By: 21 October 2013

The General Medical Council’s guidelines entitled Doctors’ Use of Social Media have caused much debate about the benefits and drawbacks of physicians using online media anonymously, and the effect this has on the profession’s integrity. Hadley Middleton investigates



SocialMediaAs the use of social media grows rapidly in the medical profession, the benefits and drawbacks of a doctor’s online presence continue to be debated. On March 25 this year, the General Medical Council (GMC) published their directions and guidelines for practicing doctors using social media, due to come into effect on April 22. From Twitter, to Facebook, to personal blogs and internet forums like, physicians are expected to retain their professionalism and accountability, ensuring that public access to online debates or discussions will never discredit patient trust or confidentiality. But for many, one clause in the guidelines continues to cause confusion and concern, as the GMC are now suggesting that any person representing themselves as a doctor anonymously or through a pseudonym, should identify themselves online.

Clause 17 of the GMC’s social media guidelines states that “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.” According to the GMC, posting anonymously is not recommended, based on fears that the public will fail to differentiate between the medical opinion of one doctor and those shared by the entire profession.

Following the publication of the guidelines, ironically, it was the Twitter-sphere where debate developed, as doctors struggled to clarify the guidelines. Fearing reprisals for tweeting anonymously and that their ability to communicate effectively on social media had been restricted, several prolific medical profiles were cancelled. In opposition, an e-petition with over 4,000 signatures was sent to the Department of Health, with doctors claiming their rights were being withdrawn by the GMC without prior discussion. The petition labelled the restrictions “draconian,” adding that doctors “should have the right to express themselves as they see fit in any medium provided patient confidentiality is never breached or in any way compromised.”
However, for the GMC, these guidelines are not rules, and in their response to the outpour, the council has sought to clarify any vagaries in their anonymity advice. Jane O’Brien, from the GMC Standards and Ethics team confirms “the guidance is a statement of good practice, and the paragraph on anonymity in the guidance is framed as ‘you should’ rather than ‘you must’, to support doctors exercising their professional judgement.” According to the GMC, their guidance is not a threat to medical professionals’ freedom of speech rights, and any anonymous or pseudonymous comments will “not raise a decision about your fitness to practise,” unless instances of serious bullying, harassment or breaches of confidentiality have occurred. The GMC’s guidelines are influenced by persistent fears that there are no systems in place to curb a perceived culture of bullying in the NHS. At the British Medical Association’s annual conference, doctors called for a new system of regulation to hold managers to account. Attendees also raised concerns that bullying and secrecy were creating a “toxic working environment” in the NHS.

Social media is a powerful communication tool and recognised as such by other medical bodies who have introduced similar guidance. Dr Riley, Curriculum Director for the Royal College of General Practitioners believes “there are many opportunities for GPs to take the lead in developing how social media can be used to improve healthcare. Although in general, we would encourage doctors to identify themselves openly and honestly when using social media, in line with professional guidance, a number of specific circumstances were highlighted in which the use if a pseudonym may be professionally appropriate.” The RCGP agree with the GMC that anonymity has advantages and risks, foremost as a forum to challenge authority, but also as a misrepresentation of identity which may threaten public faith in the healthcare system.

In the aftermath of the Francis Report, one of the central recommendations made by public inquiry chairman Robert Francis QC was that any concerns should be raised “freely without fear.” This April, a Royal College of Nursing Poll of more than 5,277 nurses revealed that 24% had been warned against commenting on poor standards of patient care. For some medical professionals, attempts to protect patient care are still accompanied by risks of reprisals or victimisation, and speaking out against authority often results in personal attacks. Following reports of poor patient care at Stafford Hospital, Nurse Helene Donnelly experienced physical threats after she revealed severe neglect by NHS staff. Kay Sheldon, a Care Quality Commission member who gave evidence at the same inquiry, also felt “tainted” as a whistleblower, after her past struggles with depression were used to discredit the legitimacy of her evidence.
Social media is a method to bypass a defensive NHS culture, as anonymity gives concerned professionals the security and power to speak frankly. Dr Max Pemberton, a Telegraph columnist writing under a pseudonym, argues that anonymity has helped him to write honestly about “the day-to-day stories of life in the NHS that so often expose larger truths; and the candid thoughts of those on the coalface dealing with the fall-out of government policy.”

Anonymity and the use of pseudonyms remain dubious methods of whistleblowing. Dr Sarah Wollaston, MP for Totnes, believes the GMC guidelines are reasonable in their attempt to direct doctors’ concerns through more secure avenues of communication. “Anonymous whistleblowing is less easy to investigate and means that a professional is putting their own interests before [their] patients’. It is tough to air problems with a service or individual colleagues, but the NHS culture is not going to change unless we get a grip on making sure that complaints are properly handled.” In their attempt to re-direct complaints from social media and internet forums, the GMC advises contacting their confidential helpline. However, the conflict remains whether casting doubts on the legitimacy of social media to voice anonymous fears will make concerned doctors naturally more cautious to do so.

As anonymous doctors continue to ‘out’ themselves on Twitter, the main concern is that anonymity removes credibility, rendering medical opinions far less reliable. Retired GP Dr Michael Blackmore argues that “if a doctor chooses to use these means to promulgate a general message about a particular topic, I can see no reason why they should not reveal their name and to do so may increase the credibility of their comment.” However, for several medical students entering into the profession, anonymity has proven a reliable resource to gain the credibility and knowledge to excel. Nick, a final year medical student at Newcastle University with an anonymous profile observed, “through Twitter I’ve been able to ‘meet’ doctors from the entire spectrum of the health service. It’s a huge arena of support for all medics. I’ve always found it a supportive place, but that may well have been different had people found the need to be un-anonymous.” The question seems to be not whether doctors are undermining their credibility by posting anonymously, but how doing so can also strengthen their integrity through professional networking.

The GMC believe that the greatest risk in doctors communicating via social media is the potential to breach patient confidentiality. As distinctions between public and private become blurred, so do boundaries between doctor and patient. According to the GMC, anonymity allows some medical professionals to become disinhibited when discussing individual patients and their care in publicly accessible forums. But surely doctors should be allowed to exercise their professionalism and judge for themselves what would constitute such a breach. M, a final year medical student at Keele University, wishing to remain anonymous, believes the guidelines demonstrate a lack of trust in the profession. “Doctors have always shared information about patients, their care pathways and any relevant details with the consideration towards keeping it all anonymous and entirely confidential. As long as the person is not recognisable then doctors should be free to discuss patients as a useful learning tool for other doctors observing these exchanges.”

The GMC social media clause is articulated neither as a set of rules, nor a ban on anonymous tweets and blog posts. The GMC have stressed that these guidelines will not affect doctors tweeting anonymously or under pseudonyms, unless patient confidentiality is breached. For the time being, divisive conversations on the topic by anonymous doctors and the GMC continue to be orchestrated via the very medium that is itself under scrutiny: social media websites.

With so little definitive instruction, GP Dr Anne-Marie Cunningham suggests there is only one way to move forward, by interpreting the edict according to individual ethics of professionalism and practice. “As a professional you read the guidelines and say how does this fit with my work and my practice? If something is ‘should,’ it doesn’t necessarily apply to every situation, it will not change the reasons for you coming in front of the GMC, but if you were bullying a colleague, or you were breaking confidentiality, that might possibly be an aggravating factor.”


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Hadley Middleton is a freelance journalist with a masters degree in Magazine Journalism from The University of Sheffield.