The American Medical Association (AMA) appears to have appointed itself as Ministry of Morality in response to the ever growing numbers of physicians embracing social media.
You may recall (you may not, but that’s why I’m here, to help you remember this kind of trivia) a recent letter in JAMA indicating that, “3% of physician tweets contain unprofessional content.” Unprofessional content on Twitter is also discussed in this in this article from a recent edition of the AMA News reporting on doctors and social media.
The article mentions a doctor who lost her privelages for violating HIPAA. A worthy point. PHI should never be disclosed anywhere, but HIPAA violations are not really the purvey of the AMA. The Health Insurance Portability and Accountability Act of 1996 Privacy and Security Rules are enforced by The Office for Civil Rights not the
Ministry of Morality AMA. But fair enough for the AMA to stress the point and offer a reminder.
The article also suggests that anonymous postings might seem liberating, but could in fact be dangerous because physicians might feel emboldened to cross HIPAA lines because they are shrouded by the thin veil of anonymity offered by a fake name and a cartoon avatar. I have to say, I have never read any PHI on Twitter from either self- identified doctors (or nurses or pharamcists) or from those tweeting anonymously. One example of an anonymous doctor tweeting about a patient with priapism was held out as an example. The suggestion was this particular doctor went too far, although whether she tweeted a real case or a fabricated one is not known. If indeed the case transpired exactly as tweeted, someone aware of that particular patient’s problem could have potentially read the tweets and put two and two together. I don’t think that’s a HIPAA violation, but it might make some people feel sad/mad/angry. Then again, how different is it for an anesthesiologist to tweet about a priapism than for an OB/GYN to tweet they just delivered a beautiful baby girl? That’s about the same amount of general information, the only real difference being that a priapism is not a blessed event.
But for me, the most concerning part of the AMA News article is the concern over “profane” language. Swearing apparently earns one (and by one, I certainly mean me) a big fat scarlet A. The AMA News couldn’t even quote some of the tweets because they were so “profane.” I didn’t know the AMA News was read by impressionable 12 year olds, then again, I’m not privy to their circulation statistics. Perhaps the AMA News is in stiff competition with junior high newspapers across the county and can’t print the language that you can hear in just about every PG-13 movie.
So here’s the thing. Tweets are not medical advice and Twitter/Google +/Facebook are certainly NOT medical offices. If swearing on Twitter is unprofessional, then swearing walking down the street must be unprofessional too. Or maybe swearing when you stub your toe (although maybe not, because there is evidence based medicine to suggest that swearing helps reduce pain). What about swearing during sex? What if you go to an R-rated move and a patient sees you? Or, heaven forbid, a XXX movie? When I was a medical student it was considered unprofessional for the guys to not wear a tie and for a girl to wear a mini skirt. Yes, I wore mini skirts anyway.
Who decides what language is right and what constitutes moral behavior outside of the office and within the boundaries of the law? The AMA certainly doesn’t speak for me. If fact, they don’t speak for most doctors. At last count, only 15% of American doctors in practice were members.
With social media you choose who you follow. If what someone has to say offends you, then you stop following them. It’s not Clockwork Orange and no one is going to bring out the eye speculums and force you to read offensive tweet after offensive tweet. Grown ups are supposed to change the channel when they don’t like what they see.
In my opinion getting all hot and bothered about swear words smacks of insincerity, because if morality in medicine was the real issue, the AMA would be getting a lot more worked up about doctors receiving $1,500 a pop for drug dinners or $50,000 a year to sponsor a book tour (complete with promoted tweets). Studies tell us Big Pharma money affects prescribing, yet somehow that’s not unprofessional behavior but swearing is?
If the AMA really cared about medicine and how we deliver care they would be less concerned with the words doctors use in social media and worry a lot more about bad medical care, like opioid naive patients getting 400 OxyContin tablets (I read about that in a tweet!) and the asshats who write those prescriptions. Most non-medical people I asked don’t think a doctor swearing outside of the office is of any concern. One of my tweeps put it most eloquently when she said, “It means they’re real.”
Maybe the AMA is afraid of new technology. Less than a hundred years ago doctors were warned about using the telephone because it was impossible to deliver care without the “laying on of the hands.” I guess doctors who used the telephone were unprofessional. We’ve also worried a lot about e-mail in medicine, but many doctors use it quite effectively. I’m not saying social media is necessarily a platform for delivering care, I’m just pointing out that a lot of new technology that at first seemed to have sprung from the loins of the devil himself has actually proven to be quite useful. Perhaps the AMA forgets that medicine and innovation go hand in hand, and if you drop an f-bomb along the way, well, so be it.
What do you think? Should the AMA care about profanity in tweets?