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02/19/2011

Docs Who Give Bad Tweet: Unprofessional or Just Uneducated?

Social networking among physicians is raising concerns for a variety of obvious reasons–it challenges our standard ways of thinking about the physician-patient relationship which for the most part has been confined to the exam room. Now social networks open up physicians and patients to each other in entirely new ways–some of which researchers suggest are not altogether positive.

According to a recent study published in the February 9th issue of JAMA, out of “5,156 “tweets” sent by 260 U.S. physicians, each with 500 or more followers, last May, researchers found that 3 percent were unprofessional.” (See story at Businessweek.com)

What does this really mean? Approximately 150 tweets, less than 1 tweet per physician on average, contained content that was profane, sexually explicit, discriminatory, or potentially violating of patient privacy. This is problematic, of course, on its face. But what truly matters however is whether among these 260 twittering physicians is whether there were just a few bad eggs who repeatedly were unprofessional or was it in fact that more than half of the sample unprofessionally tweeted?

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This matters because we all know that a few outliers can really skew a sample based on percentages. Moreover, there is nothing to suggest that these docs are truly bad eggs–perhaps they are just uneducated about Twitter, how to use it, and what the bounds of professional conduct are for social networking. The first profession-wide standard for social networking was just released by the AMA in late 2010.

Moreover, what has to be distinguished is whether these Twitter users were posting tweets in a professional capacity, or it just so happened that they could be identified as physicians who ALSO had a Twitter account. I do not think that the authors of the JAMA article would want to argue that all physicians must act with propriety at all times. To suggest such would mean that a doctor could never tell or hear a dirty joke among friends or drink alcohol to excess simply because he or she is a doctor. What matters for Twitter and other social networking sites is whether the user is online qua physician or simply as him or herself and how that activity effects their professional lives.

Thus, what matters is WHO is reading their tweets. Twitter, unlike Facebook, is much more difficult to manage in terms of knowing people’s true identities and thus who is “following” whom. Patients who “follow” their doctors on Twitter may do so under an alias a physician may never be able to recognize. Then if patients read inappropriate posts (regardless of whether the doctor was tweeting in a professional or personal capacity), it could create a rift in the physician-relationship for which the physician cannot be held responsible. This is perhaps the biggest moral issue with physicians using Twitter–but it is not captured by estimating that 3% of some portion of physicians on Twitter post inappropriate material. Whether patients see that material or not is a much bigger problem–and one for which we do not have a way to answer.

Without massive efforts to education physicians about how to use social media appropriately, there are bound to be violators of medical professionalism and ethics. But I don’t think we should hold physicians’ feet to the fire just yet about their lack of professionalism online–not until we have had ample opportunity to teach them about the boundaries between the professional and the personal online, how social networking can both benefit and harm the physician-patient relationship, and until we know more about whether this problem is the result of just a few uninformed or inappropriate Twitterers or is endemic to physicians in the world social networking.

Summer McGee, PhD

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