(Disclosure: I am not a physician or engaged in any aspect of health care, other than being a patient.)
Update 5/30/2011 mommy_Doctor is no longer on twitter and her tweets have been removed. I think this is a sad and sorry outcome.
Around here, it's been the time for controversy over online privacy. First there was the big Waldorf Critics dust-up (my post on it, and I'll return to the subject below) and then, starting the night of the 23rd, "the storm in the tweet-cup" (see backstory, below): the..situation blew up between @Doctor_V (Dispatches from the frontline of social media and medicine by Bryan Vartabedian) and @mommy_doctor (Mild-mannered anesthesiologist by day, suburban ninja mom by night. Tweets are based on fictional characters and situations) .
The latter situation...while I've never met either one in person, I've been following @mommy_doctor for some months. I've read some, but all posts on her blog. I find her online company both informative and enjoyable. I have a longer relationship with Dr. Vartabedian: I've been reading, commenting at Dr. Vartabedian's blog, and exchanging correspondence, for over four years. I continue to have a positive regard for him, and I'm looking forward to meeting him in person this fall, when he'll be in my neck of the woods for a conference.
Since this particular event has become so polarized, I want to make my point of view perfectly clear:
Reasonable people can disagree
Now then, on to what I think:
It is my opinion that Dr. Vartabedian was led astray by several assumptions he holds:
- That any physician not using his or her own name is bound to say "stupid things" and act like "a hooligan" and Unless we know who you are, you don’t count. If you’re anonymous I have to assume you’re actually a disgruntled medical assistant with an axe to grind.
- That there's no difference between anonymity (facelessness; lack of identity; having no distinctive character or recognition factor) and pseudonymity (using a name different than the one on your medical license. Pertains especially in writing and publishing.)
- That @mommy_doctor published on twitter the actual gender and actual medical condition of a patient.
These assumptions (things that are accepted as true or as certain to happen, without proof) led Dr. Vartabedian to behave badly: he published a blistering post about @mommy_doctor alleged improprieties without without in any way checking reality, including contacting @mommy_doctor for her point of view. She was held up to criticism and ridicule, both from Dr. Vartabedian and his commentariat:
One of the commenters asked (correctly, in my opinion):
Jennifer Adaeze Anyaegbunam ....Have you reached out to these people and let them know the error in their ways? I think if I made a mistake, I’d rather be alerted privately than (further) exposed in a public forum.
Doctor Vartabedian replied:
One: just a few hours before, Dr. Vartabedian had responded to an anonymous commenter -- anonymous in the sense of using a pseudonym that did not link back to any other body of work.
Two: @mommy_doctor, although she doesn't use her real name, is hardly anonymous. She has a huge body of work -- over 9,000 tweets. At the time Dr. Vartabedian wrote his post, her twitter profile linked to her blog, with entries going several years.
In short, it is my opinion that Dr. Vartabedian allowed his assumptions to guide him to treat a fellow physician without the respect the physician deserved.
I also think that all of us should pay attention to the difference between anonymity and pseudonimity. It isn't a trivial or hair-splitting distinction.
Part of an email I sent Dr. Vartabedian:
Some of the bloggers I most respect are pseudonymous. Here are a few:
Example #1 Prometheus at http://photoninthedarkness.com/ Prometheus doesn't use twitter, but does comment widely at blog posts having to do with autism, pseudoscience, and the discredited vaccine-autism connections.
Example #2 Sullivan, part of the group blog LeftBrain/RightBrain. http://leftbrainrightbrain.co.uk/ Sullivan recently (with his wife's consent) agreed to out himself as Matthew Carey PhD.
Example #3 would be Orac Knows, who was pseudonymous for years at Respectful Insolence. He was outed by others, but when he joined Science-Based Medicine decided to blog there under his own name, David H. Gorski MD
People have various reasons -- personal, professional, or both -- for using pseudonyms, and others equally complicated for setting aside the pseudonym.
Dr. Vartabedian's blog, 33 Charts, is pretty narrowly focused on social media and medicine. Its previous incarnation, Parenting Solved, was again pretty narrowly focused. That isn't to say that all blogs by medical professionals should be that focused, and that indeed might be a motivation for a medical professional to sue a pseudonym.
