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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Thursday, May 26, 2011
    Medical Twittergate

    Those of you who don't inhabit the medical Twitterverse may be surprised to know that quite the storm broke loose in that sheltered cove these past two days. An anesthesiologist who tweets under a pseudonym posted a few comments about a case she was called in on (it involved priapism, to be specific) and a self-anointed social media medical cop named Dr. Bryan Vartabedian called her out on it. I should emphasize here that there was absolutely no way to identify the patient Doctor #1 referenced and the patient's privacy was not violated. If you want to see the tweets in question, they are linked at the end of his article. I am revealing the name of Dr Vartabedian specifically because he used Doctor #1's tweets and identity without disguising them, despite wondering aloud whether the patient's privacy had been violated (again, in my opinion, it was not). The word "unprofessional" was tossed around - very carelessly, I should add.

    I read the posts and was not convinced that Doctor #1 had done anything unprofessional or inappropriate. If you read the comments at the end of Dr. V's post (there were over 130) you will see that there was a vast divide between the "appropriate" and "inappropriate" sides of the debate. Doctors, nurses, pharmacists and even patients felt that the idea of making even mildly joking anonymous comments about patients and work frustrations was either human and understandable or appalling and horribly unprofessional, depending on what camp you fall into. My comment was the last of the bunch (I guess Dr. V. got his nuts kicked in and decided to close the comments. How... unprofessional!) and I supported Doctor #1.

    The best way to explain my take on all this is, I think, to reference the movie and TV show M*A*S*H. Healthcare professionals are under fire on a daily basis (metaphorically speaking). The show is a perfect reference for what we go through all the time. Black humor is our only defense. Doctors, nurses and everyone else in healthcare have been making sick jokes and complaining about patients since the dawn of time. That doesn't mean we aren't dedicated to what we do. I love my interactions with patients and I love primary care, but if you cut off my ability to crack wise, I'd quit tomorrow. It's a stressful profession and we see terrible things. That's just all there is to it.

    Medical "social media," and how I hate that term, is an updated version of the doctors' lounge. However, Dr. V is correct in that now anyone can peer in to see what we're saying and we do need to watch ourselves. I limit my posts about specific cases for this very reason. When I do post I change ages, genders and other minor details. The underlying issues, though, are the same and will remain the same no matter how many changes I make. It's a relief to air my frustrations and a relief to see that other healthcare professionals face the same problems I do. Were Dr. V to make the rules, I daresay none of us would be allowed to post. The hell with that. I need my vent just as much as my fellow posters do. Instead of complaining, Dr. V should observe more... he might learn something.

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    I certainly respect and appreciate the right to privacy, but I don't think repealing human nature is a practical way to preserve it, and let's be frank -- priapism has been funny since the Greeks.

    But most of all, I don't think the solution to stress is to cut off one of a person's few outlets for it. Better the momentary release of black humor than the persistent oppression of a black mood.

    By Blogger Scott, at May 26, 2011 at 10:33:00 PM PDT  

    I read the twitter exchange and didn't get the humor. Or the disrespect. Sailed right over my head.

    However, I think doctors need to keep that stuff private. Not post it on the internet for everyone to see.

    It is damaging to patient-doctor relationships.

    And you all say the black humor never bleeds over to the patients, but, you know what? I found medical blogs and I saw how I was treated in every stoopid drug seeker post I read.

    There's humor that relieves and humor that pollutes, but never a discussion on what constitutes the line.



    By Blogger Pissed Off Patient, at May 29, 2011 at 5:11:00 PM PDT  

    True, there is a line. And ther certainly are doctors who overstep it. I've seen patients with chronic illnesses who have told me horror stories about their previous experiences.

    I also was tipped to this link on a surgeon's blog where he discusses the importance of knowing the "back story" of a patient: http://drcroseberry.blogspot.com/2011/05/back-story.html?spref=tw

    I guess all I can say is, I've found it really cathartic to be able to read about other doctors' experiences. Maybe it's in the approach. Dr. Roseberry's post is more likely to remind me to watch myself than is Dr. V's.

    By Blogger Dr. Alice, at May 29, 2011 at 7:18:00 PM PDT  

    I would never want to deny someone the camaraderie and support of their peers. Nor is the issue that it's on a blog. We all know that this was an existing dynamic before the advent of the internet, albeit on a smaller scale.

    But, like I said, there never seems to be discussion about the line. Or how insidious the dark humor can be, undermining compassion when it counts.

    For me, as a patient? I don't want to read stories about how much male ER doctors hate fat females who need a pelvic. I don't want to read about the little games they play to 'pass the vagina'. This was on a blog several years ago.

    That 'stress coping dark humor' was not okay, but I watched as anyone who dared to say so, was shot down in flames by other medical care professionals.

    Overall, I'm tired of the the patient hate and disgust. It concerns me that there is no awareness whatsoever that the disgust medical care providers feel for users and abusers is not hidden when dealing with other patients.

    I am not a crack whore, but I am treated like one over and over again. A good medical experience is rare. The norm is abuse or ignorance.

    Anyway, my complaints do not pertain to you specifically. I just wanted to respond to your response and further expand on my thoughts.

    The link you shared was poignant and much better than Dr. V.


    By Blogger Pissed Off Patient, at June 4, 2011 at 6:59:00 PM PDT  

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