The medical blogosphere and twitterverse are abuzz over Dr Bryan Vartabedian’s blog thrashing of anonymous blogger @Mommy_doctor for a Twitter conversation about a patient suffering from priapism (a prolonged and painful erection). The conversation was pretty much standard fare between colleagues on call dealing with an embarrassing and clinically difficult situation, and Mommy_doctor showed herself to be both funny and sympathetic to her patient’s discomfort.
But was Twitter the appropriate place to have that conversation? Dr V argues that it was not –
…the use of the social space at the comical expense of those we’re called to treat is irresponsible. …This is something I’d expect from a frat house, not a treating physician. Of course this level of dialog could only be sustained by someone hiding conveniently behind the cloak of anonymity. Case in point for putting your name and maskless face behind everything you say.
The 91 and counting comments on Dr V’s blog, as well as Mommy_doctor and Dr V’s subsequent Twitter streams make for interesting reading, as medical bloggers, patients and readers take sides in the ongoing debate about just what constitutes professional behavior by physicians on the internet, and whether Mommy_doctor was wrong to tweet what she did. (The best tweet prize goes to Scanman, who used the phrase a “Storm in a Tweetcup” to describe the debate.)
For what it’s worth, here’s my two sense
Mommy_doctor’s Twitter conversation, while typical for an OR lounge, was best had offline. In saying this, I subjected it to the elevator test – If it’s not something you’d say in a hospital elevator, it’s probably not appropriate for Twitter’s massively public venue. I also believe it was the subject matter that made this particular tweetversation a more delicate one – who would have cared if Mommy_doctor had written that she was heading down to see a patient with acute cholecystitis in the ER?
As for the cloak of anonymity some argue provides protection for both patient and doc on Twitter, it took me about 5 minutes on the web to figure out who Mommy_doctor is. None of us is anonymous, and that knowledge alone drives our behavior out of the doctor’s lounge and into the public forum.
Which brings me to Movin Meat’s excellent post on guidelines for blogging about clinical medicine, which I strongly urge you to read, in which he gives us these pearls –
- Respect their (patient’s) privacy and dignity.
- Do not think for a moment that you are anonymous.
- Don’t blog or tweet anything that you wouldn’t want you boss/hospital administration to read.
- Don’t blog about real patients.
- Add some redeeming value.
I do blog about real patients, but only with their expressed permission and offering them the chance to vet what I am writing before I post it. Blog posts about real patients follow the time-honored tradition of the case report in medicine, something I’d hate to see us lose, and for which there are standard guidelines for protecting patient’s rights. Let’s not throw the baby out with the bathwater here.
I also think there is much value in the real time tweeting that some docs do – it gives a true sense of what life is really like as a doc. Reading Mommy-Docs tweet stream overall one gets the impression of a very dedicated, busy anesthesologist who on the whole treats her patients with dignity and respect and who I’d trust to put me to sleep any day. It would be great if we could find a way to retain the real world authenticity that tweeting gives medicine, while still protecting patient privacy.
Finally, as a prior anonymous blogger who threw away the Emperor’s cloak of anonomity, the biggest piece of advice I can give to Mommy_doctor is to come out of hiding and take public credit for her tweets and her blog. As a physician, she has lots to share that is meaningful and worth listening to. She also has a job to protect.
UPDATE – Mommy_doctor appears to have taken both her blog and twitter accounts offline. I hope it’s temporary.
More on the issue from around the web –
- Seattle Mamadoc tells us she has taken tweets down in the past to protect patient privacy after being asked privately to do so.
- Colin Son argues that Dr V should have approached Mommy_doctor offline
- Movin’ Meat doesn’t buy Dr V’s definition of unprofessional
- Scepticemia thinks it’s all much ado about nothing, but gives a nice discussion on the issues
- Buckeye Surgeon has a nice set of rules for online case blogging
- Fierce Practice Management asks where the line is, and does a good summary of the issues
- All Twitter asks readers to weigh in
- Jeffrey Parks posts his excellent guidelines for medical blogging, and reminds us that op consents should include permission to use images for educational purposes.
- Ryan Madenick also makes reference to the elevator comparison
Image from JonasRash designs, used with permission