The central part of medicine is patients - don't push them out of social media

Clinical medicine is disappearing fast as topic for blog posts

Something happened to medical blogs in the past 6-12 months. They now seem a lot less interesting, more industrialized and aggregated. They have also become "too safe", generic and detached for regular reading.

There seems to be a rise of group blogs, guest posts and semi-syndicated contents. Several "clinic-focused" health bloggers have retired due to a variety of professional and HIPAA-related concerns.

It looks like clinical medicine is disappearing fast as a topic for blog posts in the U.S., replaced by posts about social media itself. As a side note, "social media" is actually a plural noun (media vs. medium), but it seems to be used mostly in singular form nowadays.

The central part of medicine is patients - don't push them out of social media

The central part of medicine is patients. Yet, we tell doctors: "never, ever blog about patients". This somewhat misguided advice displaces the most important part of the equation - the patients themselves.

Some health bloggers claim that we have to "aim above HIPAA" to avoid privacy breaches and comply with the highest standard of professionalism required by our occupation as physicians. How high "above HIPAA" is good enough though? In most clinical scenarios, the compliance with omitting the 18 unique HIPAA identifiers strikes the right balance.

Physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content first to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities (Source: AMA Policy: Professionalism in the Use of Social Media, 2011; my edits are in bold in the text above).

Different standards for individual doctors vs. health system conglomerates

There seems to be a discrepancy of the methods employed by doctors and institutions when using social media. We tell doctors: "never answer patient questions on Twitter". Yet, Cleveland Clinic runs regular Twitter chats soliciting patient questions which are then answered by doctors and healthcare personnel. Mayo Clinic and other institutions do the same.

A blog is your notebook for lifelong learning

Don't forget the most important thing: A blog is your notebook for lifelong learning. Doctors learn from their patients every day. Patients learn from their doctors every day too. Both groups must try their best to excel in the joint quest to achieve the best possible outcome.

Comments from Twitter:

@scanman (Vijay): 3 doctors, @kmathan @razmohan & I, set up a twitter account @DrTamil to answer medical queries from Tamil tweeters.

@DrVes: You know the comment that you are going to get, right? "It will never happen here."

@macobgyn (MacArthur Obgyn) why do you think that is?

@SarahStewart (SarahStewart): I wonder if medical blogs are reacting to fear of litigation etc.

@DrVes: I'm sure they are. The community itself is not making things easier either.

@Skepticscalpel (Skeptical Scalpel): You're reading the wrong blogs. Try mine http://skepticalscalpel.blogspot.com

@CardioNP (Cardio NP): mirroring medicine in general? Agree w you re blogs; miss the early years ~2004-5. Agree skeptic that ur blog is a nice welcome addition

@marciovm (marcio von muhlen): will change as social media permeates society, informed consent will be feasible re: sharing medical info. Difficult to explain now.

@scanman (Vijay) This tweet - http://bit.ly/mpPL0P - by @DrVes, one of the most consistent medical bloggers, was meant for the Social Media Moral Police.

@vincristine (Vincristine): Who is 'we'? I imagine doctors will tweet what, where and how they choose to tweet, no matter what 'we' say

@laikas Laika (Jacqueline): A lot of interesting observations by @DrVes on the evolvement of medical blogs & social media use. I will take up my #FF habit #ff @DrVes

References:

“The powers of medicines and the practice of healing - to exercise the quiet art” - Virgil, Aeneid http://goo.gl/5BUb3

The making of a modern physician - The Lancet http://goo.gl/SYfTu

Strictly speaking, “Doctor” is a word incorrectly applied to most medical practitioners http://goo.gl/wjA0S

Despite the dire warnings, use of social media among emergency physicians is unusually strong http://goo.gl/QlqnK

AMA Policy: Professionalism in the Use of Social Media, 2011.
Image source: Wikipedia, GNU Free Documentation License.

Disclaimer

I am the Editor-in-Chief of several case-based curricula of medicine and related specialties. This is the information regarding patient data: There is no real life patient data on this website. Please note: we do not write or “blog” about patients. All case descriptions are fictional, similar to the descriptions you can find in a multiple choice questions textbook for board exam preparation. Case courses and descriptions do not follow real cases.

Polish Your Online Image, AAMC Advises Medical Students and Residents

How can you make sure future program directors find only the best “you” online? Follow these suggestions when using social media services such as Facebook, Twitter and blogs:

- Consider carefully what you’re posting
- Avoid posting patient stories
- Periodically search yourself
- Check the photos in which you’re “tagged”
- Define funny - Humor can be hard to interpret
- Choose your friends carefully
- Restrict your privacy settings

References:

Careers in Medicine. AAMC, 2010 (PDF).

