(This post is my rapid response published online by BMJ on 13 Feb 2012 in response to the  journal’s paper published 23 Jan 2012)
How much of a social media profile can doctors have? The answer is – as much of a profile as they have in real life. There is no distinction between social media and reality. So many words are posted/blogged/published about how social media is somehow different. It is not.

Should you say ‘yes’ if a patient rang you and said she wanted to be your friend? No. Therefore non-commercial Facebook access is out.

Should you say ‘leave the room please’ if a patient attended one of your public lectures? No. Therefore Twitter for education is fine.

Should you identify a patient in conversation on a crowded lift/in a public canteen/on public transport? No. Therefore you don’t identify them on social media.

In fact, should you talk to anyone about a patient apart from referring doctors/legal guardians/in court? No.

Should you discuss the operation/resuscitation/disease of an anonymous patient to a group at at party? No. Therefore you don’t do this on social media.

We learnt about this in medical school, as I did 40 years ago. Doctors can and should involve themselves in social media because, as the Mayo Clinic says: ‘Our patients are doing it, that’s where we need to be’

We cannot legislate or pontificate against stupidity. It requires the same undergraduate education about ethics that has been taught since Hippocrates.

The distinction between social media and real life is moot. Arguments about permanent storage and retrieval of your comments are irrelevant.

As I have said elsewhere, being Social on Professional Media – It’s Not Rocket Science

Let’s start with The Principles and Practice of Medicine by Sir Stanley Davidson. 1968 edition. I did read it in my 4th year of medical school, in 1969. What did it say about coeliac (spelt celiac in North America) disease? On page 941: “In coeliac disease of children and its counterpart in adults, malabsorption is due to an idiosyncrasy to gluten, a protein in wheat and certain other cereals”. THAT’S IT. Nothing else.

In 1969, the great imitator was still syphilis. If you couldn’t figure out what caused the rash/neurological problem in your final year clinical exam, and if you didn’t suggest a syphilis test, you failed.

Proteus. Woodcut by Jorg Breu 16th C

Syphilis had protean manifestations. After Proteus, the greek God who could change his shape in a wink. Fast forward to now, and Proteus has cast his mantle over coeliac disease.

Coeliac disease is an autoimmune disease, not an allergy. It is triggered by gluten found in wheat (and wheat sub-species), barley and rye. We know coeliac disease increases with age. There is also some evidence that coeliac disease is increasing in prevalence within a particular age group. This is based on analysis of frozen serum from past decades (I appreciate feedback from Alex Gazzola via Twitter @HealthJourno for this information).  It is diagnosed more easily because of a simple blood test. As a result, we now realise about 1% of the population suffers from this disorder. In 1969, you had to have chronic malabsorption of the bowel before a gastroenterologist would perform a duodenal bowel biopsy. That was the only way a diagnosis was made.

The blood test has opened the door to Proteus. Here is a sample of chronic conditions now linked to coeliac disease:

• Bowel: irritable bowel symptoms, indigestion, acid reflux
• Brain: depression, ataxia, neuropathy, psychosis
• Blood; anemia, iron deficiency, thromboembolism, coagulopathy, hyposplenism
• Skin; dermatitis herpetiformis
• Oral: aphthous ulcers, cheilosis, dental enamel problems
• Growth: failure to thrive, short stature
• Bone: osteoporosis
• Limbs: neuropathy, muscle cramps, joint pains
• Liver: abnormal liver tests, fatty liver
• Immune: low IgA, malignant lymphoma, autoimmune diseases
• Nutrition: low B12, folate, vit D, copper
• Reproductive: Infertility (male and female), delayed puberty
• General: fatigue, loss of weight

Social media is agog with warnings about germs.

Nosferatu (1922): vampires killed victims by inoculating germs

Nothing new. Movies from Nosferatu (1922) to Contagion (2011) prey on human loathing and disgust of microbes. OK, there are important nasty strains, pandemic flu, resistant Staph, but here we are talking about a surge in paranoia about everyday exposure to germs. Witness the fetish for using germicidal soaps and sprays in the home.

Remote controls came under scrutiny after a study in a hospital found more germs on the TV remote that the toilet. Yipes! The news spread quicker can a virus in a pre-school, and was immediately extrapolated to remotes in hotel rooms. Dirty, dirty remote controls. Don’t touch them. You could use the controls on the actual set…hang on, the last 50 guests knew this trick. Yuk. Or press the buttons with the end of the ubiquitous pen in the room. Then, whatever you do, don’t touch the end of the pen.

The next headline involved Malls. Yep, there are eight places that are dirty, really dirty, in malls. They are: makeup samples, gadget shops, clothes in fitting rooms (quote “that’s why it’s important to wear underwear” – I knew there must be a reason), toy stores, ATMs, handrails, tables in food courts (I’ll let you in to a secret – you’re more likely to get sick from the food), taps in the bathroom.

No-one has mentioned the buttons in elevators. I reckon they must be filthy! So if you work on the 21st level, do not use the elevator. Go up the stairs. Do not touch the handrail. Warning: you may die of a heart-attack.

It’s not the number of germs, folks, it’s the type. There are 10 times as many germs in the human body as cells. These are normal. The collection is now referred to as the human microbiome, and important for good health and good immunity. When you touch, kiss, or even talk with someone, there is a pleasant exchange of germs. Live with it. Relax.

If you touch people, or food, for a living, there are strict precautions. And the severely immunosuppressed need care. Vaccinations work where available. There are sensible tips when you travel. But for everyday life, just follow these three rules:

• wash your hands after going to the toilet
• wash your hands before a meal
• don’t suck your thumb