So there's this Twitter machine, which you might have heard of. It's all the rage among the kids these days. Doctors have adopted it too, and as happened in the blogosphere there are no shortage of self-righteous, self-appointed internet scolds out there to police our conversations and make sure we all stay in line with their view of how doctors should comport themselves. The most recent is Dr Bryan Vartabedian, who blogs at 33charts and tweets at @Doctor_V. He chose yesterday to attack an anesthesiologist over a middle-of-the-night exchange about a patient with a priapism: Unprofessional Physician Behavior on Twitter
Now, I'm not averse to picking a fight or using strong language on the internet. Nor am I averse to calling someone out by name. You need to be able to handle criticism on the internet. But a couple of things struck me on this.
First, the tone: I have been attacked relentlessly on the internet and I've never hesitated to respond in kind. I took out a little frustration on DrRich the other day, and maybe that was a little over the top, but he's a guy who himself engages in hyperbolic language so I don't feel too bad about it. But It's, well, it's just rude to come out and lay into someone who is generally nice and inoffensive. Not only is it rude, it's self-defeating. You could initiate a conversation and have a teachable moment. But when your headline contains the word "Unprofessional" it takes the teachable moment and makes it an adversarial encounter.
Furthermore, Dr V high-handedly asserts in his comments, "Regarding outreach, I don’t engage anonymous people."
Isn't that convenient, as well as self-righteous? I understand that DrV has a principled issue with anonymity on the net among medicos. Fair enough. Don't link to them or endorse them. But are the anonymous health care provders some sort of unspeakable unpeople to be shunned? Especially when you are willing to call them out publically? Frankly, it's a jerk move to do so while maintaining that it's beneath you to correspond with him or her.
Then you have the actual substance of the complaint. DrV's central complaint was that there was a little giggle about the nature of the patient's medical condition. I take it that DrV has never read this blog, which at times has been a celebration of the strange mishaps, maladies and sexual proclivities of our fellow human beings. I'm sure his head would explode at these posts. For my part, I try to remain non-judgemental, educational when possible, and respectful, though it's impossible to ignore the very real humor in some cases. Some of my fellow bloggers, and I'll prove myself better than DrV by not pointing fingers, are real assholes with nothing but scorn, contempt, anger and disdain for their patients. They are truly a disgrace to the profession. So if you are looking for physician behavior on the internet which you want to shame and label as "unprofessional," DrV picked a fairly weak case, I think. And if you're going to pick a fight, you really need to have a clear, cut and dried example of behavior which crosses a bright line, which was most definitely not the case in the incident thread.
It's more arrogant, I think, for DrV to impose his personal value system on behavior for which there is not a consensus within the medical community. We all agree that HIPAA is a minimum standard, and that there is a moral obligation to be more protective towards patient privacy than the law's bare requirement. There's a lot of diversity of opinion, however, on where the line is. While DrV asserts that simply "disclosing the details of a case" is unprofessional, if you look at the actual conversation nothing more was disclosed beyond the diagnosis, lack of risk factors, and the duration of symptoms. That's hardly a lot of detail. I should also pont out that she expresses significant empathy for the patient which is to her credit.
The real issue here is that as a profession we are grappling with how to take the conversations that go on between healthcare providers and adapt to the internet. If this were a private exchange at the nursing station, or at a cocktail party, it would not raise an eyebrow. In the public arena, though, the boundaries are less clear. DrV is clearly an absolutist in his view of the amount of patient information that providers can discuss publicly - zero. He's entitled to his opinion, but clearly a large number of doctors and nurses disagree. I think it is OK to discuss patients so long as it is clearly anonymous, respectful and has some redeeming value. The value may be educational, or it may be in telling a human story. It may be to express a strong emotion that a healthcare provider feels, be it anger, shame, humor, satisfaction, etc. It may just be because the provider wants to tell his or her story. Just because we are doctors does not mean we cannot share our experiences. I took an oath of confidentiality, not silence. I would also point out that every single medical journal has sections in which doctors express their human feelings and experiences. The internet is no different, just self-regulated.
I think we all agree that the internet and social media is a new ecosystem for health care professionals, and that there are landmines which incautious physicians can step on. I think we agree that patients' identities and dignity must be protected. There's more common ground here than disagreement. To DrV, I would suggest that his version of appropriate physician behavior is not universally accepted, and he creates more heat than light by insulting well-meaning and inoffensive physicians.