Doctors, Identity, and Social Media. A Crisis or a Kink?

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A new platform, a new potential — a new potential problem. Tweets, blogs, posts, “many to many” e-communications have created fears over doctors having an online voice within a public domain.

For all health professionals, social media poses an opportunity and a challenge.

Fast and free, many-to-many messages enable engagement within communities, with patients, and an opportunity to set the health record straight in a misinformed media.

This new e-voice comes at a cost. By its very nature, the internet is a disobedient arena. A cause for concern for reasons highlighted by researchers at John Hopkins University –

  • messages can spread with little control
  • boundaries can blur
  • mini blogging misdemeanours are open to public viewing at best, public sharing at worst

Official guidelines by the American Medical Association (AMA) advise physicians to consider a double online identity; one professional and one private.

Not since the strange case of the troubled Dr Jekyll has a doctor been subject to grapple so with their identity. The 21st century physician faces a far less odious and much more common conflict; to jump in with all 10 digits as a professional doctor, or as a Mr/Mrs/Miss/Ms, or not at all.

Identity Crisis or Kink?

John Hopkins University associate professors researched the modern day dilemma of doctors tweeting in a recent article in the Journal of the American Medical Association; “Social Media and Physicians’ Online Identity Crisis.

The team, Mathew DeCamp MD, Thomas W. Koenig, MD and Margaret S. Chisolm concluded in favor of doctors having an online identity within their professional capacity, rebuking guidelines to manage a double persona. The reasons put forward for engaging within social media as a professional health practitioner include –

⦁ to have two separate identities online is impossible. People can connect the “professional” you with the “personal” you in a snap

the positive impact of doctors tackling misleading medical information outweighs the potential pitfalls

opting out of the online conversation is not an option. Engagement is a must.

The recommendation by the American College and Federation of State Medical Boards (FSMB) to have two identities is impossible according to the John Hopkins team, simply because “with minimal information, searching the web can quickly connect professional and personal content.”

Dr Jekyll was never a good advocate for doctors dabbling with more than one identity. Even in the less curious of cases, managing dual identities is hard work and according to John Hopkins’s research team, essentially “operationally impossible.”

As any good Careers Counsellor will tell you, the professional self is an extension of the personal; a complex interplay of everything that makes us individuals with the allsorts that adds meaning to our lives.

To divide the two would be a separation “verging on the nonsensical,” researchers conclude.

People are not just their jobs. As one Doctor, dying and intending to tweet from her death bed to normalize the death process demonstrates in her Twitter biography. Not just doctor, but patient too –

Wife, daughter, sister, aunty, friend, doctor, patient and author. Always trying to look on the bright side of life…” Wakefield · @grangerkate

What Tweets?

Dr Katherine Chretien, an Internist at the Washington DC VA Medical Center looked into the content of doctors tweets by analyzing 260 Twitter accounts. To be included in the study, each doctor had to have at least 500 followers.

A total of 5,000 tweets were analysed. The last 20 tweets of each user sent between May 1st and May 31st were categorised by Dr Chretien’s team as either “health related”, “personal” or “inappropriate.”

Agreement was implicit in 78% of cases. Of the tweets that were classified by a tweet judge as inappropriate, consensus was sought in the team to confirm the original moderator’s suspicion of a tweet.

The results were published in JAMA. Of over 5,000 tweets –

  • 49% (2543) were health or medical related
  • 21% (1082) were personal communications
  • 14% (703) were retweets
  • 58% (2965) contained links
  • Seventy-three tweets (1%) recommended a medical product or proprietary service
  • 634 (12%) were self-promotional
  • 31 (1%) were related to medical education

One hundred forty-four tweets (3%) were categorized as unprofessional, of which –

  • Thirty-eight tweets (0.7%) represented potential patient privacy violations
  • 33 (0.6%) contained profanity
  • 14 (0.3%) included sexually explicit material
  • 4 (0.1%) included discriminatory statements.

You can very quickly match doctors with their content, according to Dr Kathleen Chretien and her research team.

“Of the 27 users (10%) in our sample responsible for the potential privacy violations, 92% (25/27) were identifiable by full listed name on the profile, profile photograph, or full listed name on a linked Web site.” Dr Kathleen Chretien comments in the JAMA article.

Still, It’s Good to Tweet

The John Hopkins article however would argue perhaps that despite the 3% of tweets being classed as unprofessional, physicians active on social media object to giving up an e-voice for exactly the same reasons that others argue it should be quashed.

The article highlights that social media by it’s very nature –
> blurs boundaries
> levels hierarchies
> leads to transparency

One self confessed twitter user would agree. Lisa Rodrigues CBE, NHS Chief Executive urges senior medical staff to tweet because “it is just a new way of communicating. It’s free, it’s easy and it’s totally in your hands.” Lisa Rodrigues, NHS Executive and CEO Sussex Partnership Trust.

Lisa adds, “Social media is just another way to network. And good leaders must be great networkers. Otherwise how can we learn, keep in touch with our own people and share what we are thinking or doing to help the people we are here to serve?”

Lisa’s reasons for using Twitter include –

1. To share good news, in 140 characters and via links to my weekly blog or other things on our website

2. To talk about the difficult stuff – such as when we make mistakes, or the stigma our patients, and our staff, face on a daily basis

3. To make contact with people whose ideas or chutzpah I admire

4. To hear about and discuss new ideas

5. To encourage and motivate people – myself and others

6. To signal change or challenges such as the impact of the recession on the NHS

7. To talk about trivia (eg *The Archers) * a popular UK radio serial

8. To hone my writing skills – you would be surprised what an improvement using 140 characters can make

9. To show I’m human

10. To say what I’m thinking without anyone editing it or giving it their own spin.

My name is @LisaSaysThis and I am a Twitter addict.

Social or Asocial Media?

Regardless of our position we should all tweet with care. For a doctor to ignore the online conversation is not an option. To juggle a professional and personal online voice is up to the particular tweeter, as long as they are aware that there is no guarantee that their professional identity is concealed. Armed with a wireless connection, anyone can quickly track you to your professional persona.

The real question is why wouldn’t you tweet/blog? The internet is the 21st century information party where everyone is clambering for health information. It’s where patients are answering their health questions, rightly or wrongly. Nibble a volauvent and rely, as John Mandrola suggests on common sense to see you through, but just make sure you are there –

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.

John Hopkins University: Social Media and Physicians’ Online Identity Crisis
Social Media JAMA article (link)

Dr John M, Heart Rhythm, Medicine and Health
Blog of Dr John Mandrola: Commentary on electrophysiology, atrial fibrillation, healthy living, cycling, and knowledge.

Image: RGB Freestock “saavem”