Defining Online Professional Behavior

March 2, 2011

This week a reporter cornered me on the issue of professional behavior in the social space.  How is it defined?  I didn’t have an answer.  But it’s something that I think about.

Perhaps there isn’t much to think about.  As a ‘representative’ of my hospital and a physician to the children in my community, how I behave in public isn’t any different than a decade ago.  Social media is just another public space.  Sometimes it’s easy to forget that we’re in public.  When I’m wrapped up in a Twitter thread it’s easy to forget that the world is watching.  But the solution is simple: always remember that the world is watching.

On Twitter I think and behave as I do in public:  Very much myself but considerate of those around me.  I always think about how I might be perceived.

Here’s a better question, online or off:  What is professional behavior?  I have a pediatrician friend who, along with the rest of his staff, wears polo shirts and khaki shorts in the summer.  The kids love it.  One of my buttoned-down colleagues suggested that this type of dress is ‘unprofessional.’  Or take a handful of physicians and ask them to review a year of 33 charts posts and my Twitter feed.  I can assure you that some will identify elements that they find ‘unprofessional.’  I believe I keep things above board.

This is all so subjective.

The reporter was also interested in how I separate my professional and personal identities in the online space.  I’m not sure the two can be properly divided.  The line is increasingly smudged.  I try to keep Facebook as something of a personal space.  I think it was Charlene Li who suggested that she only friends people she knows well enough to have over for dinner.  That’s evolving as my rule as well.  But independent of how I define ‘well enough,’ Facebook is still a public space.  My comments and photos can be copied to just about anywhere.

Social media has not forced the need for new standards of physician conduct.  We just need to be smarter than we were before.  Everyone’s watching.


DoctorLinguist March 2, 2011 at 1:33 pm

I’m sure a lot of what I write would be considered unprofessional by some standards, but I’m very careful to observe privacy by swapping up times, history details and generalizing visits. I think it’s valuable for certain aspects of the physician lifestyle to finally lose the artificial varnish they had before the advent of the social space. If that’s considered unprofessional, then I think professionalism needs some reevaluation.

DrV March 2, 2011 at 1:50 pm

The artificial varnish is eroding. But wood in its natural state can be so beautiful.

Good to hear/see you, DL. Surprised you commented since the post failed to make any mention of food!

DoctorLinguist March 2, 2011 at 2:41 pm

Well, I was already eating, so … ;)

Terry Kind @Kind4Kids March 2, 2011 at 1:37 pm

Ah, you got cornered by the reporter! For another (related) take on the matter of online professionalism, see in J Gen Intern Med. 2010 Nov;25(11):1227-9. Online professionalism and the mirror of social media (by Greysen SR, Kind T, Chretien KC)

Marya Zilberberg March 2, 2011 at 2:51 pm

Professionalism is hard to define. Yet unprofessional behavior online is one of those things: you know it when you see it. I especially love it when people hide behind pseudonyms.

DrV March 2, 2011 at 3:03 pm

We could say it’s like porn: hard to identify but you know it when you see it. But that would be unprofessional.

Daniel March 2, 2011 at 4:33 pm

Bryan, thanks for your perspective on this problem. I’ve been trying to articulate the same thoughts for a while, and feeling like for all the hand-wringing over personal and professional behavior in social media, it sometimes is just a matter of common sense (and remembering not to forget you’re “in public”).

Glad I have a link to share the next time someone asks me about this :)

Greg Smith MD March 3, 2011 at 8:19 am


Thoughtful post. As you know, I have been struggling with this as well. I think I am going to err on the side of less overall “friending”, especially on Facebook, keeping that to good friends, family, and trusted associates. Twitter is a little different in that I want wide exposure for things like links to my blog, but still have to understand that the space is certainly public, as you pointed out.
The bottom line for me? Be myself. Be appropriate. Have fun, but know that I am a professional. Know that everything I say and do is being seen, heard, and watched by somebody.


