Physician Anonymity: No Room for Aliases

01 August 2011

Editor’s note: A few weeks ago, the American Medical Association published a blog post discussing the pros and cons of online physician anonymity. Around that same time, a group of influential doctors who’ve previously written about the issue, among them Bryan Vartabedian, MD, and Wendy Sue Swanson, MD, teamed up with the Mayo Clinic Center for Social Media to record their viewpoints in a YouTube video.

Since then, the dialogue’s been enriched even further (we especially enjoyed reading this essay by Mark Ryan, MD and this one from Jen Gunter, MD). Here, Michael Nierenberg, MD, Clinical Professor of Medicine, Emeritus at Stanford University and member of Doximity’s Advisory Board, offers his opinion on what’s at stake, including how a verified community such as Doximity can benefit doctors.

There’s logic behind why the convention of anonymity has dominated healthcare forums: Anonymity protects us from retribution, makes it easier for us to feel confident making bold arguments, and helps flatten status differences. But anonymity comes with a price. A few years ago a team of researchers argued in the journal Communication Research that the unintended consequences—specifically, fostering a culture of mistrust surrounding participants’ motives and expertise—may outweigh the benefits. I’m inclined to agree. Here are five reasons why we need to kick anonymity to the curb and how a real-name network like Doximity can radically improve doctor-to-doctor communication.

Accountability promotes credibility Adding your name to a comment affords you an opportunity to pause and make sure you really stand behind what you are saying. Anonymity suspends real-world judgment and emboldens us to jump into a dialogue, to express strong opinions, and to stick to our guns in the face of peer pressure. But it also fosters hasty, sloppy reasoning, making mistakes more likely. As healthcare providers, we have an ethical responsibility to be sure what we’re saying is true. This is especially important on the Internet, where an offhanded slip can live on forever (racking up pageviews all the while). Put simply, accountability increases veracity.

Anonymous conversations can get unruly Why do bank robbers wear masks? Because their identities make them accountable for bad behavior. Accountability holds people up to a certain standard of conduct. Not everyone needs that reminder, but it takes only one or two disruptive individuals to spark hostility in a debate. When this happens, otherwise productive conversations lose focus—and participants—fast.

Identifying yourself demonstrates expertise and expedites dialogue Allowing people to see who you are and what you’ve done can actually help get your point across. It gives readers a frame of reference to interpret your comments. One is more inclined to trust a statement about an anemia made by J. Archer, Stanford hematologist, than one made by a physician with the handle “Crackerdoc71.”

Knowing who-and what-is involved brings people to the conversation Online conversations are a little like buying a car. You want to check out the product before you invest. Say you’re reading a discussion about a controversial weight surgery device. As much as the commentators’ experience and expertise matters to you, you’re also going to want to evaluate their involvement and any conflict of interest. Wondering whether doctor X—an enthusiastic proponent—is a bariatric surgeon with a financial interest in the company may keep you from fully trusting what they have to say. Once you know with whom you are dealing, you can start looking at their comments on their own merits. Ultimately, knowing who’s participating and what’s at stake improves the level of communication and builds trust that’s essential for community. Trustworthy dialogue draws more people into the conversation and makes the interaction more robust.

Letting people know who you are opens up opportunities to network, collaborate, and build your reputation and practice Good comments get good attention; it’s as simple as that. By going public you have an opportunity to get your opinion out there, and to make connections. The beauty of participating in online conversations is that it lets us all go beyond the social and geographic parameters we already know to forge new connections and make new discoveries. Say I have a patient moving to Stanford, California, and I don’t know a lot of physicians in that area to refer him to. I’m far more comfortable referring to Dr. J Archer, Stanford hematologist, with whom I have interacted online, than to “Crackerdoc71”. The same goes for clinical studies. If I’m working on a study and I come across a forum with an insightful group of physicians, I can contact them about a way to collaborate.

Physicians all too often act in isolation because of the logistical difficulties of communication. Letters and phone calls are time-consuming. The internet can solve this problem but interaction needs a foundation of trust and openness to succeed. Doximity is trying hard to provide this environment. I’m eager for all of us to take advantage of this powerful tool to facilitate physician-to-physician communication without the need for aliases.

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