Image source: OpenClipArt.org, public domain.

How to Use Social Media for Medical Education

Here are a few suggested approaches for social media use in medical education:

- Peer student groups can utilize a private blog to share clinical experiences

- Course/program directors and staff can use a wiki to manage course/program materials and centralize frequently used documents

- Longitudinal preceptors can use a microblog (e.g., Twitter) to share links to journal articles, medical news, and reminders

- Admissions personnel can use social networks during the application, interview, and acceptance processes to build a community before students ever set foot on campus

- A public affairs office could generate podcasts to share graduate news, campus information, celebrations, and research success stories


The Networked Teacher - Diagram, Flickr http://goo.gl/CVddi

References:
Saarinen C, Arora V, Fergusen B, Chretien K. Incorporating social media into medical education. Academic Internal Medicine Insight. 9(1):12-13, 19. Read the full-text PDF here.

For doctors: How to be a Twitter superstar in two easy steps

Warning: The purpose of this article is to inspire you to use Twitter, not to scare you. There are plenty of other blog posts and newspaper articles about doctors posting pictures of body parts on Facebook and getting fired. This is not it. Social media is amazingly useful for doctors and patients if you use the tools responsibly, have common sense, and never share the 18 HIPAA identifiers online or offline with unauthorized parties. The advice below is derived from extensive personal experience. I have used social media for professional purposes, as a physician, for more than 7 years, while working at some of the leading institutions in the U.S. such as the Cleveland Clinic and the University of Chicago. My account @DrVes has just been ranked #6 on the list of the Most Influential People from Chicago on Twitter (selected by Chicago Tribune and Klout.com). My blog websites have had more than 7 million page views. Just as an example, every time I hit the "publish" button of the sites, the message reaches more than 25,000 people every single day: 15,700 RSS and email subscribers, 7,000 Twitter followers, 2,200 daily visitors, and 1,000 Facebook fans (statistics for the sites ClinicalCases.org and CasesBlog, AllergyCases.org and AllergyNotes, and the Twitter accounts @DrVes and @Allergy).

This is somewhat of a typical example nowadays. There are many other physicians who are much more popular than me on social media and make the stats above look minuscule. You can be one of them. Here is how.

The basics of Twitter use for busy doctors

Most doctors are really busy. Several questions always come up when doctors consider the use of social media for professional purposes: Who has time for Twitter? What am I going to say there? To whom? And why Twitter, to begin with? What about Facebook or YouTube? My office is a mess and I always say "ehhh" when recorded -- I don't want to do video. Do I need a blog too?

Good questions. Here are the answers.

The circle of online information for me is as follows: Google Reader -> Share on Twitter -> Get feedback -> Write a blog post -> Share via RSS and Twitter -> Get feedback, go on. You don't need to use all services.


The circle of online information (full version) (click to enlarge).

1. Who has time for Twitter?

You do. Twitter should take no more 30 minutes per day and it will be beneficial for you, your colleagues and your patients. You will learn more and will feel better about it. Make it part of your normal routine - just like checking the news. In fact, Twitter is just that - checking the news - and then sharing the ones that you find most interesting with your followers. This takes a single click, and 2 seconds. Ten tweets per day, 2 seconds each. This is 20 seconds. You can do it.

2. Why Twitter?

Start on Twitter because it is quick and relatively easy. Twitter has the lowest barrier to entry among all social media services. "Being on Twitter" requires just 10 short sentences per day, with approximately 7 words each. You can reach thousands of people with a single sentence. Would you like to share the latest guidelines for food allergy? Just click and all your Twitter followers will know about them instantly. You will also get feedback to your tweets via replies and re-tweets.

3. What am I going to say on Twitter?

The answer is simple. You are an expert. There is a flood of medical news that hits the wires every day. I want to know what YOU think is important. Share the 3-10 news items per day that you find interesting. I will subscribe to read them. Many will do the same.

4. Who is going to read my tweets?

As a physician, you are an expert in your field. You provide valuable insight - just be selecting what you think it’s important from the news of the day. Embed this little personal news stream in your practice page. Your patients will appreciate the helpful updates, hand-picked by their doctor. Your colleagues may find it interesting too.

5. What about Facebook or YouTube?

Those are nice but I would start on Twitter first, and then expand if you see the need to do so. It may be a good idea to start a like/fan page on Facebook for your practice and re-post some of the tweets there. This is simple and not time-consuming. It can be done automatically.

