Tweeting in Algonquin

Last Saturday morning, while drinking entirely too much coffee and pretending not to dance to KidzBop, I was pleasantly surprised to see a twitter alert in my email that said:

Gardner Campbell mentioned you in a tweet!  @GardnerCampbell: @GoogleGuacamole meet @amcunningham. I think you’ll have much to talk about!

I admit that the first thing that popped into my mind was that Gardner was being a Doug Engelbart. According to Christina Engelbart, who visited Virginia Commonwealth University the week before, her father Doug loved connecting people and organizing groups, including Scandinavian folk dancing groups.  Being a huge fan of networking, Engelbart, and Gardner Campbell, I wandered over to Twitter to see exactly what sort of mischief @GardnerCampbell was trying to start up. 
In @amcunningham, I found a delightfully expressive advocate for student-centered education, digital presence, and medical education reform in the form of a clinical lecturer on primary care and public health from the University of Cardiff.  I watched her video on digital presence and professional identity (as should you) and it triggered me to think about my own struggles with professional identity, particularly in the context of the medical profession and digital environments.

 The idea of multiple identities is not new.  It is generally accepted that people have fluid situational identities which easily adapt to the environment as well as less mutable core identities.  Psychologists who worked hard to develop that framework could have just as easily turned to seventeenth century Virginia. During that time period, an Algonquian tribesperson had many names.  They could change their names over time as they aged or change them frequently, based on situational context.  They even had secret names, known only to parents or spouses.  If a secret name were discovered, it left the Algonquian in question vulnerable to attack.

When I was a physician, I approached professional identity like I was Chief Powhatan’s daughter.  I was Doctor Gogia and, at my best, I could be a listener and a lecturer, an empathetic, conscientious, hardworking, and well-meaning physician.  As much as I was allowed to be emotionally connected with patients in their concerns, I did not allow myself to be publicly reflective, emotional, or uncertain about my own concerns.  To do so would be the modern equivalent of revealing my secret name.
A story comes to mind. As a full fledged attending physician, I rarely ever had patients in the ICU.  I credit my high success rate not necessarily to technical skill but to having very precise knowledge about my own ability and a disciplined respect for the limitations of my clinical environment.  In other words, for right or wrong, I was very selective about what operations I performed on which patients.  
But once there was a very sick patient, and as much as I wanted to live at her bedside, I had to see other patients in my office as well.  Those two weeks were the most challenging of my life up to this point.  I won’t go into detail, but to mention one of the many challenges I faced: Every patient who entered my office and every person I met on the street knew what was going on in the ICU.  I worked in a small town and I had my community informants telling me what the town talk was.  In this town, public perceptions of moments like this could make or break a physician’s reputation.  There was precedent.  I had evidence.  It wasn’t my imagination that on top of everything else my professional persona was in the spotlight, under scrutiny.
The other doctors in the hospital tried to help me in their own ways.  As the days passed, I noticed that I wasn’t the only one spending nights and weekends in the ICU.  Specialists would stroll through at 2 AM or 4 AM or 12 AM, just because “they couldn’t sleep.”  I saw some of them expend more clinical effort for this one patient than I had seen expended on dozens of others, collectively.  There was an unprecedented level of phone calling, journal reading, internet searching, note writing, consulting, and conversing.  With all other things being equal, I can only guess that they were doing it for me, or for something I represented in their own experiences.  But the professional personas were in place.  Not a single physician was open to asking me if I was ok, not even at 4 AM, not even when they gently guided me through my first set of paper work.  And I could not find the way to take the first step—I could not reveal that secret name. 
Ironically it was a patient who broke through my professional persona.  She had scheduled a visit only to say as I breezed through the door: “I’m perfectly fine, Laura so don’t even bother asking. I’m here to find out how YOU are doing.”
“How are you?” 
A simple question, really, a cliché that as a society we ask and answer all the time without really listening to the answer.  It was the emphasis on the “you” that got to me.  It instantaneously dissolved a carefully built façade and left me sobbing in my own examination room.  I cried for a full twenty minute visit without saying much of anything.  I did, however, pull myself together long enough to make sure no one charged her a co-pay.
So what is a professional identity, really?  Should we really have well-defined, impermeable boundaries between personas, a deck of distinct names to shuffle and then whip out, depending on the scenario?
As a doctoral student, and no longer a physician, I find myself working towards a more holistic view of my identity.  Some of this has to do with the impossibility of my work situation.  To be both a student and a weathered professional is a difficult persona for me and others to grasp.  I’ve seen it challenge my supervisors as much as it challenges me.  Sometimes I think it is easier to think of me simply as Laura, “a person who does things,” rather than a “student” or a “fellow” or whatever other work label people like to attach to me.
And what to do with digital space?  To get back to my initial story, I was introduced to @amcunningham in Twitter world while she was taking part in the 12th Canadian Conference on Medical Education (#CCME14).  From all appearances, using Twitter during that conference to promote cross-discussion and worldwide information dissemination was incredibly powerful.  I took the opportunity to join in, and in doing so, I felt more connected to #MedEd and validated in my perspectives than I have maybe ever.  
But how to stay true to your holistic self while presenting yourself “professionally” to strangers, out of context, all in 140 characters?  This is a tough one, one to think about for a while, one to consider as I continue to tweet when I feel like I have something to say.  
But I have one closing thought: multiple identities are not a deck of cards whipped out of the back pocket of your favorite jeans.  They are not separate names or hats.  If we compartmentalize so distinctly, we are left vulnerable, trying to protect our “secret name” from our enemies whoever those might be.  Secret names are weaknesses only when we keep them a secret.

And so my challenge for everyone, including myself, is to find a way to live holistically and to allow others to do the same.   

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