Monday, September 28, 2009

Medical Students Behaving Badly

Posted by Darin Hayton on 09/28 at 11:48 PM

The current issue of JAMA contains a fascinating “original contribution” on inappropriate on-line medical student behavior. The concerns are not so much legal issues, though the authors gesture toward possible breaches of patient confidentiality, as potential harm unprofessional activity might cause the vaunted medical profession:

“Web 2.0 also risks broadcasting unprofessional content online that can reflect poorly on individuals, affiliated institutions, and the medical profession. Other professions are struggling with similar issues. However, the social contract between medicine and society expects physicians to embody altruism, integrity, and trustworthiness.”

In addition to violating patient privacy, the study categorized the following content as unprofessional:

  • student use of profanity or other disparaging language in reference to specific faculty, courses or rotations, classmates, or medical school
  • sexually suggestive material, provocative photographs of students, or requesting inappropriate friendships with patients on Facebook
  • photographs, videos, and comments suggesting intoxication or illicit substance use (illicit substance paraphernalia, depiction of intoxication, students holding alcoholic beverages)

Profanity and disparaging language, including discriminatory language, was the most common transgression, followed by intoxication or illicit substance use and sexually suggestive material.1 Of interest to me is the fact that this study seemed less concerned about patient privacy and confidentiality than it was with more ambiguous “unprofessional” behavior.2 Similarly, the possible implications of illicit substance use/abuse were left unexplored. While admitting that the categories of unprofessional behavior might be difficult to define and subject to disagreement, the authors claim that when medical students write and perform satirical comedy skits, which are then disseminated through YouTube and Google Video, such skits “carry the potential for significant public impact and viral spread of content. … Medical students may not be aware of how online posting can reflect negatively on medical professionalism or jeopardize their careers.” (my emphasis)

That seems to get at the heart of the matter. Making fun of medical school, satirizing the faculty of the courses, cursing about the overall experience tarnishes the image of the physician. However true or warranted such reactions might be, the world doesn’t need to know it.

The focus on the image of the profession recalls the advice medieval physicians gave their students:
It is better for the profession to predict the patient’s death. If the patient dies, medicine was vindicated; if the patient lives, medicine was able to save a dying person. Either way, the profession looks good.

Maybe this is just an adaptation of Tyler Durden’s advice:
The first rule of medical school is you do not criticize medical school. The second rule of medical school is, you DO NOT criticize medical school.

The complete article is:
Katherine C. Chretien, S. Ryan Greysen, Jean-Paul Chretien, and Terry Kind, “Online Posting of Unprofessional Content by Medical Students” JAMA 2009; 302(12): 1301–08—abstract; full text (behind a paywall)

1In good physician-turned-social scientist manner, the authors quantify their findings as follows: Of the 47 schools reporting incidents, 13% reported violations of patient confidentiality; 52% reported student use of profanity and 48% reported “frankly discriminatory language;” 39% reported depiction of intoxication: 38% reported sexually suggestive material.
2Patient confidentiality is both an ethical issue and a serious legal issue. See the AMA’s discussion here and the HIPAA laws here.

Tags: jama, medicine