6. Do I need a blog too?

Only you can tell if you need a blog. If you feel that you need to expand beyond 7-8 words on Twitter, by all means, start a free blog on Blogger.com by Google or WordPress.com and see how that works for you. Start on Twitter and expand to a blog as a natural extension if you need to write longer or provide some background. Post your blog items in your Twitter feed.

How to be a Twitter "star" in two easy steps

This is easy. It’s a two-step process for beginners and it takes about 30 minutes per day. The best time is just after your kids go to sleep.

1. Review the news of the day from Google Reader. I have ready-made subscription RSS bundles for you below. Alternatively, you can check a service such as Webicina.com for RSS feeds in your specialty.

2. Post the news items that you like best on Twitter. Don’t post all 10 tweets at once. Schedule them evenly throughout the next day. The first tweet goes on at 7:30 am EST and the last one at 8:30 pm EST. You can use Seesmic Web to schedule tweets - it is simple, free, and just works. The alternatives include HootSuite and any number of scheduling services (some of them have a limitation of up to 10 tweets per day).

This summary did no address the other Twitter activities such as listening, engaging, search, chat, HIPAA compliance, etc. They will be discussed in future articles.

RSS bundles of medical news

You can use the following RSS bundles to subscribe to medical news items. The bundles are exported from my personal Google Reader page. They update automatically several times per day. When in Google Reader, just select the ones that you find interesting and share them on Twitter. Feel free to add your own comments to some of the tweets.

Top Twitter Doctors

This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:

For doctors: How to start using social media

How to start

My advice for doctors who are interested in starting using social media for professional purposes is simple:

- Start on Twitter, expand to a blog as natural progression.

- Input your blog posts automatically to a Facebook like/fan page.
- Listen to the leading physicians, nurses and patients' voices on Twitter, and reply.
- Comment on blogs.
- Do not be afraid to share your expertise.
- Comply with HIPAA and common sense.

I posted this on Twitter yesterday: Doctors, when you don't have time to write a blog post, record a video - the orthopedic surgeon @hjluks shows how it's done: http://goo.gl/jL73J


Howard J. Luks, MD

@Doctor_V (Bryan Vartabedian) said, "My blog is my home. Twitter and Facebook are outposts."

I actually disagree a bit. My use of Twitter goes beyond a simple outpost. It's my digital notebook and idea feedback system.

The circle of online information for me is as follows: Google Reader -> Share on Twitter -> Get feedback -> Write a blog post -> Share via RSS and Twitter -> Get feedback, go on.


The circle of online information (full version) (click to enlarge).

Substance over style

Going back to the video embedded above, I think that @hjluks is the current leader in creating original, honest, tell-it-like-it-is clinical content among physicians. This is an example to follow. The technical execution does not have to be perfect, as you will see from the discussion started on Twitter and summarized below. However, the content must be factually correct and professional.

@yayayarndiva (P. Mimi Poinsett MD) had a few comments about the technical aspects of the video such as "if you are going to do a video - make your background a tad less busy:)"

I actually liked the background - it's "authentic" and gives you something to look at during the 8-minute video.

@hjluks actually polled 100 patients on that. They like the laid back office view.

@yayayarndiva P. (Mimi Poinsett MD) thought that "authentically messy AND 8 min video with a head in bouncing chair - think I would rather read the transcript... I think docs like everyone else can sharpen their presentation skills with video... still good to continue. Video? A talking head doesn't confer authenticity- just a new toy:)... Or you could use Dragon software and dictate your post..."

@ePatientDave (Dave deBronkart) convinced @hjluks to do the transcripts, primarily for Google. "Otherwise, thy pearls of light are hidden under a YouTube bushel. I emphasize it's not just *marketing* SEO - it's for being findable for those in need", said @ePatientDave.

I agree. You need the transcript for SEO and quick info. SEO doesn't just apply to marketing - it's a way for people (real humans) to find you online.

Nothing beats video for authenticity though. I understand the concept of creating technically flawless presentations but if you wait to do a perfect video and you are a busy doctor, you may never do it. The same applies to blog posts - if you are going to write a blog post for 2 months, write a journal article instead.

I had some final encouragement for @hjluks: "You don't have to be pro with video. You are pro as orthopod - who uses video."

I think he liked that.

Do you need a social media policy for your medical practice?

Another good discussion point was brought up by an office manager of a pediatric group in Chicago: Do you need a social media policy for your medical practice? http://goo.gl/7APvI - I think you do.