DrV March 5, 2011 at 12:13 pm

Greg – You need to define some of these issues for the mental health population. I think the boundaries for this group are much different. Something for your free time.

drmattmurray March 3, 2011 at 11:02 am

There is a core curriculum on “Professionalism” that the Accreditation Council for Graduate Medical Education (ACGME) has developed for physicians-in-training which includes training on professional behavior in areas such as: responsiveness to patient needs that supersedes self-interest/ respect for patient privacy and autonomy/ compassion, integrity and respect for others/ sensitivity and responsiveness to diverse patient population such as diversity in gender, age, culture, race, religion, disabilities and sexual orientation/ and accountability to patients, society and the profession.

The line that distinguishes sensitivity from insensitivity to human diversities seems to me most difficult to discern. Mother was right– keep it to myself if I’m not be comfortable hearing it re-broadcast on national TV.

Cheryl Handy March 3, 2011 at 8:35 pm

As a patient advocate and health policy writer, I rarely notice unprofessional online behavior by medical professionals. From my perspective, the unprofessional behavior is when physicians complain about patients generally (being annoying, “ghetto,” liars). Not surprisingly, these “docs” post anonymously & I pray/trust/hope they aren’t nurses, PAs, NPs, much less doctors. Professional Behavior is all about common sense.

Now let me take your thoughtful post in a slight curve – another look at defining professional behavior . . .

“Defining Online Professional Behavior”-cool that I just wasted space repeating the title of your post, huh? But it’s a significant title in that you are really (re)defining your profession to a dubious patient public. Social media allows physicians to regain control over the profession. The profession has been (wrongly) defined by attorneys, insurance companies, politicians, governments.

The best patient/physician relationships exist without interference from governments, insurance companies, attorneys, risk managers. The most immediate benefit I observe with physicians (like you) online is that the public reads physicians’ professional thoughts, opinions and begin to drop their negative attitudes about physicians. The once frustrated patient population begin to understand that most physicians are just real people. That is critical to patient care.

My experience with many patients is that they feel physicians hide behind attorneys and insurance companies. Many patients don’t feel that physicians care about patients. (“Doctors are just ripping out kids’ tonsils to make money”) And, of course, the great majority of physicians genuinely care about patients. Social media gives a great forum for doctors to use their good judgment and extend a virtual hand directly to the online world – reintroduce the medical profession to the public and stop allowing governments, insurance companies, attorneys to define and marginalize a noble profession.

ps. Dr Brian, We need more puppy posts

DrV March 5, 2011 at 12:15 pm

Yes. I need to find a way to integrate Molly the Autralian Labradoodle into 33 charts somehow. I’ll work on it…

John Luginbill March 4, 2011 at 8:58 am

Dr. V:
I am a long-time reader first-time commenter. I appreciate the consistently informative and easy readability of 33Charts. Thank you.

As a healthcare marketer I agree with the need to be concerned about what YOU say, but healthcare professionals also need to know what is said ABOUT them. This is a very present danger to professional reputation even more than a physician’s own words.

Every physician needs to monitor his or her “online presence” with a listening platform of some kind. Trackur is a good one. SocialMention is a basic start.
I love the potential of RepuChek. Now in its beta stage, this is an online tool that protects the reputation specifically of medical professionals by monitoring social media, search engines, provider review sites and web activity, then enables them to respond appropriately.

As previously pointed out, anonymous posters sometimes say awful things with impunity. But those libelous comments can be removed or at least mitigated in 99% of cases. But we must first be listening to respond appropriately.

Cheryl Handy March 4, 2011 at 9:59 am

Mr. Luginbill-

Actually, my passion is to rebuild the patient/physician relationship and, in that regard, my concern is *physicians* who post anonymously that patients are horrible. Is there a reputation tracker to protect patients?

As an aside, physicians or groups of physicians should sue sites that allow anonymous reviews of physicians. It is cowardly, does zero help society and does not allow the doc to face his accusers. (sorry to go off topic Dr. Bryan).

healthy living March 4, 2011 at 6:46 pm

Indeed everyone is watching. But, it is not an excuse to be “human” sometimes. We are not perfect and those who watch us should realize that too.

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