I fear this post may be a bit of a downer for some e-health enthusiasts, Internet addicts and others who might otherwise follow @medicallessons, but after nine months of “studying” medicine on Twitter, I’ve reached the conclusion that it’s probably not a good idea for most practicing physicians to use 140 character Web-broadcasted messages for communicating with or about their patients.

Sorry if I’m ruining a tweetchat, tweetup or doctors’ virtual party somewhere. I just don’t think these belong in the doctor’s office or, especially, in the O.R.

When I signed onto Twitter, I did so primarily as a journalist, curious about the possible uses – and potential harms – of this new media platform in medicine. At first I searched for people to follow with relevant interests using terms like “health” and “doctor,” and came upon the usual suspects: KevinMD (of course) and a few other bloggers whose sites I knew, but they were, mainly, anonymous or not so – Happy and Doctor Rob, among other excellent examples.

There were and are plenty of fake doctors, too –

I followed TheDoctors for some months, initially uncertain if they were true or make-believe. Early on, I found who I thought was Dr. House, the real TV show diagnostician, but soon realized that my source was, instead, a fan club based in Poland. Fortunately, today, I was able to successfully locate Fox’s DrHouse and have decided to follow him in his network on Twitter, at least for the time being.

Finding plastic surgeons and dermatologists was easy, but many seemed too eager if not frankly solicitous; for some, tweets are integrated into a medical marketing strategy. Another thing evident was a relative abundance of twittering ER docs; I give those guys credit, not just for (a few of them) helping maybe to save my life a few times, but as pioneers among the breakneck firers of health communication missives.

For emergency health preparedness, Twitter makes a lot of sense. Still clearly I recall that 9/11 morning when the usual communications systems crashed. I resorted to using a portable, battery-driven radio to hear updates on what was then a rapidly-unfolding medical crisis in my city. The same goes for urgent public health alerts and other general, the-more-people-who-know-about-this-the better kinds of things like blood drives when a rare type is needed, as I’ve posted previously.

So I’m convinced Twitter does have potential and practical, true value in our health care system.

But I don’t get why a regular doctor, sitting at her desk in an office or exam room, or standing in a hospital corridor with an iPad in hand, would tweet something about a particular patient. There’s too great a risk of breaching privacy, inadvertently or just stupidly, and even it’s been “OK’d” by the patient at the time. On Twitter there’s no taking back something said – it’s out there, period.

That surgeons or other hospital employees would send tweets from an operating room suite seems dangerous beyond reason. Last week, health journalist Gary Schwitzer posed this issue as a question on his HealthNewsReviews. Thoughtful quilter and surgeon Dr. R. L. Bates, wove a detailed discussion of the recently-tweeted, 18-hour double-hand transplant on her blog, Suture for a Living. This has happened before, and will likely happen again in the future as more hospitals decide to post updates about the progress of patients in the O.R., on the Internet in short blurbs.

As a patient who’s been there, under anesthesia more times than I care to remember, I can’t imagine anything much worse than knowing while I’m unconscious my doctor might be on-line or even just dictating tweets instead of concentrating on me, my arteries and veins and spine and wherever I’m bleeding.

Except maybe to think of how my parents might have felt, or my husband and sisters and aunt, as they were so worried in each of those long days while they waited anxiously for information. They told me how it went: periodically, a receptionist or family-room person would come out and tell them how I was doing, and that was never sufficient. Sometimes the doctor, a surgeon, would come out on a break, and that helped. And they’d call my other relatives, and nowadays I suppose they’d use email or directed texts.

As trying a situation as that may be, I can’t help but wonder what happens when and if an operation goes badly, and the text stream suddenly stops or changes tone. Twitter’s no way to tell a patient’s loved ones that things have taken a turn for the worse…

Fortunately I’m here, writing, and I hope this trending practice of O.R. tweets will stop, for good.

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