Unprofessional Physician Behavior on Twitter

May 23, 2011

I woke up this morning to a couple of DMs from physicians alerting me to the Twitter thread seen below (tweets read bottom to top).  Is it unprofessional?  Decide for yourself.

Whether you change details or not, the use of the social space at the comical expense of those we’re called to treat is irresponsible.  While the detailed depiction of the patient’s problem is bad enough, the suggestion that you would have somehow ‘fixed’ the situation long before 36 hours is reprehensible.  This is something I’d expect from a frat house, not a treating physician.  Of course this level of dialog could only be sustained by someone hiding conveniently behind the cloak of anonymity.  Case in point for putting your name and maskless face behind everything you say.

Concerning doctors and public dialog, if the crowd doesn’t look after things, someone else will.  But I shouldn’t complain.  This sort of stuff gives me fodder for my next presentation.

What say you?

Comments to this post without a proper name and link to a digital property (Blog, Facebook, Twitter, etc) that identifies you as a palpable human being will be deleted.

Comments are now closed.  There are an amazing variety of views below as well as a number of ongoing conversations throughout the infosphere.


{ 129 comments }

Jody Schoger May 23, 2011 at 9:51 pm

From the patient perspective?

This is the kind of thing that makes me ill. Ill.

For all I know about hospitals, hospital errors, physician errors, patient problems, “scuttle butt,” hospital gossip talk, what in the world has happened that people speak so idly of issues that mean a lot to a particular person?

I’m adrift, considering this. I’m mad as hell,considering this, and happy to write up a discussion on ethics whenever you want one.

Thanks for an incredible post, Bryan. As upset as I am, you put issues where they need to be.

jms

DrV May 23, 2011 at 9:56 pm

Thank you, Jody. While this individual claims to change details to protect privacy, it almost doesn’t matter. It’s the absolute disregard for the individuals under her care that’s so concerning.

Lots evolving in this area of digital professionalism.

Drsteventucker May 23, 2011 at 9:55 pm

Well this does not exactly meet the AMA Social Media policy “to maintain a positive online presence and preserve the integrity of the patient-physician relationship.” It is NOT a professional online presence. The flipside is the challenge of understanding the authors intent. Did they mean to hurt or be unprofessional? It is the challenge of expressing personality in short bursts that gets an author in trouble. I read again yesterday, somewhere on the web, remind yourself to consider your online presence as if you are speaking in an elevator. Always a nice reminder.

DrV May 23, 2011 at 10:00 pm

Yes, Steven, especially when considering posts of 140 characters we have to understand that intent can be difficult to ascertain. I, for one, am frequently misunderstood. But it’s hard to back this up with anything good. For the viewing world looking at us as physicians, this is not where we want to be.

Joe Hage May 25, 2011 at 11:17 am

Steven, reminds me of the Hippocratic sentiment, “First, do no harm.” I agree, her commentary does not maintain a positive online presence. And it certainly hurts her personal brand.

Nick fogelson May 23, 2011 at 10:25 pm

If either of these folks can be identified to a particular hospital, or even zip code, this is a HIPPA violation.

DrV May 23, 2011 at 10:50 pm

For sure. But when it comes to this type of unprofessionalism we spend too much time focusing on HIPAA. Our commitment goes beyond legislation. HIPAA is important but perhaps not as important as the ethical breech that this type of dialog crosses.

Disappointed May 23, 2011 at 10:44 pm

Do these people have morals, or even a soul, or even common sense?

DrV May 23, 2011 at 10:52 pm

No. Probably not. Apparently not.

Pranab May 24, 2011 at 11:44 am

Come on, isn’t that a little too severe? And Dr. V, isn’t this kind of comment supposed to be deleted? :-)

James May 24, 2011 at 1:03 pm

Shame on you. You wanted an example of unprofessional behavior. You made one.

Pranab May 24, 2011 at 2:28 pm

I wonder how life is as a depressed adjective :P

James May 24, 2011 at 2:39 pm

Can’t be too bad. After all, it comes with it’s own website… :p

Tkyle DO May 24, 2011 at 12:07 am

The doctor-patient relationship is to sacred to have an attitude like mommy doc has. As a first year osteopathic medical student, one more exam left until first year is over!, I can say that my school has taken many measures including lectures and requiring 40 hours of community service a year to ensure that we understand the importance we will be playing in our patient’s life. The emphasis that my school places on the doctor-patient relationship has taught myself, and the majority of the other students, that being compassionate and respectful of our patients is essential in providing the best standard of care.

Jennifer Adaeze Anyaegbunam May 24, 2011 at 12:15 am

I don’t even understand what’s going on in these tweets… So I’ll take your word for them being unprofessional. But just a few thoughts:

Have you reached out to these people and let them know the error in their ways? I think if I made a mistake, I’d rather be alerted privately than ( further) exposed in a public forum.

Also I know you are trying to educate people, but by posting these tweets aren’t you further perpetuating the problem/ further broadcasting the patient’s issues? I know I would never have seen them if hadn’t seen them here.

Best,

Jenn

DrV May 24, 2011 at 8:22 am

I’ll help you. A doctor discloses the details of a case. The thread suggests that this gentleman’s priapism would have been handled personally by the commenting doctor. Unprofessional by all counts.

Regarding outreach, I don’t engage anonymous people.

Bennett May 24, 2011 at 12:18 am

I saw the tweets live ( I follow the doc in question). She is neither unprofessional nor uncaring and I saw this as nothing more than someone passing comment on her night on call.

Yes, you can argue that as docs we should be called to a higher standard (in terms of revealing information about other people) and that yes, potentially this unusual diagnosis could be personally identifying. But her intent seemed far from trying to mock ths situation – in fact she seemed quite empathic towards a patient suffering from a disease she has no chance of ever experiencing herself, for obvious reasons. Poor judgment perhaps in posting, but sometimes the immediacy of the event lends itself to SM. People post about their jobs and work all the time on SM – it’s just that our jobs involve other people. So we have to be careful, but we shouldn’t be crippled.

I have seen far, far worse from Docs, Pharmacists and other health professionals who intentionally post the most absurd and annoying encounters they have had that day in order to vent. The fact that social media is NOT an elevator is what allows them to do this! :-) If you want examples of this kind of thing there are far better ones than the one you used – I think only the fact that it involves a sexual organ makes it stand out. For example, #penisfriday is a hashtag that is devoted entirely to comically sexually-oriented patient encounters, which seem to end up being saved for the last day of the week. You would have half a dozen examples to choose from in any given week.

I’m not suggesting that we condone one by saying “it’s not as bad as all that” but I certainly wouldn’t have picked THIS conversation up as one example to flag for medical unprofessionalism.

On the other hand, maybe I’m just following all the unprofessional medics ;-)

DrV May 24, 2011 at 8:06 am

A couple of things. Suggesting that you would have personally handled a priapism (fish or cut bait, as this person said) is blatantly unprofessional. Keep in mind that this was in response to the suggestion that this poor individual’s condition was the result of staring at the doctor for 36 hours. This person may in fact be caring but this thread represented remarkably poor judgment.

And the suggestion that ‘the immediacy of events’ is somehow an excuse for bad behavior is almost funny. If you can’t control your impulses to post, perhaps you shouldn’t post.

While you may not find this individual’s feed unprofessional, the rest of the medical world does. In my discussions doctors surrounding ethical conduct in social media, this name consistently comes up again and again. You might rethink what constitutes good behavior in the social space.

There is worse, for sure.

James May 24, 2011 at 11:37 am

I think you misunderstand the old colloquialism “fish or cut bait”. I have to say, I re-read the tweets three or four times trying to figure out what it is you find so shockingly unprofessional and have come to the conclusion that you either mistakenly took these words out of context or purposefully took them out of context to suit your own point. I’m going to go with mistakenly since I have not read anything else by you and so can’t purport to have any real understanding of your character.

But, since you do not understand, I will break it down for you.

Tweet one: MD expresses shock at received report (I don’t really think anyone should discuss their job and/or profession online as it leaves themselves too open to brouhahas such as this, but she doesn’t mention anything that can identify either herself or her patient so enough with this HIPAA rubbish).

Tweet two: MD expresses concern for her patients feelings.

Tweet three: an attempt to flirt with said MD

Tweet four: (the now infamous fish-or-cut-bait tweet) MD assures would-be flirter that she would never be so cruel as to make anyone suffer in such a way. <–only unprofessional if she were a professional sadist, not MD

Tweets five and six: More concern and more defense of the patient.

Now, perhaps this offended your personal sensibilities. And that's completely acceptable. But don't pretend that this breaks some high-moraled professional rule. It doesn't. Just having the letters M & D after your name doesn't absolve you from being human, from having human concerns and human thoughts and frankly, human moments. Acting as if it does is what harms your patients, and it is pretending otherwise that is unprofessional.

altissima May 24, 2011 at 12:45 pm

What James said. For heaven’s sake, get off your self-righteous high horse. The doctor was concerned for her patient and sympathetic–that’s bad? Stop trolling around the internet looking to be offended. (Yes, I know you say you didn’t go looking for this, other people sent it to you. I’m sure the lurkers support you in email, too.)

Viki May 25, 2011 at 11:49 pm

Seriously, James? Seriously? All you see is concern and empathy for her patient? What I see is someone using a patient encounter to get attention on twitter. A 36 hr erection is pretty sensational. If doctor_mommy had said that her patient had walked on a broken ankle for 36 hrs no one would have responded because it’s b-o-r-i-n-g. But she witnessed a painfully engorged penis. Most people have only seen that in movies. Exciting!

Bennett May 24, 2011 at 12:51 pm

If this lady’s name consistently comes up again and again in that context, I would say that the people you’re talking to have funny standards! I don’t doubt that high standards are appropriate for medics, but are “normal” standards entirely inappropriate?

Poor judgment – probably yes. Medical humor is black humor and doesn’t always translate well to the public. That is obvious from the reaction this topic has got! I know I have posted things about medicine (and politics) that I would NEVER say to a patient in person. I have never posted anonymously, even as a med student when I would drop F-bombs into discussions on the idiocy of AIDS denial out of sheer frustration. I’m sure that wasn’t particularly professional. But that experience, 13 years of online discussions and having to deal with the repercussions of a badly worded reply or two, have taught me how to moderate things. I push the envelope a little – but that makes me more human I think. I’m pretty sure that MDoc will adjust her posts as a result. I hope she doesn’t stop though.

