Doctors and The Right To Privacy

I had a bit of annual leave last week and I spent a lot of it messing around in a cassock – last week, not being at my day job didn’t mean not being in the business of fear, death, and, occasionally, if we’re very lucky, resurrection. But I  didn’t have to go into work and for the first time in longer than I can remember, I had ten days when I didn’t check my work emails or look at ePortfolio or blog anything about medicine.

But even I, buried under my Holy Week shaped rock, could hardly have failed to notice the heehaw brought about by the new GMC guidance on doctors’ use of social media, which is part of the 2013 update to Good Medical Practice and will come into effect on April 22nd.

It is my view that this is not entirely a bad thing.

My guidance on the use of social media as a doctor came from the person in my Trust who is in charge of Information Governance and the advice she gave to me was: “I think that social media is dangerous. I don’t have a Facebook. I don’t have a Twitter. I think that you shouldn’t have them either.” This was patently ridiculous.

So, always with the awareness that the GMC were both entitled and willing to discipline doctors who they judged to be doing inappropriate things with social media, most of us have been left to judge what they might consider the appropriate use of it through the potentially dangerous combination of hearsay and common sense. It is good to have some clarity. It is good to have some uniformity. It is especially good to have those things from a body that acknowledges within their guidance that there are many benefits to the use of social media.

And most if it is exactly what we might have expected – don’t breach patient confidentiality, don’t accept friend requests on Facebook from patients or their families, don’t bully or harrass individuals with whom we interact online, etcetera, etcetera.

Then, this slips in:

If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name.

It is that sentence which has caused most of the heehaw.

Some of the best blogging and Tweeting  on the Internet is done by medical students and doctors who choose to blog and Tweet under a pseudonym.

I don’t write under a pseudonym. The decision to shake off my anonymity was one that I made years ago, and it was one that I made entirely for myself. I did it because I was frankly never that good at being anonymous. My medical school flatmate figured out who I was and my priest knew who I was the first time he met me and my choral director, well, he thought that I was the lovely and far more talented Margaret McCartney and so I was compelled to admit to him that I was not — and those are just the ones who told me about it. And then I realised that there were things that I wanted to write about but hadn’t been because I was worried that they would make me too easily identifiable. I had become trapped behind the veil of anonymity that had been supposed to liberate me.

But those are all decisions that I made for me.

I have no wish to make that decision for everyonenor for the GMC to make it for them.

There are a great number of pseudonymous doctors and they are pseudonymous for a vast array of reasons. There are doctors who identify with racial or sexual or disabled minorities, and who would prefer when applying for jobs for those things about them not to be easily accessible. There are doctors  who have revealed deeply personal things about themselves and are understandably wary of having everyone in their real life and the whole Internet automatically attach those things to their real name. There are doctors who would prefer patients not to discover through the power of Google what we do when they aren’t being doctors, not because the things they do are illegal or immoral but because a personal life is meant to be just that.

I found a safe space on the Internet when I was fairly young where I could learn how to be the person I was becoming. I didn’t at that time identify myself by my real name. I don’t think that only teenagers need that safe space and I don’t think that people should be denied access to it merely because they happen to be doctors.

Do we require teachers who use social media to identify themselves by their real name? Do we require it of engineers? Or plumbers? Do we require it of nurses or of allied healthcare professionals?

And if we don’t, then why is it now required of doctors?

What do the GMC mean when they say that we should identify ourselves by name? Are doctors allowed to merely say publicly that they will provide privately their real name to anyone who asks for it? Or does their real name have to appear publicly on their website or Facebook account or Twitter? I don’t use a pseudonym, but, interestingly, while I’ve been writing this, I’ve discovered that the GMC website has no record of any doctor by the name of Beth Routledge. It is my real name. It is merely not the full form of the name on my birth certificate. I wonder how that fits in.

It is good to have some clarity and to have some uniformity.

But I don’t think I agree with this part of it and I am not convinced that it’s been thought all the way through.