John Sharp and I worked on a social media policy for Cleveland Clinic back in 2005 when all that was a big unknown in healthcare. It still is for many organizations - in terms of professional involvement and outreach. A social media policy provides some much needed guidance and boundaries.

The number one rule is very simple: comply with HIPAA and do not share any of the 18 identifiers: http://goo.gl/WR5MR

Top Twitter Doctors

This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:

Comments from Twitter and Facebook:

Bryan Vartabedian: "When I present this stuff I recommend doctors find 2-3 role models in their specialty and follow them. Watch and study how they do things. Great place to start."

Reasons to stop blogging

I know medical bloggers who stopped blogging or closed their Twitter accounts for similar reasons to those summarized below:

"He says in his final blog post that while he intended the personal blog to be a place where he could talk about ideas, his posts had started to “spark whole conversations that I never intended to start in the first place, conversations that leech precious time and energy while contributing precious little back.”

More related thoughts:

"So many things can go wrong (with social media) if you don’t do it right. You can get stampeded and lose the game. Playing on the sidelines is more appealing.

If you run a hospital and decide to establish a vast living presence on the Web, people will say bad things about your doctors, your nurses, your waiting times in the ER, your food. You’ll have to deal with HIPAA. There’s also a chance that you’ll say something you’ll regret. Playing on the sidelines is more appealing."

On the other hand, consider this:


Duty calls. Image source: Xkcd.com, Creative Commons license.

See a perfect example why you must read medical blogs in this post by a practicing electrophysiologist: The first 4 months of a new era - anticoagulation with dabigatran. You can't find this first-hand real-life experience in any textbook or medical journal.

References:

Twitter Staffer Stops Blogging After Backlash. GigaOM, 2010.

Better to Play It Safe. Phil Baumann, 2010.

Social Media in Medical Education: What are the Burning Questions?

The 2011 Association for the Study of Medical Education (ASME) conference will take place in Edinburgh in July.

The conference organizers are asking all the right questions:

- Is a WordPress blog more useful than a Blackboard module?

- How social is social bookmarking?

- How can social media help medical education researchers?

- How can we manage and develop our own digital identity?


The Networked Teacher - Diagram, Flickr http://goo.gl/CVddi

References:
Social Media and Networks in Medical Education: Workshop at ASME

Nursing student successfully challenges dissmissal from school because of Facebook photo

A Kansas college is facing a legal challenge over its dismissal of a nursing student who posted online a photograph of a human placenta studied in class - the WSJ video is embedded above.

The lawsuit includes a letter that Ms. Byrnes wrote to the college apologizing for what she called a "lapse in judgment" but asking that she not be dismissed.

The school said the four students are allowed to reapply to continue their nursing studies in August 2011.

Most reader comments on the story follow this pattern: "I fail to see why this posting should result in dismissal from school. The student broke no confidentiality, and the posting was certainly not obscene."

References:
Odd Facebook Post Leads to Student's Ouster, Suit. WSJ.

Why doctors should use social media: it benefits their patients enormously

Wendy Sue Swanson, who blogs as Seattle Mama Doc, is a pediatrician in Seattle who recently gave a keynote at the Swedish Medical Center as part of their 2010 Health Care Symposium. See for yourself why doctors must use social media to stay uptodate and educate the public:



Link via KevinMD

The Value of YouTube Videos for Cancer Patients - Mayo Clinic

Ruben Mesa, M.D., describes his experience using YouTube videos to provide in-depth information about blood cancers.

Lawyers Opinion: Risky Business - Tweeting the Symptoms of Social Media

From Risky Business - Tweeting the Symptoms of Social Media (PDF):

"To date there are at least 540 hospitals in the United States utilizing social media tools: Hospitals account for 247 YouTube channels, 316 Facebook pages, 419 Twitter accounts, and 67 blogs.

The number of individual and independent medbloggers is in the thousands.

In December of 2009, a hospital employee was forced to resign because of a single tweet.

On October 29, 2008, a patient provided what is believed to be the first live tweet from the operating room. “Bad bad stick. Ow ow ow ow ow.”

In response to online physician rating websites, like Yelp, RateMD, and others, a company now offers physicians an antidefamation service, including contract provisions restricting a patient’s right to make negative comments on rating websites.

There are a number of other scenarios that could lead to liability. For example, what happens if an “off-duty” physician responds to a health question by a neighbor while doing yard work? Suppose the same exchange occurs through online “messages” between a physician and one of the physician’s “friends” on Facebook, creating an electronic record of the exchange that could potentially support the existence of a physician-patient relationship, thereby creating certain liability arising therefrom (e.g., HIPAA, medical malpractice, patient abandonment, etc.).

