Recently we saw a flurry of discussions about online physician professionalism, the merits of being anonymous, and teachable moments. As a newbie I’m trying to figure this out. But I need to be more mindful of the filter bubble – a self-imposed bias by preferentially linking to people and things we agree with, thus unwittingly trivializing reasonable alternatives.

I’ve just had 3 “Uh-oh” moments:

1. Right after the #hcsm Twitter chat on 5/24, something didn’t sit right in my gut. A single topic – one physician’s controversial tweet – ended up dominating the whole session. The chat was pretty one-sided (I too sang in that choir) with few new voices. Unfortunately, I suspect its only legacy was that the physician who sent the tweets in question quit Twitter.
2. I got this comment on my last post from a physician: “Thanks for your boldness and willingness to police the profession. Blog On!” … I appreciate the applause but I’m just a first-year med student. If I gave the impression that I’m “policing” anything, I’ve gone wrong somewhere. Which dovetails into the next one:
3. Posting a single view is a classic way to spark dialogue. I count on that dialogue to refine or correct my views. If I change my mind about something, my old view must have been flawed. But if I’ve published it already, I feel it’s dishonest to go back and delete/change what I’ve said. When I wrote about how med students can cultivate their online profiles, I thought social media profiles are either business or pleasure, and that it’s bad to mix the two. I now realize there’s a vast gray in between where physicians and nurses blog anonymously, exchanging lessons, humor, support and inspiration. It’s tricky to paint such diverse contexts with one broad brush.

On point #1, any physician’s demise is a net loss for our online community: we can’t grow from something that scares more of us away. The fallout illustrates the human-nature pitfalls of social media: excessive crowd-reactivity, and conformity of thought that often befalls a grassroots club. This isn’t the doing of any one person or blog post, it’s just mass effect (not a video game reference) and we should keep an eye out.

We’re like goalies at World Cup Soccer. We can catch 9/10 shots, miss 1, and the crowd boos and the death mail pours in. Any one thing we do in public can affect our community rapport. Not a question of fairness, but it comes with the territory.Friends of mommy_doc on Twitter defended her as a witty, competent and compassionate MD. I don’t doubt them. An ill-fated remark does not a bad doctor make. We’re human, but we try not to end up in places that require us (or friends) to explain our character.

On points #2 & 3, there’s lots of gray areas. Some push for moral consensus and accountability. Others vigorously defend the ethical no-man’s land where we are free to vent, entertain, and share anonymously. I’m skeptical of the latter’s value proposition, since there’s a potential for conflict of interests: one’s desire to tell a story vs. duty to the patient’s dignity that goes far beyond HIPAA.

A snapshot of this moment reminds me of a pendulum: in any one cycle, the weight is more likely to be found at either ends than in the middle. People seem polarized by different motives/forces. But while the back-and-forth never truly stops, in time, I hope the weight approaches middle, due to the uniform pull of – not gravity – wanting what’s best for our patients.

Still, it’s hard to imagine a bunch of physicians willing to go halfsies on their beliefs like school kids swapping lunch meat. I’ve heard that “getting any number of physicians to achieve consensus is like herding cats.” We’re addicted to heirarchy, guidelines and criteria, yet we scoff at compromise. Is there any way out?

We can start with a bit of introspection. Some of the more senior med blogs may have found their own ethical steadiness. For as long as we call ourselves “Dr. so-and-so” online, it’s only fair that we prepare by thinking through the following:

• What’s my reason for tweeting/blogging? Is there a redeeming quality?
• Am I effective at managing others’ expectations of my online persona?
• If I let a friend secretly guest-post in my name, what would I ask of him/her?
• If a patient recognized himself in my remarks (never mind HIPAA), how might he/she take it?
• Which remarks could be taken the wrong way, and what type and magnitude of reactions can I expect?

The many flavors of med-blogs are characterized by different sets of risks, roles, and audience expectations. If each of us can keep our own answers straight on these questions, the world might feel less confused about what’s acceptable for physicians in their various online incarnations.

Jin Packard is a medical student who blogs at Fresh White Coat.

 

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