Good behavior? I understand that what qualifies as “good” is different from us than from everyone else, but I don’t think this necessarily crosses the line to “bad” either. Obviously that conclusion is a matter of opinion. Clearly “the rest of the medical world” doesn’t include a bunch of people posting here and on my twitter feed defending her!

When I was a young kid I said “I don’t want to be a doctor….I want to be a normal human being who just knows a lot about medicine.” as if Doctors were somehow less than human… It turns out that was probably the right attitude to have. I teach physician/patient communication skills, but I’m not sure those ‘rules’ apply to a public anonymous blog, which for many people is what twitter is all about.

txmed May 24, 2011 at 7:01 pm

“While you may not find this individual’s feed unprofessional, the rest of the medical world does.”

A little hyperbolic. Anecdotally the response to this issue seems to be highly mixed. Certainly I’ve never had a problem with her running commentary.

Jin May 24, 2011 at 8:00 pm

You know, if you have to explain your intentions, you’ve already caused offense. Part of being adults and professionals is that you are sufficiently NOT socially tone-deaf and you would think before you say stuff the whole world can hear.

One bad tweet does not a bad doctor make, but professionalism should be self-evident in each thing we do. It shouldn’t require that you be personally familiar with that Doc in order to feel that she is a compassionate pro.

K Comalli dillon May 24, 2011 at 1:34 am

Dr V,

Thanks for calling this out.

Two wks ago I read a very similar series of mocking posts about a “260-pound patient” with whom the tweets said no one would want to have sex. Comments were made about how disgusting/impossible it was to insert a speculum thru all that fat, etc.

I don’t see patients these days, and I’m not a Christian, but when I did see fat patients or smelly patients or mean patients I tried to remember Mother Theresa’s description of the poor as “Jesus in His distressing disguise.”

Pious? Goody two-shoes? Nope. I blew off steam, vented, joked, laughed about this to regain my sanity. BUT NOT IN A PUBLIC FORUM.

I think professionalism in this context requires a line to be drawn in the sand: is my comment harmful tweeted in this public forum–even if “no one important” saw it?

Sad,

Kcd

DrV May 24, 2011 at 9:08 am

Precisely. What we think and what we share should be two different things.

Pranab May 24, 2011 at 11:49 am

So what you are saying is that it would be absolutely fine if this twitter conversation was made through DMs rather than live tweets?

Jin May 24, 2011 at 8:03 pm

Not absolutely fine. If it was DM’d to me I’d find it wrong. But the damage would be considerably less. Think about it: would you be hurt more if you were embarrassed in front of a huge crowd, or just in front of one friend? Be honest, scale matters. To a patient, it does. MDs should know that.

Pranab May 26, 2011 at 12:22 am

Well, now that we are talking scales, I am pretty sure Dr. V is culpable here too! If he had not blogged it like this, it would not have been turned into what a lot of people are calling Twittergate! And much, much lesser people would have known about it!

Howard Luks May 24, 2011 at 6:25 am

The simplest and most succinct of Soc Med Guidelines… don’t be stupid. In Ortho we have a saying… you are only as good as your worst X-ray. I personally see how this applies across the social media environment. Because of the pace of activity in the cloud, your crowd of followers may only recall your latest stream of comments—and may react accordingly. Your deeper contacts, as mentioned by Bennett may be more forgiving… but.

Physicians will always be held to a higher standard. .. and we need to behave accordingly.

Aside from the obvious HIPAA violation, these posts are in very poor taste and clearly run afoul of the aforementioned guideline… don’t be stupid :-(

DoctorLinguist May 24, 2011 at 7:33 am

I’ll defend mommy_doctor and say there but for the grace of God go I and all other medical professionals. We’re people. We can’t be expected not to have a reaction. I take pains to shuffle up my patient tweets and alter information as appropriate, but I’m sure one day I’m going to have a reaction like this one.

DrV May 24, 2011 at 8:12 am

I think that there’s may be a difference between discussing your involvement in a case and discussing it in a way that’s disrespectful. We see the former all the time. And even when those are de-identified we can discuss whether that’s even appropriate. The challenge with social media is not having the reaction but how we transmit our reaction in real-time.

And as has been mentioned, there are worse examples than this, for sure.

Jin May 24, 2011 at 8:06 pm

And when you do “have a reaction like this one” be sure to decide to tweet about it.

We can have reactions, of course. What you do with it and how you voice it, that’s what separates professionals from the un.

DrGwenn May 24, 2011 at 7:35 am

This is a HIPPA violation plain and simple. There’s a reason after the Flea malpractice case that we have a Healthcare blogger code of ethics. While “blog” may be in the name, I believe it applies to all social media engagements. As physicians, we owe it to our patients to protect their privacy and use diligent discretion online – and offline.

The other issue is language. If someone is going to violate HIPPA, at least use professional language. Whether an Attending or a Resident, let’s put our best feet forward online.

Docs who violate HIPPA in one setting tend to in others. That’s what worries me.

DrV May 24, 2011 at 9:22 am

On their bio this individual claims to change details so regarding HIPAA it probably gets dicey. I think we spend too much time focusing on HIPAA, Gwenn. The tone and direction of this thread goes well beyond the law. But you’re point is well taken…and probably correct.

hereticnurse May 24, 2011 at 7:42 am

Hang on a minute – is the moral outrage over the fact that she said penis online, or that she was discussing a pending patient’s symptom? If she had said there was a 36 hour muscle spasm in his calf, or 36 hour hicups would you all be still so full of righteous indignation?
Of course, she shouldn’t have entered into any discourse with the mob, cause once you do it degenerates into inappropriate comments – people are idiots at the best of times, online simply more so.

But it does raise the continuing question – how DO you inform, educate and engage without running the risk of appearing unprofessional? Studies are fine but to really capture emotional attention you need narratives with human beings in them. What’s the answer?

DrV May 24, 2011 at 8:34 am

Actually I hung on for alot more than a minute ‘hereticnurse.’ Yesterday I discussed this case with a number of respected nurses and doctors in the social world and the universal consensus was that this was irresponsible and unprofessional. In fact, I never would have seen this thread had 2 physicians not alerted me to it.

And no righteous indignation here. I hold myself to the same standard as every other health professional.

Thanks for commenting.

DoctorLinguist May 24, 2011 at 7:46 am

Yes, I wonder how much of the kneejerkery is over the fact someone dared to say the word “penis” on Twitter.

Pranab May 24, 2011 at 11:55 am

I have been reading 33charts for quite some time, so I know that Dr. V should be above such petty semantics. I guess its the tone and the public nature of the discourse that incites his ire…

Jin May 24, 2011 at 8:11 pm

DoctorLinguist,

If I was your patient and you tweeted about my condition, which would cause me more emotional harm? A) about my broke arm B) about my penis. The correct answer is B.

Ethically, both are wrong. But to a patient, the nature of the insult MATTERS. This is beyond policy and legalese. The unprofessionalism stems from the lack of a physician’s ability to look out for her patient’s interest, and the violation of trust that this represents.

Mark Hawker May 24, 2011 at 8:00 am

I guess, like Jenn, I don’t actually “get” what was said by any of the parties. However, there are some real questions about why particular situations would be tweeted in the first place and whether the default reaction of posting to Twitter (or any other “social media”) is the right one. People on the front-line of the health services are, I’m sure, bombarded with so much information that transferring these experiences through any form of media becomes a kind of second nature. I don’t think it’s wise to pass judgement on how anyone controls or things about this process. People use different methods to slow down this process such as the ones hinted at by DoctorLinguist. Even more removed from the original post is the question as to whether “social media” being the default reaction is indicative of wider organisational issues such as tensions between staff or there not being systems in place to share, collaborate and learn from experiences. Would this conversation have been better directed via other channels? Who knows.

Anne Marie Cunningham May 24, 2011 at 6:03 pm

Yes, it would be interesting to know if some health professionals want to share anonymously because they lack other channels for learning from their experiences. But sometimes it feels as if people tweet anonymously for their own entertainment and somehow or other that feels like an abuse of power.

I’m fascinated by how many of these conversations codify the ‘hidden curriculum’ which can seem illusive to medical educators. Next we’ll be asking our selves what we need to do about it, if anything.

Marya Zilberberg May 24, 2011 at 8:15 am

Let’s not hijack the valid criticism under the guise of puritanism — this is not about the word “penis.” The tweeter in question consistently tweets stuff that makes me cringe a little, just as I sometimes find myself chuckling. Her comments are an uncomfortable reminder of many of our experiences in both training and practice, where even our mentors showed their disrespect for patients with no compunction. This is a sorry little non-so-secret right of passage of our profession, and many of us never grow out of it. I would hypothesize that away from SM this is even more pervasive, as here we may be at least somewhat hesitant to come out of this ugly closet.

Mommy_doctor is but an archetype of our profession; she is not the whole problem. If I understand correctly, she is a (very) junior attending barely out of training, and clearly there has been a mentorship failure here. So, I urge other tweeters and bloggers not to accuse but to show her and others how to be respectful and empathic, not full of contempt, toward patients. We need to change this culture of immaturity claiming to be a sense of humor, and the change starts with each of us. This kind of playground behavior is not funny, it is hurtful. I hope that mommy_doctor and others in her shoes reflect on this and realize that they must break this chain of bad behavior and make a positive difference for the next generation of docs, despite the system’s failing of them.

Viki May 25, 2011 at 11:39 pm

I thought these archetypes were supposed to talk trash while playing golf with other archetypes? Perhaps doctor_mommy’s problem is that she’s relying on social media too much and neglecting good old fashioned socialization.

Sani Yamout May 24, 2011 at 8:23 am

Dr V,
Thank you for bringing this up. I had been following that user for a few weeks before unfollowing her because of a string of posts talking about how a case was a ‘blood bath’ and such. I had to use extreme self-restraint not to directly contact here and did not know what to do about it, so thank you for putting this out there.

Immature and embarrassing behavior.

DoctorLinguist May 24, 2011 at 8:29 am

I didn’t find her attitude contemptuous at all. Yeah, okay, in retrospect #3 from the top probably did cross the line. But I’ve told all of my male patients who I put on PDE5s that if they wind up with priapism, they’re going to be the butt of jokes for the next few hours in the ER and to go there anyway. And they grimace, and chuckle, because it is funny, and take the Rx. One of them did, btw, a year or two back. We laughed about it in the office afterwards.

