Earlier this week, blogger and pediatric gastroenterologist Bryan Vartabedian, MD, posted an entry spotlighting what he considered unprofessional behavior by a physician on Twitter, and, in so doing, sparked a vigorous debate about what constitutes professional behavior by health-care providers when they're using social media. The debate raised many interesting points about professional conduct on the social web, so I contacted Vartabedian to continue the conversation and get a little more of his perspective. His responses are below.
The conversation about whether a particular physician’s tweets were unprofessional involve someone who has opted to conceal her identity. Why do you advise doctors against remaining anonymous when engaging in social media?
Anonymity creates a false sense of security for physicians using social media. And with that false security comes the risk of behaving in ways that you wouldn't normally behave. The fact that my name and picture sit to the right of every blog post makes me think about how my ideas are perceived. I try to keep in mind that everything I write will be seen by my department chair, wife, mother-in-law and patients. Dr. Wendy Swanson, blogger for Seattle Children's Hospital put it best, "Simply put, remaining anonymous protects the person/physician tweeting, not the patients or profession."
Physicians often use HIPAA as one of the guidelines to determine whether content comports with professional standards. While HIPPA is essential to consider when engaging in the social space, is there a need for physicians using these tools to aim above the legislation?
While HIPAA offers critical legal guidance in health care, it's important to understand that physicians have an obligation to patients that extends well above the law. There are certainly instances, for example, on Twitter where we can appropriately de-identify information and still run the chance that a patient could recognize a scenario we discuss. And independent of protected health information, HIPAA has no bearing on how we conduct ourselves in public. Physicians have few established standards of good conduct and professionalism in social media.
A common defense among health-care bloggers, and others, facing criticism for comments published online is that their remarks were misunderstood and well intentioned. How can doctors take precautions to avoid such problems?
Understand that in the fast moving medium of short form, real-time dialog it's easy to be misunderstood. So you have to be extremely careful with the way you handle sensitive subjects. Think of how your comments may be potentially perceived. When patients are watching, perception trumps reality. I operate under the belief that everything I write and say with be screen grabbed, reposted and placed on a billboard. If you're concerned with that level of transparency you need to be more careful with what you say or not say anything at all. That's okay too. Lots of doctors just watch.
Some physicians may view this exchange as yet another example of why they, and their colleagues, shouldn’t engage in social media. What’s your advice to them?
Clearly this sort of public dialog in the medical community runs the risk of keeping doctors silent. Understand, however, that this and other public events involving physicians in social media typically involve very isolated incidents. Professional misconduct on Twitter, for example, is statistically quite rare. Having been blogging since 2006 and on Twitter since 2008, I have seen lots of doctors adopt and thrive using social media. I can think of very few that have had any problems. Going forward we need to move from looking at social media from a risk perspective towards one that recognizes its opportunities.
Vartabedian will be a moderator at the Stanford Summit at the Medicine 2.0 conference on Sept. 16 at Stanford.