The authors of a National Law Journal article warn that bosses who “friend” are begging to be sued."

References:
AHLA Connections: Legal Implications of Health Care Social Media.

Image source: public domain.

The Ultimate Social Media in Medicine Presentation (182 Slides)

Networked Social Media in Learning, Teaching and Research

View more presentations from sl.medic.

The author, Maged Boulos, has published widely on social media uses in medicine and health informatics. He features this website in the presentation as one of the examples of medical blogs but I have had no influence on the inclusion. The link is via Berci.

The Lancet is alive and kicking on social media networks

As per its editor Richard Horton, the journal Lancet is alive and kicking on social media networks with a Twitter and Facebook pages. He commented on the social media involvement of the journal on the regular podcast available from the links below:

Lancet Podcast
http://www.thelancet.com/audio

Facebook
http://www.facebook.com/TheLancetMedicalJournal

Twitter
http://twitter.com/thelancet

Medical blog content and relationship with blogger credentials and blog host

A quantitative content analysis was performed on 398 blog posts from a constructed 1-week sample of posts in WebMD, Yahoo!Health Expert Blogs, and independently hosted blogs.

Most health and medical blog posts highlighted and provided commentary pertaining to medical issues found in external media such as books, television, Web sites, magazines, and newspapers

Only 16% contained actual health or medical information.

Distinct differences in patterns of content were evident between credentialed and noncredentialed bloggers, as well as different blog hosts.

References:
Health and medical blog content and its relationships with blogger credentials and blog host. Buis LR, Carpenter S. Health Commun. 2009 Dec;24(8):703-10.

Comments from Google Buzz:

Shabber Hussain - Now if I can some how know about those 16% medical blogs that "contain actual health or medical information", it should make my day. Feb 26

Arin Basu - I think (I just read the abstract perhaps a closer reading of the full text of the article might be more useful, @Ves, did you have a chance to read the full text?)

* The findings are not unexpected, at least that's what you expect based on "credentialing the blogger who has written the posts"

* There seems on first reading at leas the abstract that there may be quite a bit of bias in that study (just one week snapshot (too few blogs sampled), few selected sites (selection bias right there), and interpretation)

* Not surprised that most blogs contained commentaries published in popular press and journals.

I think that's what blogs should ideally do. Raise awareness, enable and alert people to read & interpret meanings. I'd not expect blogs to replace "actual" texts (well, that's my perspective)

* Which makes @Shabber's point very pertinent, what are those 16% saying, on a one week selective sampling?

All in all, a very interesting article. I think it needs to be closely read and discussed in medical blogosphere. Feb 26

Image source: public domain.

Doctors use Facebook Pages to connect with patients

With a 500-million large audience, many practices find that creating a Facebook presence can be an easy -- and free -- way to stay in touch with patients or attract new ones.

Businesses, including physician practices, can create something similar: pages (previously "fan pages"). Anyone on Facebook who elects to "become a fan" or like your page receives, on his or her own home page, any updates, photos, videos or Web links that you post.

Rather than having patients "friend" you on Facebook, you can direct them to this page. Having a moderator is important, because having someone dedicated to responding to people makes them feel more connected and encourages respectful and on topic discussions.

References:
Amednews: How Facebook fan pages can connect with patients.

Facebook Pages Manual.pdf - File Shared from Box.net via @sandnsurf.

10 Easy Ways to Enhance Your Facebook Page. Web Worrker Daily, 2010.

Image source: Wikipedia.

Updated: 07/15/2010

Benefits and Dangers as Doctors Start to Use Social Media

From Medscape:

"Dr. Choi has more than 3000 Facebook friends, many of whom are patients and colleagues.

But he draws the line at talking about cases with colleagues or sending diagnoses or test results to patients on networking sites. "I can't do any patient care using their messaging or using the site because it's not HIPAA-compliant," Dr. Choi says. "I'll pick up the phone to discuss a case."

Because doctors can be hesitant to share their e-mail addresses -- and regular e-mail is not secure to HIPAA standards -- it's not unheard of for people to find their doctors on Facebook. But the doctors interviewed generally say they avoid making diagnoses or communicating test results over the Internet."

References:

Doctors and Social Media: Benefits and Dangers. Medscape, 2010.
http://www.medscape.com/viewarticle/711717

How do you keep up with health news?

Steve Rubel asks How do you keep up with industry news - RSS, email newsletters, Twitter, Facebook or other (elaborate)? He now primarily uses newsletters, Twitter and Facebook to follow several dozen sources. He uses his RSS reader as an archive:

http://www.facebook.com/steverubelstream

This does not work very well for me. Google Reader is still one of my primary sources for health information - I channel Twitter feeds, YouTube subscriptions, Flickr and podcasts through it as well.

