The Eight-Fold Path of Internet Ethics: A Primer for Health Care Professionals
The Eight-Fold Path of Internet Ethics: A Primer for Health Care Professionals
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.
References
Thanks to Dr. Moffic for the interesting point about the Tucson tragedy (I have a long article on that, posted on the Psychcentral website). It's undoubtedly too soon to know--if we ever will know--how much the inflammatory political rhetoric contributed to the shooter's motivation. But whatever turns out to be the case in this instance, I am convinced that for a small but dangerous subgroup of already disturbed persons, such invective and "fighting words"can be a catalyst for violent action, even if mental illness is the "rate-limiting step". And, aside from such effects, the rancor and vituperation so commonly seen online sullies life for all of us, and makes the world a cold and hostile place. I think life is tough enough, without adding to its burdens! A little kindness goes a long way. Thanks, Steve....Best, Ron Pies
As an interested layperson, I want to thank you for addressing this topic in the context of professional communication. The intemperate comments littering so many otherwise valuable websites and blogs take a toll on at least some of us readers, and might be reduced if the writers can't hide behind anonymity and pseudonyms. There are circumstances, however, in which the mask hides not cowardice but courage, by whistleblowers and others who have valuable contributions to make and simply can't safely do so without the mask, not necessarily for reasons of life and death but due to legitimate professional or personal concerns. The question will be how to devise a nuanced policy that encourages civility without silencing those with legitimate complaints or disclosures, particularly when there are significant imbalances of power. There needs to be a way to ensure accountability for speech content when accusations are made. Moderators can do this; it takes vigilance, common sense and regular reminders to participants in a given blog of the ground rules, since blogs tend to have their own cultures, which vary widely in what is considered acceptable. Your Eightfold Path should be shared widely as a template for blogs with diverse memberships, since even though it's intended for a limited, professional sector, much of it truly is about general etiquette.
There is an obvious problem in speaking up, whistle-blowing, being the squeeky wheel, etc. We address this in training, where students are able to talk to a certain prof who generally can keep things "anonymous,"as they go to the faculty being complained about. site visits for re-certification and so on often include "private" interview opportunities so that they can solicit/precipitate comments and insights that simply will not come out in some big staff meeting. These are normal practices, and more of them should be developed. I will blog 'anonymously' because my job does not include covering the relevant things that my expertise allows me to see that is critical/informative, and because I want to maintain certain relationships by maintaining discretion in what I say. I stick to facts and evidence. But along the line, the workings of Big Pharma, or the govt, or whomever, can be reasonably accused of 'nefarious' or negligent intent. No one is gonna say, 'yes. you caught me publishing a lousy study purely for its marketing value. No. But we can blog and paint a picture that says, 'buyer beware,' and such.
Dr. Pies makes excellent points; however, there is an implication that there is no control at weblogs over what is posted in comments or by whom. Certainly, blog owners or moderators can block or delete comments that are deemed to be unsuitable. While this is censorship, there is no obligation for weblogs to pander to the irresponsible expression of free speech --- especially at blogs intended for professional/medical audiences. -- S. Leavitt, PhD; moderator of Pain-Topics UPDATES.
I thank Paul Rowan and Stewart Leavitt for their comments. I agree that, in certain "whistle-blower"scenarios, maintaining anonymity may be justified.
With respect to "maintain[ing] certain relationships by maintaining discretion..." I am not sure why "discretion" would require concealing one's professional identity--but perhaps I'm just missing the specific circumstances Paul Rowan is alluding to. I suppose I take the somewhat concrete and perhaps naive view that anything worth writing is worth signing--and if you have doubts about signing, you may want to re-examine the value of (or motivation behind) what is being said. In any case, unless there is strong reason to believe that significant harm to self or others will ensue by using one's full name, I believe doing so is appropriate in all professional communications.
I agree with Stewart Leavitt that "blog owners or moderators can block or delete comments that are deemed to be unsuitable"; indeed, they ought to do so.
I also believe that anonymous postings should simply not be allowed, except in extraordinary circumstances that are disclosed to the blog moderator/owner; e.g., the person writing has convincingly explained that he or she would be endangered by providing a full name (for example, when an abused spouse is writing about his/her abuser, or in similar dire circumstances).
Best regards, Ron Pies
My thanks to Tamara Lichtenstein for her helpful comments. And, yes--one needs to be flexible and
"nuanced"vis-a-vis anonymity. Psychiatric Times, for
example, once took the very unusual step of permitting an article to be published, with the author's name concealed. This was owing to an extremely sensitive professional concern re: repercussions with employers. We felt that the content of the piece was so important, the trade-off was worth it, in terms of serving the public good. By the way, I do believe the "8-fold" path is applicable to any persons, not just health care professionals. --Ron Pies MD
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If it will turn out that inflammatory rhetoric, internet and otherwise, contributed to the Tucson tragedy, Dr. Pies was terribly prescient in his recommendations. They are certainly applicable beyond our psychiatric circles and should be circulated widely.