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Ethics, Medicolegal, social media

Poll results are in: should doctors blog and tweet anonymously?

I will be the first to admit my poll is not of the highest scientific standard. It is mere snapshot of opinions from slightly more than a handful of people. I don’t know if most who responded are doctors or not (or any other demographic for that matter as the poll was completely anonymous). It is also possible that there is a huge bias as I am a supporter of the right to use social media anonymously and I suspect my followers (or at least the ones most likely to visit my blog) are like minded. Then again, I could be wrong.

I am also no PhD in designing polls. I appreciate there is a whole science to how you ask the question, the order you list the responses, and even the font. Maybe one day I’ll have funding to do the study with a more rigorous scientific methodology. I also appreciate some people would have preferred slightly different options (or more options) to chose from. All I can say, is “Live and learn.” I will try to over come these deficiencies the next time I poll people.

The voting is a clean as possible – the software is supposed to prevent stuffing the ballot box by limiting voting to one per IP address (no, I didn’t see the IP addresses and even if I did, I would have no idea what that mean, I’m really a computer neophyte).

So the results are: a staggering 98 people voted (I really thought more would vote, but it’s better than a kick in the pants) and more than 78% felt it was “acceptable for medical professionals to blog and tweet anonymously.”

Yes, anonymous sources should be given far less weight if the content is medical. Source verification is the #1 rule in assessing the validity of health information on-line. However, IMO the way our patients can get better content is not by silencing the anonymous, but by instructing how to better use the Internet for medical information.

Might anonymous sources cross the HIPAA line more often? This past week I saw more patient information in named threads than in the much talked about “priapism” tweet made by the anonymous anesthesiologist who was drummed out of social media. There was a post about a 5 week old in daycare admitted with pertussis and a post about 30 year old pregnant women with pertussis just to name a couple (a lot of pertussis lately folks get vaccinated). Do these practitioners get permission to make these posts and, just as important, before anyone retweets them do they ask if this consent was obtained? I don’t think these posts crossed the line, but if they have the same amount of content as the priapism tweet, why the free pass?

Well, having followed the outing of the anonymous anesthesiologist blogger closely, as HIPAA was never violated and clearly many other doctors on twitter mention content with the exact same amount of information, it must have all come down to taste. The way the information was displayed must have been offensive to at least one blogger. Apparently there was sexual innuendo. However, it wasn’t offensive to everyone.

So who decides about taste? Are taste and professionalism what they was 30 years ago when these standards were decreed by the same people who thought nothing about asking female medical students to sign a contract stating they would not get pregnant in medical school? Is professionalism wearing a tie? Is it saying, “Yes, sir?” Is it knowing the literature backwards and forwards? Or is professionalism more nuanced than that. Is it more about how you care for your patients? How you stay up at night searching Pub Med? How you cry with your patient who has just lost a child?

In times gone by doctors never, ever shared anything personal with their patients. It’s still frowned upon by many, but I can tell you I have helped more women in despair over the loss of their child by sharing my own story. Is that unprofessional or is it caring?

The Internet, and especially social media, is changing every thing. Not just medicine but how we interact. I don’t think we can apply ancient standards of professionalism to today’s world. Using social media in an anonymous fashion is just one example of how we need to think outside of the box.

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Discussion

8 thoughts on “Poll results are in: should doctors blog and tweet anonymously?

  1. My personal physician and I were talking about that last week. I’m a therapist and a blogger who writes pseudonymously and NEVER talks about individual cases, and my doc wants to talk about stuff other than his practice in his writing, but it is a struggle on a lot of levels. HIPAA is only a part of it.

    I had a co-worker at a previous job where I worked in a supervisory capacity try to get me fired over blogging because she felt that the act of blogging itself was unprofessional. It made for a lot of unwanted attention by my work superiors, but eventually was decided to be ‘much ado about nothing’.

    In the last fifteen years or so, mental health professionals have been trained with the concept of judicious use of the personal story as part of their training on professional boundaries. Where years ago no therapist would share details of her own life in a therapy session, now the standard is ‘is this helpful to the client without being uncomfortable or potentially damaging to the client-therapist relationship). So your instance of a story about losing your child would fit neatly into the category of acceptable (as long as you’re comfortable with it).

    When I left that position about a year ago, the company was just starting to come to grips with the implications of professionals being on Facebook and Twitter and Live Journal and other social media hubs, including questions about whether or not its acceptable to have patients/clients on friends lists (and under what circumstances) etc. Social media has clearly opened a big ol’ can of worms that needs exploration.

    Posted by Maureen O'Danu | July 31, 2011, 12:49 am
  2. I think it is important for doctors to be transparent. that doesnt mean they talk about individuals or cases just that people know who they are. After all blogging and social media is about building communities and relationships.

    Really interesting question you pose about professionalism. I dont have an answer but will watch this debate with great interest.

    Posted by Ali Handscomb | July 31, 2011, 12:02 pm
  3. I’m a Gynecologist tweeting about all- things- gynecology. I appreciate your point on ‘taste’. I find myself pondering this issue each time I make a tweet about ie, ‘vaginal’ infections, or need to use the word ‘vagina’. Of course, I use the words everyday in my clinical practice…just don’t want to offend anyone scrolling through tweets.

    In regards to HIPPA, I usually choose a gynecologic ‘topic’ that I addressed that day, as ‘educational’ material for my tweet. I figure if the one patient in my office that day had questions about the topic…so do countless others out there in the twitter world and blogosphere!

    DrSuzyyHall
    Twitter.com/DrSuzyyHall

    Posted by drsuzyyhall | August 3, 2011, 3:39 am
    • Suzyy, thanks for your feedback. Vagina is totally fine for tweets (though clitoris gets you more feedback from the twitterverse!). Yes, I agree with not doing specific cases, but questions/topics are so universal that they make ideal teaching points.
      Jen

      Posted by Dr. Jen Gunter | August 4, 2011, 2:09 am
  4. Generally speaking I don’t have a problem with it. However, when anonymity is used as a shield for complaining about or poking fun at patients (and we all know docs who do that, especially on Twitter), that’s a different story.

    Posted by Diana Lee | August 4, 2011, 2:19 pm
  5. Just wanted to let you know that I’ve nominated you for a Kreativ Blogger Award. It’s just my way of saying that I think your blog is amazing. I’m not in the medical profession but I always appreciate intelligent reflection. Whether or not you’d like to participate is up to you – I’ll still love your blog either way, but if you’re interested details are at http://allthegoodblognamesaretaken.com/?p=403. Thanks, and keep writing!

    Posted by audamel | March 15, 2012, 10:14 pm
  6. Very interesting topic…

    Posted by Physicians Costa Rica | May 2, 2012, 12:46 pm

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