How (Not) to Twitter Your Professional License to Death

Are you a nurse? A doctor? A lawyer? A CPA? Do you make a living protecting, defending and fighting for the confidence, dignity and honor of others? Do you Twitter? When Twitter asks “What are you doing” do you know what you’re doing? That is, do you know how to use Twitter to convey your professional experiences without betraying your sworn duties or breaking enforceable laws?

Online, there are millions of ways to breech confidentiality, compromise protected information, humiliate your fellow human beings, cast doubt on your profession, emit regrettable thoughts…jeopardize your license.

For those of you in health care, there is of course HIPAA to follow. HIPAA, however, isn’t the be-all-end-all of patient protection. Doctors and nurses aught to realize that they can harm patients even without violating federal law. A bit of common sense and courtesy is probably enough to keep the risk of harm as low as possible:

  1. Don’t Twitter or use social media when you’re angry. Go get a milkshake.
  2. If your case is fascinating then reflect on it, find an eternal truth and then Twitter your revelation instead of the details. Write a short story.
  3. Assume that anonymity is an illusion. If you believe that you can achieve absolute anonymity online then go work for the NSA (apply here).
  4. Even if you don’t disclose identifiers, or if you conceal them behind fiction, be aware of triangulation. Temporal proximity and one detail might be just enough to cause embarrassment.
  5. Don’t dismiss patient dignity. You protect your patients from physical harm, so why not do the same for their dignity?
  6. Ask yourself: if I came accross a Tweet in TwitterSearch that sounded suspiciously familiar, how would I feel?
  7. Ask yourself another question: if I came across a Tweet from a patient about me (and it wasn’t nice), how would I feel?

Of course, these guidelines work for any profession, not just health care. Confidentiality and dignity are universal human needs. Entire economies depend on them. Without trust, what’s money worth?

Beyond patients or clients, you also need to consider: your co-workers, your bosses, your facility’s administration and other professionals who you might feel tempted to discuss on Twitter.

Don’t assume that just because most of the health care industry is stuck in 1953 that you won’t be located. If anything, one of the first uses of social media by the industry will probably be to hunt down employees. (I hope I’m wrong but…I digress.)

We deal with stupid, annoying and dangerous people all the time among our work settings. You can talk about them online. But what does that accomplish? Is it free, or might that cost you something valuable? Just because you can, do you have to say what you want to say?

Think about how you use Twitter. There’s a lot you can reveal in 140 characters or a tiny url. Perhaps a more secure analog to Twitter will come around. Until then, be mindful of how Twitter might affect your licensure.

You worked hard to get through school, pass ridiculous exams, get through your first few years to get this far. If you got through critical care, endocrinology or the U.S. tax code, you’re smart enough to use Twitter without killing your license, aren’t you?

8 Ways to Become a Better Nurse

One of the benefits of being away from bedside nursing is that I’ve had time to reflect on my own performance. How could I have been better? What simple precepts would have helped? Being out of the “fog of war” has given me a clearer view of what’s right and what’s wrong in health care. Our culture doesn’t offer much positive encouragement for the nursing profession. That’s a costly shame, as many Baby Boomers soon will discover. To help out, I’ve come up with eight ways to become a better nurse.

  1. Pay attention to how you perceive your patients
  2. Intend nothing but the best for your patients
  3. Speak the truth in a way that echoes your wisdom, not your darkness
  4. Act on the facts but respect your intuition
  5. Live your life as a connection to something greater than yourself
  6. Work through your hardest times, not against them
  7. Mind your mind: its power to destroy is its power to heal
  8. Focus on the moment, not the past

Some of us are cut for bedside nursing, some of us aren’t. I think if you’re in bedside nursing and enjoy what you do then you’re a Jedi Knight who commands more respect than you probably receive.

For those of you who don’t quite enjoy what you do, think about your reasons for what you do. Consider the eight precepts (or make up your own) and see if anything changes for the better. You have more options than you realize.

Feel free to add your own suggestions for becoming a better nurse. If I get to 101, I’ll post your thoughts here and promote the living shit out of the list.

I hope the list I’m offering here helps you to become a better nurse, a better person, a better part of our quickly-changing world.

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War Is The Ultimate Sin, Isn’t It?

War is fascinating. It gives us a rush. A warm thrill flows through our blood whenever we gather together to commit collective murder. It’s a sacred and ancient tribal communion we enjoy, in spite of our intellectual disgust. War binds us. It equalizes us. It dilutes our individual sin against each other into a larger crest of sinning. War is the shadow of our darkest parts cast out onto the world. Without our knowing, war is the ultimate sin.

What is it about our need to engage in sacrificial violence, no matter how distant and remote the conflict is from our hands? Why do we bundle tighter together when we face what we agree to call a mutual enemy? Why is it that the swiftest achievements in technology transpire during war? What’s in us that lusts so speedily to transform every work of technology into another extension of our murderous urges?

