Physicians on Twitter

I recently read a controversy about physician use of Twitter. (see and My Heart Sisters)  I hemmed and hawed about entering the debate, but in the end felt it was my duty. So here are my thoughts:

I (and hopefully most physicians!) would agree that noone should tolerate bad doctors. Period. We take an oath to help patients; and part of this includes identifying when our peers are not safe.

I believe that there are many different types of “good” doctors. Some of us have great emotional intelligence, and are just the kind of doctor you want during a palliative care discussion. Others have great spatial intelligence, and are perfect orthopaedists. Etc. Not everyone has all skills, of course!! …. And cardiology is a unique specialty in that one does not *have* to be good at procedures to become a cardiologist — many, many cardiologists practice *without* being interventionalists. (As opposed to, say, ob/gyn, or emergency medicine [my own specialty], where procedural ability is a critical part of the training.)

Also, as radial caths are relatively new, even great proceduralists may not have trained in this — and need to learn a new technique. There is no way around this need to learn, if a technique was introduced after a doctor finished fellowship. Simulation is a terrific, and growing, alternative to learning “in real life” — but simulation of course can’t account for every variety of the human body. So for many interventional cardiologists, they may (correctly) feel that they are “great” at traditional (fem) caths, but “will never be good” at radial a. caths — simply because they don’t have the safe, supervised arena in which to practice. At least, that would be my interpretation of Dr Dillon’s comments — I can’t know for sure, as I don’t know him ;).

As to who will protect patients? Again, I absolutely think it is our profession’s responsibility. And other healthcare professionals, too — nurses, midlevels, etc, frequently report (& change!) unsafe practices. It is also the hospital system’s responsibility (as a last resort, they can be reminded that they need to protect their own reputation). And of course we need patient advocates like you. It is as always a system of checks & balances.

All that said — I do hope that Dr Dillon stays on Twitter. There is a curve to learning social media, as well as cath techniques :). It would be a shame if an unintentional mis-step silences a person who seems to be a strong voice for patient engagement and improved outcomes.

As to Paul’s title — yes, physicians need to “be careful” on Twitter. But so does everyone else!! And I would hate to see all healthcare providers disappear from SoMe for fear of reprisals. After all, if nothing else, engagement in Twitter and other SoMe reminds on a daily basis of the full variety of the patient experience, and keeps providers honest/humble/open, and allows for conversations like this.


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