Doctors, anonymity and the GMC: the social media debate a year on

By Ian Rhodes

It’s been a year since the General Medical Council published guidelines on doctors’ use of social media. Clause 17 proved controversial: if doctors identify themselves as doctors when posting in public social media, they should use their names. Concerns were raised that the guideline might not be in line with respect for private life and the freedom of expression under the Human Rights Act.

In response to the concerns, the GMC took to Facebook to provide clarification in April 2013. Jane O’Brien from the Standards and Ethics team explained: “Doctors are accountable for their actions and decisions in other aspects of their professional lives – and their behaviour must not undermine public trust in the profession. So we think doctors who want to express views, as doctors, should say who they are.”

An e-petition to the Department of Health was opened and this week closed after a year of being online. Signed by more than 4,000 people, it described the guidelines as placing “draconian” restrictions on doctors and called for medical and healthcare workers to “have the right to express themselves in any way they wish provided patient confidentiality is not compromised.”

The GMC said shortly after the e-petition was opened that it acknowledged the strength of feeling it represented. “However, there is nothing in the guidance that restricts doctors’ freedom of speech online or stops them from raising concerns….The paragraph on anonymity in the guidance is framed as ‘you should’; rather than ‘you must’; to support doctors exercising their professional judgement.”

Dr Peter English, who works in health protection, was one of the doctors who voiced his objections to the recommendations in public social media including on Facebook. An early adopter of social media, in the late nineties he set up two closed groups on Yahoo!

One of those was Vaccination Coordinators UK so all professionals involved in immunisation policy and practice could share knowledge and experience. Speaking in a personal capacity for this interview, he said: “I took the line that if I’m not sure of the answer to something, there must be people who’re just as unsure as I am so I’d ask a lot of questions.”

15 years later, the group has grown to more than 1,150 members. For Dr English it was a place he learned a lot from people with more experience than him. Now, he lectures on vaccination. As a Twitter user with nearly 27,000 tweets to his name, he finds links posted give him early sight of information which he might otherwise never have found that are relevant to his work.

Dr English identifies himself by name in social media. A year on from the publication of the GMC guidelines, he says the guidance on anonymity was an “unreasonable line” for the independent regulator to take. As a result of the guidance, he believes several doctors with interesting, considered and thought-provoking voices writing anonymously in social media have stopped posting altogether.

Dr English said: “I fully understand the duty of doctors not to identify patients to protect confidentiality, but I think anonymous tweeting can help with that, rather than hinder it.” He believes that if people know you’re a doctor, you don’t state which hospital you work in and you tweet about issues that might relate to patients, it’s less likely that anybody could make a link to a particular patient.

A newer user of social media is Dr John Cosgrove, a GP in Birmingham. With a strong interest in policy, he started tweeting three years ago on a personal basis “out of curiosity” and now has more than 1,500 followers. He has also always identified himself by name in social media.

Like Dr English, he believes that he is better read professionally as a result of his interactions on Twitter. Dr Cosgrove says that it provides “an opportunity for sharing frustrations, discovering solutions and sharing information.” He cites a robust discussion on Twitter last year about new research on the use of antibiotics for back pain meaning that when he was at a seminar on pain management and the topic was raised, he was “probably the most knowledgeable person in the room.”

Dr Cosgrove is one of the doctors behind Grassroots GP, a website which evolved from Twitter discussions. It aims to ensure patient needs are heard in debates on healthcare: a recent campaign has been around dementia. He has also set up two groups on Google Plus: UK Healthcare is a public forum for anyone interested in healthcare in the UK – the other is private and is a confidential, mutual mentoring project for GPs which will be demonstrated at two medical conferences later this year.

More and more doctors are using public social media. A recent study of healthcare professionals on Twitter identified more than 75,000 were tweeting – a massive growth from the platform’s birth in 2006 when just 23 doctors were signed up. They are also seeking advice on how to use social media for doctors. In December 2013, the Medical Defence Union, which represents more than half of the UK’s doctors, reported a 40% increase in calls about the use of the internet and social media with around five inquiries a month.

Relating specifically to the social media guidance, the GMC reports that nine calls have been made to the Standards and Ethics Team since it was launched a year ago. In response to a question on whether there had been any cases of disciplinary action over issues involving doctors choosing to be anonymous in social media, the regulator said a Freedom of Information request would need to be submitted.

Dr English would like to see the guidance revert back to the original wording of the GMC consultation so that doctors should “usually” identify themselves in social media. However, the GMC has no date set to update the guidelines on social media. Classified as explanatory guidance, it may be reviewed at some point within the next five years.

 This article was originally published in Pharmaphorum.

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Ian Rhodes