How human can your doctor be?

I mean, how many of us can honestly say that at one time or another he hasn’t felt sexually attracted to mice. I know I have. It’s like murder – make a thing illegal and it acquires a mystique… Look at arson – I mean, how many of us can honestly say that at one time or another he hasn’t set fire to some great public building. I know I have – Actor playing a psychiatrist in Monty Python’ Flying Circus

Does medical student behavior as seen on social media networks reflect the degree of professionalism they will bring to medicine and if so should or does it influence whether patients will choose that particular person as his or her physician?

These are the type of intriguing questions raised by new research conducted at the University of Michigan and just published in Medical Education (gated to subscribers only) by Dr. Anuja Jain and colleagues with an accompanying commentary by Cardiff-based medical education expert Dr. Anne Marie Cunningham.

The conclusions from the study looking at how students, faculty members and the public judge Facebook postings by medical students are open to a myriad of interpretations and, as with much good research, raise many more questions than they answer.

Through an online survey, the researchers evaluated the perceived appropriateness of a number of mock med student Facebook screenshots showing students drinking, smoking dope, and interacting with students of the opposite or same sex. Subjects were then asked if they would be ‘comfortable’ having the students who posted the content as their future physician.

Jain and colleagues main finding was that thresholds of acceptable behavior differed. All three groups rated screenshots containing derogatory or private information about patients as being most unacceptable followed by images suggesting marijuana use, while images of intimate heterosexual couples were rated as most appropriate. Medical students were more accepting of the postings of same-sex relationships, alcohol use, partial nudity and partying than either the faculty or the public.

In her commentary, Cunningham quotes J. Duffin and talks about the danger of producing “vanilla physicians” as a result of medical students feeling constrained from showing diverse backgrounds or attitudes.

While noting that doctors both online and off must respect the dignity of patients or colleagues, she asks whether regulating med student behavior in social media risks reversing the trend of humanizing medicine and having doctors who are “fallible but professional.”

One major caveat of the research that the researchers themselves noted is the assumption in the survey that all these Facebook profiles and postings tested would be accessible for general viewing. I think this is a big flaw as it runs counter to the behavior of any savvy student or user of social media who is careful to control their privacy settings.

I also think the study mixes clearly unprofessional behavior such as revealing confidential patient information and illegal activity (smoking marijuana) with activity that some may only find counter to their own values (alcohol use, same sex relationships).

While this type of research is timely I don’t think society can yet answer the question of whether the public does or should use social media postings by students to make decisions about that person’s suitability as his or her physician. And while it might be nice to have a family physician who shares your views on life, in Canada, at least, the reality is that such discriminatory taste is a luxury given the availability of family doctors.

Medical students mirror their generation and that generation using social media platforms extensively as a window to their lives. When those students become physicians many of their patients will have the same attitudes and I think many of the issues surrounding appropriateness of posting may become moot.

(Comments on the Article abstract can be posted here and Dr. Cunningham’s views can also be read here)



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