What does Mark Zuckerberg have to do with Twitter patient privacy issues?

If any of you have any interest in health care, and have been on Twitter, you all know about the debate which has been swirling about privacy issues and professionalism. Let me start out by stating that I highly doubt this post (or any post) will likely change some people's behaviors. At the end of the day, Twitter is a free space where you are able to to post whatever comes to your mind, so the individual will still have the ultimate choice what goes on their stream. If you missed it, the original post by Dr_V, Bryan Vartebedian, that brewed the 'storm in a tweetcup' (name via @scanman) is found here.

However, choosing what one puts on the stream got me thinking about one of major issues in the divide between those who are for healthcare professionals posting whatever comes to mind, and those who are against it. It brought me back to an article I read a while ago about Mark Zuckerberg. The link takes you to a similar article (I couldn't find the exact one I read), but the essence is that with the progression of the use of social media, and in particular Facebook, Zuckerberg felt there was no more need nor use for privacy. What I read his remarks to mean is that in the world before Facebook, we went to work as doctors, nurses, PA's, etc, and we shared a social space with those workers which was different from how we were when we were in a space with patients present. We then went home, and had a social space with friends. There were social norms associated with how I was to act as a doctor with my patients (or in earshot of patients), and these were different that if I was in the resident room with the door closed. The language was different, the tone of the conversations was different, and the subject matter was different.

Enter Facebook. Now, I have this social feed that goes not just to targeted groups, but to everybody at once. The old physical barriers of social spaces were broken, and now I share everything with everyone. Everyone has made social gaffes by temporarily forgetting who all is in the 'room' and a Facebook status that would otherwise have been innocuous becomes a social nuclear bomb. There are two ways to go once you have had this experience. One, which Zuckerberg advocates, is to say that the old paradigm of having a compartmentalized existence is essentially a false way of living, and everyone should understand that there really is only one you, thus you should be free to express any thoughts you have to all of your friends. This creates a more real and genuine world over all. Thus, if my patient can look at my social media presence and see that I struggle with daily frustrations just like everyone else, I'll be better to relate with them, and build a better bond in the long term.

The other view, is that these social spaces were created over time for a very good reason, and there really should be boundaries between professional life and private life (and what is said in front of patients and what is said in the resident room). This view argues that the blurring of these lines leads to confusion in the doctor-patient relationship. How can a patient trust me to talk to me about a potentially embarrassing social history point or pain in an unflattering area of the body if they are concerned that I will likely step out of the room and make a disparaging remark about them on their Twitter feed. That remark may then be retweeted to viral levels before I've found my car in the parking lot.

Obviously, this debate is more complex than just this point, but I think a large part of it comes down to whether you agree with Zuckerberg's position or not. Do you feel that your online social media presence on the open web (and Twitter is much more open than Facebook) should be compartmentalized or not? I thought about this as @DrGhaheri had a conversation with @SeattleMamaDoc about how to define the lines of the debate. He had wondered if if was based on political viewpoint, but quickly corrected himself. He tweeted, "not cons/liberal from political standpoint but as a lifestyle. Maybe "proper" and "conservatism" had to do with judgment." I think that the line is not entirely conservative vs. liberal (although each of those views probably lend to having you lean one way or another). I think the answer is more, are you pro-Zuckerberg or anti-Zuckerberg. Feel free to leave your thoughts below.