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The death of the GP blogger? How new GMC guidance on doctors writing anonymously has divided the profession

Dr Jonathon Tomlinson tweets @mellojonny and blogs at A Better NHS under his own name. He is a GP in Hackney, east London

If you are using social media “as a doctor”, as I do, then your opinions are given additional weight by virtue of the power and status associated with the profession.

Professional status also carries responsibilities because we’re seen (like it or not) as representatives of our peers and it follows from this that we ought to behave in a way that is respectful. I do think that someone claiming to be a doctor who does puts the profession in disrepute by virtue of their behaviour, ought to be held responsible, but I do not think it follows from this that they need to use their real name. 

The GMC guidance fails to recognise the wide range of reasons why doctors use social media – some will be raising very important issues, such as what it’s like to be a sick, anxious or bullied doctor or a doctor who has made a mistake. They may be seeking support or hoping to raise awareness. It’s important these people are not put off by the GMC.

Anonymous GP who blogs at NiceLadyDoc. In a full response to the article, she wrote:

For most of 2012 I tweeted life in NHS general practice to up to 2,000 followers. 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.

Draft [GMC] guidelines [are]… an attempt to extend their control of doctors’ behaviour far beyond the consulting room… I wrote my own response to the GMC ‘consultation’ but received no reply, so cannot know whether it was read, considered or ignored… 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.

Dr Trevor Stammers is the programme director in Bioethics and Medical Law at UCL. He is also a former GP.

Generally speaking, I do think that doctors should identify who they are when writing on social media but I don’t think this applies just to doctors – to hide behind anonymity is usually indicative of something being ethically suspect.

However, I write this at the same time as headlines about GPs signing “gagging” clauses with their CCGs. This is a sure way to incite whistle-blowing and when doctors take on the role of whistle-blowing – as they must when patient safety or welfare is at stake – then anonymity may well be necessary and is certainly understandable given the fate of most whistle-blowers who in benefiting others often lose their own livelihood.

I think the GMC guidance here in general is sensible and indeed timely.

Dr Una Coales tweets under her own name at @drunacoales, and is a GP in south London

As a GP victim of intense cyberbullying by doctors online, I was able to meet with the GMC and submitted evidence to help draft their guidance in an attempt to change behaviour and raise awareness of cyberbullying of doctors by doctors.’

The GMC has kindly incorporated all of this evidence when shaping the policy. Doctors are professional pillars of society and should not be engaging in denigrating women, or humiliating or bullying female colleagues. ‘Flaming’ is not a euphemism for cyberbullying; it is cyberbullying, as is trolling, stalking and inciting cybermob lynching. I am pleased that the GMC are reminding our medical profession that we are doctors 24/7 and should behave accordingly with high morality, integrity, caring and professionalism at all times.

I agree with the new GMC guidance. It will not affect the doctor-patient relationship nor will it affect a doctor’s right to a private life. Take responsibility for your posts and re-tweets, as words can hurt and inflict mental suffering to victims. A doctor’s first duty is to do no harm.

Jobbing Doctor is a GP who writes anonymously for Pulse and also writes his own blog.

I have blogged for five years as the ‘Jobbing Doctor’. It started out as an online reflective diary of an average GP. I never expected many people to read it, so I’m flattered that I have a regular audience for my ramblings. I wanted people to look at the message I was talking about, and not who I am (which is unimportant). In that time I have been threatened by people who do not like my opinions, and that threat is not naming me, but reporting me to the GMC on various spurious grounds.

It would appear that, by issuing guidance preventing me from blogging under a pseudonym, the GMC wish to extend their control. It can ruin me by withdrawing my license to practise. Appointed by the Department of Health, it seems to me to be an arm of the executive.

Dr Kevin Hinkley is Pulse’s Through the K Hole blogger and a GP in Aberdeen

My reaction doesn’t come from any brave beatnik notion of free expression, it’s much simpler than that. It’s about my right to hear you. If you’re silenced then I’m deprived the right to hear your opinion. If you’re too afraid to give voice to your ideas then no-one else will hear them either, there will be no thought and no liberty.

