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?


  1. Hope you realise that is my little joke 🙂 Looked to me like the writer of 'clinical cases' was taking me seriously, so just wanted to clear that up.

  2. I'm new; never been to your site before but have followed a mention in a Yahoo!pipe blog feed. It's important for you to know several things, from my opinion:
    1) wonderfully written post. Articulate, humorous, interesting, thought-provoking.
    2) refreshing to find healthcare professionals embracing social media apps. what crazy thing might happen next – bankers blogging?
    3) your content – advice is incredibly timely, and very accurate/relevant
    4) beyond the topic of patient confidentiality and the ethical role healthcare professionals play in conducting treatment, you bring to light (for some, reinforce for others) universal suggestions all in the vein of “do unto others as you would have them do unto you.” And that, my friend, is golden

    Keep up the good work! Glad I stopped in.

  3. This is more lawyer intimidation of the doctor. The doctor cannot even say a word without getting threatened. The scapegoating patient feels totally free to unfairly bash the doctor. The lawyer has given it total immunity, to make false allegations, spew hatred, and file weak claims.

    It should become the an accepted doctrine that the defendant will always attack the oppressive government thug lawyer personally. Always demand total e-discovery of the enemies of clinical care, including the plaintiff, the plaintiff lawyer, and the vile, biased judge enabling their plunder. Always sue the licensing board, always countersue the CMS thugs, always sue the plaintiff. Always file ethics charges against the plaintiff lawyer enemy for every utterance that potentially violates a rule. Do so one at a time, once a month, so that the lawyer spends the rest of its life under investigation. No enemy of clinical care should spend a day without uncertainty. To deter.

  4. My other piece of advice would be not to use Twitter when you've had too much alcohol to drink!

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