Twitter, Doctors and Professionalism

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

25 Responses to Twitter, Doctors and Professionalism

  1. I agree with you. I just wish Dr V had approached her with a private message first. A quiet reprimand. A quiet lesson. An “I have your back.” Wouldn’t we do that for colleagues who said too much in the elevator?

  2. Well said… also a good synopsis of what took place over the course of the day.

    My own personal filter is quite simple. Assume that the patient in the next examination room is reading your posts… never post anything you wouldn’t want them to see.

    In the big sheme of things… this was a good teaching moment… perhaps not well executed… but in the end many new comers (I hope) have learned a bit about boundaries, social skills, etc…

    HJL

  3. Well-balanced summary of the situation. Regarding outreach, Ramona, whether it’s appropriate or not, I have chosen not to interact with the anonymous (or as little as possible).

  4. Well said, Dr. P.

    For most of us, this tweetstorm has now become more about ‘how would you call a colleague who has been inappropriate?’ instead of the appropriateness of the initial conversation.

    All of us make mistakes. All of us would appreciate a private ‘Are you sure about this?’ before a public berating. Dr. V can’t very well say he does not engage anonymous people if he chooses to criticize them on his blog.

    I don’t follow either doctor, but I find Dr. V’s approach more off-putting than mommy_doctor’s.

    • Purplesque –

      It’s interesting. I think Dr V spoke what many might think. It’s much easier to talk around the topic as I have done than take on a blogger or tweeter straight on as he has. But agree that perhaps the tone could have been sweeter – as my dear mother always told us “You get more flies with honey”.

      Then again, it was his tone which elevated the discourse into the blogosphere, since honey doesn’t generate much conversation, so if he stirred up the pot a bit, well, as my mother also used to say “This is good – we’re talking…”

      Peggy

      • 🙂 Mothers are always right, and nothing sells like a controversy. Maybe that was the reason behind the incendiary tone of the article.

        I still don’t like it.

  5. I was involved in this debate today morning.

    Let us look at a few facets of this story–

    1) Does one need to keep a Doctor profile if the intention is not to help patients with hcsm? One can always go ahead with a personal profile.

    2) Why does have to be anonymous with a doctor profile if the intention is to help patients? How many patients will really trust you with an anonymous profile?

    3) Why use social media to poke fun at patient’s suffering? In fact it is a great avenue to learn from patients. To listen to something that would otherwise be untold.

    I am sure, the debate would continue. Hoping to learn from it……

    • Doctorakerkar-

      I agree that our reputation is enhanced when we come out of anonimity and patients will trust us more.

      One more quote from my mom – If you can;t say something nice about someone, don;t say anything at all. I’d say that’s good advice when talking about patients. Also about fellow bloggers?

      Peggy

      • Yes. indeed; Dr. Polaneczky.

        If we tweet in the capacity of medical professionals, let our tweets add some value. What’s the point in tweeting in this fashion…

        And yes, you are absolutely right about the tone & the controversy. Nobody ever kicks a dead dog you see!

        Dr. Akerkar

  6. I write about life as a junior doctor. The patients I meet inspire me, but I would never dream of using them in my stories and I find the original tweets extremely unpleasant to read. Even if I was guaranteed complete anonymity (which I certainly wouldn’t want), I still wouldn’t tweet about patients in this way. Not nice.

  7. Good post. Let me start out by saying that I personally prefer person-to-person interactions to deal with situations like these….

    BUT, here’s the kicker – We don’t know who this anonymous person is. So I started to wonder:

    1)Does it matter that her twitter handle was posted? Theoretically, it shouldn’t have repercussions on one’s professional reputation when one is anonymous and changes details for patient privacy. If there are other repercussions, what are they?

    2) How would you reach this anonymous person for a private conversation about the issue if she isn’t following you ? (You can’t direct message someone who isn’t following you.)

