A Health Affairs blog post (Doctors and The Bully(ing) Pulpit) suggests guidelines for civil discourse in online comments. Some of the ideas are good and others are silly. But the most important guideline –using your real name when posting a comment — is omitted completely.
The authors: a nurse practitioner, primary care physician, and program director of internal medicine residency programs focus on a flame war between doctors and nurse practitioners on KevinMD over whether nurse practitioners should be allowed to practice independently. At least that’s a topic worth fighting over. (For the record my view on that topic is that NPs should be allowed to practice independently, but I’d rather be seen by a physician.)
The authors list seven “principles for a civil online discourse” and give examples:
- Anecdotes are fine, but avoid drawing generalizations from one story. (“We had that dumb NP once. She didn’t know where the gallbladder is located. So NPs must all be dumb.”)
- Identify the underlying emotion of a comment that irks you, and name it when you respond. (“Doctor Strangelove, it sounds like you’re frustrated that NPs have fewer hours of training and are asking for the same salary as MDs. Here’s my take: ….”)
- Name-calling is out. Polite, respectful comments are more likely to be taken seriously, and to stimulate a productive conversation. ( “SJ, I appreciate hearing your viewpoint. Here is WHY I disagree with you.”
- Own your comments. Instead of making broad generalizations, make it clear that you are offering your opinion. (Rather than saying, “NPs simply should not be practicing without some sort of physician supervision,” say “I don’t think NPs should practice without any physician supervision.”)
- Consider phrasing your comment in the form of a question. (“I’m troubled by the thought of NPs working in a rural area with no access to collaborating physicians. Does anyone have experience with that?”)
- Go for the win-win. (“The demographics, economics and politics of health care reform suggest there’s enough pie for all of us in the primary care world. We are all undervalued and overworked. By uniting in cause and working with each other, both groups stand to gain in terms of creativity, relationships, and (dare we say) income.”)
- Find the best alternative to a negotiated agreement (known as “BATNA”—taken from the classic tome, Getting to Yes). (“NPs are here to stay, with increasing autonomy across more and more states. Let’s find a way to work together—whether you’re a doctor or NP, our end goals are the same.”)
These are nice rules for in-person conversations, but they aren’t especially well suited for online discussions:
- Anecdotes are useful, especially if they provide a new perspective. The reader can figure out for him/herself if they’re generalizable
- The underlying emotion is probably irrelevant to those reading the comments
- Yes, “name calling” or ad hominen attacks are a bad idea, not because they’re rude but because they discredit the attacker in the eyes of observers
- When I read “own your comments” I thought the authors were going to say, “Use your name.” But no, they just meant to make it clear that the commenter is offering his or her opinion. (I won’t do any “name calling” but folks, this is not a helpful guideline. Obviously commenters are expressing their own opinions.)
- Phrasing comments as questions, go for the win-win and look for the BATNA seem irrelevant for online discourse
Finally, my favorite rule is to use your own name when you blog, offer a comment, or participate in any form of social media. Using your real name means your are standing by what you’re saying, and taking responsibility for your tone and content. Google, Facebook, the NSA and your employer know who’s posting what, so there’s no real anonymity on the web in any case.
I can think of only very limited situations where the “real name” rule should not apply. Even then, consider sharing the information with a trusted friend who can post using his or her real name and provide the context.