Tweeting well

I AM a keen user of social media. I access my Facebook and Twitter accounts daily, read, and occasionally, comment on favourite blogs and maintain my Academia. edu profile. Social media allows me to connect with, and learn from, a wide range of people across the world. I stay in touch with colleagues who have moved countries and share thoughts, questions and ideas with a global community of collaborators.

Social media does, however, carry risks for the unwary. The BMA has issued guidance for doctors and medical students on the practical and ethical aspects of using social media. Professional boundaries, confidentiality and the reputation of individuals and the professions at large are areas of particular vulnerability when using social media. If you have not read that guidance, I commend it to you. Yet, as with all general guidance, it is in the detail of its application to daily experience that the ethical realities are revealed.

Several recent experiences have reminded me again of the power and potential difficulties of social media. This month I have observed several clinical colleagues disagreeing on Twitter. The contents of their exchanges were open to all and made for interesting reading.

However, at some point the interaction ceased to be a constructive expression of difference in opinion and assumed a personal tone. Such is the nature of social media that the moment at which this occurred and the reasons for the change were imperceptible. Nonetheless, the communication made me increasingly uncomfortable. Healthy debate yielded to unedifying questions about credentials and opaque references to rumour.

Many readers will know that disagreements in a working context are neither rare nor always handled with professionalism. However, unlike on Twitter, most work-based conflicts take place within a limited setting and are not open to anyone interested in observing. What’s more, the capacity for contextualising and containing disagreement in person is considerably greater than the 140 characters allowed for by Twitter.

The second experience that has given me pause for ethical thought concerns messages sent by members of the public to clinicians. Now, the vast majority of practitioners on Twitter neither discuss nor advise on clinical issues. Clearly to do so would be unethical. However, when clinicians discuss a topic on Twitter that has particular resonance for an individual, he or she will often make a comment, ask a question or contribute to the discussion. As with professional differences of opinion, a healthy exchange can quickly degenerate into a terse, polarised stasis. And perhaps the stakes are higher given the disparity in expertise, experience and perspective. Neither party intends it to be so, but both the limiting and limited nature of the format can transform the constructive exchange into a damaging one swiftly and irrevocably.

Finally, there is a minority on Twitter who seem intent on provoking and insulting other users: the so-called ‘trolls’. I was astonished when, after participating in a radio programme on people with learning disabilities, I received a stream of messages from strangers making unrepeatable and repugnant statements about both the programme and me. I pondered what to do. I wanted to engage, to reason and to discuss. I quickly learned that was not an effective strategy and turned to the ‘blocking’ facility. However, every day on social media, people’s passion for a subject and willingness to engage in debate even with those whose language is intemperate and hostile, end in ill-judged and unedifying ripostes by the frustrated and exasperated.

So, what are the principles for ethical engagement on social media?

First, think about the balance between the personal and professional. It is a judgement how much you choose to disclose on social media sites and it is likely that you will share information differently depending which site you are using. Be aware of your audience: both seen and unseen. For example, you may have a list of your followers on Twitter but not know who views your profile and tweets. You can and should adapt your communication according to your audience (and you can use your privacy settings to help you do so) just as you would in any other area of your life.

Secondly, be authentic, be constructive, be forgiving and be kind. It sounds simple but it is difficult to remain calm and professional when you receive a thoughtless or even insulting message via social media. You don’t have to engage with anyone: you are in control. But, if you do respond, professional communication is required, even if you do only have 140 characters.

As social media becomes more integrated into our lives, it is likely that the ethical challenges of its use will evolve and there will be much to discuss. Perhaps you could share your experiences? I’d love to see you in my timeline (@deborahbowman)!

Deborah Bowman is Professor of Bioethics, Clinical Ethics and Medical Law at St George’s, University of London