Med students misbehave online: Educate, not regulate

Physician treating a patient (480 - 470 BC)

Do you really want to see pictures of your doctor acting all sloppy and stupid sucking on a beer bong? How about what they did at a party that got out of hand … or, even worse, after it ended?

Our new techno-enabled expressive freedoms raise lots of questions about the ancient injunction to above all else do no harm. While tweeting private patient information would be a clear violation of professional ethics, posting sexy pictures from that party on Facebook might not be.

Recent research published in the Journal of the American Medical Association surveyed medical school administrators about problems coming from docs-in-training online behavior.

Although some of the incidents identified in this survey appear to be clear-cut lapses in professionalism (eg, violation of patient privacy and photos involving illicit drug use), others fall into more ambiguous categories (eg, using profanity and being sexually suggestive). Certain examples, such as negative comments about a student’s institution or profession, might not be considered unprofessional. The line separating protected First Amendment rights and inappropriate postings may be unclear.

via JAMA — Online Posting of Unprofessional Content by Medical Students, September 23/30, 2009, Chretien et al. 302 (12): 1309.

I got an email this morning from Jack Drescher, a friend and colleague who is Clinical Associate Professor of Psychiatry at New York Medical College and President-Elect of the Group for the Advancement of Psychiatry (GAP is a “psychiatric think tank” with a distinguished history dating back to 1947 of helping shape research, practice and policy), pointing me to a current article in Psychiatric News; he sent me the link suggesting it as a Simu-Nation post (thanks Jack). The article reported,

Online behaviors by medical students that are deemed unprofessional and result in school interventions appear to be common, the anonymous survey found. Among the responses from 78 medical-school administrators in charge of student affairs, 47 (60 percent) said they were aware of at least one incident in the prior year related to students’ online postings.

Among the examples cited were posting too much confidentiality-threatening information about patients on blogs and Facebook, which many respondents said were the most serious violations. Other types of incidents included posting sexually suggestive photos; posting text, photos, and videos depicting intoxication or use of illicit drugs; requesting inappropriate friendships with patients on Facebook; and using profanity or making discriminatory or disparaging comments about faculty, classmates, or their schools.

via Should Med Students Be Protected From Their Own Internet Use? — Yan 44 (21): 16 — Psychiatr News.

Jack and I talked (well, we emailed) about the problem of how us “old folks” can help younger colleagues cope with challenges and conflicts we never imagined, let alone encountered. We agreed the conflict of freedom of speech with professionalism seems to elicit an authoritarian pull to regulate rather than educate. We also have to work against the unfortunate but perhaps inevitable tendency to assume that tomorrow will be more like yesterday than the facts would suggest.

JD: “Free speech is never free.  There are always social consequences for speaking one’s mind (and exhibiting one’s private life to professional colleagues on Facebook).  Rather than regulating speech, teaching these facts to medical students should be an important part of their medical education. Then let the students decide how they wish to proceed. … Older professionals are not doing themselves or their younger colleagues any good by bemoaning this cultural shift. We need to be open to understanding how these new technologies serve a social function and how they can be integrated with historic professional standards of ethical and professional behavior.  To simply say, “don’t do it” simply will not fly.”

And what about those beer-bong pictures? Well, unlike a clear, unambiguous prohibition against divulging private patient information, private information about the professional is much more complicated.

JD: “There is a conservative tendency within mental health professions to assume that revelations about a therapist’s personal life may somehow be injurious to patients.  Self-disclosure in therapy is controversial despite the fact that therapists may be inadvertently self-disclosing information about themselves all the time.  If our field were to acknowledge the inevitably of self-disclosures (in the therapy session, in the virtual agora, etc.), then we could do a better job of training therapists to deal with the consequences of patients discovering information about their therapists.  And if there is any harm to such disclosures, they could be either minimized or even opportunities for therapeutic growth.”

Problems with med students’ online behavior reflect a problem not just with today’s med students as much as with today’s teachers and programs. Those of us who grew up with rotary phones and black-and-white TV need, in a sense, to grow-up all over again in today’s world so we can best teach the next generation(s) of students.