A workshop for medical students on Professionalism in the age of Social Media.

I have been asked to do a workshop for 3rd year medical students (just starting clinical years) on professionalism in the age of Social Media.  The recent brouhaha in the social media world gave me the material I was looking for this workshop (resources listed at bottom).  Unless you just got off the spaceship from Mars, you are aware of this story.

A very concise summary:

A physician posted on Twitter about a male patient's genital problem.

• The physician is a female (Let us call her Doc T for twitter)
• Doc T was writing under a Twitter handle that does not directly identify her.
• Doc T does not identify the patient in the tweet
• Doc T tweets that she feels sorry for the patient
• Someone else (non-physician?) makes a sexually loaded comment 
• Doc T responds to this person with a comment that could be interpreted as having sexual overtones.
• All this seems to occur even before she sees the patient (my interpretation of the Twitter posts).

A very well known academic physician blogger (Let us call him Doc B for blogger) 

• Posts the entire Twitter thread (5-6 posts) on his blog and comments about this being unprofessional.
• His post includes the Twitter handle of the physician.  
• This blog is very widely read and creates a flurry of comments where people take different sides.  

Plan for the workshop:

• Have the students organize in small groups and present this case.
• Each group will be assigned one of the following questions (bold).  They will be asked to discuss among themselves and report back to the main group.  
• Hope they will not come back with a Black/White answer.  Hopefully they will raise more questions about each question.  Some of the sub-questions that might come up are listed below each main question.  
• This should lead to a lively discussion and hopefully to a consensus that is close to the professional values of putting the interests of the patient before those of oneself.

These are the questions and sub-questions:

1. Is it OK to post information about our patients in the public space 
1. What if the patient consents to it?
2. Why do you want to post patient information in the cloud?  Does it serve the patient's interest in anyway?  Does it serve the poster's personal interest? Does it serve societal interest?
3. What if their is an educational value to this post - to help other physicians or patients?
4. What if the patient is not identifiable? 
5. What if the patient reads this and realizes this is him they are talking about?
6. What if another patient of yours is a follower on Twitter?
7. What if you are the patient, your physician makes a sexual comment in the context of this Twitter thread?
8. What is the role of Institutional Review Boards?
2. Is it all about HIPAA vs. the freedom of speech or are physicians held to a higher standard? What about our professional code and values?
1. Will the professional values change because of Social Media? Or have they already?  Who decides?  Does anyone need to? 
2. Do physicians have a responsibility to uphold the image of the physician community?
3. When students enter the medical profession, they are asked to taken on the "burden" of wearing a white coat and all the responsibility that comes with this.  This can create a lot of stress for some students who feel they are living double lives.  Is this good?  Are we asking for too much?
4. Should physicians just be who they are, in private and public, and let the patients and society accept them as such (or reject them).
5. Can we ever succeed in getting all our physicians to go from TRYING to be professional to TRULY BECOMING professional and thus resolve the stress of dual identities?
3. What do you think about people (professionals) posting anonymously?
1. Have you heard of the Flea Incident? 
2. Can you ever truly stay anonymous in this age?  
3. Does posting anonymously lead to posting irresponsibly?
4. Should physicians take the attitude that they are their online personality and they should be proud or comfortable of what is attached to that personality?
5. Should readers take the attitude that "I don't care who you are but if what your write is good, I will read it"?
6. Are there instances where posting anonymously is the best or only option? 
4. Did Dr. B do the right thing?
1. Should Dr. B have sent a direct message to Dr. T instead of posting it on his blog?
2. Should Dr. B have hidden the Twitter handle of Dr. T when posting on his blog?
3. Did it matter that Dr. T was using a Twitter handle and not her real name?
4. Will the intense flurry of discussions and chats and comments help improve the level of professionalism? 
5. Is it OK to use humor when Blogging and Tweeting?
1. What if there is potential for misinterpretation?
2. What is the risk for this when blogging vs. Tweeting?
3. What is the difference between laughing at incidents vs. laughing at patients?

Resources:

Blog post by Dr. B - http://33charts.com/2011/05/unprofessional-physician-behavior-twitter.html

Better Health http://getbetterhealth.com/blogging-guidelines-for-physicians/2011.05.26

The Flea Incident http://www.newyorkpersonalinjuryattorneyblog.com/2007/05/doctor-flea-settles-malpractice-suit-after-blog-exposed-in-court.html

KevinMD.com http://www.kevinmd.com/blog/2011/05/doctors-professionally-behave-twitter.html

#MDChat transcript - a twitter group discussion on this topic - http://www.slideshare.net/mdchat/mdchat-transcript-may-24-2011

Dr. Madanick http://ryanmadanickmd.wordpress.com/2011/05/25/anonymity-and-professionalism-on-twitter-room-to-educate/

Moving Meat http://allbleedingstops.blogspot.com/2011/05/i-don-buy-your-definition-of.html

Drs. Mostaghimi and Crotty http://www.ncbi.nlm.nih.gov/pubmed/21502653

Swick in Acad Med http://faculty.ksu.edu.sa/11489/Documents/Definition%20of%20professionalism.pdf

Acad Med Professionalism Theme issue: http://journals.lww.com/academicmedicine/pages/toc.aspx?year=2007&issue=11000

Hafferty http://journals.lww.com/academicmedicine/Fulltext/2010/02000/The_Increasing_Complexities_of_Professionalism.31.aspx