~~ This was meant to be a response to Dr Cunningham’s post on the GMC social media guidance: I’m also cramming for finals so its not a complete view yet. ~~
The GMC have issued guidance on social media, it has got some people upset, particularly 17, which has changed between draft and final guidance, below.
17 If you identify yourself as a doctor in publicly accessible social media, you should also identify
yourself by name.Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.
18 You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin.
17 If you are writing in a professional capacity, you should usually identify yourself. Any material written by authors who represent themselves as doctors are likely to be taken on trust and/or to represent the views of the profession more widely. You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin.
I think the change between the draft and final guidance is the correct one, to identify as a doctor online is to be doing so in a professional capacity. The only reason to identify as a doctor in a public space is to use that aspect somehow, whether to network and discuss with other medical professionals or to use it to give weight to what you’re saying. To overtly identify as one on a personal account doesn’t make sense to me, its either a type of boast post to your readers/followers who will either know that already (people you know privately) or not care (people reading for other reasons). A personal account cannot be as much if you identify yourself as a doctor, you are then expressing opinions in a professional capacity By identifying as a doctor, all the responsibilities of a doctor in a clinical setting come with it, its as if you are sitting in the hospital canteen with a stethoscope around your neck.
So, who’s ready for anecdotes?
3 years ago, at the height of my political career, I was running for local authority council, I had badge saying vote for me and everything. I was also a 3rd year medical student, on placement at a hospital within the local authority boundaries, I had a tutorial with a consultant and was told to take off the small pin badge. The consultant made a good point that you can’t have patients seeing you with overt political opinions, theirs might be different, even polar opposites and a part of the relationship would be ruined right from the beginning.
Society’s image of the doctor, while esteemed, is essentially inhuman: an anonymous cog of the healthcare system. Impartial, non-judgemental, fresh, skilled and unaffected by their surroundings: they deliver care. Any deviance from this in the public domain risks undermining the perception and interaction between the public and doctors.
This is not to say that doctors should make their profession their life, more that when the profession’s mask (or shall we say stethoscope around the neck) is on, the personal cannot exist, to do so would be an affront to some, if not all, patients.
Using social media to public debate with others (and by its very nature allow lay people to be witness) is very beneficial, but while differing opinions within the profession can exist because they are still bounded by this professional sphere. However, being professional opinions the speakers must be held accountable for that they say, the easiest way of this to encourage real name use, as while we would hope that all discourse would be constructive there is a real risk the reputation of the profession could be damaged by some.
Some have said they feel they wouldn’t be able to state they had a bad day as a doctor without putting their name, I think is is entirely appropriate for a public forum. The natural response would be for people to enquire as to why, which would fall down to either bad experiences with colleagues, patients or something personal. The first two are entirely inappropriate to be discussed in public in such a way, the latter distorts society’s view of the doctor and damages this notion of what the doctor is.
My father, a barrister, gave me two pieces of advice before starting medical school, the first “don’t piss off anyone on your course or in hospitals, you never know when they might be interviewing you in the future” and the second “never write anything down you wouldn’t want to be seen by a judge”.
There seems to be a misconception that somehow social media is not proper public forum, or that it is possible to remain anonymous within a public forum. I have taken part repeatedly in the World Naked Bike Ride (one of the best experiences by the way), the first times I didn’t tell my parents who I normally wouldn’t balk at informing of me demonstrating, celebrating or protesting. The slight embarrassment of explaining myself put me off, while neither of them check my online profiles, this got back to them after a few years, it made for an awkward conversation but I won them around to how it didn’t matter who knew I went on the ride, as I feel I can justify my behaviour to my peers. If you believe in something strong enough to say it, stand up and say it, the profession and public will judge its appropriateness and if you’re not willing to have it read in court you probably should step away from the keyboard.
I’ve already altered my tweeting behaviour since Dr Cunningham and others retweeted a blog I wrote about lecturers at my university and follow me. Not only do I wonder “what will they think if they see this” but also “what will their followers think if they RT”, I see a former supervisor follows her, someone I might want to have a reference from, this makes me think twice when I tweet personal experiences of my university experience. This is a form of self regulation enforced by the profession already, and by reducing the use of pseudonyms encourages accountability and reflection of what you are saying before posting. Consider any twitter spat between MPs to see that while this is not a guarantee of good behaviour, I think it would be well to tamper people into being more constructive.
I do believe you can be a doctor on twitter, not identify as such and follow the guidance, even if you are identified as one by readers, so long as its not a central focus of the persona on the social media. All those identifying as doctors, however, I feel are rightfully going to be limited to interprofessional debate and benal small talk about the weather. Much like it is in the concourses of the hospitals.
If you want to tweet in a personal and professional capacity, the adoption of twitter apps allowing for multiple accounts exist and will be beneficial; but unless the profession redefines itself anonymity is unsuitable and impossible. To set about this new image of the doctor will be easy, write it down, publish it, be judged by your peers and the public, it is they who decide if it’s appropriate or not.
Much of the above relies on the continuation of current standing of the doctor, which while I might want to change, I’m not sure is possible given such prescriptive choice of healthcare patients have (being almost entirely geographically based). Should the profession collectively decide to come out, I still believe one should have the strength to put a name to a view and either accept or challenge the consequences.
Come August I’ll keep tweeting about my bowel habits, I’ll probably create an account for use in a professional capacity and use an app to manage the two. But if there was something I believed that both Mr Gibbons and Dr Gibbons should be saying, I’ll pick up my badge from 3 years ago, and engage my peers and patients.