Since I’m posting again anyway instead of eating my toast, I’ll just say this: I’m super-leery of people going around saying what is and isn’t “professional” for physician tweeters. I tweet under my own, real name because I think that it’s useful for social media to demonstrate that doctors are people and have human reactions. I laugh, cry, congratulate and get frustrated with my patients. I’ve posted this on Twitter, and I bet I land on those sanctimonious JAMA studies disapprovingly calling out such tweets every time. (For the record, since someone brought up HIPAA, we don’t know what hospital, we don’t know what time [I shuffle patient tweet order for exactly this reason], we don’t know how many priapic patients come through on the urology service, and of course we don’t know the attending anesthesiologist. So if simply posting a patient’s diagnosis and your reaction to it constitutes a HIPAA violation, good grief.)

But if all social media can offer is a place to talk blandly about patient tips, getting your Pap smears and dew-eyed interns getting ground down on their second week of rounds, rather than putting the humanity back in medicine, then we need to go back to the smoke-filled inscrutability of the medical journals, because that’s all it’s doing for our profession. I’d rather be down in the trenches. The last thing we need is the AMA issuing some hypocritical diktat further reducing the ability of docs to be human.

So, while I’ll concede tweet #3, I’ll stand behind her. Now I need to eat this toast.

DrV May 24, 2011 at 8:58 am

Cameron – Regarding your example of penis dialog, it’s important to understand that the jocular dialog that happens between a male doctor and a young male patient is one thing, sharing it publicly is another. And making publicly degrading comments about that patient is very much another. So I think there’s a difference between how we handle these situations and what we ultimately share in public.

Concerning ‘judgment,’ keep in mind that I refuse to follow this character. This was brought to me by some really respected people who thought this deserved some kind of public dialog. They judged it while I was fast asleep. But after showing the thread to a host of folks who understand medicine and this medium, the consensus was that this reflected poor judgment. I should also add what I said somewhere above, when the discussion with my social peers turns to unprofessional, over-the-line Twitter behavior by physicians, @Mommy_Doctor consistently comes up. This is the community speaking, not me. If that isn’t enough, the number of DMs showing contempt for this person’s online behavior have been almost too numerous to read.

And I think we can keep it real without offending the public or one another. You’re a great example. In fact there are many examples of real doctors sharing real experiences in a way that isn’t degrading.

DoctorLinguist May 24, 2011 at 9:08 am

> And I think we can keep it real without offending the public or one another. You’re a great example.

Oh, I dunno. I’m sure I’ve tweeted something that bent someone’s nose out of joint somewhere or another. But I’ll agree to disagree. Thanks for the kind word.

DrV May 24, 2011 at 11:26 am

Let’s go to Arby’s

med student May 24, 2011 at 8:50 am

I’ve read the comments on this post and I’m still confused as to exactly why this is that outrageous. She tweeted about the case, she seemed emphatic. Someone implied it was because the guy had the hots for her, she said that she would have either pursued him or let him go, not leave him hanging if that were the case. I saw those as abstract hypothetical jokes not to do with the real situation and more about her than the patient.

Is it the later parts that are offensive? Is it that she said something at all about the priapism? Obviously not everyone thinks this is as offensive as you do. Please clarify what we’re missing. It seemed in a whole different category to me than directly making fun of an obese patient but someone compared it to that.

DrV May 24, 2011 at 9:04 am

And….this is why we need mandated medical student training on professionalism in social media.

Another med student May 24, 2011 at 11:46 am

So please, instruct us!

All I’ve learned from this post is that someone online said something you wouldn’t have. (this person identifies as an MD, but could be a llama farmer for all you know)

Expecting all health professionals to conform to some nebulous standard of “professionalism” online ignores the fact that doctors are people too. To what extent do you think regulating heath professional’s private lives is possible?

Dr_Mum May 24, 2011 at 9:12 am

If mommy_doctor had tweeted about any symptom that didn’t happen to involve the penis would it have been seen as unprofessional?
Her tweets were empathetic and the only thing it mentioned was a 36 hour priapism. It is only tweets by others, who can’t seem to handle the fact that a penis was mentioned that turned it smarmy (yes I admit that the fishing/bait comment was a little off colour).
I know we are still trying to work out where exactly the boundaries should be in this meld of medicine and social media and the lines are still a bit blurry, I just don’t think this one crossed it. Are doctors not allowed to post about their day at all?

Arps May 24, 2011 at 9:22 am

I agree with DrLinguist and Bennett above, in saying that MommyDoc is a compassionate doctor to say the least. Even in the featured string of tweets she has showed concern over the fact that the patient did not have any risk factors for the condition.

I like the way she keeps a human touch to her tweets by posting narratives. In her descriptions she has constantly provided the triumphs, joys and frustrations of being an anesthesiologist. I like reading these better than some other doctors’ whose Twitter feed consists of nothing but a constant stream of links to articles and updates.

While there might some things wrong with the featured stream of tweets, I am not posting this comment to press a judgement on that. (Am too junior to do anything of that sort!). Rather my main intent is strictly personal.

I am a graduate fresh out of med school and tweet semi- anonymously.
While my tweets so far have mostly been personal and not relating to any sort of patient encounters, I had always assumed that there might be some patient related tweets in the future, since as an intern most of my day would be spent with them. I had decided to keep patient information in these tweets altered so as to not identify anyone.

But then, looking at this post today regarding MommyDoc’s tweets, I hesitate to engage in social media once I start working. You never know what might be construed as unprofessional behavior online!

- @Paediatrix

PS: Also, I would agree with some of the people above who say that this is not even close to the worst. Hashtags like #PenisFriday are far worse, and in bad taste.

DrV May 24, 2011 at 11:06 am

The danger with this sort of dialog is that it puts attention on why doctors shouldn’t be using these tools. We need your voice. Best advice I try to follow…

1. Don’t talk about patients
2. Don’t be anonymous
3. Remember everyone’s watching, even the pt you’re talking about
4. Be nice

Bobby Ghaheri May 24, 2011 at 10:35 am

I think there are several issues here.
1) Certainly, whether you think it’s true or not, the subject of priapism itself is what brought attention to this string. You have said in previous responses that you’ve seen “numerous” instances of this behavior. I’ll counter by saying that I have followed her for over a year, and I have actively engaged in conversations with her. I have not seen a pattern of behavior. She has tweeted 9000 times. Are a few tweets a “pattern”?
2) Violating your brand of medical ethics does not equate with a HIPAA violation.
3) You say that medical students need “proper” training with respect to professionalism. I’d argue that you shouldn’t apply current standards non-SM situations to the arena of SM. This is an evolving field, and to use statements that “I talked to respected people in the arena” followed by “We of the medical community are outraged” isn’t fair. I personally don’t agree with you on this matter. I actually LEARNED something here, and I wasn’t outraged. And that doesn’t mean I’m unethical or immoral. You illustrate the problem with the AMA’s social media policy. Who gets to judge what’s unprofessional?
4) The problem with your stance on this issue is that it furthers the idea that doctors are NOT allowed to have feelings or frustrations. You further the idea that we have to be stuffy and on a different playing field than our patients. SM has changed that. SM is a discourse, and what happened here is that some people were offended. That does not equate with a HIPAA violation.

DrV May 24, 2011 at 11:21 am

1. Despite the Freudian direction of this comment stream, this wasn’t about the penis, but rather MDs absolute disregard for the gentleman suffering with the penis problem.

2. This isn’t my ‘brand’ of ethics. This was brought to my attention by someone who actually listens to this person. I discussed this with other physicians in the social space who have been doing this for some time. The post doesn’t mention HIPAA.

3. Regarding the standard, you’re in the deep minority suggesting that this was somehow a productive way to discuss a patient. I think you’d have a hard time getting any group of physicians, social or not, to concur that this was professional behavior. Who judges this sort of thing? The crowd decides.

4. I never suggested that doctors are not allowed to have feelings. It’s where we share those feelings that represents the problem.

TheAngryPharmacist May 24, 2011 at 11:06 am

So although I hear your concerns, how is this a HIPAA violation? No patient specific information was given, she doesn’t publish where she works, and even *I* have seen a 36 hour priapism. This all could have taken place days, or even weeks ago.

As Bobby said, offending your holier-than-thou medical ethics does not equate a HIPAA violation. I don’t even find it in bad taste. Throw in a few jokes about hanging stuff (like a paper towel roll) off of it and maybe your complaint would hold water.

Regardless on how you personally feel, was it necessary to throw her under the bus and publish her twitter name? Obviously you don’t follow her and see her vent her frustration or sadness of a case gone horribly wrong (or rejoice when something went right). You saw an opportunity to use one of your own to further your agenda. Don’t follow @BurbDoc or your head might explode.

DrV May 24, 2011 at 11:24 am

I never suggested that this was a HIPAA violation.

Regarding the bus, she crawled under when she made the decision to publicly discuss a patient under her care.

No agenda here. Just creating sorely needed dialog.

Daphne Swancutt May 24, 2011 at 11:09 am

oh my god. that is all.

Pranab May 24, 2011 at 12:05 pm

profound.

Arps May 24, 2011 at 12:23 pm

Haha!

Susan Giurleo May 24, 2011 at 11:39 am

Here’s an easy way to avoid these situation and debates – never discuss patient issues in social media. Her mistake was mentioning the case in the first place. Then it just went downhill from there. No deep ethical rules need to be put into place to evaluate these sort of things. Just don’t talk about patients in public spaces. Don’t we already know that?

fern May 24, 2011 at 11:48 am

Is there nothing better to do than be critical – no hippa issue, no identifiers, Not a problem here. Like Jenn and others said reposting this if it is so offensive to you is pretty stupid. Get a life

Trisha Torrey May 24, 2011 at 11:58 am

Happy there is debate – at least for those who are not anonymous, it lets us patients know where doctors (the doctors we might actually want to see someday) stand on what is clearly an issue of ethics and patient privacy violations…

Which only gives more support to my article about using social media to learn more about the doctors we might choose to see.

[hark! do I hear Cyndi Lauper singing "True Colors?"]

Trisha Torrey
Every Patient’s Advocate

DrV May 24, 2011 at 12:53 pm

Of course, it gets a little more difficult when the doctors are anonymous.