    • Linda –

      1) I think the repercussions come only if you are “outed” as some anonymous med bloggers have been (Flea comes to mind …)
      2) Hmmm… You’re right. If someone is anonymous, how does another blogger reach out to them confidentially? One way is through their blog, where usually there is a place to send an email. I guess the other is to follow them and hope they follow you back?

      Thanks fro your comments.

      Peggy

  8. I don’t like the original tweets that led to all of this – I really don’t. But what I dislike even more was the way this was handled. Let’s just think for one moment…

    1. Dr. V doesn’t wish to engage anyone posting anonymously but has no problem publicly humiliating them on his blog.
    2. Dr. V doesn’t follow the original tweeter and was told about her tweets by others. Who are the others? Why do they remain silent? Why did he feel, if he dislikes anonymous bloggers so much, that he needed to get in the middle of it when he doesn’t even follow this person?
    3. Why didn’t the original people who notified Dr. V message @mommy_doctor or find someone she does engage with on twitter to discuss the problem with her?
    4. We are worried about the professional image of health care providers by examples such as this one, but look at all of the attention it has now – far more than had it been dealt with quietly. It looks much worse now than it ever did originally. And what’s more, it looks callous, malicious and a whole host of other not particularly nice things. I don’t think most people viewing this whole situation are going to be focusing on the original tweets but rather what ensued after them.

    Treat others as you would wish to be treated. Act out of kindness. You can still make a teachable moment without doing what Dr. V did. Just as any medical professional should use composite, imaginary patients, he could have chosen to use a composite made up example of the tweets that go on all the time that he personally feels are inappropriate.

    The fact that all of this resulted in a much needed dialogue still does not make it okay. The ends don’t justify the means. The fact that @mommy_doctor “started it” by posting the initial tweets does not make it okay. I stand by what I said on twitter – two wrongs do not make a right. Rise above. Be kind first and foremost. The medical blogging community earns no brownie points from this whole exchange – it comes across as a sad, divided place rife with judgment and public slammings without any attempts at handling it cordially. There are no excuses. Refusing to engage with anonymous bloggers is no excuse for this. Rise above.

    Carrie

    • Carrie –

      “The medical blogging community earns no brownie points from this whole exchange – it comes across as a sad, divided place rife with judgment and public slammings without any attempts at handling it cordially. ”

      Wow. Them’s harsh words. I do agree that the comments sections of blogs seem to bring out the worst in some folks, but if you read the various blog posts I’ve listed at the end of mine you’ll find on the whole a quite thoughtful and civil discourse.

      We’re in the wild, wild west era of the internet, a place where we’re all learning the rules as we go along. With no one in charge but us.

      I think we’re doing pretty well considering.

      Thanks for your comments.

      Peggy

      • Hi Peggy,

        Honestly I don’t intend to be harsh – but I watched this same thing tear my own unit at work apart. Someone said something inappropriate on facebook and it was being dealt with. Rather than just go on and let it be handled as it was, some people took it upon themselves to make a huge deal out of it and nearly got the person fired. A year later, it’s still not the same and people still do not feel the same way about each other. That kind of act speaks volumes more than the initial incident itself. I don’t believe anyone deserves to be treated that way – even if they did do something they shouldn’t have done. Just my 2 cents… I’m just very tired of the high and mighty attitude of some. I see some of the social media rules creating a bigger divide rather than bridging one. But that might be just me… I tend to look at things differently than others at times.

        Carrie 🙂

  9. Some of the reactions have been really interesting. I read some blogs specifically because there’s something really interesting and different about the person’s field of work (Waiter Rant, for example, and this blog). For medical and nursing blogs, I’m guessing (totally guessing) the majority of non-medical readers read medical blogs for a good story. But the good-story-ness probably edges into ethical gray areas sometimes.

    A lot of the good story medical blogs have been taken down; sometimes, there’s been a comment that the blogger’s work didn’t want them blogging or someone in their professional life found out and felt it was problematic. From my point of view, I miss some of the good stories.

    On the other hand, I hope to be so boring that any medical person who treats me for anything wouldn’t bother to blog it at all or even to tell their partner.

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