At the end of the day, I do not see social media as an end to itself. I enjoy the conversation and the opportunity to learn outside the walls of my medical school without having to put in too much effort. I relish the (illusion of?) freedom that it provides by drawing together the world’s most technology and innovation-driven minds. It allows high-level discussions of even the most esoteric topics and promotes conversation and dissemination of information across a globally dispersed network of people. But I avoid writing about it on its own because I think of it more of a tool towards social change rather than a method of changing the world.

However, I have been asked by others interested in what I do regarding how I manage my digital presence and the potential questions of professionalism on digital media. I don’t have answers for anything, but I did have the opportunity recently to take part in a MacLean Center for Clinical Medical Ethics discussion regarding the issue. Thankfully, the talk did not revolve around what indiscretions should not be shown on social media and how we should prevent them (though from time to time during the discussion these issues did come up). As I listened to the discussion, I realized that it raised several critical, unresolved questions that the medical profession would need to answer in order for us to move forward in shaping social media policies for students and physicians online:

• Is there a distinction between a physician on social media and a person that just happens to have an MD on social media? Obviously, since this is the internet, one does not have to brand oneself as a physician but can develop an identity based on whatever you want (though on the flipside, since this is the internet, you will almost always be found out for who you are). On the other hand, internet use is so pervasive, for everything from your high school classmates’ wedding pictures to managing your bank account. Should it still surprise the public so much that doctors might use it for their personal use? and that they might have lives too?
• Should professional education use regarding social media focus on “never events” or on more proactive online identity management? If the latter, what should that look like? This is the topic of most debates around social media policies, including the one at this ethics panel, and the conversation can quickly become far-ranging going from what defines a “never event” on social media (besides breaches of patient privacy) to whether or not the common sense of better social media use can be taught. These are all important questions, though they remain markedly difficult to resolve when people remain divided on the answer of the first question.
• How should doctors engage with informed patients or patients looking for information on the web? And how do we manage our time and the liability risk in doing so? We are still moving slowly from groaning when a patient comes into the office visit saying they’ve looked something up on the internet to encouraging patients to look into certain issues further online. Doctors are also starting to see the benefit of online communication as a way of keeping tabs on patients / answering patients questions without having to have them come in for an office visit. But the questions of reimbursement and liability remain big unresolved issues of the health care system.
• Last but not least, should doctors be on social media at all? And if so, for what purpose? Many others besides me have written about this in great detail, and a few points reiterated in the talk included a) that being on the internet was inescapable and b) it was, in some sense, where many-most of our patients are. Even the most social media skeptical at the talk were able to acknowledge that more readily-accessible, evidence-based online resources for patients would be valuable, but people were still skeptical whether direct, meaningful interactions with patients was possible over such an informal and public forum without violating HIPPAA somehow.

I don’t have the definitive answer for any of these questions, but I do think that until we develop some sort of a consensus on these questions, we will never have an ethics of social media use for the medical profession that makes everybody happy.

Emily Lu is a medical student who blogs at Medicine for Change.

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