Bennett May 24, 2011 at 1:22 pm

I don’t know if privacy is an issue, nor even ethics. It is perhaps a politeness issue (mentioning someone pubically, even anonymously is kinda rude) and a professional one – meaning “held to a higher standard that the public”. That is not a bad thing, I believe that Docs SHOULD be professional. But I think this specific example has been blown quite out of proportion to what it really is.

I agree wholeheartedly that the debate/discussion about it has been a good one though. It is not new – I am reminded of the Amateur Transplants – a duo of UK surgeons who have sung all manner of over-the-line songs. “Yellow”, “One hand” and “Your Baby” are three that spring to mind that I’m sure many here would find offensive.

http://www.youtube.com/watch?v=sCKIraYQjPM

Twitter is just the latest thing.

Kevan May 24, 2011 at 12:02 pm

stupid

PuterPrsn May 24, 2011 at 12:20 pm

Idle gossip over the back fence. Worst of a yenta. Wonder if she’d like her gyn to post snippets of her private affairs?

Pranab May 24, 2011 at 2:31 pm

I am pretty sure her gyn does! ;)

Amanda May 24, 2011 at 12:21 pm

Thanks for this post, Bryan.

I was feeling a bit sympathetic for Mommy_Doctor, but then I checked out her Twitter feed, and saw other instances where she refers to patient situations that caused her to have an unfavorable reaction — whether that be second-hand embarrassment a la this situation, or being plain grossed out (“Just suctioned carrots out of a patient’s stomach. I barfed a little bit.”)

I agree with comments that patients are on Twitter, and regardless of whether you can find this woman’s information and make the determination that she is your doctor, it goes against patient/doctor privilege in conveying these things, and it undermines her role as a caretaker, protector and authority. I would hate to think that my doctor were tweeting about something I suffered that grossed her out or made her cringe, even if my patient details weren’t revealed. A line needs to be drawn here. I would love to see if Mommy_Doctor turns a new leaf and decides, well, a lot of my communications have benefited and educated others, but maybe I need to take the ‘venting’ about patients to a more private space.

Albert Oh May 24, 2011 at 12:40 pm

How did you derive “absolute disregard for the individuals under her care” from those tweets?

How do you know “the rest of the medical world” finds this unprofessional?

What exactly is a “positive online presence”?

Martin Young May 24, 2011 at 12:56 pm

Bottom line is this – if you are not prepared to take responsibility for your opinions as a doctor, stay off social media!!

All major medical players on Twitter tweet under their own names or with clear links to their full identities.

All else is like scribbling graffiti……..

Katie Fassl May 24, 2011 at 1:19 pm

My jaw literally dropped, when I read this post. Wow, wow, wow.

While I understand that physicians are people and make mistakes (as one of your commenters said), I think we need to remember that the patient she was making fun of is also a person….with feelings and the right to have their medical records kept private.

What’s more: from a female’s perspective, this doc’s sexual comments just perpetuate the whole women not being seen as equals mentality….ugh.

Julie May 24, 2011 at 2:18 pm

Seriously this is what all the hubbub is about? Get a grip people.
If you really think you can walk into a hospital or doctors office without some type of office gossip about you, then you are living in a dreamworld. Especially if the circumstances are strange. I see no difference between this and office gossip.
And yes I fully realize that I am including myself in this. I’m sure that at some point medical staff have talked about me in an impolite way. They are human after all.
It happens. Move on.

Robert Haung aka beRT_MD May 24, 2011 at 2:32 pm

I’m disturbed by the holier than thou attitude of the OP.  I don’t think any of us know @mommy_doc well enough to judge her.  I won’t try to defend her comments but I think we need to be careful about criticizing her versus her comments.  I will defend her character from what I know from following her for close to 2 years.  I find her to be a witty and compassionate person, a real person with many good qualities and some faults.

Do we need to have a self policing body on twitter for healthcare professionals?  Don’t like what she’s saying, don’t follow her.  No need to wag your finger ,and invoke the almighty AMA guidelines.  This is clearly her personal twitter account.  She posts pics of her kids and how’re they doing on it.  The wisdom of her use of specific language or tweets about patients are up for discussion.  However, we must remember that we’re her colleagues, not her parents.

Jen May 25, 2011 at 10:47 am

I’m not a physician, so maybe that invalidates what I’m about to say in a lot of people’s eyes — but from what I’m reading, it seems as though the point is less about being “her parents” and more about what tweets like this may mean for her colleagues in the social space who have worked hard to translate their offline professional ethics into guidelines for physician activity online.

Let’s just say that the saying “one bad egg spoils the bunch” is around for a reason.

AnniBricca May 24, 2011 at 3:13 pm

We work with doctors and patients every day – this is so unthinkable to me I don’t have words for it. As patients, we don’t want to hear these inappropriate dialogs coming from those who are supposed to care for us. As providers and liasons, we want to make sure our patients are treated with the highest level of care and dignity possible. I’m so saddened by this and hope it’s not a sign of things to come.

Christina May 24, 2011 at 3:21 pm

For those who don’t get it: if it was your dad or son with the priapism, and you happened to stumble upon the above tweets, would it make you feel a little upset? Really. Imagine this situation.

Cheryl Handy May 24, 2011 at 3:34 pm

1. Quick answer: unethical, unprofessional.

2. Less clear for administration: The relevant risk management offices probably ought to check to see if enough identifiers create HIPAA concerns.

3. Issue for those of you docs who know about it: Attorneys have an ethical obligation to report even “possible” unprofessional, unethical behavior of our peers. Physicians have a reputation of protecting one another (from negligence, bad behavior). Should docs who know other docs are tweeting (or “behaving badly” on social media report those docs. It is irrelevant that the docs are “anonymous” or heck may not even be docs. No one is anonymous with an IP address.

I believe the medical community has an ethical obligation to report possible instances of unprofessional, unethical conduct. If you don’t know the state then report to your own state and ask assistance. At least you have complied with what should be considered an ethical obligation within your profession.

DrV May 24, 2011 at 4:46 pm

Clean and well said, Cheryl. If we don’t begin to look after ourselves someone else will.

Linda Pourmassina, MD May 24, 2011 at 4:02 pm

When I read her twitterstream for the first time yesterday, the tweets regarding the priapism stood out, but it was actually another statement that surprisingly caught more of my attention. 

“Just suctioned carrots out of a patient’s stomach. I barfed a little bit.” 

Somehow that felt more unprofessional than the erection conversation. I couldn’t help but wonder if the tone in those closely spaced tweets represented her approach to patients in general. True, it is a human response to feel slightly nauseated during that type of procedure, but patients believe doctors should be above that. They do, unfortunately. And they wouldn’t want to be the one suctioned by a doc who “barfed a little bit” while doing so. 

Sure, patients want to know that their doc is human….but to a point. People who follow her have been proclaiming her good intent. In fact, I suspect she is a good person. This is not about being a good or bad person. (And to her credit, she recently tweeted “I did cross the line with a tweet or two so I apologize.”) There is an issue of professionalism (which appears to be important to fewer and fewer people anymore) but, also, if we make public statements somewhat nonchalantly, we risk being misinterpreted (not just personally, but as a profession). I shouldn’t have to follow her for 2 years to understand what’s behind her real-time 140-character tweets.  

ajr May 24, 2011 at 4:11 pm

apparently dr.v hasn’t seen what other professionals tweet about (since he is “above” following those who are anonymous?) because if he had, he would have a LOT more to complain about. a certain anonymous doctor in ‘suburbia’, for example…i had to stop following said doctor because of the sheer negativity/immaturity/ridiculousness regarding patient encounters. i agree with james and pranab and bobby…who is to decide what constitutes ‘professionalism’ when it comes to social media? it is new and evolving…and as for med students, is there really time to add more to what they already HAVE to know in order to save patient’s lives? especially when the prospective subject matter is so abstract…but if it’s the case, then yes, TEACH THEM!
people are fooling themselves if they think that healthcare professionals (who are HUMAN, btw) do not talk about what they hear/see on a daily basis. do the letters “MD or “DO” or “RN” next to ones name mean that the person must give up all rights to venting/worrying/stressing/being HUMAN? if i’m honest, i don’t know mommydoctor all that well, but from what i’ve read/seen on twitter, she seems to be a compassionate and intelligent HUMAN BEING and doctor, and if she were to be my anesthesiologist should i ever need one, no way would i feel uncomfortable. and the fact that all of this has been blown out of proportion and made PUBLIC (which, isn’t that the main problem dr.v has with all of this in the first place?) just makes it even easier to feel for her in this situation.
and may i ask…who on earth would go looking for information in order to CAUSE her to have violated HIPPA or these unspoken ‘rules’ of professional behavior on twitter? wouldn’t that just make you worse than the “offender”?
this is just ridiculous…perhaps it’s true, some go in to medicine to serve their “god” complexes…apparently saving lives isn’t enough for some….

Jackie Fox May 24, 2011 at 5:19 pm

Here’s another one from the patient perspective: Regarding physicians who think it’s okay to tweet that sort of thing, a quote from my mom sums it up better than I could: “I wouldn’t send a dead cat to her.”

In response to ajr, there’s a world of difference between doctors and nurses telling war stories among trusted colleagues/friends and broadcasting some unfortunate patient’s situation on Twitter. Yes, doctors have the right to be human. But another aspect of humanity is compassion. I expect and deserve that from a doctor. And the doctors who have earned my undying loyalty have it in spades.

I do not respect anyone who thinks acting like Beavis and Butthead and making fun at someone else’s expense is clever (online or off). And for someone who’s taken the Hippocratic Oath, it’s even worse.

I am squarely in Doctor Vartabedian’s camp on this one, including his stance on anonymous remarks.

shadowfax May 24, 2011 at 5:34 pm

My comment got too long so I promoted it to a full blog post: I don’t buy your definition of unprofessional.

http://allbleedingstops.blogspot.com/2011/05/i-don-buy-your-definition-of.html

And you don’t have an excuse to engage me, because although my name is not on the blog, I’ve written/linked under my own name in the NYTimes, Annals of EM, WaPost and Daily Dish

Gail Zahtz May 24, 2011 at 6:29 pm

I am actually not going to comment pro or con on the issue at hand on the twitter posting.

