They say transparency’s king. The more you share the better you look. But I’ve got rules. Here are a few things you won’t find in my Twitter stream:
Beer. I was recently speaking at a meeting out of town and caught up with some friends at the end of the day to visit and have a beer. I was in a different time zone and noted on Twitter the specific microbrew I was enjoying. The following week in my clinic a parent commented on my social activity. While I’m no stranger to transparency, the realization of my visibility was eye-opening. It reminded me that everyone’s watching and 140 characters doesn’t offer enough space to explain the why, or the time zone, of what I’m doing. So I’ve sworn to keep activities like beer consumption out of my twitter stream.
My kids. I try to keep my children out of my social footprint as much as possible. But as most of you who follow me know, they sneak their cute little selves in on occasion. It’s unfortunate because everybody loves hearing about my kids. This is at the request of my wife who’s a booger about privacy. I do mention the occasional date night with my daughter but, by and large, you won’t hear much. Kids are great jumping off points for personal digression but we have to be careful about using them to our own advantage.
Patients. With the exception of broad examples or aggressively deidentified stories I try to keep patients out of my social dialog. They creep in occasionally because they’re such a huge part of my world but typically I catch myself.
Their circumstances are their property and to use that without their expressed permission is a violation of their trust – even if HIPAA compliant.
Work grievances. Sure I’ve got problems in my clinic just like every other doctor in the free world. And I love to vent on occasion but I try to keep it off-line. My community’s got nothing to gain from it and no one likes a negative Nelly (or Nelson in my case).
Bad language. Don’t tweet anything you wouldn’t say in front of the Virgin Mary. Again, everyone’s listening. In a tweet this morning from Mike Cadogan, Emergency physician in Perth and author at Life in the Fast Lane, he makes it a rule to avoid “sex, swearing and relationship issues”. Solid advice.
Consumer complaints. I always think it’s in poor taste when a prominent member of the SoMe community broadcasts an isolated negative consumer experience in order to make a company jump (“I’ve got followers. Do as I say or the brand gets it”). In a way it represents journalistic irresponsibility. Your negative experience at the boarding gate isn’t my business and leveraging a large personal network to try to get quick results is a cheap tactic.
I’ll add more as they come to mind. What do you avoid in your social world?
{ 12 comments }
I never tweet stuff like "I just got into a taxi" or "I'm at the mall/coffee shop/bar/airport." If I had a zillion followers I might (but maybe not). I will admit to having done one beer tweet–when the Wall Street Journal reported that dark beer and Tamoxifen don't mix. Bummer.
Good post, and good reminder that it's all on the record. Thanks!
Great point on how we need to evolve our own personal rules. I was in the bar with you and I can still say that I enjoyed the beer because I don't have pediatric patients or their parents as an audience.
I agree that you made a good choice and I'm still comfortable with my sharing.
We all need to learn about what is right for the audience we think is listening, and those that are tuning in on the edges of our conversation.
The more followers I get (and the more that those followers are populated with folks I know in "real" life), the more careful I think I need to be about what I tweet, which is a drag. I agree about not tweeting about patients. I follow docs & nurses who tweet about patient care while on duty. It makes me nervous for them, even while I think the case might be interesting. I refrain from offering any medical advice on Twitter. There are medical tweeps who might ask "what do you think about this…" but I don't offer an opinion. There's a real person attached to that case and I have no intention of having my name (even my Twitter handle) associated with it.
The main question I ask before posting is this: is this thought a "distractor", or an "informer"?
Distractors usually include any swear words, complaints that don't give a lead for solutions, and anything remotely self-pitying. Informers don't necessarily have to be happy; vented frustrations often lead to rich conversation. Informers also help paint a picture of myself in the context of a community–which sometimes is the microbrew-aficionado community, but it does get tricky when you start to offend people.
I imagine earning the trust of your patients' parents is comparable to earning the trust of medical school admissions committees, so maybe some things just aren't worth tweeting about. I figure that unless I'm in the beer-brewing industry, that part of my life isn't central to my identity, so I'm inclined to leave it out of my online presence. Sometimes in real life I swear, too… but that level of self-censorship doesn't bother me.
