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He Lied

He Lied
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Sunday, 31 March 2013

Pseudonymous Doctors: Another Point of View

I am very happy to host the thoughts of the Nice Lady Doctor, who has now left twitter. Here follows her views on the new GMC guidance:

"On another blog, a colleague has suggested we should be using social media for “meaningful work on behalf of the profession".” Sounds terribly po-faced, doesn't it, and not something I would wish to claim for myself. However, much worthwhile thinking and writing can be done without such seriousness, and to good effect. More to the point, even second-rate creativity is necessary to produce the first-rate stuff.

For most of 2012 I tweeted life in NHS General Practice to up to 2000 followers, many of them laypeople who were by turns amused, intrigued, educated, kept up to date on medical matters, and occasionally infuriated. In my own turn, I learned a huge amount from many bright and inspiring people, often non-medics such as @MentalHealthCop, @NotSoBigSociety, @AlysonPollock and a multitude of third-sector experts, campaigners, journalists and of course patients. Some of these people were anonymous or pseudonymous, and I can't say it occurred to me to bother about that. You can spot a troll or troublemaker easily enough without needing to know whether their username is their legal name.

Anyway, I tweeted quite a lot for a while: probably wasted far too much time on it, but I also felt I was contributing a unique viewpoint, expertise tempered with humanity; some gentle humour but not satirical; professional but not inaccessible to the lay(wo)man. There may have been a few hasty tweets, but I don’t recall saying anything unprofessional, abusive, illegal, or that I regret.

The major downside of gaining followers - which may not be apparent to those who have less than a few hundred, or who network mainly with fellow doctors - is that you become a target for certain types of people who have an axe to grind and who decide that you can be their grindstone; and many more, with innocent motives, try to enlist you in their campaigns of various sorts. In just a few months I was accused (wrongly I believe) of racism by one person, of bullying by another (for a single comment about her blog), and threatened with referral to the GMC. Twice I was asked to intervene in the lives of complete strangers who were apparently on the edge of suicide. I was telephoned late at night by an acquaintance who knew my real name, to warn me off upsetting someone powerful. A high-up person in medical politics contacted me in the middle of my holiday to give advice: well-meaning, but not very relaxing on a family break.

Then, a few months ago, the GMC issued their draft guidelines which made it clear that they had decided that anonymity was no longer to be an option, for fear of troublemakers (ironically, those who had given me trouble were not anonymous). I do not believe this was accidental, rather an attempt to extend their control of doctors’ behaviour far beyond the consulting room. I should make clear that to me the consulting room is sacrosanct: in there I suppress my politics, my religion, my philosophy, my ‘rights’. I censor my own language, opinions and dress sense, to put the patient first. Always. And I leave in there my patients’ stories, their pain, their fears, their secrets. These are not for sharing. However, when I leave the room and come home and log on, may I not ‘put on’ with my tatty jeans, my personal beliefs which make me in fact the doctor I am?

I wrote my own response to the GMC 'consultation' but received no reply, so cannot know whether it was read, considered or ignored. I pointed out a number of problems, not least that it effectively discriminates between those whose registered name is common (Dr John Smith will remain impossible to identify) and those like me whose registered name is unique in the UK. Given that the GMC itself publishes my name, maiden name and graduation year, and that doctors’ workplaces are also usually available, this means that giving my ‘real name’ on Twitter amounts to publishing my address, telephone number, my children’s school, my parents’ address, my colleagues’ names and addresses, with every tweet. I already know (as above) that perhaps one in a thousand twitter users is liable to cause me problems. Do I and my family want to risk any fallout from the occasional disagreement or misunderstanding with a member of the public over (for example) abortion rights? No. Do I wish to continue tweeting whilst forever stepping on eggshells to avoid mentioning anything real or controversial? No again. And while it seems unlikely that the GMC would be able to win a court case on this as a human rights issue, do I wish to bet my whole career on that by becoming a test case? No again.

My twitter account, on hold for some months, is now closed. A fond farewell to tweeting friends from ‘the Nice Lady Doctor’.

@theniceladydoc

9 comments:

  1. I find this whole thing so sad. I'm a nurse and have friends and family in various medical capacities who tweet. How can they stop anonymous tweeters if they don't know who they are? Twitter is an eye opener to different professions and long may it be so!

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    1. GMC advises that no-one is truly anonymous online: we all leave a footprint that can be traced. I have no doubt if they were so inclined they would find what they needed to pursue Fitness-to-Practice hearings. There is an assumption that anonymous tweeters are there only to "bitch & rant" in an act of cowardice. For my part, I don't use twitter like that but feel it remains my choice to be pseudonymous yet still professional.

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    2. Why would they want to stop anonymous tweeters? If they are being harrassed or the victim of a hate crime, they can contact twitter, or the police, who will likely have the resources to identify the anonymous tweeters. If they don't like what somebody says you can block them, or just choose not to follow them.

      I'm aware that there are some people behaving badly (as "dicks", as the Australian vernacular, with typical earthy vulgarity, has it - see e.g. http://blogs.discovermagazine.com/badastronomy/2010/08/17/dont-be-a-dick-part-1-the-video/#.UVl9bRyTjQo http://heathen-hub.com/blog.php ). But there are a lot of good reasons for posting/blogging/tweeting anonymously aside from being a "dick".

      The questions I'd like answers to are - what problem[s] is/are the revised GMC guidelines trying to solve; and what evidence is there that the revision will help solve these problems?

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  2. Im so sad that TNLD has gone. Ive often wondered about her and what happened after she stopped tweeting. Twitter needs more ppl like her and she represented so much that was good about doctors on Twitter. ..:-(

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  3. I couldn't agree more, Biggus!

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  4. I miss TNLD she intervened in a twitter argument I had and calmed the waters I entirely agree with her blog twitter is about discussions not debate and bullying. It is polarised by individuals who close down discussion by using bullying tactics TNLD's twitter archive is valuable and should be locked away I have a suspicion as to who may have been bullying her and they should be referred to the GMC gow well TNLD best wishes in your next cyberlife Tom

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    1. Thanks Tom, I do hope TNLD gets to see your lovely comments...

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  5. Hi Gilula, I'm writing a piece for the Orthopaedic Product News and would love to get in touch with The Nice Lady Doctor for her perspective? Do you happen to know how I could do that at all please? My email is hadleym3@googlemail.com if you have any questions!

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    1. TNLD got in touch with this piece and then left twitter. I kept my promise to delete her single email and now have no means of contacting her

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