What I wanted to comment on was two things:
1. I see friends, colleagues and peers (and yes, members of our own organization) on both sides of this debate- and it makes me immensely proud of whatever small role I play within the world of healthcare social media/ Health 2.0, and also reminds me of how great a responsibility- much greater than would otherwise be proportional- each of us on all sides of of the healthcare spectrum have in molding what is and is not acceptable, appropriate, and most importantly affective for all stakeholders in our conversations of healthcare within social media. We are- relative to the full numbers of physicians, patients, caregivers, healthcare administrators, health communicators, etc- a very small percentage of “early adopters” within what will be the normative healthcare world for our next generation. Therefore, in our (perhaps deeply scrutinized behaviors) and debates such as these, we are forming the groundwork for what that world will look like. I know personally and have deep respect for many of the commenters in this particular debate, and I must say, that this new world is well led, so long as we continue to encourage open dialogues amongst all of us, allow individual mis-steps, and realize (as one of the commenters told me recently on a different issue) “we are each trying to find our way in this new world.”

My second comment is to frame how we would view this if it were offline. As a patient within hospitals, I have been appalled by what I have heard in hallways, elevators, nursing stations and more by physicians and other healthcare providers about my case or other patients on the service. As the wife of a physician, I know that (in accordance with HIPAA) I hear about patients not as people, but as the specific type of case (surgical procedure) that my husband shares as part of his work day. As a patient, I would be horrified to hear about people being cases, as a support of a physician provider, the nature of the communications must be- from many perspectives- not about the people he treats, but only about the work he does.

So the sum total of my comments is this:
1) When thinking about the situation, please reframe it to think about it offline (as online does not change the nature of what is expected from all of us- we can’t accept racism or bigotry, or any other countless human failings, anymore online than we can offline). Within that framework, though, there are horrible infractions of professionalism and patient confidentiality and all of these issues that occur on a DAILY basis within the hospital and healthcare delivery systems- that no matter how many policies, it has not been my experience (with over 30 hospitalizations just myself) that just has there are highly trained healthcare providers, and some who are just not as good…there are providers who are highly sensitive to what patients may overhear, and those who frankly, seem to have a total disregard for patient privacy and professionalism when letting off steam or joking about patients, within the earshot of other patients- including often the patient in question. While in all of my hospitalizations, I saw daily “horrific” infractions of healthcare provider professionalism and communication in person, I never heard a word, or saw any public debate or recriminations on the providers who breached this level within the offline setting.

2. It leads me back to my first point- which is that as pioneers within the new world of online communication… that each of us- within our postings and within our interactions, and even within our debate- have to hold ourselves to a higher level of scrutiny than might be even normative. We are each leading the way- amongst a whole host of naysayers…and positive or negative, agreed or disagreed, I think the most important thing for us to focus on is that we continue to all sit at the table and be able to have healthy debate, mutual respect for credible people on all sides of the equation, and that we try to commit ourselves to being the best ambassadors for this new world as we can be.

And all that being said, we ARE each human. Social media has crossed so many lines, putting healthcare in particular aside, here I find my family life (like my kids that I’ve always kept separate), my personal life (even my private religious practices), my professional life, all crossed over when I’ve kept them all very separate. There are times when I have trouble figuring out which person I am within the general social media context, in that I am not someone who can only be defined by the work I do and the interest I have in that field.

I am not “copping out” by not taking a personal stand on this issue…I just feel that many people for whom I have great respect have taken strong stands on both sides of the debate. I wanted to offer what I could that I felt had not otherwise been offered directly.

Thank you.

Jeff Kraakevi May 24, 2011 at 6:51 pm

Interesting discussion, and I think it looks like it needed to happen. I agree there are more obvious choices for examples of inappropriateness on Twitter, but then this discussion may not have been as rich as this case blurs the line a little more than others. I also follow @mommy_doctor and have found her in general to be a reasonable physician. However, I think the tweets under discussion do cross the line on professionalism. Not because of patient privacy violation as it would be very difficult to identify whom she is talking about based on the information given.

I think it is the tenure and tone of the interaction with @dockim23 that is the point of this whole discussion. Sure, the ‘fish or cut bait’ response can be read in a more innocent fashion, but the trouble is that it can also be read in a way that is not innocent.

If this exchange took place in the surgery locker room, the anesthesiology break room, or even in the halls of a conference somewhere, they would still likely be frowned upon by some, but it would not be open to as much debate as you see on this blog post. The issue is that this exchange took place in a very public forum where anyone can pick up on it. Could it it have passed by as a tweet in the middle of the night lost in the noise, yes. Did it? No. Why? Because Twitter is different than a locker room or a cocktail party. Twitter leaves a public, permanent record of what is discussed 140 characters at a time. This is why we as physicians need to be careful when we engage in sites that are open to the public domain. Do I think @mommy_doctor is an uncaring physician? No. I don’t even think most of her tweets are questionable. I think she slipped a little while seeing a case that was a little out of the ordinary in the middle of the night. I also think from reading her tweets today that she’ll be more careful in the future.

Lois Teston May 24, 2011 at 7:21 pm

Twitter and all social media are public forums with an undefined but voluntary audience. I chose not to follow the above MD in light of her conversational tone and tenor. Crass and rude at best. Her comfort in exposing herself is obvious and she lives with those consequences. I doubt she crossed the line in this tweet frame anymore than she does everyday at work. I will not be her audience…my choice. I don’t believe a code has ever been honored regarding what makes for professional conversations and we have a great history of offensive words with patients and family. Twitter gives exposure and we follow those we respect and often those who enlighten. Such tweets are a dime/dozen in any alley or hospital corridor. I smile and move on….

Brian McGowan May 24, 2011 at 7:49 pm

As Gail put it – there is so much to learn from this conversation.

I once knew a guy who never left the house w/o a 3 piece suit and french cuffs, never passed a shoeshine stand w/o getting a new coat of polish, and never met an admin or waitress or doorman w/o giving the person a smile and exchanging a few tips or words of wisdom. Most people who met him liked him and saw him as a really nice, outgoing, and ‘professional’ man.

The truth was that every suit was a cold hard calculation – will this appearance get me noticed – and he worked hard to keep up appearances . Morevoer, he only spoke to the admin or waitress or doorman if he thought he could benefit…his idea of ‘professionalism’ was somewhere out on the lagging long-tail of a societal norm.

I tell this tale b/c several posters above have made some pretty thin arguments about who defines professionalism and about whether docs can be ‘human’…these are great sound bites and they would be tough to combat, if it wasn’t for the basic reality (one DrV points out repeatedly above) that a ‘profession’ is given special privilages in society and for that those privilages they must 1) self regulate and 2) meet many many many higher standards.

Perhaps I see DrV’s argument differently than some: to me ‘professionalism’ is not in the eye of the beholder; you can’t fake ‘professionalism’; you can’t conveniently move the bar of ‘professionalism’ to meet your needs; and you certainly can’t acutely lower the bar of ‘professionalism’ to meet some new cultural phenomenom or technology. This is not about online vs offline, private vs public…

The argument that suggests docs are just human misses the point completely…if you want to ‘be human’ than you need pack up the white coat, donate your new iPad stethoscope; shred your prescription pads, and by all means stay out of the business end of the ED or OR. These are the privilages that the medical profession has spent 100′s and 100′s of years evolving to, and you don’t get to reboot the professionalism of the profession b/c you have a smartphone and 15 minutes b/w cases….

Daphne Swancutt May 24, 2011 at 8:01 pm

Ok. I’m back to elaborate on my earlier comment. So, here’s the thing: I’m not a doctor or a nurse, so I don’t have a great sense of what helps to get them through their days as they face some really bad stuff. I’ve worked in hospital environments, though, and have definitely been exposed to some interesting ways that these clinical folks deal with situations that are often unspeakable to the rest of us. Among themselves. Not publicly. At least not purposely.

That’s where this particular scenario gets really uncomfortable. If I were the patient being discussed on a platform open and visible to millions, I would feel shame, embarrassment and also hopelessly devalued as a human being. Call me a clueless prude, but this just seems wrong. Forget the ethics, the concern about HIPAA–which are real concerns, despite some earlier comments. Even worse from where I’m sitting is that this is simply indecorous, indecent and a doctor behaving badly.

But, like I said, I’m not a doctor or a nurse–just maybe the would-be patient who might one day be the subject of such public venting. It’s wretched and disheartening.

Thanks for your post, Bryan.

Daphne

DrV May 24, 2011 at 11:21 pm

Beautifully put, D.

Cheryl Handy May 24, 2011 at 8:14 pm

As a patient and advocate for patients, physicians should just understand that whether you are in the “real world” or the “virtual world,” you are creating and maintaining an image for yourself, your practice, your future.

I warn my young adult nieces about posting on social media. It may seem cute right now. But current and future employers may not think its cute. Social media is a bit more complicated for medical professionals.

Young (and not so young) physicians must understand that there are consequences of conducting themselves unprofessionally on the Internet:
1. Patients (and potential patients) are less likely to respect the medical profession generally. Physicians risk cheapening themselves and frankly the entire profession. Patients will lump you all together in a heart-beat. Many docs stay off social media for that very fear of cheapening the profession. Once the profession becomes cheapened in the eyes of the consumer (patient) public, it translates into poor receivables and more litigation. Patients do not care whether you get paid. And if the outcome is not 100%, patients certainly don’t care whether you get sued.

2. Don’t kid yourself. Social gossip is as ugly in the virtual world and the real world. Professionals need referrals, contacts, networks, subsequent employment, letters of recommendation.

Physicians, nurses must re-evaluate why they are tweeting/posting/blogging about their profession. Your virtual audience is vast and you are representing your profession with every key-stroke.

ER Jedi May 24, 2011 at 9:57 pm

I’ve written about this issue a bit myself, and tried to develop my own standard of what is “professional” to write about. I guess I’d call it the elevator test. If I heard the above statement in a crowded hospital elevator, would I deem it inappropriate? If the answer is yes, then maybe it shouldn’t be said on the worlds largest elevator, the internet.

Allison May 24, 2011 at 10:42 pm

Thank you, Dr. Vartabedian, for creating such a wonderful discussion! I don’t want to reiterate any of the ethical issues involved here, as they’ve been beaten to the ground. However, I felt compelled to comment.

