Anyone who has written blogs or published articles online knows that the Internet is the new “Wild West,” so far as etiquette is concerned. As a physician who has blogged on several different websites, or responded to postings by other health care professionals, I have been astounded by the level of bile and vitriol that infects so many communications among “colleagues.” Worse still, many websites aimed at health care professionals permit anonymous postings—-a sure-fire invitation to the “flaming” email, in which someone purporting to be a physician or other professional berates a colleague in terms that would embarrass the proverbial fishmonger’s wife (my apologies in advance to fishmongers and their spouses).
As Neil Swidey recently wrote in the Boston Globe,
“Anonymous commentary is a push and pull between privacy and trust…Online postings can sway political opinion and heavily influence whether products or businesses thrive or fail. They can make or break reputations and livelihoods. On one side, anonymous comments give users the freedom to be completely candid in a public forum. On the other, that freedom can be abused and manipulated to spread lies or mask hidden agendas.” 1
Recently, there has been a movement toward restricting or prohibiting anonymous (or pseudonymous) postings on the internet—and not only on professional websites. For example, on the Psychiatric Times website, those who respond to our regular bloggers are required to provide their first and last name—though admittedly, this sometimes leads to a few “Herman Herman” or “Joe Joe” postings. Still, it’s a step in the right direction, and mass media papers like the Washington Post are said to be re-assessing their own posting rules.1 There has also been a good deal of discussion in legal circles regarding the “unmasking” of anonymous bloggers who clearly defame another individual. Thus, according to Joel Reidenberg, founder of the Center on Law and Information Policy at Fordham Law School, the judicial trend has been to “…permit unmasking of anonymous bloggers when there is a strong showing that the statement is defamatory and that the victim would be likely to prevail in a defamation lawsuit.”2
To be sure: there are extremely rare instances in which an anonymous posting may be justifiable; for example, when someone exposing a genuine social evil or criminal act risks retaliation, revenge, or even death, by providing his or her real name. But in my view, it is not enough that an anonymous health care professional wishes to avoid “embarrassment,” or finds it “inconvenient” to provide his or her name. I find it especially deplorable—and cowardly—when one physician hides behind the safety of a pseudonym while attacking a named colleague.
But my aim in this piece is not to engage in still more adversarial exchanges. Rather, I’d like to suggest some ethical guidelines for health care professionals (or anyone else) who post blogs and comments online. In addition to urging my colleagues to provide their full name and degree (MD, PhD, etc.) in all online communications, I would also encourage them to build their critiques on a foundation of collegiality, respect, and fairness. In my view, this is not a matter of “Emily Post” etiquette, but of ethical and professional responsibility. And so—with apologies to the “Noble Eightfold Path” of Siddhartha Gautama3—here are my eight principles of ethical online conduct:
1. When criticizing a colleague, try to begin your critique with something appreciative and positive—or at least neutral—such as, “Dr X. raises some very timely and important questions in his/her thoughtful essay.”
2. Try not to write anything about your colleague that you would not feel justified in saying to his or her face, at a professional conference (and bear in mind, that’s where the two of you may meet next!)
3. Never dash off an email or blog comment in a fit of anger; rather, write a draft version “off line”; reflect upon it; revise if necessary; and send only after a suitable “cooling down” period.
4. Always consider having a colleague read over any critique that leaves you feeling uneasy or slightly “guilty” regarding statements about another person.
5. Always phrase your criticism in terms of ideas or behaviors, not your opponent’s character or mentality; eg, say, “The notion that we should use that approach is misguided, in my opinion”, not “Dr. X is totally out of his mind!”
6. Try to include some points of agreement with your opponent, if you can legitimately find any (and look hard for them!)
7. Hard as it may be, try to attribute a benign intention or motivation to your opponent; eg, “Dr. X clearly intends to protect the welfare of the general public; however, in my view, her approach may lead to serious problems.” (“In my view” is a good mantra to recite).
8. Always try to summarize your opponent’s view in a fair and convincing manner, while allowing for the possibility that you have misunderstood his position. (In the Talmud, the School of Hillel garnered more approval than did its opponents, the School of Shammai, because in writing their opinions, the Hillelites typically began by accurately stating the Shammaites’ point of view).
As one commentator has observed, in discussing the Buddha’s concept of “right speech”: “The importance of speech in the context of Buddhist ethics is obvious: words can break or save lives, make enemies or friends, start war or create peace.”3 Surely, those of us whose livelihood and calling depend on the power of words must take this counsel to heart.
Dr Pies is editor emeritus of Psychiatric Times. He is professor of psychiatry and lecturer on bioethics and humanities at SUNY Upstate Medical University in Syracuse and clinical professor of psychiatry at Tufts in Boston.
1. Swidey N. Inside the mind of the anonymous online poster. Boston Globe, June 20, 2010. http://www.boston.com/bostonglobe/magazine/articles/2010/06/20/inside_the_mind_of_the_anonymous_online_poster.
2. Karni A. End of internet anonymity. Fordham Law. http://law.fordham.edu/faculty/18870.htm.
3. The Noble Eightfold Path. http://www.thebigview.com/buddhism/eightfoldpath.html.