I'm Not Sure I Follow You Doctor …

Abstract

It was a typical Friday afternoon—a busy geriatric medicine clinic with many complex, challenging older adults to see. Time was ticking on rapidly. As I popped my head out of the clinic room, the friendly clinic nurse passed me a hot drink and another set of medical records. The name on the front of the medical records was immediately familiar to me—a common situation perhaps, but not in this instance. I racked my brains. I could not possibly have seen the person in the clinic before, because I had only recently joined the department. Had I met him on call in the acute admissions department? Had I met him as an inpatient on the ward? Neither of these jogged my memory. Then, it suddenly dawned on me. I did know the man. In fact, despite having never met him before, I knew all about him. I knew about his medical condition. I knew about his family life. I knew about the daily activities he could no longer do and how immensely this frustrated him. I knew about his day-to-day coping strategies. I even knew what he thought about the last doctor he had met in clinic. How? I followed the patient on Twitter. Twitter is a micro-blogging web-based service where users can post short written entries limited to 140 characters. The most-recent estimates suggest that there are almost one-third of a billion registered Twitter users worldwide. In recent years, there has been increasing recognition of the potential that Twitter has as a tool for medical education, as well as an appreciation of the potential pitfalls associated with the medium—when health professionals use it. In response to these concerns, the United Kingdom's medical regulatory body, the General Medical Council, has issued specific guidance to doctors about the use of social media, reminding them of the need to “maintain a professional boundary between you and your patient.” The man in the clinic was a regular user of Twitter and frequently tweeted comments about his experiences of living with a neurodegenerative disorder, as well as web links to longer pieces that he published on his personal blog. Despite there being 330 million Twitter users and an estimated 150 million bloggers, I had somehow stumbled across his tweets and his blog several months previously. I had found his eloquent writing about his condition insightful and enlightening; it provided a window into living with a chronic disease that, as a geriatrician, I found fascinating. Consequently, I had followed him to hear more, but encountering this man in clinic had opened a veritable can of medical ethical worms. Should I acknowledge that I followed him and “knew” him? What should I do if he were to contact me via Twitter for medical advice? Given that he had previously commented about his interactions with health professionals, would he make reference to our interaction? Might his tweets provide some insightful feedback on my consultation skills? Or might they be scathing? During clinic I opted to proceed as normal, making no reference to the virtual world, just the regular clinical world. After clinic, having reflected on how best to proceed, I opted to quietly unfollow him, meaning I would no longer be able to see his tweets. In effect, I slipped away quietly into the digital ether, leaving no trace of our online association. Conflict of Interest: None. Author Contributions: I was the sole author of this work, having conceived, drafted, and finalized this work myself. Sponsor's Role: Not applicable.