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Hinda Mandell: "This is a can of social media worms that I’d rather not open." Pictured: A new father heralds the arrival of a son Wednesday, Feb. 20, 2013 in Houston, Texas. His wife's live-Tweeted birth experience was part of a growing trend as hospitals and doctors hungry for clients use social media to promote their services. (Women's Memorial Hermann Hospital/AP)

My gynecologist just followed my vagina on Twitter.  TWEET At least, that’s how it felt when I received email notification that I had a new Twitter follower.

To be fair, maybe it wasn’t my gynecologist who hit the “follow” button, but an employee at her practice. Does it matter? Because my ob/gyn’s name and Twitter handle are the same, and her Twitter avatar is her practice’s logo of a mother and child, entwined. Now she — or whoever her office’s social media manager is — knows my political views, sees the photos I take of my crafting projects and reads the recipes I plan to cook. It sounds innocuous, but it doesn’t feel so innocent.

I feel uncomfortable, because I don’t know how to navigate this new, social media dimension of our very professional, very contained-to-a-medical-setting relationship.

“That’s an invasion of privacy,” said my husband, puffed up with righteous indignation.

“Creepy,” wrote one friend on Facebook.

Another friend commented that her dentist follows her on Twitter. “I don’t get it,” she wrote.

What I find most confusing is my own reaction. It does feel unseemly, slightly freaky and certainly uninvited for the physician who helped bring my daughter into the world 13 months ago to know the Twitter version of myself.

But why?

After all, I know on a conscious, logical level that my tweets are public and can be seen by anyone. I mean, isn’t that the reason I use Twitter, to broadcast my ideas and opinions to a wider audience and to share the online content I find of interest? And if I already have a confidential, private relationship with a medical professional, who cares if she sees my very public tweets about the hottest Parisian beauty balms or chefs who have discontinued favorite dishes in New York restaurants?

The fact is that I do care. I feel uncomfortable, because I don’t know how to navigate this new, social media dimension of our very professional, very contained-to-a-medical-setting relationship. Is she going to re-tweet links I share? Is she going to respond with an “LOL” when I share mishaps about my day? Is she going to tweet reminders of upcoming appointments?

I doubt it. But still, I want to know the rules guiding her Twitter use, especially as they relate to her patients. But I don’t feel comfortable asking her directly. This is a can of social media worms that I’d rather not open with the woman who tells me where to plant my bum on the exam table and that the speculum might be cold. You’d think that if I felt comfortable talking to her about sex and babies and pap smears, I’d have no problem rocking a conversation about her Twitter use. But I resent being put in a position of even having to ask. The onus is on her to get it right.

So I contacted the American Medical Association, to see if it offers guidelines that address the patient-physician relationship on Twitter. It doesn’t. But the AMA’s code of ethics does have a general section on “Professionalism in the use of social media.”

There is, for instance, this advice: “If they interact with patients on the Internet, physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines, just as they would in any other context.”

Is she going to re-tweet links I share? Is she going to respond with an ‘LOL’ when I share mishaps about my day? Is she going to tweet reminders of upcoming appointments?

That appears to be the guiding principle of my friend Michael Katz, a cardiologist practicing in Rochester, N.Y. He is recognized as a top Twitter personality at American College of Cardiology conferences, and he’s very enthusiastic about physicians using Twitter — responsibly.

“I make a conscious effort not to follow patients that I am in a medical-care relationship with,” he wrote in an email. “While I would never intentionally violate patient privacy, Twitter is a public forum, and I would avoid even the perception of public discussion of private information.”

When asked what advice he’d offer his colleagues in the healthcare profession about Twitter use, he directed me to the social media policy of the Mayo Clinic: “Don’t Lie, Don’t Pry, Don’t Cheat, Can’t Delete, Don’t Steal, Don’t Reveal.”

That’s a good start. I’d like a little more specificity, though, so here’s my brief, free advice to medical professionals, especially those with social media profiles:

1. Post a sign in your reception area that states the social media policy for your medical practice. This will make sure your medical practice has a policy, and it will preemptively avoid awkward situations like mine.

2. Hire a social media professional if you have to, but identify the social media rules that fit with your mission. Yes, it’s the Wild West out there. But guidelines to rein in rogue Tweeting cowboys and Facebook-liking cowgirls exist.