The RSS reader collects all rich media in one place - a true "inbox for the web". The disjointed approach described by Steve Rubel above can be confusing to many and a time-waster to even more. Everybody has their own preferences, of course.

For example, Steve abandoned his popular blog MicroPersuation to move to life-stream, then Facebook. Alternatively, I decided to stay with my blogs and send their updates to Twitter and Facebook. My blog is still my home on the web. You can build a professional profile on LinkedIn, Google and (may be) on Facebook but I decided to keep a separate website just for profile information. You can build it for free on Blogger.com by Google, control every aspect of it, and the only expense is the fee for domain registration ($10).

Comments from Google Buzz:

Tim Sturgill - I've started to use GR as you are for Twitter. I wish Twitter had RSS for direct messages as well.

Vamsi Balakrishnan - I use Google Reader for my news sites (both tech and health). And, for the individual people I follow, like you, I'd use my Buzz. Every few days I log on to Twitter to check messages / replies / etc.

Lakshman Swamy - GR and buzz!

U.S. Hospital Social Media List Includes More Than 600 Hospitals

280 YouTube Channels
382 Facebook pages
470 Twitter Accounts
82 Blogs

Twitter is the easiest and blogs are the most difficult and time-consuming social media channel, respectively. This explains the difference in numbers to some extent - 470 Twitter Accounts vs. only 82 Blogs.

References:

Hospital Social Media List Update. Found In Cache.
http://ebennett.org/hsnl_03_28_10

Image source: OpenClipArt.org, public domain.

Facebook Friend Request - A young doctor gets a message from a dying patient

From the NYTimes:

"Last winter, in the middle of my intern year, I became Facebook friends with a young man who was dying in the intensive-care unit. An investment banker in his mid-20s, he thought he was healthy until a fluttering in his chest and swollen ankles took him to a doctor. Now he was in the I.C.U. with a rare cardiac condition and the vague possibility of a transplant.

“Are you on Facebook?” he asked me. “I’ll friend you, and you can see the pictures.”

He’d been sending upbeat status updates from the I.C.U.; to read them, you’d never know he was so sick, but to me they were missives from a dying man."

Comments from Google Buzz:

Mark Hawker - Just before I do comment, I'd like to say that I do not have a clinical background so I cannot comment or empathise on the writer's clinical content or her situation. However, I can comment on my personal feelings about the story.

My reaction to this story was one of shock. A testosterone-filled medical student who got herself into a preventable situation. The lines that made me most uncomfortable were:

- "This boy on Facebook was, well, hot."
- "I didn’t think there was an ethical principle about following a patient on Facebook, and I didn’t worry that he’d see a picture of me in a bikini on my page."

It's not the fact that she didn't reply to this patient's message but the fact that she got herself into that situation in the first place. Would a doctor take a patient's telephone number to "see how they were" or go out bowling with them? Her emotions got the better of her and this led to more stress/turmoil in the future stages of the case. Does she feel this way to all her patients, or just the good-looking ones?

Secondly, "I signed on to our medical-records system and followed the notes that led — inevitably now — to his death." What now? In my opinion she had no right at all to do this. Her access was not about clinical care at all, nothing shy of being nosey. Does she also look up the medical notes of her ex-boyfriends etc.?

i just can't see how this would be OK? Maybe I'm missing the point... 10:51 am

Ves Dimov, M.D. - I see your point and I think it's a valid one. We already know that some physicians have hard time looking at patients only from a professional point of view, and I agree with you that this is a problem. It has little to do with Facebook though since this mind set can be propagated through any communication channel. Facebook provides some misunderstood "privacy", if not anonymity. 11:04 am

Mark Hawker - Yes, that's right. Facebook is merely a "medium" much like telephone, an address, papyrus, etc.

I can't come to imagine how hard it must be to separate from a patient but can you be too human which can lead to enormous emotional stress in the long-term? Maybe this encounter led the writer to feel lonely about her own situation? Would she have reacted the same if she found that he was not single? Though, this is information she should never really have found out about...

Can this type of separation be taught, or is it embedded within us and cannot be taught? 11:11 am

Ves Dimov, M.D. - "Can you be too human?"

Yes. There are two rather simplistic schools of thought for professionals: cold and technical but gets the job done vs. warm and fuzzy, bubbly and compassionate... "When you have appendicitis, you want a surgeon, not a poet holding you hand for comfort."

