The idea of permanence is an important concept for the public physician.  It’s important because it’s a new concept.  Since the dawn of civilization medical students and doctors have had opinions, ideas, beliefs and complaints.  Anger and frustration were around long before the digital medium for sharing.  Traditionally remarks went no further than earshot of the nurse’s station or surgeon’s lounge.  Now the news is full of stories of doctors and their offhand remarks caught on Facebook.

So the question isn’t can you be frustrated and upset.  The question is what do we do with those emotions given a new set of tools for immediate and perpetual publication.

NYU Internet theorist danah boyd has suggested that there are four properties of our networked presence that change the dynamic of how we operate.  In Howard Rheingold’s Net Smart, boyd suggessts that our conversations are subject to four unique forces that we need to keep in mind.

• Persistence.  What we say is now part of a permanent record.
• Replicability.  We can take things from one platform and paste them into another.  Pictures, posts and comments can be screen-grabbed and shared outside of the context and community in which they were originally intended to be shared.
• Scalability.  A single post or comment to one person has the technical potential to be seen by the world.  It’s a blessing or a curse depending on your message or mistake.
• Searchability.  What we say and what we’ve done can be searched by anyone.  You have a digital footprint that defines what the world understands about you (more on that later).

Remember that comment or picture that you share lives on at the pleasure of the person who received it.

During the early years of blogging and social media, the cognoscenti of the blogging world would get together every year in Las Vegas to plot the future of new media.  Beyond the meetings there were lots of parties.  Smart phones with cameras and video were new.  The saying there was always, ‘what happens in Vegas stays on Twitter.’  The point being that what you say and where you’re seen may well go public in a moment’s notice.

Sure you can take stuff down before it is subjected to boyd’s four forces.  And very often that will eliminate the possibility of someone seeing it later.  But don’t count on it.

Once you publish, assume that it’s forever.  Somewhere.

The above post represents an excerpt of teaching material that I am putting together for medical students and residents.  I would love your input.  Amazon links represent affiliate links.