So You’ve Decided to Tweet

As the new medical-academic year begins, I'm guessing a bunch of new interns will learn about how great FOAM is, and at the same time, get an orientation lecture on "threats to professionalism." Obviously I think there is a ton of potential benefit to using social media as a medical professional, and here are some of the ways I "maintain professionalism" (read: keep myself out of trouble).

One of my big keys is to not try to "not violate HIPAA" – that's easy and too low of a bar.
The real key is to not piss off the carpetwalkers: I don't want to have to defend myself in a meeting with Risk Management. Instead, I want to maintain a general profile I can defend to my dean and my department chair (and maybe someday to the promotion & tenure committee).

Twitter is a Giant Elevator
My big overall philosophy is that social media is like talking on an elevator. But: my mom, department chair, medical school dean, the patients' family, and a million other people are in the elevator. Obviously that doesn't mean that I'm always banal and polite. Rather, I recognize that people will see what I write and it is always tied to me.

Patient Privacy
Easy version: never talk about real patients.

Slightly tougher but still easy: if I do want to talk about real patients, I change enough of the details so that if the actual patient were to see it, the patient wouldn't recognize that it was them.

Two mistakes people make: date of service and age over 90 are HIPAA-protected PHI. The number one thing I do if I am referencing something that happened to a real patient is that I don't do it the same day (or even the same week).

I never even reference "oh look what happened on my drive to work today" so there can't be a real connection between anything I say and a real patient. And I don't share pictures from work or of patients without all of my ducks in a row (if at all).

On Anonymity
I'm not opposed to being anonymous, but I'm very much intentionally not. This is partially as a check on myself -- I know whatever I say is tied to me. A big part of it is to avoid the fear of people discovering my secret identity.

I'm not recommending anyone be anonymous on social media, but if I were, I would tell all my relevant bosses (e.g. program director, chair). If something serious "goes down," i.e. there's some sort of scandal, and it's a total surprise and secret to everyone, I imagine that there will likely be a big sense of betrayal.

But I don't want to be anonymous, it means you are giving up a lot of the upside. I imagine the benefits are possible but a lot harder if anonymous. Because the bottom line is that there are legitimate career, academic, and potentially financial benefits to being active on social media as a medical professional.

Urine Drug Screen False Positives

Urine drug screens aren't completely useless, but they have a number of limitations. Here is a table where I have compiled all of the false positive causing drugs I could find (pdf):



Update 4/22/2016:
Here are my sources:

I started with this paper which was I originally heard on EM Abstracts (Jan 2011):

Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA.
Commonly prescribed medications and potential false-positive urine drug screens.
Am J Health Syst Pharm. 2010 Aug 15;67(16):1344-50.

Special thanks to Jon Cole from Hennepin who made this fantastic video.

Other sources include:
UMHS Guidelines for Clinical Care May 2009

Standridge JB, Adams SM, Zotos AP.
Urine drug screening: a valuable office procedure.
Am Fam Physician. 2010 Mar 1;81(5):635-40.


Reisfield GM, Haddad J, Wilson GR, Johannsen LM, Voorhees KL, Chronister CW, Goldberger BA, Peele JD, Bertholf RL.
Failure of amoxicillin to produce false-positive urine screens for cocaine metabolite.
J Anal Toxicol. 2008 May;32(4):315-8.

Ly BT, Thornton SL, Buono C, Stone JA, Wu AH.
False-positive urine phencyclidine immunoassay screen result caused by interference by tramadol and its metabolites.
Ann Emerg Med. 2012 Jun;59(6):545-7.
doi: 10.1016/j.annemergmed.2011.08.013

Swift RM, Griffiths W, Cammera P.
False positive urine drug screens from quinine in tonic water.
Addict Behav. 1989;14(2):213-5.

Updates 5/1/2016
Reordered alphabetically
Added lamotragine -> PCP
Geraci MJ, Peele J, McCoy SL, Elias B. Phencyclidine false positive induced by lamotrigine (Lamictal®) on a rapid urine toxicology screen. Int J Emerg Med. 2010 Dec; 3(4): 327–331.

Added a few more -> PCP
Phencyclidine (PCP) Test Systems Executive Summary. Chemistry and Toxicology Devices. FDA
2013 Apr 25, Link.