How should doctors behave online? This is a funny question, isn’t it?

Medical establishment loves rules and hierarchy. Social media does not. Social media levels the playing field of who gets to talk; it gives real caregivers a voice. That’s very cool.

This is just a guess, but I suspect there are many more acts left to play out in the healthcare social media play.

The American College of Physicians and the Federation of State Medical Boards have gotten together and published a position paper on how doctors should behave on the “new frontier” of the Internet. At 14 pages and nearly 6000 words, this is one heck of a hefty instruction manual. The authors might have a tough time on Twitter and Facebook.

It’s got to be simpler. Of course it is.

Let’s start with a real case.

Years ago, early on in my blogging career, I wrote a post about a patient who presented to the ER with third degree heart block. She was dying before our eyes. As most doctors can attest, emergencies bring out the best in American healthcare. The patient was transferred immediately to the electrophysiology lab where I implanted a permanent pacemaker. She went home the next day alive and well. The teamwork that led to a life being saved made me tingle with delight. Adding to the joy was the fact that emergencies mandate jettisoning BS. You have to act first and check boxes later.

That night I sat down at the computer and celebrated the joy of doctoring with words. Mindful of privacy issues, I changed a number of details of the case (time, age and gender, for instance).

Then came the comment. My heart sank. Despite changing many of the specifics, a commenter thanked me for saving their family member. Though all were happy with the outcome, my attempt to maintain privacy had failed. This lesson has stuck with me.

With that case as a backdrop, here are my top-ten nuggets of wisdom on social media for caregivers:

1. Do not fear social media. It’s an amazing tool for advancing the greater good. The voice of caregivers has never been more vital. I believe the greatest problem with medicine right now is not the lack of available treatments, but rather, a lack of patient education. Patients cannot truly share in decision-making unless they have the real story. Both patients and doctors are starved for candid unfiltered information. Social media does real, real well.

2. Never post anything when angry. Never is a big word but it fits well here. Nothing further needs to be said. Just don’t do it. A corollary: Do not post while neurologically impaired: I’ve said some really dumb things in the haze that encompasses one right after a bike race.

3. Strive for accuracy: People will read what you post. I’ve written many times that blog posts are not journal articles, but that doesn’t mean you should get lazy with words. Here is the problem: You think electrophysiology is complicated. See what happens when you try being absolutely precise with the English language.

4. When in doubt, pause. Sleep on it. Re-read. Remember the permanency of digital media. You are a doctor, not a journalist. You have time.

5. Don’t post anything that can identify a patient. Changing details of the case is not enough. It’s especially important not to post in real-time. Avoid terms like, “this morning,” or “today.” It’s one thing to tell a story about a patient you saw two months ago; it’s yet another to talk about the patients you saw today. Don’t underestimate privacy.

6. Ask permission. If you want to write about a specific case, get permission from the patient.

7. Be respectful. Don’t say anything online that you wouldn’t say in person. If you are critical of someone pretend that you are going to run into him or her at a meeting next week. Put yourself in their shoes. Try to understand their position. You think they are conflicted; what about your conflicts? My wife once told that me that all unsolicited advice is self-serving.

8. Assume beneficence. I’ve been in healthcare for two decades and can testify that truly bad people are a rarity. Most of us aim to do what is right. Some say doctors are too protective of each other.  But the thing about medicine is that it’s much easier to practice with a time machine. Social media tempts one to toss stones. Resist that urge.

9. Be careful “friending” patients online. I say careful because I don’t like rules. Clearly, some patients can also be friends. The lines here are blurry. My attempt at a solution is to have a DrJohnM Facebook page and a regular John page. I try to steer patients to the professional page. I am also a bit old-fashioned with Facebook. I try to avoid posting compromising stuff—even though it would be fantasy to think doctors are any less human than non-doctors.

10 Educate yourself and ask questions: One of the best references for caregivers interested in learning more about social media is Kevin Pho’s new book: Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices (thanks for the plug! -kp). Another nifty thing about social media is that many of the experts are approachable. If you email (or direct message) experts like Ves Dimov, Wes Fisher, Jay Schloss, Wendy Sue Swanson or Bryan Vartabedian, they are likely to respond with helpful tips. That’s nice. In my limited experience, healthcare social media is populated with nice people.

The bottom line is always the same. Success comes from mastery of the obvious. Common sense, decency, truth and admitting one’s mistakes will rarely steer you wrong.

John Mandrola is a cardiologist who blogs at Dr John M.