New Tools to Teach Digital Professionalism in the Age of the “Public Physician”

By Cynthia Floyd Manley

Did you hear the one about the screaming baby on Facebook?

A pediatric gastroenterologist receives a friend request from a woman in his community on his personal Facebook page. Thinking he might have met her somewhere, he asks how they know each other.

“You don’t know me, but I have an 8-week-old baby who won’t stop crying and will only take 12 ounces of formula per day.”

This physician knows that the wait to see a pediatric gastroenterologist can be several weeks and that 12 ounces of milk for an infant this age is a dangerously low daily intake.

What should the physician do?

  1. Don’t respond to the request.
  2. Reply with the suggestion that the woman follow up with her own pediatrician.
  3. Reply with specific steps for addressing the issue.
  4. Reply with the intent of getting the child seen as soon as possible.

This case study is based on the real-world experience of Bryan Vartabedian, MD, a pediatric gastroenterologist at Texas Children’s Hospital.

Vartabedian was one of three digitally savvy physicians who participated in a panel discussion on digital professionalism at the AAMC’s 2013 annual meeting. The panel was moderated by Jennifer Salopek, managing editor of Wing of Zock.

Vartabedian noted that the moment a newly-minted physician accepts his or her diploma and adds the letters “MD” to a Facebook profile, that doctor becomes a “public physician.”

“I always assume that everything I post is publicly available,” said Vartabedian, director of digital professionalism at Baylor College of Medicine, who writes about physicians, social media, and the digital environment in his Socialized Medicine column on Wing of Zock and on his own blog, 33 Charts.

Maintaining a digital presence is a role for which many physicians—those new to the profession and seasoned—are often ill-prepared.

Use of digital technologies and social media platforms such as Facebook and Twitter—by patients and the public as well as medical professionals—are adding a layer of complexity to how physicians behave, connect, and interact. What was once a straightforward physician-to-patient interaction has become a multi-directional engagement that includes patients, physicians, other health care providers, and  the public at large, often in an online space where interactions are searchable and findable forever.

Is it a complexity for which medical education is equipping its students? Not really, and certainly not consistently across the nation’s academic medical centers, Vartabedian and his fellow panelists agreed.

The AAMC has taken an important step by making available a new digital professionalism toolkit. The toolkit is authored by Vartabedian and co-panelists Neil Mehta, MD, associate professor of medicine at Cleveland Clinic Lerner College of Medicine, and Warren Wiechmann, MD, assistant clinical professor of medicine and director of instructional technologies at University of California-Irvine School of Medicine, as well as Katherine Chretien, MD, of the Washington, DC, VA Medical Center.

The goal of the toolkit is to help medical educators create awareness and dialogue about social media and digital professionalism with and among their students.

The panelists agreed that the benefits of online engagement far outweigh the risks.  They reminded the audience that the core issue—professionalism—is the same as it has always been; only the medium has changed.

Physicians have a moral obligation to engage in online dialogue, Vartabedian said. “Physicians have two choices, really. They can participate in the discussion that is happening online and frame the story, or they can let someone else frame the story for them.”

In addition to providing real-world case studies, the curriculum toolkit includes guiding questions to drive discussion, links to source material, and a high-level assessment of each case that identifies key discussion points.

The toolkit is designed to be flexible; in fact, there may be no single approach to each case study. The hope is that those who use the toolkit will “share forward” by taking discussion points at their institution and sharing them to foster ongoing dialogue and evolution of the material.

So, back to the screaming baby on Facebook.

Vartabedian polled attendees about their chosen course of action. Many said the physician should not respond at all. Others thought directing the mom to her own pediatrician was in order. Several felt that offering specifics to address the situation would be inappropriately practicing medicine online.

“How many picked ‘D?’ How many thought the doctor should arrange to have the baby seen?”

All hands remained down.

“No one?” Vartabedian said. “That’s what I did!”

Remember the part about the case studies being flexible, perhaps without a single right answer?

Visit the toolkit website, download the case studies, and start the discussion in your organization today.

Cynthia Floyd Manley is the associate director, public affairs and marketing, at Vanderbilt University. She can be reached at