Social media guidelines for physicians frequently focus on the need for doctors to separate their personal from their professional identities, but those types of policies get social media all wrong, according to a viewpoint recently published in JAMA.

Instead, the viewpoint's authors suggest a simpler, more straightforward means for physicians to assess potential social media activity: Is what you're about to say appropriate for a doctor to talk about in public?

"When a physician asks, 'Should I post this on social media?' the answer does not depend on whether the content is professional or personal but instead depends on whether it is appropriate for a physician in a public space," write the authors - Matthew DeCamp, MD, PhD; Thomas Koenig, MD; and Margaret Chisolm, MD - from Johns Hopkins University.

But for those who remain unconvinced, the authors offer these four reasons why, for physicians, it simply isn't feasible to separate personal and professional identities:

It's operationally impossible: With minimal effort and information, anyone can do a web search that quickly connects a physician's personal content to her professional content - assuming both types of content exist. And if both types of content do exist, there's no way to keep them separated, when a connection between the two is just a Google search away.

Lack of user consensus: Despite recommendations from groups such as the American College of Physicians and the Federation of State Medical Boards, some physicians remain unconvinced of the need to maintain separation between personal and professional content. For some, blurring the lines between the two is part of the reason to use social media in the first place, as doing so can level hierarchies and increase transparency, the authors say.

They're often the same thing: Separating personal and professional identities is inconsistent with the concept of professional identity. In other words, professional identify is determined to at least some extent by personal identity. For example, medical students undergo identity changes from student to professional and from consumer of medical services to provider. Those personal identity transitions help shape who they are as professionals. "When recommendations fail to acknowledge the complex, mutable nature of professional identity and its connection to personal identity, the recommendations fail to offer the unambiguous, practical guidance that is needed," the authors write.

It could be harmful: Doctors aren't required to avoid personal contact with patients offline, so why should they be required to do so when they're using social media? In small or rural communities in particular, such encounters can be unavoidable, and they can even be beneficial to both doctor and patient. The unrealistic expectation that physicians need to maintain two separate identities can carry with it a "psychological or physical burden," the authors write.

The authors stress that they aren't proposing that doctors should "eliminate boundaries," or that "anything goes" on social media. Rather, the key to resolving physicians' "online identity crisis" lies in recognizing that social media exist in primarily public spaces, not in exclusively professional or exclusively personal ones.

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