“Accountability promotes credibility. Adding your name to a comment affords you an opportunity to pause and make sure you really stand behind what you are saying. Anonymity suspends real-world judgment and emboldens us to jump into a dialogue, to express strong opinions, and to stick to our guns in the face of peer pressure. But it also fosters hasty, sloppy reasoning, making mistakes more likely. As health care providers, we have an ethical responsibility to be sure what we’re saying is true. This is especially important on the Internet, where an offhanded slip can live on forever (racking up page views all the while). Put simply, accountability increases veracity.
Anonymous conversations can get unruly. Why do bank robbers wear masks? Because their identities make them accountable for bad behavior. Accountability holds people up to a certain standard of conduct. Not everyone needs that reminder, but it takes only one or two disruptive individuals to spark hostility in a debate. When this happens, otherwise productive conversations lose focus—and participants—fast.
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Online conversations are a little like buying a car. You want to check out the product before you invest. Say you’re reading a discussion about a controversial weight surgery device. As much as the commentators’ experience and expertise matters to you, you’re also going to want to evaluate their involvement and any conflict of interest. Wondering whether doctor X—an enthusiastic proponent—is a bariatric surgeon with a financial interest in the company may keep you from fully trusting what they have to say. Once you know with whom you are dealing, you can start looking at their comments on their own merits. Ultimately, knowing who’s participating and what’s at stake improves the level of communication and builds trust that’s essential for community. Trustworthy dialogue draws more people into the conversation and makes the interaction more