I am well aware that the unfettered tongue doesn’t make our lives any easier. As a conscientious adult I know that opinion can often make us uncomfortable and can sometimes get us into trouble. But who wants to live in a society where the tongue is cut out for blasphemy or where the sky is stained with burning books?

It’s true that tighter control of social media is a long way from out-and-out tyranny, but the first step has been taken and with enough backward shuffling the profession will lose all of its richness and diversity. If we allow ourselves to live in fear of reprisal, to be told by the GMC what we can read and what we can see, then in the fullness of time we will find ourselves cowering in the shadows, distilled down to a single mind and a single opinion.

Dr Martin Brunet is Pulse’s Beyond the Headlines blogger and a GP in Guildford.

If you were an anonymous GP blogger when the guidance was first issued, I can see that it would have been alarming. It was easy to miss the importance of the word ‘should’ (reveal their identity) rather than ‘must’. The subsequent clarity from the GMC has been helpful here, and it is clear now that an anonymous doctor who tweets responsibly will not get into trouble with the GMC.

It has, however, raised the issue of why a doctor would want to be anonymous. While I think they should have the right to do so, I am not personally convinced that it is beneficial or wise. For me, what makes Twitter very safe is the fact that it is completely open. I have no illusion of privacy and so I have to assume that every tweet I make can be read by the whole world, and would come back to haunt me if it was unprofessional. As one doctor wisely said to me – before sending a tweet, make sure that you would be happy if it was read by a) the last patient you saw; b) your grandmother c) the Daily Mail.

I worry that some doctors might make tweets anonymously that they would not make if they were identified, and that this might not be the best for them, their patients or the profession. Having said that, there are plenty of examples of tweets from identified doctors which, in my view, have been unprofessional. I also feel that identifying yourself brings greater authenticity and authority to your voice on social media.

Dr Ben Dean blogged anonymously as Ferret Fancier but ‘came out’ after the guidance was published. He works as an orthopaedic registrar in Oxford.

Why is it good practice to be named? The GMC writes “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.”

This piece of guidance is still inadvisable in my eyes. They say doctors ‘should identify’ themselves and say it is ‘good practice’ to do so. I fail to see how this is the case, many doctors have good reasons for remaining anonymous and surely it is irrelevant of anonymity, it is down to one’s conduct on the social media whether ‘good practice’ is seen to be observed.

Overall I would say the GMC guidance is reasonable in most areas but this piece of guidance on anonymity is poorly thought out. Doctors have every right to remain anonymous and it is not ‘good practice’ to be named, any more than it is good practice to be anonymous.

Dr Phil Williams tweets @scottishphil83 and blogs under his own name. He is a GP in Lincoln and sits on local boards for the RCGP and BMA.

The GMC seems to miss the point of Twitter in that there really is no boundary between “social” and ‘professional’ accounts already. I feel they may be trying to close the gate after the horse has bolted. I would suggest that the GMC revises this document to have “musts” and “best practice” sections. The “musts” could lead to a doctor’s registration being at risk, whereas the “best practice” clauses would recognise that it is very difficult to legislate in this area.

Andrea James is head of healthcare regulatory at George Davies Solicitors LLP, and a former in-house solicitor to the GMC

I think that if a GP is writing about clinical issues, for example expressing their opinion on a particular kind of treatment, it is reasonable for the GMC to want them to identify themselves so that patients know whether the advice is that of a genuine GP or not. 

I don’t agree with the GMC’s guidance that doctors talking about anything in publicly accessible social media should identify themselves by name. I can’t see why doctors should be fettered in their expression of non-clinical opinions, for example their political opinions or opinions on the current NHS transformation, yet many do feel constrained by the new guidance. If the GMC does try to pursue a fitness to practise case against any anonymously blogging or tweeting doctor, it will be interesting to see whether the Human Rights Act entitlement to freedom of expression is raised as part of that doctor’s defence. 

In practice, I think it is unlikely the GMC will be interested in policing this aspect of its new guidance robustly.