Here’s a question: Let’s say you have a little down time between patients in clinic. So you take to Twitter to share an interesting article or story.

Is this a problem? What if the patient in the waiting room follows you?

It’s an interesting question because new communication tools raise new considerations for physicians and how they appear to be spending their time.

Like we tell our medical students: the needs of your patients should always go ahead of your communication needs. Professional calls (barring emergencies), personal calls, text messages, and social exchange of all types happen only when patient obligations have been reasonably met.

With that said, there are a couple of things to think about when tweeting between patients:

Social media is just another form of professional communication

We should see it no differently than the telephone or email which, as we all know, can be misused at the expense of patient care. To the uninformed, it’s assumed that social dialogue is frivolous dialogue, but your social feeds may very well represent a core of your professional connection to the world. They will hopefully represent your personal learning network. Ultimately, platforms of this variety may eclipse email as our core mode of communication. 

Communication and patient care are not mutually exclusive

You may hear this: “I would rather have my doctor spend more time with me than write a blog or share on Twitter.” Of course, who wouldn’t? But one does not happen at the exclusion of another. Our clinical obligations should never be shortchanged in order to create time to communicate. The two will always need to coexist. We shouldn’t see the two as mutually exclusive.

Perception trumps reality

To an extent, what patients perceive may be as important as what’s occurred. If a patient believes that your social dialogue has occurred at the expense of their care, that’s a problem. That goes for the occasional tweet during thirty minutes of downtime, as well as your weekend on call. While we have to educate patients about what we’re doing, we need to be sensitive to their perceptions.

But sometimes reality trumps perception

Anyone who shares conversations understands that transparency comes at a cost. When bits of your professional dialogue are public, you may be judged, and there will be those who misunderstand or take commentary out of context. This is a well-known risk of short-form dialogue, but it’s important for doctors and lurking patients alike to understand that the potential for misunderstanding doesn’t mean we stop talking.

As we move from the idea of social media as goof-off medium to social media as tool of communication, there will be growing pains. The adoption of real-time physician communication will draw attention to the issue of boundaries. A lot of this will come down to the expectations we have of our providers and our understanding of how and when social dialogue should take place.

The bottom line: When you communicate in public during working hours, consider how that may be perceived by those under your care and weigh it accordingly. Remember that perception trumps reality.

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!