Doctors and social media: Damned if you engage, damned if you don’t

August 15, 2014

Like symbol on white backgroundHinda Mandell felt creepy after being followed by her OB on Twitter.  Her post on Cognoscenti, Brave New World: Your Doctor, Your Private Parts, Twitter And You, is provocative on a number of levels.

Think perverts, not OBs.  It’s funny that the author’s friends and husband are concerned with her OB.  There’s little regard, however, for that serial pervert in a dimly lit room enjoying her recently shared images.

(That troubling little scenario puts things in perspective)

‘Following’ is irrelevant.  Your conversations are likely visible to every member of the planet whether or not you are followed.  Your comments are publications.  So if you’re uncomfortable with your ideas and images being seen, don’t publish them.  Or think about what you’re publishing.

Engagement is relevant.  What’s done with regard to engagement between a doctor and patient is what’s important.  Any social encounter has the potential to cross the line.  This isn’t specific to social media, however.  If you don’t like what a doctor does in the office, at the bedside, at a PTA meeting, on the phone, in church, or on Facebook, vote with your feet….or your mouse.  Relationships go both ways.  By assuming we have no control we make ourselves victims of our own visibility.

Damned if you engage, damned if you don’t.  One e-patient wants engagement, the other thinks it’s creepy.  No wonder doctors are confused when it comes to their public voice.  Let’s just face the fact that every social relationship is different and those participating need and want different things.  Policies at checkout windows will never fix that.

If you want a delineation of what I’ll do on every social platform, be prepared to wait.  I’m not sure if I follow any patients at this point but I suspect I will never have a Twitter policy on who, when and why I follow.  If, for example, a parent happens to run a blog, company, or organization that deals with technology and medicine, it might be something that I’m interested in.  I have plenty of patients who run non-profits for their children and associated diseases.  I might want to support these patients.  I won’t rope myself into a written policy because someone’s husband chooses to puff his chest out.

Committees are unlikely to legislate social engagement.  Just as there are no AMA guidelines on how I should deal with a mother who approaches me at a cross-country meet, there will likely never be actionable and practical guidelines that direct doctors to the seemingly limitless situations we face in the public space.

I could come up with another 20 points.  Where have I gone wrong?

h/t to Greg Matthews for pulling this story into my feed. 

Just found an excellent post on this story over at the Mayo Clinic by @LeeAase


Greg Matthews August 15, 2014 at 11:50 am

Of course you’re right, Bryan … we’re a long way from having a “bright line” distinction here, and I’m not sure if we’d even want one. Having said that, though, I think that there are some common-sense questions we could ask or principles we could apply. For example (and these aren’t mutually exclusive or related in any way):
- I won’t follow anyone I know to be a patient.
- I won’t follow anyone I know to be a patient unless there is some compelling reason to do so which is not directly related to our doctor/patient relationship.
- I won’t follow anyone I know to be a patient proactively, but I may follow them back if they follow me first.
- I won’t follow anyone I know to be a patient proactively, but I may follow them back if they @message me in an appropriate way.

That doesn’t seem so onerous to me … where have I gone wrong?
P.S. Greg only has 1 “G” at the end. How would you like it if I called you brIan all the time? ;-)

DrV August 15, 2014 at 1:57 pm

Thanks Greg. And you haven’t gone wrong and the idea of hard lines on this is tricky. This is where the policies and ‘guidelines’ attempted by major physician organizations have gone off the rails.

We all have to define how we want to play in public. I’m not sure I can put all of my ‘principles’ into black and white and I’m not sure that I want to commit to that. All of your dash points are reasonable for docs who want to create an internal compass for themselves.

But let me shoot holes in them, just for fun..

I won’t follow anyone I know to be a patient. So is it okay to then look at their Twitter feed? What if the patient or parent runs a non-profit for children with a particular disease. What if, in my case, a parent happens to write the hottest blog on digital apps. Am I then disallowed from following them or engaging?

…unless there’s a compelling reason. This point seems closest to what I do. But what would be a compelling reason? If I put this on a ‘policy’ at check out, what does it mean?

I won’t follow but I’ll follow back. This seems reasonable. But I think the following and friending is a remote second to the kind or engagement that happens. What is the nature of the convos? Is everyone comfortable with this level of dialog. Agreed that personal health related convo is clearly off limits.

Having thought alot about this I think it’s really hard to legislate engagement. Your points are, however, good jumping off points.

And as we tell our medical students, the discussion is more important than the answer.

DrV August 15, 2014 at 1:58 pm

And I changed the spelling of your name. And for what it’s worth, the entire free world spells my name with an ‘i’.

Rob Russell August 25, 2014 at 6:33 pm

Bang on for common sense, Dr V. So rare ..

I expect my MDs to be professionals. I trust them as acting professionals to make sensible, circumstance relevant decisions. Do we have to codify every potential act with a policy?

I’m sure I’m wrong, but I can’t help but think one of the most promising ways to open the reams of (raw, unbiased) patient health-valuable socio-economic data is to have a sensible social media interplay between provider and patient communities. It starts simply. Then … one day, we’ll be able to move from that to ‘more open’ health records … to the benefit of all.

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