The Blurred Line

Is it possible for a doctor to be a journalist?

A journalist a doctor? 

A runner to be a journalist and a doctor?

In trying to be all the above I walked (arguably crossed) a line which sparked disappointment amongst my co-workers, and criticism from the public.

When I started residency we had a lecture on the Do’s and Don’ts of social media. Don’t talk about patients, don’t post pictures of patients, don’t friend your patients. Don’t post pictures of yourself taking shots of flaming whiskey, especially not with your patients.  

Simple Do’s and Don’ts. We were now experts on navigating the social media kingdom.

Three years into residency I ran the 2014 Boston Marathon. I was convinced by The Boston Globe to take a selfie at every mile, creating a time lapse of the day. Multiple news outlets had asked me to tweet every mile, capturing the rawness of the race. I was to be a journalist for 26.2 miles, delivering real time details through the eyes of a runner.

At mile 19 a runner went down. I stopped to help. Due to the quick response of volunteers and bystanders the man was saved. Once the ambulance arrived it was time to continue my race.  I made a quick decision, snapping a picture I tweeted: “First responders saved a life. Thank you to volunteers who save lives at every mile.”

Later that night when going through my tweets I realized I made a mistake. Part of the injured runner’s face was in the picture. I immediately removed the picture from my twitter account.

 It was too late.

Boston.com had noticed the tweet, taken a screen shot and published an article. Even though I had deleted the picture, my internet footprint was permanent.

The criticism of the public was harsh. Here is one of the comments:

“What's so noble and admirable about stopping running so she can film this unfortunate individual and then tweet it out for his family and friends to possibly see? How is that 'helping'? Is tweeting in that moment the most important thing to her?”

I also received feedback from my  co-workers expressing feelings I had crossed the line of privacy and respect.

I felt sick knowing the unintentional consequences of my tweet had potentially caused harm.

Questions were racing in my mind: Had I violated this man’s privacy? Was he considered my patient? Did I do something unethical? Could I get fired for this?

The boundaries had become blurred at mile 19 on marathon Monday.

If I were just a  runner, no big deal, unlikely the picture would have gained attention.
If I were just a journalist, my job would have been to take the picture.

But I am a physician.

Am I held to a higher standard of moral conduct and professional responsibility, no matter the setting?

Curious about this intersection between social media and medicine I began to investigate.
One of the most famous cases of social media mis-conduct is the story of Dr. Alexandra Thran, a Rhode Island ER physician. She wrote about one of her patient’s injuries on Facebook. Although she did not reveal the patient’s name, a third party was able to identify the patient. She was fired from the hospital, reprimanded by the state’s medical board and forced to pay a fine.

I took a look at some public posts, by physicians, on Facebook. Here are recent quotes:

“Trauma team couldn't get back a 1month old...May god bless you and keep you little baby”

“Our ER is full of drunk morons who sleep on RV roofs”

“Yeah. I'll rank last night as a top three most disastrous night. Six MICU admissions. One death. One ECMO. Two other codes. Way to go out with a bang”

 Do these statements give away patient information? Are they unethical?

In 1847 (prior to Facebook) the American Medical Association gathered in Philadelphia and adopted the world’s first code of medical ethics. Much of it is not applicable to 2014 but one message is clear:

“There is no profession, from the members of which greater purity of character, and a higher standard of moral excellence are required, than the medical.”

If you ask today, most will still say the medical profession requires the highest standard of moral excellence. But how does that moral excellence translate into social media, especially when we are out of uniform and not on duty, say at mile 19 of a marathon.

What I did on marathon Monday may not have been legally wrong, but ethically it was a mistake.  As physicians we should be deliberate in our actions and conscious of our meaning in any setting.

I am left wondering, should medical residencies have dedicated curriculum's teaching how to tweet, blog and share information across social media platforms? As a medical resident am I responsible for the content I choose to publish online or is the institution I represent ultimately accountable?

While I continue to explore what social media has to offer the world of medicine I may make more mistakes. But If I am deliberate, mindful and meaningful in my message my hope is no harm will come to those I took an oath to protect.