As a medical student, the only formal education I’ve received regarding social media is a resounding, “Don’t do it.” I don’t listen. I still (proudly) use Facebook, Twitter, LinkedIn, and maintain a blog. I’d also like to think I’m also able to do so rather professionally. I can’t say I was always that way. I used to post song lyrics as status updates, and let people know when I was going to the gym and eating dinner. Then came medical school – I engaged other medical students, and began reading blogs and tweets, not unlike this post, and gradually came to my own understanding of online professionalism.

With regard to the tweets at hand, I personally view posting the ins and outs of patient interactions (whether they are ethical or not) the same way I view posting song lyrics and gym status updates – all are pointless and undermine the very nature of social networking itself. Details about one’s daily routine are just not what I look for in the daily trends. Not to mention, I seriously doubt there are physicians out there trolling hashtags and trends to discuss all things priapism, so let’s please remember to tweet and post with purpose!

Perhaps I can say all this because I am fortunate enough to have “grown up” with social media. I made my social media mistakes early, before they really counted against my professional life. Regardless, this is why I think social media education should begin much sooner than a hospital policy or HIPPA law, and should be encouraged, rather than swept under the rug. In addition to social media education courses, medical schools (perhaps even colleges!) should integrate its use into the curriculum. You can give me a course on “online professionalism” but unless I’m given an the opportunity to use it in real life, chances are there will be little impact.

Thanks again bringing this subject to light!

Peny@medical products May 24, 2011 at 10:48 pm

Medical professionals are well respected by the society due to their contribution on health and necessity for helping people to live happily and healthily. However, looking unto these tweets from this medical practitioner makes me think of the professionalism of some of the doctors who use social media to inform others (unconsciously) of the true loopholes of healthcare and physicians. This is a perfect example of a doctor that gives the medical world especially the doctors a bad name. Whew!

MJ Gaie, PhD, RN May 25, 2011 at 12:26 am

As a researcher in strategic health communication, I’m astonished that health care professionals are defending the extremely unprofessional communication behavior in this Twitter exchange. This discussion has focused almost entirely on this physician’s right to say what she said about her patient in public forum. However, this is not a matter of the free speech rights of the physician. When providing health care, the outcomes that matter are ABOUT THE PATIENT, NOT THE DOCTORS (or nurses or therapists, etc.). Some of you seem to have forgotten this.

Regardless of the very real human need to blow off steam, to express oneself, to be free to speak, etc., this matter specifically involves a physician publicly communicating about a patient. Legally and ethically, the physician has a responsibility to protect the patient, who is designated a vulnerable party entitled to formal protections. These protections are in place because there is an inherent power differential in the physician-patient relationship. The physician is not the one who is expected to entrust his naked body to an absolute stranger; the patient is vulnerable to that physician because the physician literally has life and death authority over the patient. As such, the physician is privy to information of an extremely personal nature that is also protected. These and other characteristics of the clinical interaction make the patient a higher priority when it comes to protection. These legal protections are in place because historically, some physicians have abused their power and shared confidential information in a way that caused harm.

The doctor is paid money to provide professional service to patients. Part of this exchange of money for service includes the formal and legal expectation that physicians will keep their mouths shut about their genitalia problems and any other details of their health care. (Same for all other health care professionals.) You do not have the right to say whatever you want in your capacity as a physician. If you want the privilege of practicing the profession of medicine, you must also bear the responsibilities that accompany that privilege. That includes restricting your speech to protect patients. You don’t have to like it; you just have to do it.

Messages don’t always do what we want them to do and can actually be very messy in their effects. When a message is sent, the sender’s intent does not necessarily have any influence on that message’s effects. In fact, messages often have effects that the sender did not intend, did not foresee, and did not want. This does not, however, make those effects go away. Therefore, even if the message sender does not intend harm but harm occurs, the sender is responsible for that harm.

We do not, and practically speaking, cannot evaluate the effects of every single message, so we can’t say for certain that harm has occurred from the messages sent re: the priapic patient. But we certainly can, and in fact have an ethical imperative to consider and anticipate the worst-case scenario of any message we send in a professional capacity, then weigh against it the potential benefits to that patient. If the risks for a message to do harm to patients outweigh the expected benefits for patients, the physician has an ethical responsibility to refrain from sending it. Notice that nowhere does the physician’s need to express a sense of humor enter the equation. This, too, is a standard of professional behavior.

If we (rightly) focus on the most vulnerable party here, the priapic patient, I think we can all agree that if we were that person, or that person were our father, son, brother, etc., this physician’s messages would most likely have negative effects. We might expect severe distress, anger, extreme humiliation, and profound embarrassment…but now keep going. Consider how likely it is that this patient will ever trust a doctor again. How likely it is that this patient will return to clinic if it happens again, or a new problem emerges. And how likely it is that he will teach his children to trust doctors. Now think about what he’s going to tell his family, his friends once this public humiliation has occurred. And what they will tell others. And so on. Do the expected message benefits outweigh the harms to the patient?

Perceptions drive attitudes, beliefs, motivations, and behaviors. Think about the effects on perceptions of the clinic/hospital that employs the physician who sent the messages, and all of its physicians and other employees as well. How might this affect perceptions of the professionalism of this institution and its staff? If you had a choice between some random hospital and the institution that let its doctor share your most personal humiliation in a joking manner in a public forum, where would you go? Do the potential risks of sending this message outweigh the benefits?

Now consider effects on a more mass level. Think about what happens in the minds of patients when they see that not only do doctors laugh and joke about every guy’s worst nightmare, but they do so in a public venue and other doctors defend that behavior, saying doctors have a right to do so. How likely do you think it is that the men who take Viagra are laughing? What about adolescent boys who might get it on the street? How easily do you think they will disclose embarrassing but clinically relevant facts during consultations? And what about the women who are expected to spread their legs at least once a year and have some stranger palpate their sex organs? Think they’re laughing? It has already been well documented that patients do not want to talk about personally embarrassing health matters, and that this reluctance has quantifiable negative effects on their health and is a major to obstacle to providing care in some cases. Public humiliation has very powerful effects; why do you think public speaking is the #1 fear of so many? Can you still be sure this physician’s all-important need to express herself has done no harm?

OK, now for the potential benefits of the message to patients…*crickets*. There’s no informative or educational content to help the public know what to do if this happens to them. The physician got to express herself! Booyah for her. Is there any potential benefit to disclosing details of this patient’s clinical encounter other than the amusement of two indiscreet and inconsiderate people? Oh yes…the amusement of others who think a patient’s embarrassing clinical experience is too funny to keep private.

So again, consider the big question: Does this message’s potential benefits outweigh the potential harms?

Like it or not, the speech of all health care professionals is restricted when it comes to information they gain in a professional capacity. When in doubt, keep your mouth shut. That’s what you get paid for. Any health care professional who is more concerned about his/her own need to tell joke than to protect their patient from potential pain, humiliation, and distress are in the wrong business. Is the stress so bad that you HAVE TO tell public jokes about patients for your own mental health? GET COUNSELING. Somehow the majority of physicians manage to treat patients with compassion, dignity, and respect…and retain their sanity. How? They discuss difficult cases among themselves and yes, joke a bit, but in the end, they protect their patients. Why? Because as physicians, that what they’re supposed to do. They recognize that it’s their privilege to know about a patient’s most personal vulnerabilities–not their right.

Cheryl Handy May 25, 2011 at 7:04 am

Well said Dr. Gaie.

Katherine Chretien May 25, 2011 at 7:28 am

Important discussion here.

Daphne’s perspective is so valuable – does it really matter if all of us disagree whether this was unprofessional or not when the patient/public would feel devalued and shamed by reading this about themselves?

Another question to ask is: whose benefit does this content serve? If it’s not the patient- and we have an ethical obligation to protect their welfare – then it really doesn’t belong here. Certainly not for careless banter, for others’ entertainment, or some other selfish motive.

I know you didn’t mention HIPAA at all – and I agree with you that we sometimes lose the bigger ethical breach when preoccupied with the actual law – but I think this is a privacy violation. The one-liner disclaimer that details have been changed would not hold up in court should, god forbid, this patient or his family, see these tweets. I’d bet that any staff involved would be able to identify that specific patient by this exchange (yes, lots of cases of priapism in this country but how many with that duration, no risk factors, getting seen at that moment?) – And it’s the sum total of parts disclosed…which can include photos of the poster’s children that someone mentioned above which was also tweeted which negates the “anonymity.” Even if a patient just thought the feed was referring to him by the description but wasn’t actually, what would that say?

We held small group discussions on finding consensus on online professionalism at the AAMC last year. In the room were deans, other medical educators, administrative staff, IT experts, medical students. We had real examples of possible unprofessional online content for participants to discuss. In my group, some of us were debating whether a twitter feed represented a HIPAA violation when one of lay members of our group spoke up. “Why are you guys focused on that when there’s the larger problem here that this doctor has no respect for his patients to write about them like this? It’s horrible and degrades the patient-physician relationship entirely.”

We all stopped talking and sat thinking, yes. It’s so much larger than that. We need all stakeholders in this discussion to be meaningful.

John Brewer May 25, 2011 at 7:48 am

Quite simply, it is unprofessional.
It is unnecessary.
It opens a doc to liability.

Just because we can communicate to many instantly doesn’t mean we should.

We all know that everyone online has an opinion and is not afraid to give it when mostly (to completely) anonymous.

Bennett May 25, 2011 at 8:22 am

I still think the tweet stream was neither meant for amusement nor at the expense of the patient. I interpreted it as an expression of empathy towards the poor guy and a flirtation WITH SOMEONE WHO REPLIED TO HER. No joke about the patient. Nothing about how she would “manage the patient” as Dr V assumes. It sounds to me as if he is assuming the worst, probably based on his preconceived idea that she is unprofessional (based on prior conversations with other medics online – which didn’t include me obviously).

The hashtag #dearpatient is one worth looking into for all those posting here.

She lacked judgment in posting, she did not lack compassion for that patient. I’m not saying it was a good idea, nor am I defending her right to post for the sake of it – I am defending her intentions.

Communication is a two-way thing. If people here misunderstood her intentions that is as much her fault for not being clearer as it is the others for misunderstanding – but I firmly believe this is a misunderstanding of her intent.

