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

Anonymity

The new GMC guidance advising doctors on social media sites to use their real names has caused many to review their position and perhaps withdraw from these sites altogether when the guidance comes into force on 22nd April 2013.

I don't pretend to talk for all of us who remain anonymous but I will tell you the events that made me realise anonymity is important to me, and you can make your own judgement.

In 1998 I returned to the UK after a 'gap year' in Australia. Back then Basic Surgical Training rotations were in their infancy. You were expected to micromanage your own experience, training and education. Serial 6/12 SHO posts was the norm. I had been a surgical SHO for 4 years. Sitting the old FRCS Part 2 I had done the Thomas's course where of the 36 SHOs on the course, 31 wanted to do T&O. With its 88% pass rate I knew I would be seeing these same SHOs at reg interview after reg interview so I ran. All the way to Australia. Just so I could be a registrar.

Another historical point: being a T&O SHO back then was no picnic. It was a house job. We all came in at 7am to get as much ward work done as humanly possible to allow us to get into theatre, with evening catch-ups on the day's patients. No F1s, no phlebs, no ECG technicians, pre-assessment clinics and regular clinics with your own template ... and you were glued to your boss. If he did an evening ward round, you did. If he had a Saturday PP list, you were there. That was just how it was.

So I got my Part 2 & five days later I was on a plane to Oz. 18/12 of registrar-level trauma experience. It was amazing. Had juniors and everything.

Came back and started applying for registrar rotations. Had a great logbook, broad range of surgical specialities under my belt and the Exam.

More history: no online applications in 1998. Each post wanted 10-15 paper copies of your CV and application form. That is some weight of paper, for starters. 33 registrar applications later, my confidence was waning. Jobless, I went back to an old hospital and was welcomed with open arms by A&E where they knew I could keep Minors flowing without concern.

Then this article came out in "Hospital Doctor". Two page spread from a Prof of T&O encouraging people to apply. So popular, 300 applicants per post, 1:8 regs were women, la la la.

The red mist came down. I wrote a letter. My experience. How could they encourage trainees to put their life on hold in a perpetual hamster wheel of house jobs whilst application after application went by the wayside. SHOs had to have career progression and realistic guidance. Churning out pointless papers in the name of 'research' was an exercise in futility.

And "Hospital Doctor" printed it. In its entirety. With my name on the bottom.

The phone calls were of two varieties. Former registrars thought it was the longest career suicide note in history. A Regional Advisor from an area I'd never worked in got in touch and was hugely supportive and helpful, as were two former bosses, who were kind enough to help rewrite CVs and application forms.

Then I got shortlisted for a registrar rotation. I couldn't believe it. After 33 applications and a public baring of the soul, the invitation to interview.

I had maybe a week, ten days, of being quite jolly, making plans and booking appointments with those on the 22 member interview panel who were seeing candidates.

Then a phone call. Thank goodness for that phone call. From the Programme Director's senior registrar, someone I had known a little, earlier in our careers, who I did then and still do respect hugely. 'They have short listed you to see who you are. You are not going to get a job'.

So I went in prepared. Well not totally, as who can be strong enough to withstand the opprobrium of 22 senior academics and clinicians seated on 3 sides of a giant square table, handing round copies of the magazine with your printed letter open just in case someone hadn't seen it.

It was a massacre.

The following day one of the panel rang me to offer me a Trust grade registrar job. With his help & support, and the backing of that unit, my next interview for a training rotation the following year was successful. I've now been a consultant for six years.

Now we have outlets for our concerns, our anxieties, our anger. It's healthy I think to have somewhere to vent & share, to have things put into perspective, to receive support in an otherwise isolating environment. But anonymity is key. I put my name to my feelings, and stalled my career.

I will not make that mistake again.