The 1886 novel by Robert Louis Stevenson about a man who transforms seamlessly between two personalities (one during the day, another at night) and the havoc that occurs when those two personalities collide in the same world may seem like a distant memory from the mandatory reading list in middle school. But, during a recent patient visit I realized this may be a reality that most young physicians face every day.

I was meeting a young new patient in his thirties. A pleasant attorney, he described a classic case of benign premature ventricular contractions. We wrapped up the visit and as I was about to say goodbye, he shocked me by saying: "Oh, by the way, I follow you on Twitter. I really liked that photo you posted from your trip to the mountains last week… keep them coming!"

I suddenly felt as if the apocalypse had occurred and had invaded my innermost privacy. His revelation created a sudden collision between my work world and my personal world. I'm not sure why I was so stunned and felt so viscerally that he had crossed a boundary that should not have been crossed. Why should I be surprised? I was fully aware when I posted that photo to my Twitter feed that it was accessible to anyone in the public and to my hundreds of followers, which could include current and future patients. Furthermore, I also knew that modern-day patients Google their doctors before coming to their visit.

As do so many nowadays, I have a Facebook profile, a Twitter handle, an Instagram profile, a LinkedIn page and a Doximity profile (phew...did I miss any?) to which I regularly post. For me, it goes something like this: LinkedIn and Doximity are professional posts only and Facebook and Twitter are a mix of professional and personal posts. But, what starts to become a challenge for young physicians active on social media is when the lines between personal and professional social media begin to blur... and when worlds collide and someone from my professional world suddenly gains access to something in my personal world... or the other way around.

Should we as doctors try to keep these worlds in parallel and separate universes? Is this even possible? Or is it better to embrace the modern-day culture in which privacy no longer exists and every patient has access to knowing everything personal about their physicians. And should we, as physicians, only post those things that we want to be extremely public about ourselves. And if we do this, how does it influence what we are posting and are our posts still "honest?"

Last fall when I was interviewing for my current job, I spent about two weeks reviewing all my social media posts from the past three years and Googling myself to ensure there was nothing on the web that a potential employer may frown upon. I even changed my profile photo from what it used to be (me in front of the Duomo in Italy in a tank top) to a professional headshot of me smiling, bright-eyed with a crisp, sparkling white coat. Similarly, during the time I was interviewing for my position, I was very careful to only post on Twitter and Facebook seemingly brilliant insights into the latest clinical trial or study rather than talking about the new restaurant I just tried or posting family photos.

Somehow, unwittingly, my social media profiles, once an outlet for true social connection with friends and family had now become a professional networking, self-promotion and discussion platform. Even after I got my job, this behavior propagated itself. I'd gotten in the habit of pausing and asking myself before posting: Do I really want this out there forever? How does this post make me look?

Now, such behavior isn't a bad thing. A wise old adage to follow is "if you speak, carve every word before you let it fall." It's not a good idea to tweet without thinking. But does this make our social media less of a reflection of how we really interact? For example, how many times do you pause before every statement you make when having a face-to-face conversation with a friend or colleague? And do you usually "cherry pick" what you say when you're catching up with an old friend? We've all learned there's a difference between profiles and posts from our family and friends and what's truly happening in their lives. Does social media then just become a public platform for self-promotion without being a means for true social connection?

So, in some ways, aren't we all living the life of Dr. Jekyll and Mr. Hyde, where we have a personal persona and a professional one? Where we have a persona the world sees on social media and one we reserve only for those in our innermost circles of trust? And, just like in the story, will one of those personas permanently end up dominating the other or can they coexist?

With my patient that day, I avoided his comment. Immediately after he left, I blocked him as a follower on my Twitter account. But, is this possible for all future patients? I was painfully aware of an inconvenient truth: When posting to social media it may not be possible to keep my personal and my professional worlds apart.

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Payal Kohli, MD, FACC, practices at the Heart Institute of Colorado in Denver, where she treats a variety of cardiovascular diseases. She is also the lead physician of the Women’s Heart Center.

Keywords: ACC Publications, Cardiology Magazine, Social Media, Privacy, Friends, Lawyers, Reading, Restaurants, Emotions, Learning, Habits, Physicians, Personality

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