Who Defines Professionalism in Social Media?

Earlier today, Dr. Kelly Sennholz (@MtnMD) posted on her blog, discussing her concerns with how physicians and others define professionalism on social media (especially on Twitter), who determines that definition, and what happens if someone violates that definition.

Here is my response:



Your concerns are well put, and I think they reflect the fact that we are still establishing the roles of physicians on Twitter and social media. The rules are not well-defined, and there are few useful guidelines out there to help us.

I feel that the movement away from anonymous accounts is a good one: each of us should be able and willing to say what we want to say and then we should be willing to stand behind it in public. So, in general, I think moving towards accountability is a good thing.

Having said that, I don’t really see how it is any one person’s role/position to police what others are doing and to criticize others as if they were the sole authority. They certainly have a right to their opinion, and to be critical of others’, but they should do so respectfully. And, I think they should expect that the general audience out there can make their own decisions: if a post or comment is truly offensive or “unprofessional”, then they can make that decision for themselves.

I follow @BurbDoc’s Twitter account, and I agree that his (?) language and comments can make me cringe. But I view him as an “EveryDoctor” dealing with “EveryPatients”: I wonder if any if the patients he describes are real, or if they are archetypes set up to describe the challenges, frustrations, and difficulties of being a physician in this day and age. Even if they are real, there would be no way to identify them as described: they are generic enough (unlike the @MommyDoc case) that they really could be anyone. That, I think, is the point.

I think we are all entitled to reacts as individuals as to whether we like or dislike something on Twitter. I have done that a few times, when I felt comments (or accounts) had done something egregious. But I did it as myself—not trying to lead a movement or define “professionalism” overall or for all.

I do think physicians who are on Twitter as identifiable physicians should be professional—but should be able to retain our own voices and our own opinions. We have to be willing to stand by what we say, and we should say what we say for the greater good. But before trying to set the rules you expect all of us to follow, it should be determined if all of us agree upon those suggested rules. I agree that identifiable is better than anonymous. But I also feel that anonymous (and pseudonymous) posts have their roles. Professionalism is, to some extent, in the eye of the beholder—both on the wards, in the office, and on Twitter. Just an action doesn’t meet my definition of professionalism doesn’t mean it is, inherently, unprofessional. For example: I tweeted picture a few weeks ago showing me, in a fake moustache, drinking a beer at a party. Some might consider that unprofessional. Why? By whose standards? Who is setting the definition of professionalism? The AMA’s definition? Someone else’s? Who decides?

I think there is enough room on Twitter for many voices to share many opinions—some agreeable, others not. I think that, as physicians, we need to guard our patients’ privacy (which was part of the issue with @MommyDoc), and we need to work towards our patients’ (and society’s) wellbeing. We need to provide information that is valid and reliable, and we need to do so in a way that advances discussions and ideas. These are my beliefs, and I will try my best to abide by them. However, I do not feel that I need to force others to do so.


3 Responses to Who Defines Professionalism in Social Media?

  1. We all know that @BurbDoc doesn’t give any quarter to exposing patient privacy. There is not one iota of his remarks that can be pinpointed to a patient in his care. The man has a healthy sense of humor, albeit bent, and I love him for it. We have all heard Dr. V’s sermon about how doctors can’t have purple hair and what not. Complete and utter prattle. Therein lies the generational divide. Let’s face it, when you can get a tattooed at a mall, it is mainstream. So, to say that someone with tattoos or piercings is not being professional is simply out of date. We’re beyond that. For those with a serious curiosity, you will find that @BurbDoc and his brethren expose the hypocrisy of the profession use satire to critique it. His kind are worthy of a Mark Twain award, not shuns and hisses.

  2. Thanks for this post! I could not agree more. I feel the same about @BurbDoc. Honestly, I read him for a while without following him. Initially, he shocked me…with time I started to see that all he said was mostly true and recently I decided to follow him. I agree with the man, sometimes profanities included. He says things that we can’t, not even out of SM. As you said, he plays an important role in SM; we need both anonymous and non-anonymous accounts.
    I express all my thoughts, the way I think, but respectfully; some people might not like it, but I will never change the way I see the world. I still don’t have a license in this country, but even with one, this will not change.
    I have learned a lot in Twitter. It is an invaluable tool for learning about the Healthcare in this country, among other things. Sometimes what NOT to do or NOT say. I’ve networked with a lot of HCPs and planning to continue in participating in many interesting projects.
    The professionalism is a part that I am not 100% clear. I think at some point all the companies will establish guidelines for its employees.
    Is it too hard to be “professional”?Just be honest, have ethics, be respectful and recognize when you’re wrong…maybe I’m naive, because that’s the way I am….however, I will be forever grateful if someone thinks I’m not, please let me know.
    Great post!

  3. mtndoc says:

    A belated reply to your post:

    I am very, very heartened by the overall response that people, including doctors, should be allowed to speak. In a recent survey, over 70% of people were supportive of anonymous accounts, for the very reasons outlined above. Not touched on this enough are the myriad of reasons one would need to post anonymously, including job, stalkers, need to express beyond normal boundaries, safety in many venues, etc etc.

    I love the analogy to Mark Twain. Who says we can’t have “Mark Twains” in our modern world? A big “hoorah” for creative thinking.

    Thanks for the great, succinct post.

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