We have an inborn ability to imitate each other. We learn by imitation. It’s a powerful aspect of our brains: in it perhaps is the crux of our success as a species. The development of our infants depends almost exclusively on this single power. This imitative mechanism opens the door to our ability to imitate the good in each other. Being good can be infectious.

Our power to imitate also induces our susceptibility to copying the wrong kinds of behavior from each other. If someone transgresses against us, we long to imitate the gesture and return the favor. Revenge is a mirror. There was a reason the Greeks locked Narcissus’ gaze downward into eternal reflection. They may not have understood fully the nature of their own mythology, but they knew somehow that their own blood-lust was rooted in the power of imitation. We have much to learn still from those little stories.

Once we understand the awe-some power of imitation in our lives, we can see the way out of war. So long as we imitate the wrong in each other, we are forever enmeshed in a web of violence.

When war comes, put down the mirror. The mirror is a trap. When we look to each other and feel the resonance of our collective anger and fear, that’s when the binding agents of war take hold.

Whatever your belief system, it doesn’t take much convincing to realize we all sin. Whether that sin is against some Central Being of Purpose or against each other or ourselves, it’s a universal trait. Individual instances of sin happen all the time. They can usually be addressed through face-to-face meetings, where the transgressor asks the other for forgiveness and commits to the hard work of making things up.

War is ultimately different than all other sin. The sin of war is far greater than the sum of individual sins. War provides the condition in which we silently or loudly give ourselves permission to lie to ourselves, to order murder from a distance and to re-brand our murdering policies into national pride. War is a peculiar form of sinning that runs deep in our culture.

It’s easy to protest against the obvious sins of others. Pacifists too are subject to the invisible power of imitative anger. When we are the sinners, we don’t see things that way. We not only see ourselves as innocents but also as heroes. We idolize ourselves. What could be more sinful than that?

If we are to avoid war we are going to have to understand how deeply we imitate the good, the bad, the ugly and the fearlessnes in each other. Whether you know it or not, we are entering deeper into a new kind of war. It will happen with our consent. You and I are willing sinners in a cosmic battle against our own innocence.

If we keep getting into trouble because our imitative powers are stronger than our intellectual visions, then we are going to need to point our gaze somewhere else. We are becoming increasingly sibling in our social structure. We no longer look to our elders. We increasingly look to each other through technologies which give us the illusion of community. We are in big trouble.

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Let’s Go Back to Gas Lamps

Earlier today I almost had a brain aneurysm. I was sitting in the offices of an important health care facility when the subject of electronic medical records (EMR) came up. What I heard uttered out of the mouth of a highly talented and solidly experienced health care professional made me realize just how bogged down in the 20th Century our health care industry has become:

What do we do if the computers go down?

Now this is an obvious concern. But it occurred to me that this line of reasoning is a deep-seated logos in the health care profession. I wanted to ask this person what the facility would do if the electricity would fail. I’m pretty sure I would hear “Well, our backup generators would kick in.” Why hasn’t this kind of acceptance of electric backup grown with respect to other kinds of technology? If we all followed this person’s logic, why wouldn’t we just go back to using gas lamps in hospitals?

What is the source of such fear? Why is our health care system so behind in the proper management of health information? Do we even know what are the economic and social opportunity costs of using paper for the majority of our health information?


According to some studies, less than 10% of health care facilities in the US employ health information technology (HIT). 90% of of the health information is on paper! Is it 2008? Is this the 21st Century?

I know there are many reasons for the delay: federal and state regulations, privacy concerns, reliability, cost, etc. These are all major considerations. Something tells me, though, that even if these concerns were addressed an allayed, there would remain perhaps the single largest Dip our health care industry would have to get up and over: culture.

Social media geeks are all coked up about Twitter and FriendFeed and many other white lines on the web, but what could be more geeky than healthcare? I’ve worked in the ICU and the technical geekiness required to safely titrate a vasopressor or manage ventilator settings is far more wicked than anything on the web. If health care workers can learn these gadgets to save lives and restore the sick to wellness, what gives? Why such a gap in using health care data with as much comfort as using Google or any other informational interface?


We live in a time when cost containment is being addressed by folks who aren’t thinking about the consequences of their decisions. Refusing to reimburse facilities for Hospital-Acquired Complications (HAC) is admirable and understandable. Ultimately, however, facilities will need to start documenting care for the primary benefit of payors instead of patients. Those facilities that rely on paper to document events, in turn, will place the burden of this kind of documentation on health care workers.

When does this deadly game end? When will the body count be sufficient for this Pagan God of cost efficiency? The opportunity cost of paper documentation is quality care. Period. The right ideas in the wrong heads are always dangerous.

If our health care system is still burning gas lamps in an age of light bulbs, how blind our we getting? Time for some eyes to open up. The dusk is coming and the lamps are buring low.