When you take to the virtual space you have some decisions to make. Specifically, what part of yourself will you show and what will you withhold. You’ve got to set boundaries as a physician online.
Politics, religion and other things that go bump in the night
A couple of years back, two physicians on Twitter carried on about whether a mosque belonged in lower Manhattan near ground zero. Each took opposing sides and the dialogue was about what you’d expect. It wasn’t flattering.
Such stark differences in ideology are hard to put aside and will never be resolved in 140 characters. The unfortunate thing is that both were pretty visible public physicians. They’ll likely never relate to one another quite the same way again.
You might argue that Twitter is a free platform, and you should talk about whatever you want. We’re told that transparency is a virtue. Disclosure is all the rage.
Not always.
When it comes to politics and religion, transparency can be a liability depending upon your community. Social spaces are public places. If you’re interested in building relationships with those who hang there, you might keep some things to yourself. The discussion of sensitive issues will invariably incense a certain number of patients and colleagues, and you’re unlikely to change their views in such a constrained space.
As a physician in public, you’re a visible ambassador of a new medium that’s revolutionizing the way we relate to one another. Leave the loaded dialogue to political pundits whose careers are built on polarity.
Sharing your thinking can create opportunities, but it can also come with a cost. Most of us who talk about social media categorize a public presence as categorically good or bad. For those who see the power of it, it’s nothing short of amazing. If you’re skeptical, it’s something that will get you in trouble.
That OB/Gyn who shares hard-edged, politically or religiously charged views on abortion is likely to lose as many patients as he or she gains. In fact, depending upon the community in which this doctor practices, this may favor loss over gain or vice versa.
The passionate public endorsement of a presidential candidate in the last election would potentially have alienated half of your patient population. An idealist would argue that a doctor’s political opinion shouldn’t make a difference, but to many passionately polarized patients, political orientation impacts how we are seen.
If you’re a resident, your hospital or program may put limitations on the kind of health-related dialogue you can have. If you work for a hospital or large group practice, the person paying your check may have an opinion regarding how you should or should not show yourself in public. Sharing is good, but it can come with a cost that varies depending on our individual situation. Consider what you’re trying to do as a doctor and then balance cost and benefit.
Avoid public conversations when you’re angry
Beyond what you discuss, you need to consider your state of mind when you step out on the public stage. When we went from Web 1.0 (reading stuff) to Web 2.0 (talking back and participating), we began to inject into the Web. We became part of it. When we jump into the conversation, it’s often because we are invested and passionate. For many of us, we comment at times when we’ve been most moved—for better or for worse.
New tools of human communication allow near-immediate response to content and conversation. The now-ness of real-time dialogue can pull us in at times when it may not be best to leave something on the record. This ability to be part of things with effectively no filter is both the blessing and curse of social media, especially if you have any concerns about your public presence.
If you are a public physician, you will need to face this issue of emotional response.
Moving beyond your clinic space into the broader conversation requires a unique sense of restraint and equanimity. How and if you participate in emotionally charged dialogue requires poise, measure, and maturity. Knowing when to speak up and when to walk away is a skill learned on the schoolyard but tested now on the global stage. This book or a single course or a position paper will never be able to teach this kind of social intelligence.
The best way to learn this is to watch others who have perfected the drill of knowing when and how to respond. Study how they comment. Watch the more contentious threads on Twitter and see how brilliant, balanced participants engage.
Or, more importantly, don’t engage.
Until you have it figured out, a good place to start is to avoid the public record when you’re angry. Consider your state of mind and remember that the best conversations won’t disappear. They’ll be there when you’ve got your emotions in check.
Personal boundaries
This talk about religion and politics just seems like a lot of rules, but actually you can talk about both. It’s your choice. This issue, after all, is not new to social media. The debate over religion and politics in the exam room has been around as long as there has been religion, politics, and doctors.
A lot of this is personal. You need to figure out the boundaries you will set as a public physician.
When you make the move to step outside of the clinic and make your thinking and ideas available, you need to define what part of yourself you will share and what part you will keep for just you and your closest connections. As you grow as a public physician, you will have to define how you present and position yourself. This is the kind of internal decision that won’t come from your employer or office of student affairs. Policies will never be able to cover this aspect of professional life.
Some doctors keep their children out of their social footprint as much as possible. Other pediatricians use their children as brilliant examples of what they do as pediatricians. It’s wonderful to hear about how their personal experiences impact their work as physicians. It’s powerful.
Mentioning your children or your politics or your spiritual beliefs isn’t wrong; it’s just a choice that comes with how we decide to present ourselves.
Should you talk about your personal health issues?
I was once asked if I felt that doctors should publicly discuss their own health issues. The question came during the 2014 Stanford Medicine X meeting, where disclosure by patients in online communities drew a lot of dialogue. Like family, religion, or politics, I’d categorize this as a personal preference that needs careful thought.
Like any public disclosure, it comes with risks and benefits. If you are a gastroenterologist with celiac disease, your personal struggles will clearly define you as someone uniquely qualified to help others suffering with the same condition. For many, writing, sharing and finding community is a critical step toward healing, and doctors with chronic diseases are no exception. However, some conditions could potentially put your capacity to work effectively and objectively into question.
Unless you are public for needed community support or you are interested in building an identity around your personal medical story, it might not be in your best interest to have your footprint sharply defined by your health struggles. Again, how we shape our presence has to be driven by what we intend to achieve.
This page is part of a bigger project: The Public Physician, a field guide for life online. To read more check out the Public Physician landing page. Happy reading!