"Can this type of separation be taught?"

I think so. It's part of the professionalism - one of the 6 core competencies of a physician training:

http://casesblog.blogspot.com/2008/03/remembering-acgme-6-core-competencies. 11:18 am

Anne Marie Cunningham - I think I did read this around the time that it was first posted on NYT... in fact I'm sure I did. At the time I was struck by how this doctor communicated her confusion over many things... not being able to help this patient... realising that he had a life before being a patient... struggling with his death. It didn't strike me that she had been unprofessional. She engaged in small talk with the patient and he invited her to be a friend on Facebook to see the photos of his trip. She could have said "No, I'm not on Facebook" or "No, I don't think it is appropriate to be friends with a patient on Facebook", but she didn't. Instead she allowed him to invite her to see those photos. We don't know how public his profile page was. Perhaps it was public. Maybe she shouldn't have looked again. But she did. With regards to following up his medical story through his notes... well I don't think this is inappropriate either. Looking at what happens to patients after you have looked after then is how you learn. It's what we encourage students to do and it absolutely the best way to learn when you are a doctor too. Should she have written this account? Well, through it... and I presume she has changed enough so that we couldn't figure out who the patient is.... we are given something to think about. We are able to think about what she should have done. We are able to think about what we would do if we are patients. This is a generous act because she is sure to know that some people will be critical. Most of the comments criticise her for not responding to this direct message and it is what she criticises herself for. Should she have gotter herself into this situation? Who knows. Would she do it again? Only she knows. I commented on twitter, that I don't think that her behaviour was unprofessional. That doesn't mean that I think it was professional. I think that she is struggling with a professional identity. That's not surprising because she is a very young doctor.

I'm not sure from reading this if she ever actually did become his friend on Facebook. Responding to a message allows people to see more of your profile, and it sounds as if that is why she made the remarks about the possibility or not of him seeing her in a bikini. Perhaps it wasn't something to worry about because there are no photos of her like that on Facebook. With regards to seeing him as 'hot', I take that she sees that in contrast to his lack of hotness in a hospital bed. She gets to see him as the well person he was before being a patient. It probably made the tragedy of his story, and the sadness of his situation even more real to her.

Should she not have known any of this? Some would say, as a few commenters do, that the sadness is that she only came to know about him as a whole person through Facebook. The nature of medicine is that we mostly only ever get to see our patients on our turf. Seeing and knowing about their whole lives, if they are happy for us to, is not wrong or innapropriate.

Medicine is not just about information. It is about caring and that is what this story tells us about. 7:08 pm

Anne Marie Cunningham - PS For a critique of 'professional distance' as professionalism I suggest this paper by Joanna Shapiro http://www.peh-med.com/content/3/1/10

No one ever said that being a doctor was easy! 7:14 pm

From Twitter:

@markhawker

http://twitter.com/markhawker

Read this account... http://nyti.ms/dcM271 Do you think this is funny or very, very worrying? Do people think this article about a medical student and Facebook is funny? http://nyti.ms/bc80tC Maybe I'm getting too old for this...

Anyone care to count the number of ethical breaches that she abused in the story and, worryingly, admitted to. Would that happen in the UK?!

I'm still torn as to how "human" a doctor should be whilst working. Well, maybe one not driven entirely by testosterone. Yes, does require a lot of thought! I was just taken aback by the article & how the world seems to think these things are OK.

Confidentiality, looking up medical records unauthorised, wishing to respond to a "casual online message". Qualities of a Dr? Nothing catches your eye about testosterone-crazed medical students let loose to breach confidentiality regulations and ethics? You don't think that this student maybe got herself in too deep because of a hot-blooded crush which affected her clinical judgment? Would she give him a phone number etc.? Has the ICU been mistaken for a bar?! Is there a difference between being human and emotional?

It's not the fact she didn't communicate, it's the fact she got herself into that position in the 1st place.

"This well-intentioned resident naively violated HIPAA by accessing records for no purpose other than her own personal interest." Thank you.

There are many factors that contribute to this: personal, age, experience etc. I think her "issue" was preventable.

Interested in learning about the psychological effects of these interactions and skeptical about the altruism of the writer.

Interested to hear your thoughts. I think the article is wrong in many ways... Will watch out for your analysis.

I wonder if she removed him as a Facebook friend... If not, I could find his name, right? Not too anonymous.

Note:

If you see your comment here and you would like to have it removed, please let me know via comment or email and I will comply with your request within the same business day.

References:
Lives - Friend Request - NYTimes.com.

Scaring physicians aways from using social media

Image source: Wikipedia.

