We’ve all seen physicians occasionally act out on Twitter but few of us like to recognize it. Because policing doctors on social media is tricky business. The AMA has called peer-to-peer policing our professional responsibility. But when you do you’re often the odd man out.

I know because I’ve called out. And I’ve been called out.

It goes like this: Some doctor makes an egregious post or comment. Another guy calls him out for doing something not cool. Then there’s the follow-up threadstorm about inuendo, intent, perception, nuance, misunderstanding, and the right to own one’s point of view. What wasn’t a controversy is then magically shaped as controversial. And at the end of the day the whistleblower comes away looking oddly worse than the guy who originally went rogue.

Here’s the rub: Every doctor understands that physicians should live by boundaries around things like, say, patient privacy. But beyond that you’ll have a hard time getting a physician Twitter cohort to openly discuss what they think should constitute limits and rules. Give it a try. I dare you.

Medicine’s digital culture is steeped in a kind of libertarian bias. This is, after all, our space and our time. Our voices and online identities may be the last remaining thing that we truly control as physicians. And the idea of being free with our voices may sometimes eclipse the sometimes ambiguous boundaries of digital professionalism.

Don’t tell me what I can’t do. Rather, watch what I can do. Even if we occasionally get it wrong.

So fair warning: Be careful policing doctors on social media.

And if you haven’t checked out The Public Physician, it’s a collection of guidance for your public presence. I do workshops teaching this stuff using team-based learning to doctors, hospitals and institutions who don’t know how to even begin conversations about public voices and public physicians. Reach out at 33charts@gmail.com for more information.