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Saturday, May 28, 2011

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Zzzooey

'These aren't social media issues, these aren't health care professionalism issues, it's the common struggle to be human and communicate both accurately and honestly.'

Very true. These things happen in real life too, the technology only constitutes a minor difference in how these things happen and unfold as compared to real life. Humans still behave like humans, on twitter, mailing lists, blogs and elsewhere... Of course, the internet would be unbelievable boring if people weren't behaving like humans -- there would be no conversations at all, for one thing (obviously) -- but this also means any conversation is fraught with the same potential for disaster as any other human encounter IRL. I'm guilty of lots of mishaps in this department...

/alicia

Bryan Vartabedian

Liz,

While I have tried not to get wrapped up in every post and comment, I wanted to give you feedback. You were one of the first blogs I began reading in 2005-2006. And despite our long history as partners-in-crime in stamping out the anti-vax movement, I have to disagree. There's lots to say. Just a few points:

While this discussion has evolved to center on the rights of doctors to express themselves, it should remain centered squarely on the interests of patients. When it comes to the physicians in the social space, our needs, rights and interests should always be secondary to the interests of the patients we're called to serve.

To serve that end, one question will always serve us well. That question is, 'If this were your brother or father, how would you feel reading these comments?' Or better, if you were the patient under this doctor's care, how would you feel that such things were being said? It's a powerful check on what we feel is a right to free expression.

The HIPAA issue has been raised a number of times but I would agree with you and a number of others who have weighed in, it's hard to see this as a HIPAA violation without knowing all the details of the patient's case. I never suggested that HIPAA was an issue here. It may be, but few of us have the expertise to make that assessment.

If you assume for a moment that this case was effectively fictionalized, the second question that might be asked is, 'How will my patient's see me after reading this?' or better, 'How will my hospital, my colleagues and my community see me after reading these tweets?' These are important questions that doctors should ask themselves before publishing. This discussion should be just as centered on the respect and vision of our profession as it is with the 'rights' of any one physician.

And you're not the first to suggest that I should have approached this person privately. But I don't consider myself professionally accountable to someone who considers herself entirely unaccountable to the medical community or the patients she serves. Anonymous bloggers appear to live by a different standard than the rest of us. I stand behind my words and are consequently accountable for them.

Liz

I thought this tweet-stream from @burbdoc was relevant: (they are individual tweets, so read in the conventional way from the top down, not bottom up)

21_24b

21_24a

21_24

21_25

21_26

21_35

21_47

You can read more from @burbdoc by following his tweets: @burbdoc.

Liz Ditz

From Shoq

Background on Shoq and his damned "anonymity.

It should come as no surprise to my Twitter stream that I prefer to tweet anonymously. I have several reasons for choosing to do that. The two most important of them are these:

1. First and foremost is the security of my aging mother who, thanks to my political nature, has been relentlessly harassed in the past. But it's also for the sake of my brothers, sisters, nieces, nephews, partners, friends, and acquaintances who have a constitutional right to privacy, or at least a moral right to not be annoyed or harassed because some guy with a cat avatar likes to piss on Republicans, conservatives, pretentious phonies, or plain old crappy bloggers in cyberspace.
2. Secondly, way back in the AOL days, CEO Steve Case took a lot of grief of allowing "screen names" and allowing identities to be anonymous. He defended his decision because he believed that without anonymity, people would not be free to speak their mind politically for fear of reprisals from employers, churches, friends, etc. And as digital information sharing in the medical and insurance community was only recently becoming common, he also felt that any such medical issues should be openly discussable without fear of insurance companies, familes, or employers learning of it.

In my view, Steve Case was exactly right on both counts.To this day, I have many close friends who say they wish that they had kept at least one online persona anonymous so they were free to speak politically, or personally, without fear of their words showing up at the office the next morning—or in the NY Times.

I could spend 10,000 words on this topic, or you could Google for literally millions of discussions on it.

Shoq is a political blogger, not a health care professional (or maybe he is, who knows?) but I think his points are pertinent here.

Liz Ditz

Thoughts from a physician who was hounded for his views supporting vaccination and opposing quackery in medicine:

David Gorski at Science-Based Medicine: The Price of opposing medical pseudoscience.

Liz Ditz

From my in-real-life pal Karoli (who I knew back when she was pseudonymous). This isn't about health care, it's politics. (emphasis added)

But you know, I’m just sick of it all. Truly sick of it. There’s bunch of lunatics and liars out there, full of hubris and venom. And those are just the ones taking aim at my friends.

