It used to be that we knew where we were, and how we behaved was dependent upon our context. When we were in a patient room we carried ourselves one way. In church or temple, we behaved a different way. How we behave and what we share has traditionally been defined by where we are and who we are with. The context has always been clear. But now physicians and other health professionals face context collapse.

The problem with new communication channels and communities is that we don’t know where we are. We engage, share, learn, and have fun on multiple platforms, many of which cross the contextual boundaries that define us. Take a social platform with fuzzy boundaries, add in the detachment of an online identity engaging at the speed of now, and you’ve got a recipe for problems.

A young doctor’s message fashioned for a love interest finds its way in front of a patient. A male OB/GYN resident strikes a pose next to a naked statue on the Vegas Strip, and it becomes an unintended part of his application for fertility fellowship. Context is increasingly ill-defined, so it’s easy to find yourself accidentally breaking the rules. I say accidental because we can create problems for ourselves even without the intent to be crazy or snarky.

New York University’s danah boyd has called this context collapse (first use of context collapse was in this paper), and it’s something to keep in mind when chattering in public. We’re now swimming in the same pool with our patients, colleagues, and future employer. And if you look at the ways that doctors get in trouble using social media you’ll see that it typically involves some form of context collapse.

Sing like everybody’s watching

Perhaps the best check on context collapse is this reality that everyone’s watching. Every time you hit publish, think how what you’ve written might play in front of patients, colleagues, or a jury. The idea that your community is watching should be enough impetus to keep you civil, balanced, and safe.

Think of it this way: post to your Facebook page like your mother-in-law’s watching. If you’re not married, imagine what it will be like to have a mother-in-law and then picture her checking out your digital spaces. If you can’t picture that, think about your residency director or future boss.

While you can’t please all of the people all of the time, contemplating how your words will play in front of different audiences will take you far when it comes to staying out of the hot seat.

So sing like everybody’s watching. Because they are.

If you found this page useful, check out The Public Physician. It’s an online resource for physicians and health care professionals navigating life in a connected, always-on world.

Updated June 2019