As for my gynecologist, I still haven’t spoken with her directly about this Twitter conundrum. But I did follow her back.

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The views and opinions expressed in this piece are solely those of the writer and do not in any way reflect the views of WBUR management or its employees.

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  • idler

    so you’ve made an informed effort to expose yourself to the world and now complain because someone notices … what’d you expect ?

  • Jemimah Stambaugh

    I just “agreed” with idler, below, but what confounds me more about your conundrum is that if you trust your lady parts doc with such intimate details, why would you think she’d be unworthy of that trust with the stuff of tweets? Don’t you ever talk about anything other than the wonders of nature with her? Heck, anything I’d tweet, I’d be just as likely to chit chat about through my legs with my gyn. Maybe this is just a hormonal reaction. ;)
    (You’d think dentists might be the biggest perps of this type of behavior, just so they could finally make heads or tails out of the mouth-full-of-hand-and-instruments responses they get when you’re in their chair!)

  • sweetman

    I dislike taking up the reigns of opposition on personal topics, especially with the vicious nature the internet seems to foster in certain forums, but I ask Ms. Mandall to consider her opinion for several reasons:
    1. If you are on twitter, or any other social network, you are “out there”. If you feel uncomfortable about who might “follow” your every thought, add the precaution of granting permission to those who may fall in your path.
    2. If you haven’t set up any proverbial hoops for your potential followers to leap through, have you throroughly screened their employment or interests to ferret out a potential invasion to what deem twitter-worthy?
    3. Finally, have you considered the idea that your gynecologist is more than a person who peers into your insides for the noble act of keeping you well? I am certain she is a woman who thinks of more than ovaries and uteruses when she reads tweets of the many other female twitter posters that may or may not be patients.
    4. I find your guidelines limiting and restrictive to the medical profession. It smacks of a double standard–you are free to roam the Wild West but your physicians have to post their policies about social media? and/or hire handers if they want to kill some lesiure time scrolling through a twitter feed.

  • downtown21

    Nobody invaded your privacy. You voluntarily gave it away, stupid. And your demands are unreasonable.

  • DavidHarlow

    This column is tagged “humor” by WBUR, perhaps because of the provocative first line. Assuming, however, that it is meant to be taken seriously, my first reaction is that an academic in communications ought to be able to toggle the privacy settings on Twitter if she were uncomfortable with being followed by persons who are not her real or virtual friends. Moving beyond the details of this particular story, it is worth noting that even before we regularly referred to people’s “digital exhaust,” a physician in the UK’s National Health Service who followed patients on Twitter told a patient during an office visit that the patient had misunderstood instructions on how to take a prescribed medication, and provided correct instructions again. The patient was surprised that the physician had picked up on this based on the patient’s tweets, but did not seem concerned about the invasion-of-privacy sort of issues. See: The Case of the Twittering Kidney Patient: Healthcare and the Ethics of Social Media Monitoring – http://shrd.by/EnnrVa (from 2010). Clinicians following patients on social media does not seem to me to be problematic. As this one NHS anecdote demonstrates — and there are many other such anecdotes out there — learning what the patient is saying and doing outside of the office visit permits the physician to get to know the whole patient. The value of this lesson is magnified when dealing with younger patients who — it sometimes seems — live their lives online, and are more open to communication online about general health tips (though not necessarily about personal health information in an open forum, absent appropriate consent). I agree with the columnist’s point that health care provider organizations should adopt and post external-facing social media policies. I would add, however, that it is just as important to have internal-facing policies governing social media use and engagement in greater detail. I do not believe that a policy would necessarily have avoided the columnist’s “awkward situation.” Posting yet another policy on a waiting room bulletin board is not going to educate anyone about anything. If a health care provider is serious about using social media to engage with colleagues, patients and the general public, however, then I believe that only good things will follow: greater openness, better communication and, ultimately, better health care. In a small town, patients see their doctors at the grocery store and sometimes get a quick curbside consult next to the sweet corn. In the global village enabled by the interwebs, the power of the personal connection is magnified — and the potential risks associated with using this power tool are greater. Even monitoring patients’ public activities online, rather than engaging them, can yield insights about the whole patient not available to clinicians limited to the 12-minute office visit. Used carefully, health care social media can do a lot of good.

    David Harlow
    http://healthblawg.com

  • 5 cents

    this person writing this story is ridiculous. this is a joke piece, right?

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