who are fearful that their Norman Rockwell / Marcus Welby image of medicine is in decline. I get a sense that they feel that physicians’ “casual” presence in Social Media is somehow a threat to the profession’s image (analogous to not wearing a tie). I think patients like to see that we’re regular people who can drop an f-bomb with the rest of them. In fact, I often drop f-bombs during sessions with my patients, and find that it helps bridge the perceived ‘cultural’ gap. (Granted, my patient population are young male Marine Infantrymen, hence the appropriateness of such language.) Anyway, I think we in medicine, as they say, “have bigger fish to fry” and so I’d hope the AMA would have larger concerns than what percentage of doctors swear on Twitter.

    Posted by Kevin Nasky | July 23, 2011, 7:39 am
  2. Good point. HIPPA is one thing, but being the self appointed morality police is something completely different. Great post!

    Posted by Mike Sevilla, MD | July 23, 2011, 9:58 am
  3. I agree with you. We should act responsibly, and professionally…but there used to be a law that protected our freedom of speech, It seems now that our professional organizations want to legislate all we do

    Posted by Bob | July 23, 2011, 10:15 am
  4. Excellent post. I have been accused by residents and medical students of being unprofessional because I socialize with nurses and correct the students/residents during rounds. AMA may come after me for those behaviors next……

    Posted by Healthy Mama, MD | July 23, 2011, 3:55 pm
  5. Thanks for this Jen. Social media will change the g*d-like persona that many docs still value. Tweets, while quicksand professionally if used recklessly, demystify our profession. Many patients crave this. If we made it through our training, we should have enough common sense to tweet and share wisely.

    Posted by Heidi Meyer | July 23, 2011, 4:18 pm
  6. Brilliant. Thank you for this post. Hopefully the lynch mob and their furer on twitter will also take note.

    Posted by bongi1 | July 23, 2011, 5:11 pm
  7. Aloha Dr.
    Loved your post!!! Seriously people we have better things to worry about in the health care environment then a few bad word choices. Take the doctors advice and just change the channel. I am more concerned about my doctor’s bedside manner rather then his/her choice of words on some tweet. Honestly people! Your blog topic actually gave me a good laugh or two, but your point well taken. Maybe you should write a prescription for the AMA to follow:)
    Much Aloha,
    Devra Wathen

    http://www.esishats.com

    Posted by Devra Wathen | July 23, 2011, 5:30 pm
  8. I agree with your post and some of the comments because I am a patient, not a doctor, nurse, or pharmacist. I want my doctor to be professional but also ‘ touchable’. No offense but y’all are just regular ppl under that coat. Granted you are much better educated than me but so is a lot of ppl. I don’t want anyone messing with my FOS so I think the AMA needs to worry about bigger things like Big Pharma and over scripting of meds and jacking up prices for cheap meds…stuff like that, not ppl’s freedom

    Posted by Suzanne | July 24, 2011, 6:12 am
  9. I read the article in Amednews.com, but had a hard time attributing the preaching to the AMA. The AMA’s published policy on social media, barely mentioned in the article, is vague and pretty bland. Advocates of professionalism (eg, Dr_V) are quoted, but they are not AMA representatives that I could tell. Was it the editorial choice to publish the piece that rubbed you the wrong way? Am I missing an AMA position not found in the article?

    Chris Porter MD

    http://onsurg.com/about

    Posted by Chris Porter | July 24, 2011, 8:29 pm
    • I found the article in AMA news woefully out of touch. While the AMA’s policy is not published, AMA News is an AMA publication, so I attribute everything written to the AMA. They need a disclaimer otherwise.

      I think the choice to focus only on the negative is very telling, it tells me there is a lotof fear and misunderstanding. I also feel the choice to single out @BurbDoc and to describe his tweets as “vulgar” and too offensive to publish as borderline childish. Whether someone swears or not seems unlrelated to the focus of the article on being anonymous or not.

      Posted by Dr. Jen Gunter | July 25, 2011, 1:54 pm
  10. Fantastic post and a fitting reply to AMA.

    Posted by Nrip Nihalani | July 25, 2011, 11:32 am
  11. I don’t think the AMA should weigh in one way or the other on the Twitterverse. The have enough trouble with trying to follow Federal and State legislation that threatens our profession everyday. However, I do think that we as individuals, physicians or otherwise, should care about what is clearly a gradual moral decay in our society. A generation ago the F-word was rarely, if ever, heard in public, yet today there are many people who seem to have a difficult time forming a single sentence without using it a minimum of once. The anonymity provided by the faceless Internet has certainly accelerated that trend. I’m certainly not the moral police, but it seems that we have forgotten what constitutes civil human discourse, and if anyone speaks up against crass barroom language they are promptly labeled as “out of touch” or “judgmental.” Perhaps these newly liberated linguists will go on to write the next Pulitzer prize winning essay, but as for me, I will continue to do the “adult thing” as you suggest and “Change the Channel.” I can be found on Twitter @DrBob_Southlake

    Posted by Robert Sewell, MD | July 25, 2011, 10:46 pm
  12. great post!

    Posted by Mohammad Faiz | August 5, 2011, 1:21 pm
  13. “not really the ‘purvey’ of the AMA”? Wrong “purv”, hon…..no wonder so many Americans die of medical mistakes….that MD who lost her “privelages” for violating pt confidentiality at least won’t be killing any pts with misspelled Rx orders or or writing DNR for NPO …PRAISE JESUS for social media! HE does work in mysterious ways….

    Posted by Dotsy Maher | September 18, 2011, 8:53 am

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  1. Pingback: Online Physician Anonymity: No Room for Aliases | The Doximity Blog - September 1, 2011

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