The bottom line is being representative of my thoughts, passions, and interests in a way that keeps both me AND the audience focused. Informers facilitate this, and distractors work against it.
@thegooddrlaura–I think you're right to be concerned about privacy and dishing out medical advice online, but I think it's wise to look at the nuances. There might come a day when keeping your health data private is considered a disservice to the community; for my part, I know I learn SO much from doctors tweeting about cases. Virtually any shred of health info can be identifiable if you dig deep enough, be it from a tweet, case study, or drug trial. I think it's important to stay involved in the conversation about how we're going to deal with patient privacy in the internet age instead of swearing off participation altogether.
Transparency is a huge issue for both doctors and patients, and as a future doctor and lifelong patient, the points that you highlighted are certainly paramount.
In addition to monitoring your audience, I would argue that there may be appropriate times for you to voice your opinion on "hairy" situations. Humanistic qualities in doctors are what turned students like myself onto the profession, and while you don't want your stream to be ridden with negativity by any stretch of any means, I would encourage you to examine a thought process that might help to illustrate my point: What would you put into your Twitter stream if you knew of a follower who was examining a career as a doctor and his only connection and insight into the profession was your stream? You would want him to see your good days, your bad days, your sad days, and your happy days.
All that said, I would certainly be careful about exposure of your alcohol consumption and your own children. Audience is key here. For instance, when you wrote Colic Solved, there may have been physician-authors who would have loved to have read of your progress, when you're watching baseball with your family on Sunday afternoons, which team are you rooting for and what's your son, the future baseball great, yelling at the television?
Dispel the "doctors are robots" mentality through social media. You're well on your way, and thank you. Through posts such as these, you're serving as a role model to those of us who are future doctors and who already are active in the world of social media.
I look forward to exploring this topic further with you, and in the meantime, keep the tweets coming!
You know, I agree with all of the above except how I include my children in my work. I do tweet about my kids. I write about my experiences trying to do it right, being their advocate, figuring our how to be there mother better. My children are very young. There are MANY things in life that happens that I would never tweet or write about. When writing about my boys I often think of what I'm discussing with a filter… Something like: would they dislike knowing the world knew this when they were 15? 25? 35? But really, I work hard to involve anecdote for the benefit of the greater good never for my "own advantage." Rather, in the spirit of transparency, I want people to know that I'm experiencing and reading new medical information like a doctor, but also like a mother. Please help me learn how to do this. If you ever see a tweet,blog or discussion that involves my children that may cause them anguish, I hope you'll tell me. As always, I have a lot to learn on this journey in social media.
Wendy – Regarding kids, I think you're right on this and I'm just nervous. I think you handle it appropriately and, importantly, you leverage your experience as a mom and pediatrician to make other mothers feel at ease. When done right it's effective and endearing. My wife and I have been nervous about offering too many details and that can be controlled. And I need you to help me learn – We're all figuring out what works for us and our readers.
Thanks for commenting.
Becca and Erin – Too much to say except that you guys are way ahead of the curve in thinking through the role of the physician in the social space. Brilliant comments and I'd suggest you lift them and create your own posts covering what's appropriate for medical students and premeds. Thanks.
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Great post. Given your position and position in the social media community, you have a great perspective on managing your sphere of influence.
For me personally, I don't like to tweet about where I am or what I am doing, generally what I'm thinking, or find interesting. In those confines, I tend to focus on saying things I wouldn't be embarrassed to say (as you said) in front of Mary.
Good points all.
My wife and I have spoken at length about some of these very issues, especially as pertains to family and children, even though my kids are all of age now.
I love to talk about my workplace experiences in a broad brush sort of way, because as you said that is such a big part of my life that is is very interesting to me.
There are clearly some things that are off limits. The old adage used to be that you never said or did anything that you wouldn’t want to read about in the next morning’s newspaper. Now, it’s the next tweet!
The issue of your children and your blogging is interesting. I have always kept my kids out of my dialog. But this can be done right. Look at Wendy Swanson at Seattle Children’s (@SeattleMamaDoc). She has found a way to maintain their privacy while using them to help others to become better parents.
I’m constantly learning from other people.