Why Physicians Shouldn’t Tweet About Their Patients Or O.R. Cases

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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  • Excellent, excellent points Elaine.

    I don’t find this post a downer at all – and I’m a huge fan of (intelligent & responsible) adoption of emerging technologies. Just click the link above to my essay a while ago on using Twitter in healthcare.

    I actually do think Twitter has a lot of value (at least the premise of Twitter – short bursts of information and a simple following relationship). But I also think it opens up the doors to many ethical problems and challenges to not only privacy but also dignity.

    The OR tweets are now passe in my opinion. If used in the right context (and perhaps under a closed platform like Yammer), they can provide curation value to students, residents and other faculty who want simple updates on their patients.

    My concern with OR tweets now is that I suspect that some hospitals may be doing them to gain some publicity (‘look at us, we’re using social media’). At any rate, my hope is that healthcare organizations ponder the positives and negatives before just jumping into the stream.

    As you raise in your post, the problem with publicly tweeting patient info is what happens when things go wrong.

    Or in the case of childbirth – does that need to be tweeted? There’s value in it I suppose – we’re all happy with the arrival of a newborn, and so I can see some value in sharing the joy.

    But I can’t imagine what it would be like in the case of a fetal demise or some other sudden and unexpected event.

    If I had to sum up my view on Twitter (and other public social media), it’s something like this: we need to explore the true value propositions of these media in their appropriate contexts and weigh them against their costs and risks.

    Right now, we’re in a period of novelty with these technologies. My hope is that we get past the novelty and invest our efforts in fully understanding the ramifications of emerging media and adopting them in ways that ultimately defend, preserve and promote human dignity.

    Thanks, Elaine – I’m glad we’re starting to hear questioning voices, because these media aren’t going away.


  • Phil,
    Thanks for such a thoughtful read and your perspective on this. (Your original post, on 14o health care uses for Twitter – http://bit.ly/9Mb7Vv – factored into my decision to join Twitter and learn about its potential.)

    I agree that we need more discussion on this issue, and public attention to the matter, as more doctors, physical therapists, hospitals and other providers use Twitter to spread the good word about their services, i.e. to advertise. And as I tried to point out, it’s sometimes hard to know the source, which can be dangerous when it comes to public health and “real value” tweets.

  • I think you raise excellent points. As a technologist and consultant that helps clients in the medical field with Social Media/Tech this is something that I’ve pondered as well. I’m going to think of some alternatives and run them past you.

    Society’s current use of Social Media Technology is relatively new and posts like yours help inspire the foundation of DOs and DON’Ts.

    Good Work …

    @StrategicGen (http://twitter.com/StrategicGen)

  • All very good points Elaine. Ones that cause many of us to worry. Even using a “dedicated” fellow to do the tweeting as the Kentucky hand surgery team doesn’t negate the question of “what if something goes wrong.”

    The circulating nurse is often asked to “call out” to the family to give updates during surgery. Would family members prefer the call or a text message or a DMs via twitter?

  • Thanks for these thoughts.

    I’m thinking now as a mom: I’d rather get a text from my son about his whereabouts and well-being than have no information at all. In an OR family-waiting kind of situation, I think in general calls are better then texts, especially in case of bad news. And if texts are sent, out of some strange necessity, I can’t conceive of why Twitter would be better than a directed message.

    As for a dedicated fellow who tweets about a case, there’s a real cost: they’d be missing out on learning (cutting, sewing, retracting, stapling… ). If they’re not focused on the case, they should be somewhere else – outside of the OR – caring for patients, writing notes, doing research or just reading.

  • After the hospital bought a new and very expensive piece of surgical equipment, it set upon promotion. Among the proposals: Tweet during surgery. As far as I know, at our place it never happened.

    The conflict between patient welfare and hospital welfare is partly covered in Scalpel…Suction…Tweet. This conflict carries risk for the patient.

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