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
Introduction
As 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 doctors.net, 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with over 4,000 signatures was sent to the Department of Health, with doctors claiming their rights were being withdrawn by the GMC without prior discussion.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 th