Professional Boundaries

The hardest thing about physicianhood is that it is something that one becomes, as well as an occupation. Entering the profession means we become professional, and professionalism is a concept that often makes me twitch. Despite an historical review, I’m still not entirely sure I can pinpoint what is professional and what is not. I think that we have a much easier time pointing out what is unprofessional–and this is usually done with a view to criticism.

Professionals are regulated by their colleges (or other forms of associations, depending on the profession). They state the rules and expectations of conduct, and mete out punishment/education. This oversight, we are taught in med school, is what justifies the trust placed in us by the public. Formal collegial regulation ensures (or, at least, is meant to ensure) that every member is completing his or her fiduciary role. It is made very clear at the beginning of med school that by continuing on to full physicianshipitude, we agree to be watched over by our self-regulatory body.

What is even more Orwellian, however, is our modern position where people in general put their thoughts and opinions for the observation of all. Anyone can read and react to these as they would like. Blogs, YouTube, Facebook; if you’re reading this, you likely already know what I’m talking about. We’ve made a lot if what used to be quite private public.

It’s never been entirely clear, so far as I can tell, where the private/public divide lies for a professional.  It has been the case before the information superhighway that professionals were chastised for actions done in our private lives, even if we argue for work/life separation. (Nope, I’m not giving specific examples. Learn to google, or go old-school with microfilms at a library.)

So then here is the next conundrum: how can I engage in this “new media” dialogue as a professional? Some bloggers, like Dr. Grumpy or Fizzy McFizz, avoid the issue by writing anonymously. (This protects them and their patients, whom they tell stories about.) I do not think this is a bad idea, but I do think that requiring it of me is unjust. Physicians like Atul Gawande, John Dossetor, Oscar London or John Fleetwood tell anonymous stories about their patients, they just did it on traditional paper media. It seems unfair to me that I might be discouraged from partaking in new media under a fear of so-called unprofessionalism.

Each post adds to this argument, mine and all the other docs out there with blogs. We’ll see if this enterprise ends up shooting me in the foot. Maybe cyberspace is too dangerous, and my professional/private boundaries will dissolve in a massive scandle at some future point. Naming myself and saying “hey! I have my thoughts over here! Here I am!” It paints a target, and I think more people want to shoot at a professional because it is so much easier to say “look! She’s being unprofessional!” than it is to find something more specific to argue. My own patients are free to see the words I put here. As is the college. It’s an uneasy position.

But I’ll take ‘uneasy’ over ‘silenced.’


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