If twitter is only to be used to post beneficial content it may as well shut down now…

DrV May 25, 2011 at 9:41 am

What was meant is irrelevant. When it comes to real time dialog on platforms like Twitter, perception trumps reality. The real question to ask here is, ‘how would this patient feel if they were to read this thread?’ How I feel, how you feel or even how @Mommy_doctor feels is irrelevant. Once we bring this conversation back to the patient we’ll all be better off.

altissima May 25, 2011 at 1:27 pm

By that standard, it would be unprofessional to discuss any medical condition whatever, because someone with that condition might read your post, and might think that he or she was the only person ever to have that condition, and might be embarrassed, and might never visit a doctor again. So, Dr V, perhaps you should just shut down your blog.

ajr May 25, 2011 at 9:00 am

bennett, i think you are right on…i wonder if any of these people have actually read what mommydoctor said, or if they’re just going off of dr v’s rant…she never once did joke about the patient/his condition. she responded to someone who took this as an opportunity to flirt w/her. the night i was reading those tweets, i saw nothing but how sorry she felt for the man and how careful she was being about his feelings…funny how people can twist things around…also, i don’t know if the patient in question is on twitter or not, but regardless…its doubtful he had any idea she had tweeted anything remotely concerned with him until this doctor blew it all out of proportion. so in ‘exposing’ her, he has made it more likely the patient will find out and isn’t that what he wants avoided in the first place?

Wendy Sue Swanson, MD May 25, 2011 at 9:37 am

When I speak about physician use of social media, I take the stand against anonymity for physicians. Simply put, remaining anonymous protects the person/physician tweeting, not the patients, or the profession for that matter.

Like many have said before, we need to aim above HIPAA and we sincerely need to consider how our content and voices over social media reflect not just the respect of our profession, but trust in what we do. Compliance and patient outcomes depend on it. Consider what distrust in physicians does to vaccine hesitancy, for example. It has public health ramifications (118 measles cases since January).
You might also have to step back from the democracy of opinion here. It’s not the majority that matters (how many people chime in and state which side of this particular tweet stream they support). I’d say if one or more individuals believe your content is a breach of privacy and professionalism, you ought to step back, consider taking it down, and revisit your oath.

Claire McCarthy MD May 25, 2011 at 10:38 am

Have been thinking about this all morning–came back from a meeting to write something and have spent a long time reading all the posts. Thank you, Bryan, for doing this: we need to have these discussions.

We all talk about patients. We talk about patients because we need to vent, because we are affected emotionally, because it’s what we are doing all day, because we need to process what is happening to us. Sometimes we talk about them a negative or humorous way. Like on MASH, or Scrubs. It’s part of how we cope. We don’t mean anything bad by it. And we are human.

That’s fine—as long as we are doing with other medical professionals or our close friends and partners, with the understanding that they aren’t going to go repeating what we say.

We are not the point, though. Being entertaining or interesting isn’t the point, either. The patient is the point. Patients trust us to keep their information and experience private—for good reason. When we talk publicly about patients without their consent (on Twitter or in an elevator or anywhere else), even when we change some details (which I don’t think mommy_doctor did with the priapism patient, would be a little hard), we are violating that trust.

I follow mommy_doctor and like her tweets generally and think that she is clearly an empathic person, but there have been times when her tweets have made me wince, for various reasons. I thought about direct messaging her but didn’t, and in retrospect I wish I had. Social media has put us into new territory, and we need to not just talk about these issues, but reach out to each other.

Martin Young May 25, 2011 at 11:25 am

Dr Gaie says it all. Any reference to case histories I make in blogs are about mistakes I made, or lessons I learned.

We owe our patients more than to joke about them in a public forum.

altissima May 25, 2011 at 1:30 pm

But mommy_doctor was NOT joking about the patient. Please, read the tweets before you spout off.

And personally, as a non-physician, I would rather have my doctor joke about me than find I was the example of his making a mistake or a ‘lesson’ for him.

Imei May 25, 2011 at 12:04 pm

Thanks for all the comments on this discussion surrounding @Mommy_doctor’s tweets and the various responses from the medical community regarding responsible SoMe use.

While I also wrestle from time to time about my own privacy as I tweet, blog, and make video podcasts, I find that most of my thoughts are not about my own rights to my own opinions, even when I am told again and again by observers how much they’d like to hear more of it. I am so very aware of my license to practice, which is a privilege and an honor that encourages our public and clients to bestow trust. If I had to weigh my personal rights to tweet what I want about my feelings/opinions vs. my client’s rights to privacy and the possibility that my words might reach their ears, I’m going to side with my patient every time.

There have been a few occasions when a client’s unique situation or challenge has been so noteworthy that I have wished to share it with others. In those cases, I consult the client and get their consent to share. Many of them are pleased to be asked and given the option to not have even their anonymous and indentity-free thought posted on a public forum. The public’s education, entertainment, or engagement via a healthcare professional’s publications of tweets, status updates, and blogs can not be the primary decision-making factor in whether those Social Media offerings are posted.

I think our licenses and the trust bestowed upon us that comes with them call us to bear more responsibility than the common or even assumed use of Twitter and FB as a place to “vent”, and therefore, I don’t buy it if anyone dismisses the gravity of the effect of what is shared as a professional’s human need to share and vent. If a professional needs to share and vent, there are more appropriate ways to do this and protect a patient’s dignity as well as your own.

D. Chapman, MD May 25, 2011 at 1:05 pm

It is hard for me to believe there is even a discussion about the appropriateness of these tweets. I am sure we have all discussed or joked about a humorous, interesting or challenging case with a colleague or spouse, however I see that as being significantly different than posting them on twitter, facebook, etc.

That being said I think Dr. V should have approached this doctor privately and should not have compounded the issue by posting the pictures of the tweets as he did. He could have posted the words with titles like DOC1 and DOC2, to minimize further risk of exposure of the patient and minimize public embarrassment for the physicians.

I think one issue that came to mind as I read all the comments is a possible generational difference in POV. I wonder if recent medical school grads will view this the same as some of us who are “older” and did not grow up with every aspect of our life on display via twitter, facebook and youtube.

Brandon May 25, 2011 at 1:20 pm

I would say one of the cornerstones of social media is transparency. We are often encouraged to be transparent in our social media initiatives. We are encouraged to be ourselves, to show who we really are and we applaud people that are open and communicate in a genuine fashion.

Yet, when we have someone that does just that in a way we may find offensive, unprofessional or unethical, we are quick to point it out, be appalled and cast judgment.

Whether one admits it or not, inappropriate discussions like this one happens everywhere… not just in a medical setting. So why should a social media setting be any different? Social media is simply putting a light -or magnifying glass – on our interactions, and conversations. Stuff we were doing before Twitter.

Inappropriate? Perhaps. Lapse of judgement? Perhaps. Unethical? Maybe. If we agree that social media is about genuine human interaction, then why are we appalled when we witness just that?

If anything, we got a better glimpse of who mommydoctor really is (or who she wants use to believe she is. For all we know, she is a dude)… isn’t that one of the things social media is supposed to do for us?

@pediatricinc

DrV May 25, 2011 at 5:22 pm

You’ve been sucked into the vortex that has made this whole dialog about the victimization of a physician. Of course we should be transparent, but not at the expense of those we are charged to treat. That’s where it goes over the line. We can witness human interaction, but not at the expense of those vulnerable under our care.

D. Chapman, MD May 25, 2011 at 1:41 pm

Brandon:

Who is “we”? And if by “we” you mean physicians, than yes when a fellow physician “does just that in a way we may find offensive, unprofessional or unethical” they should absolutely be called out. At first, in my opinion, privately, but if the behavior continues to be repeated, then publicly. In fact, physicians are obligated to “call out” a fellow physician who is behaving unprofessionally or unethically.

Physicians are not 13 year olds tweeting about each others clothes, they are professionals commenting on patients.

ShimCode May 25, 2011 at 1:44 pm

Man! I wish my doc spent as much time “seeing me” as some of you doctors have spent on this topic.

Pranab May 26, 2011 at 12:33 am

ooooooooh!

Suz, RN May 25, 2011 at 3:41 pm

To those who were upset that she posted ‘she barfed’ after suctioning carrots. Get a grip. And after you get said grip, go to the local ICU, and spend TWO HOURS taking care of an ICU patient. Then tell me how many times you vomited in your mouth. This is not me ‘not showing compassion’ to all of my past and future patients, it’s a fact of life. Some things are disgusting. The public knows this. And they are happy there are people that don’t mind wading through the filth so they can take good care of their family who is sick.

I have a blog/twitter/FB/etc. As it is not anonymous, I take extra care to not share anything about any particular patient that could be taken the wrong way.

That being said, if a Dr./RN is anonymous, they are not hurting any sort of patients feelings by posting about them. I could care less what my healthcare providers say about me on twitter as long as it’s anonymous. To be honest, I’d much rather them say it about me on twitter than in the office right when I leave. (I’m SURE that you’ve never said anything mean about a patient to a co-worker).

You, bringing this debate to a public forum with real online names, has no room to stand when it comes to calling behavior professional or not. It’s not called ‘dialogue’, it’s called ‘gossip.’ I understand that ‘dialogue’ sounds much more constructive than ‘gossip.’

Professional would be contacting said Dr. privately to discuss concerns and then not posting names.

Nancy Onyett, FNP-C May 25, 2011 at 7:22 pm

This behavior doesn’t surprise me at all. I have seen worse on Twitter. It is unethical, immoral, HIPPA violation, and privacy violation. The sad aspect is there is a patient that is being talked about on a public platform with amusement. Twitter has the account on these two physicians and based on HIPPA and privacy violation their accounts could and should be cancelled.

Paul Dorio May 25, 2011 at 8:05 pm

Very interesting stream of comments. DrV has exposed yet another teaching moment for us all to learn and grow. I would suggest that we all remember a few things:

1- The world is sooo unforgiving. Critics abound. Someone out there will always look askance or be offended by something that each of us may write.

2- It is our duty as professionals to consider the feelings and thoughts of others when we write or post online, in person, or in earshot of another human being. A casual comment such as “don’t be an a-hole” may in fact offend the person sitting three seats down and to the left. And that person may end up sending her/his displeasure up to the administration, resulting in an embroilment you didn’t think possible from someone who wasn’t even in the same conversation!

3- Be fair to each other. Correct mistakes in private when we can. This “tweeter” was venting, but made several mistakes in so doing, as have been discussed above quite thoroughly and with interesting perspectives on both sides of the argument.

Many more teaching points. But these are a few that I can summarize at the moment.

