As health professionals participating in social media, we do come across things that we see as inappropriate for a member of our profession in terms of behaviour or content. The temptation is to leave all alone (and unwittingly be complicit to the bad behaviour) or to participate in the self regulation of the medium. SoMe has got a lot of bad press recently and as usual, it is always the tiny percentage of users who create the problems. Recently, Australian users have been concerned about the draft document of proposed regulation of SoMe amongst health professionals by our regulating body, APHRA. As it is, it is heavy handed and unchallenged into its final version would see a significant number of Australian healthcare professionals in breach of its conditions.
This got me thinking about a recent interaction that I had virtually forgotten about. I saw a tweet from a young doctor who has chosen to be anonymous when tweeting to his large audience of followers. The tweet was as follows:-
I personally did not think much of it at first but then I thought that as a public message, it was sending out a very wrong message as to what really goes on in multi disciplinary team (MDT) meetings. The reasons clinicians bring cases for discussion at these meetings is to get the best advice from a wide range of opinions from within their own field and outside the field. Too often at these meetings, I find as a surgeon, that I have not always fully considered some of the surrounding non-surgical issues with the care of my patient and I can leave the meeting with a clearer holistic approach to the care of my patient. Patients are delighted to know that we can take their case for multiple opinions rather than themselves having to cart themselves around to see different doctors to obtain additional opinions. The MDTs also helps streamline the multidisciplinary care with colleagues will look out for special cases that cannot afford to be held up by the system.
But MDTs do not always function well. The worst type is when there is the dominant clinician who loves discussion on a case as long as it is his or hers and if the final outcome is according to his or her recommendation. Less dominant or junior participants feel essentially gagged from making a contributing comment. The ideal MDT should run like a real-life in person crowdsourcing exercises.
I responded to the MDT comment with
In hindsight, perhaps I was a little too harsh in suggesting that he might be ignorant about the value of MDT meetings but it is people's live that we deal with at these meetings and not something that I thought to be for entertainment purposes amongst his following. (If you follow this user, he does provide a predominantly entertainment series of tweets and thrives on the adulation of his audience). I was also concerned that he may have developed this attitude because his own MDT experience was not associated with appropriate leadership and mentoring in cancer care. I cannot see any reason why he would come up with this thought if there had been anything but a positive experience with MDTs. This tweet did upset him as seen by the next tweet:-
This lead to a series of tweets which are fairly self explanatory
My tweet response below is to a tweet that was subsequently deleted but since I did a quoted retweet to give context to my next statement, you are able to see what was deleted.
I think that his comment about being exposed to bad MDTs (that's the tweet that got deleted) demonstrates a problem of where he has been exposed to poor leadership and mentorship in cancer care. This is sad and senior cancer clinicians should take note.
I thought that things might get a bit heated so I tried to back off and give him an honourable exit by agreeing with him on a point and stating that I did not think that he meant to be flippant. When I thought about it later, I did change my mind and think that to hell yes he was being flippant.
I did not feel like challenging him on the fact that surgery is not the only form of treatment for cancer and opinions of other non-surgeon clinicians can make a difference. MDTs are not about 'personal', they are about the patient whose care we are trying to optimise. I was about to let it go and let him continue his indignation that he had been challenged but this fortunately put out the flames.
I promptly un-followed him. I think it is always a lot easier to say things anonymously but even under such cover, if you declare yourself as being a health professional, the public and your colleagues still have an expectation for a level of professionalism for what you represent. This is of course my humble opinion on the matter.
Addendum 31 March 2013
A doctor on twitter who had read this blog piece recently, sent me the following cropped mobile phone screenshot by email (easy to track down via either one of my publications or through the University of Sydney website - you see, I don't try to hide) that was taken of a tweet made about 10 days ago - comment was made that it was seen from a re-tweet as this person like myself, does not follow @otorhinolarydoc. It wasn't sent to me anonymously but there is nothing to be gained by mentioning who that person was. Interestingly, it is noted that he has since changed his user name and from this I gather that he is perhaps no longer a trainee and now a qualified ENT surgeon. Whilst we can say it is a bit of harmless banter, it does concern me of possible attitudinal issues about morbidity and mortality meetings. M & M is an essential form of quality control and good clinical unit governance and must be taken seriously. Sadly it seems to be consistent with earlier comments about MDT meetings. Whilst we could be quick to chastise this doctor who tweets anonymously, I would raise concerns about potential mentorship issues - registrars often copy the behaviour of their mentors - perhaps there is some shared responsibility between himself and his former mentors if these are the attitudes with which he has been raised as an ENT surgeon. Let you be the judge on this.
