Your online image counts, sometimes more than your physical image. Patients decide whether to keep a referral appointment based on what they see and read about you online. Potential employers evaluate your online presence during the hiring process. So do fellowship and residency directors.

“So much is waiting to be discovered online and so many decisions are being made based on how you have presented yourself on social media,” said Wendy Bernstein, M.D., M.B.A., Associate Professor of Anesthesiology and Director of the Cardiothoracic Anesthesia Fellowship Program at the University of Maryland School of Medicine. “Residencies and fellowships are making decisions on one candidate versus another, even if they are not formally saying so, based on what they find online. Too many times you will discover a side of a candidate that he or she didn’t mention in their application or interview. And when you see it, it’s obvious why he or she didn’t mention it.”

In her Saturday presentation “You Are Who You Tweet: The Online Anesthesiologist,” Dr. Bernstein will discuss how important it is to focus on making a good impression on social media. The challenge is that there are few guidelines for what is and is not appropriate. Because social media postings feel like a private moment, it can be hard to remember that whatever goes online stays online, and remains discoverable for years to come.

“There are really two components to your online image,” she said. “One is the information you post about yourself on Twitter, Facebook, Instagram and other social media. The other side is what other people, most often your patients, post about you.

“You need to be aware of what is out there about you, and how to keep track of it. In addition, you need to know how it can affect your career and personal life. You can’t blur the lines between your professional and personal identities. It is important to keep them absolutely separate. Because Twitter and Facebook are so informal, a lot of people let their guard down, and that can affect you down the road.”

Parents often keep track of their children online by friending them and checking in periodically, seeing who they are interacting with and how they are presenting themselves. It may be useful for residency and fellowship directors to do something similar to keep track of what their residents and fellows are doing and how they are presenting themselves and their institutions online.

“Another issue is that there have been several court cases of people taking pictures of surgical cases in the O.R. using their personal smart phones,” Dr. Bernstein said. “What we have come to realize is that not everyone in the O.R. who has a smartphone uses very good judgement when he or she starts snapping pictures and posting them online. There have been some very unfortunate court cases that we will discuss.”

The other side of managing your online image is dealing with items posted by others.

“There are ways to clean up your online presence and counteract negative comments made about you,” Dr. Bernstein said. “However, sometimes professionals use very poor judgement in responding to negative online comments.

“We all know how important it is to maintain your professional image, but not everyone realizes that this principle also applies to the social media world as much as it applies to the everyday physical world. There are very few standards of conduct in the digital environment, which makes it tricky to navigate. Everything you post is discoverable. That makes it important for you to think about how you want to represent yourself every time you are about to hit the ‘send’ button.”