I have followed with interest an excellent reflective post by Anne-Marie Cunningham, who wrote about some “overheard” Tweets from doctors, who were using language that some people could be offended by.
“The terms used were ‘labia ward’ and ‘birthing sheds’ to refer to the delivery suite where women give birth, and “cabbage patch” to refer to the intensive care ward where many patients are unconscious.”
I have to thank Anne Marie for raising this issue. All the contributions to the debate have been very interesting to follow, as both the original Tweets and the debate that follows shed light on how much progress has been made in the education of medical professionals in the use of social media.
It has been interesting to note the different tones of the contributions on the blog, on Twitter, and on the Medical Registrar’s Page on Facebook.
I don’t think this is an issue confined to medical staff, I think all healthcare workers are still finding their feet in social media and appropriate behaviours (Lane & Twaddell, 2010). As with the ‘crowded bus’ analogy, I always think “would I be happy to say this in the lift at work?”, when posting in social media. As one commenter on the Facebook discussion stated:
“Discussions like this that take place in forums frequented by the public paint the medical profession in a decidedly un-professional light.”
Many posters agreed that
“I guess we like to think of Facebook and twitter as having a pint with our friends, whereas actually what we post on here is more like shouting something at the top of our voices on a crowded public bus. I don’t think this is about ‘thought police’ but about courtesy in public and the reputation of our profession.”
It’s a topic discussed with increasing frequency in the literature, as our patients and service users become more tech savvy, so must we (Brown, 2011 and Nacinovich, 2011).
As e-patient Dave so succinctly put it, in his response to Anne-Marie’s post,
“I say, one is responsible for one’s public statements. Cussing to one’s buddies on a tram is not the same as cussing in a corner booth at the pub. If you want to use venting vocabulary in a circle, use email with CC’s, or a Google+ Circle.
One may claim – ONCE – ignorance, as in, “Oh, others could see that??” It must, I say, then be accompanied by an earnest “Oh crap!!” Beyond that, it’s as rude as cussing in a streetcorner crowd.”
And equally sound advice from a poster on Facebook,
“Some of you need to really take a long look at the dehumanising nature of your jobs and try to rise above it… Social media makes the world a smaller place. Sometimes you should refrain from writing down your thoughts in public places like to FB and Twitter.”
If you want to post more… ahem… *colourful* content, my advice would be to set up closed groups in Facebook and only invite other doctors, or have profiles under nom de plumes and network on high privacy settings with people who you know IRL only. Otherwise, if we are to pursue congruent online and offline identity (and I think we must, for sanity’s sake) then be aware that everything you say online is actually covered under the same code of ethics and professional demeanour that covers the rest of your career. What you post privately today may well become available tomorrow, as privacy settings can be altered with frequency, for example on Facebook. Inappropriate online comment could be subject to complaints from members of the public, other professionals, patients, carers etc., and could lead to disciplinary action. I would counsel against posting comments such as the following, if you value your future career
“wow, really… if you’re offended, fuck off and don’t follow them on Twitter, and cabbage patch to refer to ITU is probably one of the kinder phrases I’ve heard…”
There is emerging literature available to guide the use of social media in medical education (Farnan et al., 2009; Landman, Shelton, Kauffmann, & Dattilo, 2010)
Blogging, and Anne Marie’s blog is a fine example, has been stated to be an appropriate developmental tool for clinicians (Bodell et al., 2009) and it would be a shame if clinicians failed to take advantage of such tools for fear of being accused of misconduct.
N.B. I have chosen not to identify posters who have written content which portrays them in a less than professional light.
- Edit [17/09/11] Today’s Telegraph commented on this post, and has attracted interesting comments
- Edit [18/09/11] Further discussion in the MSM today regarding this event, which is being dubbed #hcsmgate on Twitter.
- Yesterday’s Telegraph discusses the terms used as “banter”, and additionally yesterday’s post linked to above is available, as is a dictionary of medical terms used by some doctors. h/t @health20paris for Tweeting the link.
- Today’s Mail on Sunday discusses whether terms such as those used by the doctor @amcunningham blogged about have any place in modern, patient-centred care. h/t @Pillmanuk for Tweeting the link.
- It is interesting to see such polarisation in the comments between people who say black humour is a way of managing stress and we should all “lighten up”, and people who think that patients deserve respect in all settings, and that includes being protected from abusive, derogatory and bullying talk. I have to say, I agree with the latter view. Comments in public should at all times uphold the values of the profession.
- Edit [18/09/11] I responded to this blog post regarding the topic http://runningahospital.blogspot.com/2011/09/storm-brews-across-pond.html?m=1
- Edit [19/09/11] further comment from the blogosphere:
- @PaulLevy’s post in Not Running a Hospital
- @Thinkbirth‘s post
- @sarahstewart‘s post
- @laikapoetnik in Laika’s MedLibLog
all are recommended posts.
Bodell, S., Hook, A., Penman, M. and Wade, W. (2009). Creating a learning community in today’s world: how blogging can facilitate continuing professional development and international learning. British Journal of Occupational Therapy. 72(6) June pp. 279-281. Retrieved September 16, 2011, from http://docserver.ingentaconnect.com/deliver/connect/cot/03080226/v72n6/s7.pdf?expires=1316166667&id=64421118&titleid=6174&accname=College+of+Occupational+Therapists+Referrer+URL&checksum=1511D65AE17D156D5E8AF7A6E7F47B11
Brown, T. (2011). Are you a digital native or a digital immigrant? Being client centred in the digital era. British Journal of Occupational Therapy 74(7) July, p.313. Retrieved September 16, 2011, from http://docserver.ingentaconnect.com/deliver/connect/cot/03080226/v74n7/s1.pdf?expires=1316165615&id=64420866&titleid=6174&accname=College+of+Occupational+Therapists+Referrer+URL&checksum=54AC84699E58AB65668EDD2090BBC134
Farnan, J. M., Paro, J. A. M., Higa, J. T., Reddy, S. T., Humphrey, H. J., & Arora, V. M. (2009). Commentary: The relationship status of digital media and professionalism: it’s complicated. AAMC Academic Medicine Journal of the Association of American Medical Colleges, 84(11), 1479-1481. Retrieved from http://journals.lww.com/academicmedicine/Fulltext/2009/11000/Commentary__The_Relationship_Status_of_Digital.11.aspx
Landman, M. P., Shelton, J., Kauffmann, R. M., & Dattilo, J. B. (2010). Guidelines for maintaining a professional compass in the era of social networking. Journal Of Surgical Education, 67(6), 381-386. Elsevier Inc. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21156295
Lane, S. H., & Twaddell, J. W. (2010). Should social media be used to communicate with patients? MCN The American journal of maternal child nursing, 35(1), 6-7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20032752
Nacinovich, M. (2011). Rx to communicate: The E-patient will see you now. Journal of Communication In Healthcare, 4(2), 65-65. doi:10.1179/175380611X13097840494027