- you are a young resident, and want to write about, not patients, but the process of becoming a fully-trained physician in your chosen specialty, and particularly your doubts and worries, the impact it has on you personally and your family?
- you are a medical professional who is homosexual, but aren't really out to your professional colleagues? You write about the conflicts that come up, and your thoughts about coming out.
- you have a child with autism, and want to bring your professional medical insights into autism issues, but don't want to violate your child's right to privacy?
Those are all actual examples from blogs I have followed over the years. No, I'm not going to link to them, because some have been taken down, and some sort of let slip over the years that the authors were health professionals.
I think mommy_doctor made an important point here:
The Privacy Issue and Demanding the Deletion of Others' Copyrighted Works
One: Health care professionals are bound by Health Insurance Portability Assurance Act (HIPAA), which has privacy restrictions. Did @mommy_doctor violate a patient's privacy? I don't think so:
Two: This goes back more to the Waldorf Critics example than "storm in a tweet-cup". In W-C instance, an pseudonymous parent revealed that her children had had stress-related behaviors (she identified the behaviors specifically). She was quite vexed when she, by her carelessness, blew her pseudnonym, and her real name was not listed on a forum, but linked to. She was so vexed she filed a legal action against another blogger. She also requested, under the guise of copyright, that all posts relevant to her work be removed, which they were. Which, incidentally, violated the copyrights of other posters, as their material responding to hers was also deleted.
What do these two episodes have in common?
- Failure to communicate. Dr. Vartabedian didn't communicate with mommy_doctor before his post; JennSW didn't start with a simple request to Alicia H. before filing legal action.
- Letting your assumptions push you into jumping to conclusions.
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.
"Storm in a Twitter-Cup" Backstory:
The setting: Mommy_doctor was on call, and had a patient with something wrong for a long time (more than 24 hours) in the genital area--the wrongness may have had something to do with sexual practices, or maybe not. In the first two tweets, mommy_doctor expressed concern for her patient. In the second two tweets, slight flirtation happened between a random @mommy_doctor follower & @mommy_doctor, then in the last two tweets, mommy_doctor sent two more tweets sympathetic for the patient.
Dr Vartabedian on Physicians' Anonymity:
- September 22 2010 Bryan Vartabedian at 33 Charts Doctors Should Not Socially Anonymous
Selected Storm in a Tweet-Cup Responses and commentary
- May 23 2011 Bryan Vartabedian at 33 Charts Unprofessional Physician Behavior on Twitter
- May 24 2011 Shadowfax, MD at Moving Meat: I Don't Buy Your Definition of Unprofessional
- May 24 2011 Pranab at Scepticemia @Doctor_V vs @Mommy_Doctor: Storm in a #Tweetcup
- May 25 2011 Wendy Sue Swanson at SeattleMammaDoc I'm a Physician on Twitter
- May 25 Margaret Polaneczky MD at The Blog That Ate Manhattan Twitter, Doctors, and Professionalism
- May 25 2011 Shadowfax MD at Moving Meat My Guidelines for Blogging
- KevinMD Doctors on Twitter
- May 25 2011 The Angry Pharmacist at The Angry Pharmacist Extreme Unprofessional Makeover or Pimp My Unprofessionalism
- May 26 2011 I Want to be a Pharmacist at I Want to Be a Pharmacist Realistic Professionalism in Health Care Practice
- May 28 2011 Amy Sparkle at All That Sparkles Can't We All Just Get Along?
- Update May 30 2011 Jin Packard at Fresh White Coat: Does Anonymity Help Online Discussions?
Backstory: Waldorf Critics
- May 22 2011 Liz Ditz at I Speak of Dreams Waldorf School Supporter in US Uses Copyright Bullying to Silence Swedish Waldorf Critic
Selected Waldorf Critics Responses and Commentary
- May 18 2011 Alicia H at Zooey discussion; boring mindless stupid on repeat (forever)
- May 20 2011 Alicia H at Zooey Impact
- May 20 2011 Alicia H at Zooey Waldorf bliss-ninny -- not quite so blissful, after all
- May 21 2011 Alicia H at Zooey Some things are difficult to hide
- May 23 2011 Alicia H at Zooey Updates
- Alicia H at Zoey