This is why I used to write under a pseudonym and probably should have continued to. There are always awful people like Lee Stranahan and Jim Hoft ready to shit on women in order to fulfill their petty little fantasies and collect the paycheck from Big Dick Breitbart. They’re not the only ones, but they’re the ones I’m naming today. I’ll save the ones who bully me while claiming to be big first amendment lovers for another day.

Bobby Ghaheri, MD (@DrGhaheri)

edited to add paragraph breaks for readability

I feel compelled to respond to Bryan's comments above.

1) Your argument seems to come from one of patient advocacy. The problem is that your brash approach to @mommy_doctor has done other people harm. Real life patients valued her twitter stream and her blog.

Unfortunately, as you admit, you don't follow anonymous posters. I'm not exactly sure where your moral high ground comes from in deciding that, but regardless, you have subsequently trumpeted the importance that you weren't alone in your criticism. You were "alerted" to this series of tweets by several (still anonymous) people. Why not name them to have a full dialogue? You don't have any journalistic or HIPAA limitations in naming them. That's a double standard.

2) You say "What if this patient were your brother or father?" My response is simple: What if this patient actually existed? If you had done your homework (which you didn't), you would have known that she posts and blogs hypothetically. You would have understood and learned her to be a caring and compassionate doctor. Most importantly, you would have learned that the offending tweets were NOT a pattern of unprofessionalism. If you were truly diligent, you would have named every single anonymous/unprofessional account out there, specifically @burbdoc. But you didn't. Which raises the question about whether you did this because @mommy_doctor is a woman or whether you did this because the subject was phallic in nature.

3) You talk about the events as a "powerful check on what we feel is a right to free expression". I'm confused. Are you implying that you're trying to act as a check on those that YOU deem to be unprofessional? Do the thousands of people that follow her continue to follow her out of obligation? No. They CHOOSE to follow her. This cannot be equated with an unprofessional comment in the elevator of a hospital.

4) You then ask "How will my patients/colleagues view me after publishing this?" Funny, I was thinking about that, but in the context of YOUR reputation. Would I go to a doctor who attacks a colleague in public? Nope. Your initial blogpost tarnishes your reputation, whether or not you believe it. You should care, since you put emphasis on collegiality.

5) But the most curious comment you make is at the end: "I don't consider myself professionally accountable to someone who considers herself entirely unaccountable to the medical community or the patients she serves." This is an argument that my 6 year old makes. It is equivalent to "I don't have to share my toys with Johnny, since Johnny doesn't share his toys with anyone else." This implies that you are ONLY to be held professionally accountable to those who are professional. Conditional professionalism is NOT professionalism. Do you treat unprofessional patients in a different way than your professional patients? If you were truly concerned with professionalism, you would have respectfully:

a) done your homework about her
b) done your homework about other anon Tweeters
c) privately communicated with them
d) criticized her for whatever your objections were in the context that she is STILL your colleague, anonymous or not.
e) been transparent.


Whether or not you agree, I will point out what MANY people feel about your blogpost. They feel that your source(s) of complaint, along with you, are overly conservative and attacked her with a separate agenda. You hurt the patients on Twitter who benefitted from their interactions with @mommy_doctor and you hurt your image of professionalism by how you carried this out.

Karoli

As one who in better days was paid to manage health professionals who blogged for a large health website and who has been on the internet for a very long time, I see a very big difference between a person who is a health professional and a blogger/tweeter and a person who is a health professional online to dispense information to readers. As I see it, @mommy_doctor fell into the former category. Many professionals use social media anonymously in order to protect their patients and their families. It's not unheard of and certainly not unethical.

Speaking as a mom and as a blogger who heavily utilizes Twitter, I regret shedding my pseudonym. It constrains me from speaking freely, not because I am afraid of what it will do to *me*, but what it will do to my colleagues and family, who do not share my political viewpoints. Particularly family. As I sit here today, I can tell you that they have not gone unscathed. There are people online who have researched their names, their friends' names, my unrelated business and clients to that business. They have published my home address, my business address, my home phone number, and encouraged harassment. This is all very real and unfair to those unfortunate enough to be related to me.

Should I give up my voice because there are bullies out there? Is my information more reliable because I use my first name? (And yes, that really is my first name. I protect my last name though it's pretty easy to find when you search on my first name).

Anonymity doesn't shield the person. It shields others that person cares about. The minute you say anything on the internet, you own it, regardless of what name one uses. So frankly, I find it rather disturbing that someone's voice has been silenced because they chose to protect their family. Very disturbing, actually.

Anony Mouse, MS3

Where is the like button on here? (kidding, kidding ;)

But man, @DrGhaheri, you said everything I wanted to say. And more. Thank you for articulating it so beautifully.

*goes back to studying for peds shelf ;)*

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