Amerika

This neat little article showed the divide between rights, or what you can demand from society, and reality, or how you have to act to make things turn out all right.

Rights:

A new survey of medical-school deans finds that unprofessional conduct on blogs and social-networking sites is common among medical students.

Although med students fully understand patient-confidentiality laws and are indoctrinated in the high ethical standards to which their white-coated profession is held, many of them still use [social media sites] to depict and discuss lewd behavior and sexual misconduct, make discriminatory statements and discuss patient cases in violation of confidentiality laws[…].

Of the 80 medical-school deans questioned, 60% reported incidents involving unprofessional postings and 13% admitted to incidents that violated patient privacy. Some offenses led to expulsion from school.

Many students feel they are entitled to post what they wish on their personal profiles, maintaining that the information is in fact personal and not subject to the same policies and guidelines that govern their professional behavior on campus.

Though medical students would agree that physicians — and other professionals, like teachers — should be held to a higher standard of integrity by society, the new study suggests that they’re confused by how rules apply, especially in cyberspace, once the white coat comes off.

“They view their Facebook pages as their Internet persona,” says Dr. Neil Parker, senior associate dean for student affairs for graduate medical education at UCLA’s David Geffen School of Medicine. “They think it’s something only for their friends, even though it’s not private.”

So here’s the setup: they feel “entitled to post what they wish on their personal profiles” has two real points. First, they feel that rights are the issue here; second, they feel that there’s a distinction between personal profile and professional life.

What they’re not understanding is that they don’t exist in a vacuum. People depend on their for care; they have, as a result, additional responsibilities. Among other reasons this is why doctors are paid more than average. But also, people need to feel comfortable trusting doctors with some precious things:

• Their privacy. You’re getting naked in front of this person and probed in places you don’t normally show people. You don’t want to be mocked for it.
• Their health. Your doctor influences your survival in a huge way. You are placing a lot of trust in this person, among other things to value you as a human being enough to work hard to get you the care you need.
• Their fear. No one likes going to the doctor. Doctors can emerge at any time, look at a chart, and tell us we have six months left — or that we have some weird disease that will make our genitals fall off. Doctors must among other chores ward off that fear.

For this reason, like Presidents and police officers, doctors are to some degree never off duty, and it doesn’t make sense for them to mock patients or show unprofessional behavior. Sure, they may have the right to do it, but is that the question?

Younger students were more likely than older staff members to believe that their thoughts and opinions were valid to post online, regardless of their potentially damaging or discriminatory impact on others.

TIME

“Validity”,”rights” and “entitlement” mean nothing compared to the task of survival.

If you’re a doctor, especially an ethical one, there are certain standards you’re going to uphold because you want to do right by your patients.

That’s more of a pioneer attitude. I do what I need to do.

Then there’s the city person attitude: I do whatever I can get away with.

The city people are used to asking others for permission, and making others give them things on the basis of “rights” and transactions. The pioneer is used to making things work.

Doctors “should,” in the sense of what is sensible, follow the frontier model not the city model. I know I wouldn’t want to entrust my care to someone wondering how they can leverage their rights to get away with more at my expense.