The discussion on the GMC-UK guidelines on
doctor behavior on social media has proved to be most controversial and
divisive. I think that the vast majority
of doctors really could not care less but most of these are those are probably
not participating in social media in any form.
I have watched with great interest, the
arguments put forward by those who oppose Point
17 in particular.
It is also interesting to see how the
debate has those in opposition discussing the policy as if the word “should” is
“must”. There appears to be some
paranoia that the ‘should’ could become a ‘must’ over time but my own thoughts
are that the GMC are unlikely to be bothered or would have the resources to
police such a rule. If doctors do behave
themselves professionally on social media and provided there are no regular reports of
unprofessional behaviour on the front pages of newspapers, it is unlikely
that the ‘should’ would ever become a ‘must’.
The debate has become quite emotive. It was implied to me that I was being hypocritical
in my views and sending mixed messages on the basis that my avatar on
twitter has an image of me wearing loupes and a headlight and therefore obscuring my face. I totally disagreed in that the picture
perfectly reflects what I do in my work and that my name and details in my bio are totally
unambiguous as to who I am and what I do and where my interests lie. Additionally, pictures of me without the
‘theatre armour’ are easily found on a simple Google image search.
Some of the arguments I have seen include:-
Doctors
will disappear off Twitter and interaction will be lost
One argument put forward is that without
the anonymity option, doctors will disappear off social media and interaction
will be lost. I disagree totally. We
only have to look at conference tweeting – at the recent 2013 Social Media and Acute Care Conference (SMACC),
over 1200 users contributed to the hashtag for the meeting and the substantial majority were
using their real name or at least had a link that would identify who they
were. The interaction was outstanding
and the comraderie associated with knowing with whom individuals were interacting and the excitement with tweetups was palpable for anybody following the hashtag. This data does not suggest that doctors on twitter are going to disappear.
 |
| Tweet Metrics from Symplur of the 2013 SMACC Conference |
A similar interactivity was seen with the 2013 European Association of Urology Congress – again, almost all users being
identifiable. Additionally, we only
have to look at weekly twitter discussions where doctors are
significantly involved and again the substantial majority are using real names
– good examples are #hcsm, #hcsmanz, #meded. More recently, a highly interactive twitter journal club has been in operation and this has been a perfect example of doctors interacting and again, this is not likely to go away - incidentally, all doctors involved in the #urojc are using real names. What about doctors interacting with patients and other health professionals? this will continue and a great example of this is with #hcsmanz and #healthychat
Can doctors be trusted to exercise professionalism online?
Largely yes. Sadly, we need regulations to ensure that
doctors understand what constitutes unprofessional behavior. Doctors could easily argue that we do not
need to have a regulatory body to tell them not to have a sexual relationship
with their patients – whilst having such regulations does not always work, I
have little doubt it has made many doctors think twice before embarking upon
such a path. Doctors can be trusted but
a guidance on appropriate behavior can make a difference to those wavering on
taking a wrong path. That said, remember
that the guidance says ‘should’ and not ‘must’.
That
doctor anonymity will help protect identification of patient cases being discussed.
What the ...? Patient histories should not be discussed
in a public forum FULLSTOP. There are
plenty of other avenues (including online) to discuss patient histories amongst colleagues and twitter and facebook
are in my opinion inappropriate.
Suggestions have been made to run two accounts - If one account is anonymous and the other under a real name, then the user is bound to get them mixed up
This is the user's problem. Many of us have a private and work email. Many of us have a work and private mobile phone number. This is an irrelevant argument.
Why, when patient safety is not an issue?
As recently as last week, I have seen anonymous doctors on twitter giving personal medical advice without so much of a less than 140 character history and without even cursory view of imaging. The lowest common denominator factors into why there is a need for professional guidance documents.
Suggestions have been made to run two accounts - If one account is anonymous and the other under a real name, then the user is bound to get them mixed up
This is the user's problem. Many of us have a private and work email. Many of us have a work and private mobile phone number. This is an irrelevant argument.
Why, when patient safety is not an issue?
As recently as last week, I have seen anonymous doctors on twitter giving personal medical advice without so much of a less than 140 character history and without even cursory view of imaging. The lowest common denominator factors into why there is a need for professional guidance documents.
That doctors should have the right to be
anonymous in their social media activities just like any other profession.
Doctors are NOT just like any other
profession. There is a level of personal
trust and privilege and power imbalance in the relationships that doctors have
with their patients that is consistently there like no other profession. Doctors CAN engage on social media anonymously
– this right is NOT being taken away. It
is however, stated that doctors who want to say that they are doctors SHOULD
(not MUST) identify themselves. Doctors
can therefore continue to tweet and blog anonymously but should not make representation to themselves being a doctor. In my earlier blog piece on this
matter, there may be exceptions as to why a doctor needs to be anonymous and these could be stated in the bio or a link to explain why a
nom de plume is being used - I think that this would be the fair and transparent thing to do. I think that the public have a right to know why a doctor feels the need to be anonymous given the special status that the profession holds within the community.
Doctors will feel unable to comment on medicine and medical politics
Anybody is free to comment on medicine and medical politics. If they do not include that they are a doctor in their bio or links on the bio, there is no reason why they cannot continue. It is not essential to be a doctor to comment on medicine or medical politics. Other professionals such as biochemists, scientists, those in the pharmaceutical or medical device industry often know a great deal about medicine without having to be doctors. If one feels a need to state that they are doctor because they want the credibility that comes with that, then they 'should' use their real name.
There are valid reasons to be anonymous
This is something I do agree with. Particularly with whistle blowing and for doctors working in small communities. Additionally, if you want to actively debate controversial emotive topics that can truly put ones safety in danger such as abortion issues, this is also a valid reason. These doctors have good reason to not comply with 'should' and could make good argument to the case. To quote the GMC guidance:-
'You should’ is used when we are providing an explanation of how you will meet the overriding duty. ‘You should’ is also used where the duty or principle will not apply in all situations or circumstances, or where there are factors outside your control that affect whether or how you can follow the guidance.
Doctors will feel unable to comment on medicine and medical politics
Anybody is free to comment on medicine and medical politics. If they do not include that they are a doctor in their bio or links on the bio, there is no reason why they cannot continue. It is not essential to be a doctor to comment on medicine or medical politics. Other professionals such as biochemists, scientists, those in the pharmaceutical or medical device industry often know a great deal about medicine without having to be doctors. If one feels a need to state that they are doctor because they want the credibility that comes with that, then they 'should' use their real name.
There are valid reasons to be anonymous
This is something I do agree with. Particularly with whistle blowing and for doctors working in small communities. Additionally, if you want to actively debate controversial emotive topics that can truly put ones safety in danger such as abortion issues, this is also a valid reason. These doctors have good reason to not comply with 'should' and could make good argument to the case. To quote the GMC guidance:-
'You should’ is used when we are providing an explanation of how you will meet the overriding duty. ‘You should’ is also used where the duty or principle will not apply in all situations or circumstances, or where there are factors outside your control that affect whether or how you can follow the guidance.
CONCLUSIONS
In conclusion, I think that for most this will end up being just a storm in a teacup. Several commentators are propagating the argument that 1+1=3. The suggestion that doctors who say that they are doctors 'should' (not MUST) use their real name is my opinion perfectly reasonable. As per point 17, "Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonable be taken to represent the views of the profession more widely."
Update
The following piece has been published on Croakey on crikey.com.au - strong recommend that you have a look at this as well
http://blogs.crikey.com.au/croakey/2013/04/05/its-all-just-a-social-media-and-medicine-storm-in-a-teacup-says-one-surgical-tweeter/
