Out of bounds

ImageSocial 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.

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5 thoughts on “Out of bounds

  1. Thanks Pat.

    I tried splitting myself in two for a while on Twitter but it impossible and pointless in my opinion. The ‘me’ that is a doctor is also a father, consumer, cook, gardener and music nut in real life and I like to present myself as I am am online. When I use Twitter I am expressing all parts of myself and attempts I have made to separate them (ie professional persona from ‘the real me’) have been fragmented, confusing and I often mixed them up anyway. Naybody can find out who you are on Twitter anyway so there’s no point in splitting identities. I think we just need to me mindful that we are conversing in a public space and act with some dignity.’What goes on Twitter stays on Twitter’.

    Bryan Vartabedian says it best when he advises us to behave ‘as though our mothers were watching’

    I use Facebook differently though. Because there are certain aspects of my private life that I like to keep private – pictures of my kids, where I go in my time off or what I got up to while in University – I have a personal Facebook profile and a Professional one. My patients can subscribe to my professional one but not to my personal page.

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  3. I can’t help but think that the more interesting boundary issues may likely extend beyond what a physician tweets or posts on Facebook — but what they do and do not read on social media, or how they do or do not engage in on-line dialoge with patients.

    For instance: What if a mental health patient tells a clinician that they’d like the clinician to read their blog, Facebook posts or tweets to get a better idea for what they are going through and how other people are interacting with them on-line. This might be particularly relevant for a teen experiencing cyber-bullying. In the future, would more clinicians feel it is okay to look up a patient’s social media to learn more about them?

    Also, I suspect that “Do not friend a patient on Facebook” (which is sound advice), will be interpreted by many as “do not interact with a patient via social media” — which would be unfortunate. Some people might consider it a crossing of a professional boundary, but others may find it an innovative treatment approach that is much-welcomed by the e-patient generation.

    Obviously, there would be many risks that would need to be carefully managed, but I can’t help but think that 20 years from now the dialogue in this area will be very different.

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