Out of bounds

Social media tools are– or at least should be – fundamentally rewriting the rule book when it comes to boundary issues for physicians. As one pediatrician who is active on Twitter recently told me “There is only one me.”

While maintaining a distinct divide between professional and personal life has always been a central tenet of the rules and regulations that govern the medical profession (not dating your patients while in a doctor/patient relationship being the prime example), for those physicians using social media it is abundantly clear the issue is no longer clear-cut.

Nowhere has this situation been better stated  than in the recent viewpoint “Social Media and Physicians’ Online Identity Crisis” published in JAMA, Aug. 14 (v.310, no: 6, 581-582).

Authors Matthew DeCamp, Thomas Koenig and Margaret Chisolm (@whole_patients) confront the whole professional/personal divide directly and bluntly state attempting to have such a divide when using social media is “operationally impossible, lacking in-agreement among active physician social media users, inconsistent with the concept of professional identity, and potentially harmful to physician and patients.”

As they note later, the very blurring of the divide between professional and personal life is part of the draw of social media communication for many doctors because it allows for the leveling of hierarchies and more transparency.

However, the reality is that most medical regulatory authorities continue to adamantly stick to their guns and state that should physicians choose to use social media then they must strictly enforce the boundary between professional and personal identifies. Not surprisingly such an approach makes many physicians reluctant to communicate using social media for fear of running afoul of the guidelines.

The authors of the commentary from Johns Hopkins have a simple yet realistic approach to this dilemma.

They argue that rather than eliminating boundaries and “suggesting anything goes,” physicians should just ask themselves whether what they are posting on social media is appropriate for a physician in a public space – with the issue of the content being professional or personal being irrelevant.

This is an approach many physicians actively using social media have already adopted and wider promulgation of this mindset would doubtless increase the comfort level for those physicians who want to widen their horizons through the social media looking glass.

Connective Tissue

Dr. Viviana Martinez-Bianchi, a family physician and associate program director of the Duke University Family Medicine Residency Program, produces an online Population Health Daily newsletter focused on the socioeconomic determinants of health (http://paper.li/vivimbmd/1317782675).

Yesterday, one of the top stories in the newsletter was attributed to me. It dealt with a blog posting from the Canadian Pharmacists Association commenting favourably on a recent report on the social determinants of health produced by the Canadian Medical Association, the association for which I work.

Martinez-Bianchi and I do not follow each other on Twitter and I am not sure of how much overlap I have with her 964 followers. But using the paper.li tool she scooped up one of my twitter links because it concerned the focus of her newsletter – the social determinants of health.

The point is, this is not an unusual occurrence and I like to think it reflects one of the main benefits I bring to actively monitoring and contributing to Twitter. I rarely publish original research and am not a peer leader in the academic sense as I have no standing at any university (and an honours bachelor of journalism rarely trumps a PhD when it comes to being an authoritative voice on health care issues).

However, myself and many others, I think, perform and valuable function by linking people with information they might not otherwise access. We are the connective tissue that bring together people and new ideas in the social media space.

Whereas journalism has always played this role in a bigger sense by pushing out information to large audiences, social media allows this to happen on a much more timely basis and at the level of the individual. You pick and choose who you want to follow on Twitter or Facebook and you absorb the information those you follow provide, at a level that is useful to you.

Of course, engaging and interacting with others on social media and contributing to the conversations and debates that are taking place is the other big part of this. But with so many choosing to just watch and follow the Twitter feeds, I think the role of being connective tissue is not one that should be underestimated. Surely the health care community is a better informed place as a result.