Read on Twitter
When social media was new, and its promise and peril were more hypothetical, a few wise mentors in my department and at SAEM encouraged me to read and talk about professionalism for #medtwitter and other platforms.
I think the powers that be recognized that social media could help with networking and knowledge translation. But they were also hearing about lives derailed - a student posting an insensitive joke, or a resident describing a case in a way that identified a patient.
They were terrified of social media. Tweets and Facebook posts and Instagram photos can be saved, and shared, and taken out of context in a way that terrified them.
It wasn't at all like the he said/she said issues they were used to adjudicating.
It wasn't at all like the he said/she said issues they were used to adjudicating.
I don't really consider myself a paragon of professionalism, but I started collecting examples of how social media posts led clinical staff into hot water.
There were a lot of click-baity headlines (even in academic journals) that conveyed the risk.
There were a lot of click-baity headlines (even in academic journals) that conveyed the risk.
And plenty of examples of physicians running afoul of patient privacy, even when discussing a tough case amongst a private group http://www.nbcnews.com/id/42652527/ns/technology_and_science-security/t/doctor-busted-patient-info-spill-facebook/#.Xxriwy05Qsw
As for peer-reviewed evidence, years ago it was meager but it already seemed clear - the online behaviors that really threatened a medical career were not photos or political opinions but rather, ethics violations. https://jamanetwork.com/journals/jama/fullarticle/1105088
Things like misrepresenting credentials. Harassing messages. Prescribing scheduled drugs via the web, without knowing the patient.
As for discipline, most state medical boards didn't have anything on file regarding doctors' social media behavior. It just wasn't an issue.
As for discipline, most state medical boards didn't have anything on file regarding doctors' social media behavior. It just wasn't an issue.
But of course, local disciplinary actions - schools, departments, hospitals - as well as hiring decisions - are harder to track.
But research here was also illuminating. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899068/
But research here was also illuminating. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899068/
As with so many things, the attitudes of the people in power made all the difference. What's "inappropriate" is left up to the director, the chair, the dean. And those people tended to be older, with a more conservative view of how a doctor should conduct themselves publicly.
To their credit, in my interactions with leadership on social media professionalism, the scenarios they most worry about are patient-centered:
A cool case described online, that ends up violating patient privacy.
Or residency colleagues "blowing off steam" on Twitter, after a tough shift, in a way that ends up making patients less likely to seek care.
Or residency colleagues "blowing off steam" on Twitter, after a tough shift, in a way that ends up making patients less likely to seek care.
And they wanted junior docs to know that anonymity online is often just wishful thinking.
http://archive.boston.com/news/local/articles/2007/05/31/blogger_unmasked_court_case_upended/
http://archive.boston.com/news/local/articles/2007/05/31/blogger_unmasked_court_case_upended/
But there's an unmistakeable concern in medicine about 'the brand' - some hospitals social media guidelines, for instance, ask that staff not wear clothes with the hospital logo when posting photos of get-togethers.
So long as the people making hiring/firing decisions have a parochial view of doctor comportment in public, we're going to have docs penalized for photographing themselves in social settings, or arguing about healthcare and gun violence.
And some of these leaders will encourage 'research' that reflects their conservative values, like this recent study: https://www.sciencedirect.com/science/article/abs/pii/S074152141932587X
This study has been thoroughly critiqued already - a testament to #MedTwitter's many strengths and benefits. https://twitter.com/RedStethoscope/status/1286476250408771585?s=20
Here's another good take https://twitter.com/DrChowdharyMD/status/1286475918823825415?s=20
And it's always good to check the references for the methods.
Some of the foundation for this group's classifications of 'unprofessional' conduct is rotten https://twitter.com/traependergrast/status/1286467558934286338?s=20
Some of the foundation for this group's classifications of 'unprofessional' conduct is rotten https://twitter.com/traependergrast/status/1286467558934286338?s=20
It's telling that these authors view gun safety posts online as "potentially unprofessional" as well as bikinis or Halloween costumes.
They're specific about clothes & politics, but leave "offensive comments" vague - I'd say the latter is a much bigger professionalism concern.
They're specific about clothes & politics, but leave "offensive comments" vague - I'd say the latter is a much bigger professionalism concern.
These authors didn't seem at all concerned with doctors abusing their position to sell snake oil, another professionalism concern that seems more pressing than holding a glass of wine at a social event. https://www.orlandosentinel.com/news/os-ne-jay-feldman-adventhealth-social-media-posts-20191214-cjdkmjv3qbbv7hkt4gg43gbq6u-story.html
When I was asked to write guidelines for social media professionalism in medicine, I borrowed from Hippocrates.
When posting: first, do no harm.
Don't harm your patients by violating their privacy, or taking advantage of their vulnerable state.
When posting: first, do no harm.
Don't harm your patients by violating their privacy, or taking advantage of their vulnerable state.
Don't harm your colleagues or employers by unfairly, publicly disparaging them, or revealing confidential information about them.
And don't harm yourself, or your future self, by putting out into the world some ill-considered ideas, drunk tweets, or anything else that doesn't reflect your real nature.
Years later, I still that that's a fair distillation of how doctors should conduct themselves online.
Years later, I still that that's a fair distillation of how doctors should conduct themselves online.
This study's debunking, and the #MedBikini trend in general, shows that today's doctors are ... comfortable in their skin, and with their online personas.
These posts aren't harming anyone. And their honesty and approachability is probably helping.
These posts aren't harming anyone. And their honesty and approachability is probably helping.
These doctors are redefining professionalism. Hopefully they will end up judging the current system as harshly as they've been judged.
@threadreaderapp unroll please (thank you for suggestion @DrCJohns)
