Doctors and the Internet: How Will This Work?

There has been a significant amount of discussion regarding “physician professionalism” on twitter. Upon pondering the questions posed, I have read much about the concept of “professionalism” in medicine and law and would like to share a few of my humble thoughts.

First let me say, that I come from a position where I have seen the word “professionalism” be bastardized to create funding for dubious projects in medicine, to keep doctors from advocating for their patients, to keep patients fearful and “in line” and many other untoward activities. It is right up there with “it’s for the BABIES!” as a sentence that imposes immediate alliance in any situation. Who would want to be “against the babies” or “unprofessional”? No one. Therefore, when someone plays that card, it impedes real conversation about issues that affect the lives of our patients and our peers.

I think the recent article in Amednews is a fine example of how this works. A self appointed director of “who gets to be on twitter” decided that he knows best whether someone should blog or tweet anonymously or whether someone’s post is appropriate for the masses. By establishing that position, he intimates that the general public and physicians are not smart enough to decipher the words or intentions of someone else. The most offensive part of his activities from my perspective, is he has attacked those he assumed were weaker or less able to defend themselves. Someone of foreign descent, a single woman out there in the internet jungle, a man whose words may be hard to defend, etc. This is a classic maneuver to induce compliance by attacking those who can’t defend themselves, thereby making the rest of us fearful that we will be next. And certainly, as gauged by private messages I have received, he is creating success with establishing fear among doctors that they may post something of which he doesn’t approve, thereby causing embarrassment and the terrible, terrible label of being “unprofessional”.

Ironically, he participated in a chat last week consisting of the question: “How do we get more doctors involved in twitter?” It was noted that innovators were the only docs on twitter, that the “early adopters” have not even begun tweeting yet. There is a reticence, among doctors who know that every single word they write has legal implications, to open themselves to the public and share what they know, how they care and create conversation. I love doctors and I think their voices need to be heard. They have been silenced by legal implications and by this type of behavior, so we are not hearing from them. I think we need to hear from them. They are intelligent, caring, educated, experienced people who really do, for the most part, passionately care about their patients and their communities.

Now, I will be the first to say that words which burb writes, at times, make me cringe in the worst of ways. But clumsy as his attempts may have been, underneath this is a valuable lesson. Doctors are in extreme distress, financially, emotionally and with their health. It is not easy to serve the public, day after day, when you are significantly abused on an hourly basis by insurance companies, pharmaceutical companies, other forces in medicine and yes, your own patients. Recent posts on doc only sites indicate that patient theft of office items (even pieces of equipment the person could never use??) is at an all time high. Rudeness and outright violence against physicians is written about on a daily basis, but for the doctor, is to be taken in stride without comment or reaction. I, personally, had a hand fracture from a violent-patient interaction. And yes, I was expected to take this in stride, which I did. It’s a part of the job. This is the state of medicine and why, in some fields, over half the doctors are looking for alternative careers. It is a CRITICAL ISSUE in medicine and burbdoc is a free voice to speak about it. The anger, frustration, self judgment and other-judgment in medicine has reached, truly, a critical point. If burbdoc is a release valve for this, then his words need to be heard.

What would be the appropriate way to have handled someone you think is “rogue”? I believe the appropriate way to have handled this would have been to open it for discussion, on twitter or google plus. Where everyone could chime in with their thoughts and, as a group, we could have come to a higher understanding. This bullying behavior is unacceptable as it not only impedes conversation but impedes one of the greatest use of the internet, which is to move humankind to a higher plane of conversation. Bullying does not afford that possibility.

I have much more to say on this topic, but let me end with the thought that physicians need support now, more than ever. Medicine has been taken over by corporate forces which divide the patient/physician relationship rather than enhance it. Doctors and patients need more say in the process. I fervently believe if that were the case, our medical system would improve rapidly. Right now, corporate and governmental agencies are making most of the decisions and although some are good, they cannot possibly be the best for our country if patients and doctors are not heard from. Silencing voices that may be uncomfortable is not the way to do this. It is unprofessional (see how that works?  )

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Tags: bullying, burbdoc, corporate health, doctors, google +, google plus, health, internet, legal, medicine, mtnmd, patients, professionalism, twitter, wellness

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