Why Twitter may not be good enough for scientific information and discussion

I appreciate the re-tweet below but I did not say anything remotely close to this sentence:

@sevinfo Reading "top" journals only distorts your world - Argument for scrapping peer review at BMJ blogs via @DrVes & @KentBottles

http://twitter.com/sevinfo/status/10929698882

My original tweet:

@DrVes The naïve concept that the “top journals” publish the important stuff and the lesser journals the unimportant http://goo.gl/utJ5

http://twitter.com/DrVes/status/10892767666

My expanded citation on Google Buzz:

The false idea that only the “top journals” publish the important stuff

From the former Editor-in-Chief of BMJ:

The naïve concept that the “top journals” publish the important stuff and the lesser journals the unimportant is simply false. People who do systematic reviews know this well. Anybody reading only the “top journals” receives a distorted view of the world. Unfortunately many people, including most journalists, do pay most attention to the “top journals.”

http://blogs.bmj.com/bmj/2010/03/22/richard-smith-scrap-peer-review-and-beware-of-%E2%80%9Ctop-journals%E2%80%9D/

http://www.google.com/buzz/110859855629071891085/TPmyVKjvZS9/The-false-idea-that-only-the-top-journals-publish

Please click the Buzz link above to see how much more "richer" the comments there are as compared to Twitter where the microblog updates (tweets) are limited to 140 characters.

This little example adds to the opitinion that many times Twitter is not good enough for scientific information and discussion.

Follow-up:

@sevinfo: yoicks! I was agreeing to need to read both "top" & less exciting ; not saying that reading science distorts your world! For record - @DrVes points out that text on last link open to misinterpretation - Keep reading science journals both top & less glamourous!

Comments from Google Buzz (March 23-24):

Kathy Mackey - Appreciate the followup Dr. Ves. I read the article yesterday on BMJ on scientific journals and felt I was missing something. It is true that 140 characters can be difficult to relay important information to the public

Brian Ahier - This is a problem that can not be adequately addressed because of the character limitation in Twitter. But it is an opportunity for a service like Buzz to be a bridge for longer commentary and discussion. I suggest we have more conversations in Buzz and then tweet a link to the post.

Ves Dimov, M.D. - Agree. Works very well with some posts. However, the Buzz adoption rate is significantly lower than Twitter and seems to have plateaued a few week after its launch.

Brian Ahier - Quality vs. Quantity?
I have found a much higher quality conversation seems to be happening on Buzz. Perhaps some of the adoption will not be missed. I have yet to be bothered by a spam account on Buzz and many of the followers on Twitter soon become inactive.

Ves Dimov, M.D. - True. People put more thought into Buzz comments - the accounts are often tied to their "real" identity after all. Participation fatigue is a common occurrence among all services.

Brian Ahier - I am also fortunate that many of my higher profile followers like Tim O'Reilly, Richard MacManus, and Robert Sconle are active on Buzz. As Buzz matures I think we will see some interesting applications. Then when Google buys Twitter we'll be all set ;-)

Ves Dimov, M.D. - Yes. Although Evan Williams keeps saying that Twitter is not for sale not matter what the price...

Brian Ahier - Yeah, Ev is an idealist :-D

Ves Dimov, M.D. - You have to respect the guy - he brought two very important services to popularity and success - Blogger and Twitter. Even one would be enough for the Internet history books... :)

Ves Dimov, M.D. - @Brian Ahier - I'm sorry I deleted your comment by mistake and there is no "Undo" in Buzz. "You" was meant in general not for you in person. And, yes, I share the same opinion.

Brian Ahier - Buzz does need an undo - but as I said, I admire people who old to their ideals. Ev has made some outstanding contributions and has an amazing talent.

Neil Mehta - Some of my best online experiences have been on Buzz - feels like a civilized sit down dinner with a conversation. Twitter can leave one feeling like everyone is rushing around on a big field shouting "hello" to the world, hoping someone will reply and start a conversation - it is great when to find that stranger with whom you share an interest but that happens rarely and the conversation is usually very unsatisfactory. Understand the Twitter functionality was not designed for conversations......

Vamsi Balakrishnan - @Neil Mehta: It's exactly as Dr. Ves said though; Buzz is tied to your real identity more or less, which is especially true for those who have verified profiles. It's also easier to have conversations since there's no 140 character limit...and it goes to those who use twitter anyway if you've enabled it. So, for me at least, it was a seamless transition.

The only problem that exists though, which truth be told hasn't affected me yet, is that there's a 300 comment limit. 300 replies to a post can exist, no more.