A recent research letter in JAMA surveyed more than 300 high-profile (500 followers or more) physicians on Twitter and reported results of a "content analysis" of more than 5000 of their individual tweets. As one might expect, about half of the tweets were related to health and medicine; another 20 percent were classified as "personal communications," and 12 percent were classified as "self promotional." I would be interested in knowing how @MotherinMed (internist and medical educator Katherine Chretien, MD) and colleagues determined whether or not a tweet was "self promotional" - would posting links to my blog posts count, even though I have no products to sell?
At any rate, the study's major finding was that about 1 in 30 tweets were classified as "unprofessional," a category that included patient privacy violations, potential conflicts of interest, profanities, sexually explicit material, and discriminatory statements. This finding is consistent with prior reports on online professionalism and the content of medical blogs that led the American Medical Association to release a guidance statement on professionalism in social media last November. Chretien and colleagues reasonably conclude that health professionals may require more education about appropriate behavior on social media sites.
But to play devil's advocate, is this really necessary? That 3 percent of tweets were "unprofessional" seemed to me a surprisingly low figure, given the great potential for abuse inherent on Twitter, where most accounts are at least semi-anonymous and few online identities other than those of celebrities are actually verified by the company. If I visited a large sample of office practices or hospitals and recorded all health professionals' conversations that were loud enough to be overheard, I suspect that at least 3 percent would probably meet the definition of "unprofessional" that this survey used.
For several weeks I followed an anonymous family doctor on Twitter who would tweet funny observations about patients whom he or she saw throughout the day. No identifiable patient information was included, but these observations were frequently unflattering, and occasionally downright insulting. (One reason I suspect that many physicians love to watch the TV show "House" is that the main character routinely says things that we know we could never actually say out loud to patients and get away with.) This Twitter doc had a large following, many of whom also appeared to be practicing physicians who "tuned in" to this reality show-style channel for a daily dose of humor at the expense of anonymous patients.
Eventually, I tired of reading these tweets and hit the "unfollow" button. But the question remains: does this Twitter user's behavior cross the line? Should he or she be formally reprimanded for "unprofessional" behavior and instructed to cease and desist? And if so, why?