Bottom line, as Howard Luks said earlier: Be smart. Don’t be stupid.

Paul Dorio May 25, 2011 at 8:19 pm

Sorry. Number 1 of my teaching points should have been:

Be smart, not stupid. Consider what you say BEFORE you say it. Read and re-read your comments to minimize the chance that someone might be offended by your words — if you care to do so, that is. There are some out there who love to shock and awe. As physicians, though, I don’t think we should do that.

Anne RN May 25, 2011 at 8:43 pm

Wow. I’m “only” a nurse (I say it sarcastically). I believe I have been an Rn just a little less than some of you have been alive. Who made you the Twitter Police? Who made you the authority on what is appropriate? Because you are a DOCTOR? You are also qualified to judge all others? If you are concerned, contact the person directly. That is what I learned in Kindergarden. I guess you didn’t. You are worse than any tweet.

Nurse K May 25, 2011 at 10:59 pm

I second fellow nurse Anne…Someone who is speaking for the ENTIRE world of medical blogging/tweeting has an ego bigger and wider and longer than a redundant megacolon.

As I said on Movin’ Meat, Doc_V, like other “medical bloggers” who are more focused on blogging as a self-marketing tool, doesn’t “get” people who just want to tell stories or say something terse and quirky on Twitter. Why would someone want to come on the Internet anonymously and tell a funny story about something in the ER or in urology or whatever? And get NO recognition? And not advance the cause of science? Not increase their online presence to gain more patients? Huh?

Answer: Because we’re human beings, in all our evolved glory. Our brains are set up to entertain people, be social, laugh at funny stuff, point out interesting and new things, etc.

Folks like Dr. V think blogs and social media should be an orchestrated campaign to do something. People like me (the most widely-read nursing blogger in the US) just want to entertain people and let people know what the real world of [medicine/nursing/whatever] is like.

Hey bloggers: Don’t have an agenda. Just write what you like to write, and do it well. If you do that, I’ll probably stop by. If you write what everyone else is writing and do so dryly and because you heard you were supposed to at some conference, it’s going to be a passed-over, uninteresting site.

Go Mommy_Doc! *Fist bump*

DrV May 25, 2011 at 11:25 pm

Thanks for your comment. I make it a policy to reply to all comments that involve the colon.

I have to agree with you entirely about the whimsical nature of social media and the natural course of dialog. And we have loads of examples of great doctors and nurses who do this. Their feeds reflects their mindset and we should never stifle that. Take a peek at those I follow – folks who fit into this category of genuine dialog have a place in my stream.

With that said, as professionals we have to first protect the privacy of our patients as well as the way we are perceived by our patients. Whether it rains on our parade, this has to be our first priority. One way to do that is to think, ‘what will the patient/my patient’ think if they saw this. Beyond that, think how your boss or peers would view your public dialog. It’s the simplest check on professional behavior.

Finally, don’t believe everything you hear. Just because someone chooses not to be anonymous doesn’t mean they’re promoting themselves. What I promote instead is a unique, and at times fiery, perspectives on the intersection of social and medicine.

Thanks for commenting in such a balanced way. And excellent points.

Nurse K May 25, 2011 at 11:53 pm

I’m not opposed to a good GI metaphor to get my point across. This whole situation stinks of melena on the day the AC fails in Texas heat. Or something. Wait, you’re a pediatrician. You don’t know about melena. Whatever.

Mommy_doctor said just now on Twitter that her patient really didn’t have priapism. Any change in opinion based on that? After 6 years of blogging, it’s actually quite easy to convey emotions and situations without really describing the actual patient presentation down to the letter.

Let people write, doc. Creative and intelligent people can figure this stuff out.

Actual tweet: “The most INCREDIBLE IRONY about this is the patient didn’t even have priapism, but another painful and embarrassing condition.”

Jin Packard May 26, 2011 at 12:20 am

So lemme get this straight,
1) Doc tweets patient condition
2) Said tweet caught fire
3) Doc suddently claims tweet wasn’t real

… and you buy that. Am I correct? Well here’s the kicker. We may never know if the patient was real or fake, but many people on this comment stream and elsewhere defend mommy_doctor and applaud her ability to “bring the reality of the trenches” to the masses. Reality – a key word there. And now some people are saying it’s alright, her tweets were fictitious.

Look, bottom line is, it’s never decent to mock a patient in public. Real or imagined. Because if you tweet as a Dr, you represent your profession.

Nurse K May 26, 2011 at 12:44 am

Hah. Okay.

Graduate med school then come party with me in the ER. You’ll be horrified at best with your ivory tower veil of perfection-in-character. I’ll teach you some good moves to block punches, duck out of the way of urinals getting thrown at you, how to smile and give a blanket to someone who calls you the ‘c’ word, and appropriate, non-judgemental reactions to getting your butt grabbed by a drunk. Top off your evening with coding a 30-year-old while her child cries and hugs her mom’s corpse.

Repeat x a decade or so. Just hold it all inside you forever and ever until you die and never use black humor, express emotion, nor “mock” anyone. We’ll see how that works out. Either you’ll quit or be a closet alcoholic.

I don’t find the tweets to be offensive either if they’re fake or real. I’m asking Dr. V if his opinion has changed.

Jeff May 26, 2011 at 8:17 am

I was a volunteer EMT in New Jersey. If you had any idea about the black humor that we used to survive as a common person, you’d be disgusted. It’s a survival mechanism. I’ve referred to patients as Smurfs, Crispy Critters, Frequent Flyers and pretty much every other term you can think of. I’ve seen what it looks like when someone commits suicide by putting a shotgun to the bottom of their neck. I’ve pulled kids out of a wrecked car and tried to convince them that everything was going to be ok when Mommy’s brain was hanging out of her head.

If you think for even a second, that black humor is an evil of the medical community and that it should be stamped out in a holy crusade, then I suggest you either invest heavily in a psychology practice or a bar across the street from the local ER. Either will do extremely well in the event that when I tell a doc the local repeat diabetic managed to get some blood into his sugar stream which is why on my 6th visit to his ER in 4 days I’m actually bringing someone else in is something that would be banned.

When the local paramedics roll up and I tell them it’s going to be a declaration and they say “Yeah, the fact that you have two sheets for one victim kind of gave that away”, is not making fun of a horrible situation. It’s a result of opening the lockbox of horrible things we see on a daily basis so we can put one more thing in there, close it back up at the end of our shift and go on leading a normal life outside of that.

It’s called a coping mechanism, and it would do you well to realize that it exists in many fields of medicine, especially in the field and the ER. Nothing here mocked the patient. Nothing here did anything more than represent the Doctor as the one quality I actually want in someone who will treat me. That they are a human.

Bob May 26, 2011 at 12:49 am

I find it a more than a little ironic that someone so concerned about an (alleged) privacy violation and wanting debate about the issue of social media, professionalism, and ethics could not take a few seconds to scrub personally-identifying information from the examples presented above. Then there’d be no question that this post was about the putative topic, rather than (for example) intentionally damaging someone else’s reputation.

You can save the “she damaged her own reputation when she…” response; you chose to start a conflict and make it public and personal. Before chastising someone else on their ethics and professionalism again, I hope you take a good long look in the mirror.

(pseudonymous Twitter user @arclight, who has put his own job at risk via social media when professional ethics apparently offended his employers’ pecuniary interests)

Dani May 26, 2011 at 6:24 am

I totally agree. You are NO better. Health care ethics are not the only kind of ethics last time I checked. You are no better for posting her tweets without taking out the names. Absolutely shameful.

Also, After taking MULTIPLE ethics classes I don’t think she did anything wrong anyway. Sorry. You might think so. She violated you MORALS. Morals are different from ETHICS. Sorry. You don’t actually understand ethics. You believe that what she did was wrong, but ethically she didn’t do anything wrong, I can’t find any ethical principle that she might have violated and I truthfully don’t think she violated HIPAA nor does anyone in the office I worked in. Therefore, what she did was against your MORALS… sorry man.

Jessica May 26, 2011 at 8:43 am

you know what’s funny? I had my second child in your hospital.

I would now know you from this conversation that you’ve had on this subject in real life should god forbid any of my children ever come under your service.

And all I would think about if we ever met in that context was ‘god I hope he’s not judging me like he did that woman.’

This Unprofessional-ism thing goes both ways Dr V. You left her name on the tweets, you’ve been in my opinion condescending and dismissive, and you’ve refused to acknowledge the person behind her tweets because she’s ‘anonymous’ not that you -let- her be more anonymous.

To be honest, these things read to me like bedside manner primers. I see Mama Doctor and Nurse K as real down to earth women who have frustrations in their job but stick with it because they love the job itself. I get the sense that they would laugh with me, that they might grit their teeth but at the end of the day that they would cry with me too if it goes too badly.

I get the feeling…my kid wouldn’t be a person for you, and neither would I.

But what do I know..I’m not a doctor..I’m just a History teacher in training. In my world unprofessional behavior is telling a parent that their child is a sociopath who can only hope he doesn’t end up as a CSI case.

Your opinion, is not the only one, nor is it the only right one. This isn’t an ethics violation..this is a moral and personal dislike, to imply otherwise is disingenuous at best. And remember what my momma always taught me..when you point a finger at someone, four more are pointing right back at you.

Dr Alice May 26, 2011 at 10:32 am

Dr. V, I don’t read medical tweets or blogs to view high-minded, boring pronouncements about the future of medicine or “the interaction of medicine and social media.” I read them for moral support and to know there are others in the trenches like me. Others dealing with disgusting body fluids, ungrateful/noncompliant patients, frustrating cases. Do I judge my patients? Hell yes. Do I work my guts out for them? Hell yes.

Unless said post reads something like “Mr. John Doe of 123 Main Street, Los Angeles, California is a scuzzbag diabetic” I’m not going to worry about whether or not it’s a HIPAA violation. The idiot above who said tracing the tweet to a certain zip code makes it a HIPAA case doesn’t know what he or she is talking about.

M*A*S*H is real, folks. We in healthcare are under metaphorical fire every day (and for those in the military, it’s real fire). We need this vent. I have a Twitter account and a blog and I am VERY careful to disguise my cases, changing genders/ages and details – but the underlying frustrations do not change. I salute those who post the stories you sniff righteously at. In fact, I may start doing more of it myself… I’m sure there are others out there who need the support.

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