Update: 16 April 2013: The GMC published this piece of clarification on 10 April (the link takes you to the GMC’s official Facebook page). Hat tip to Anne Marie Cunningham for directing me to it.




  1. Hi Beth

    Interesting points. All professions now have social media guidelines issued throughs their professional bodies. Most of these sets of guidelines are written by folks who also don’t use social media and view it as something dangerous and sinister, in my view. The General Teaching Council Scotland doesn’t go so far as to require teachers to name themselves, but still, offers up some fairly loose guidelines about ‘professional conduct’ and taking care when engaging with students online. They are being overtaken by the widespread use of social media as a core component of pedagogy and practice both on and outside of the classroom.

    There are several wonderfully wicked and very anonymous teachers on social media and blogs. I wouldn’t want it any other way myself!!

    Until professional bodies like the GMC, GTCS, and The Law society understand social media a bit better, my view is that they should trust the professional judgement of their members.

    • That was pretty much my view about the person in charge of Information Governance who I think had been in charge of it since it meant not putting a confidential piece of paper in the confidential waste bin and who knew less about social media than the forty-odd people who she was trying to give advice to about it did.

  2. I do not use my full real name on the internet for any reason, unless it is directly associated with work. I don’t use it on Facebook or Twitter and I never have. People on there know I am a doctor. I don’t particularly talk about medicine, but I am not sacrificing my privacy and security for the GMC. There are very good reasons for not using your full real name online and the fact that they want us to shows a dangerous level of naivety.

  3. I don’t use Facebook, or Twitter. Facebook, I abandoned because of their lack of transparency regarding their use of my personal information (personal, not public). Twitter, I never felt any interest, because of the restriction on number of words.

    That said: information governance is trying to accomplish something, here. They’re saying that if you’re using your “doctor” title, then they’d like you to be able to be held accountable for your opinions. They’re saying that they’re fine with you being pseudonymous, but that it’s perhaps unethical for you to get the benefits of the title as well as the protection of pseudonymity. It makes a little bit of sense to me that way.

    As to not using your “real name,” I personally am opposed to the whole concept, but various media companies (Google, Facebook, etc.) require that you do so, and make some attempt to enforce such a thing. It’s silly, really, and difficult to enforce.

    The flip side, however, is that pseudonymity is NOT anonymity. It is extremely difficult, even for determined IT professionals, to maintain anonymity in the face of someone truly determined to discover their identity. Because of this, I resolved to use my “real name” in everything I do online – and to treat EVERY online interaction as if the conversation were held in a court of law, in front of a judge who is predisposed to throw me in jail.

    • The majority of the time, though, doctors aren’t representing themselves as doctors to use their title, they’re representing themselves as that because the experience of being a doctor is the thing that they’re talking about.

      I know that that sounds like a fine line, but bear with me here.

      A transgender man is planning to have children with his female partner. He has a history of being treated for mental illness. He is estranged from most of his family. He is also a doctor. He has a blog, which he keeps under a pseudonym. He is known amongst his online readership to be a doctor — partly because it’s part of his identity, partly because some of what he talks about is about his experience of being transgender at medical school and within the NHS and the stigma attached to healthcare professionals who are open about having had mental health problems. He doesn’t want the benefits of being known as Dr Soandso, but he also can’t really talk about that stuff without it being known, at least by association, that he is a doctor. But he prefers to remain pseudonymous because he’d rather future employers not be able to know these things about him through some casual Googling pre-interview and because he wants to have that layer of protection between himself and his estranged family. And, sure, he’s taking a risk merely by being on the Internet — as you say, if they want to know who he is, they’ll find out, but that layer of protection is a layer.

      I take a much smaller risk by being known by my name and as an openly gay Christian doctor. But I think that that’s my risk to take, is the thing.

      • Yep – I agree that there are certainly reasons for preserving pseudonymity, and the case you site is certainly an example.

        The thing is, there are good and bad reasons for using pseudonymity, and no blanket policy will be able to draw a hard line … but there can be policies formulated which include those cases at least most of the time.

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