UnknownThe General Medical Council in Britain released new guidelines on social media for medicine. Essentially, if you are a doctor in the United Kingdom Big Brother the GMC does not believe that you should be able to tweet/blog/post anonymously if you self-identify as a physician. The exact wording is as follows:

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.

First of all, no one should believe any medical information on the Internet, whether anonymous or not, that isn’t sourced and dated. Without a source it’s opinion at best. Without a date, well, medicine is constantly evolving and if a post is more than 2 years old, look for something more recent. That’s why I tell my patients to go to .gov sites because they are curated and the post indicates when it was last updated. If a blog is written by an anonymous doctor, but everything is sourced to excellent sites, is that evil? Does it mislead the public? Not necessarily.

Good online data should also come from a source that has disclosed bias up front. If you are reading information about a drug written by a doctor who takes money from the manufacturer versus one from a doc who takes no drug company money it should make a difference as to how you consider what you’ve read. Without knowing who wrote the post, it is a little like taking candy from a stranger. However, I will always maintain that sourced data is better than knowing the name of the author, but yes, both are preferable.

The GMC also warns doctors that their anonymity can be easily unmasked! Yes, at anytime Sherlock Holmes and Dr. John Watson stand at the ready to tear down the veil and let the whole world know your true identify. In reality, it doesn’t take Scotland Yard to find out who’s who on the Internet, just someone with a rudimentary knowledge of computers and the Internet and a little extra time on their hands. Anyone who thinks they are truly anonymous is in for a shock. Perhaps it bears repeating, but it doesn’t warrant censure. Reminding doctors that anonymity is no guarantee is a little bit like reminding one not to play in traffic. There are risks. Take them at your own peril.

The GMC forgets that anonymous providers have the opportunity to whistle blow. What if a hospital is doing something terrible? Maybe there’s a problem in sterile processing that is being ignored potentially putting people at risk? Maybe a surgeon is doing unnecessary surgeries? Maybe a senior doctor is making unwanted sexual advances on a junior doctor? While it would be nice if everyone had the courage to speak up, not everyone does. However, SOME PEOPLE MIGHT FEEL THAT THEY COULD SPEAK UP IF THEY COULD DO IT ANONYMOUSLY. My understand of British libel laws is that it’s a lot harder for scientists to speak up about pharmaceuticals in the United Kingdom. The GMC wants to make this even harder?

But for me, the biggest error in the GMC requiring that doctors use their real name is the unmentioned but obviously incorrect assumption that only anonymous doctors post shitty information and ever doctor who tweets/posts/blogs under their own name is an honest, true, prophet of evidence based medicine. Has the GMC never visited Dr. Joe Mercola’s website? He sells tanning beds (among other things). You know. the ones the World Health Organization say are carcinogenic? And have they never heard of the good Dr. Oz? Promoter of cleanses and the homeopathy starter kit? Thousands of doctors in the United States sell snake oil via the Internet (the hCG diet is a great one) and they ALL DO IT UNDER THEIR OWN NAMES! I don’t know the purveyors of fine British snake oil, but I have to believe they exist.

While reminding physicians that no one is truly anonymous isn’t a bad thing (though a little nannyish if you ask me), banning anonymous posting is a bit like passing around the Victory Gin and forcing everyone to drink. Instead of restricting the way physicians use the Internet anonymously, the GMC should join the 21st Century and focus on patient education regarding Web 2.0 and how to search for accurate medical information. Teaching doctors how to post evidence based content isn’t a bad idea either. And hey, it would be nice if they censured doctors who peddle useless tinctures and other assorted crap as well, but that should happen whether they do it online or in the office.

I don’t post anonymously, but I will defend anyone else’s right to do so.

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  1. Dr G,
    While I usually totally agree with you, in this case there is a position somewhat between yours and that of the GMC that makes the most sense to me. My concern about anonymity is this. An awful lot of junk academic medicine, psychology, sociology, public health, epidemiology has been conducted and believed and used to form national policy and a lot of vital research suppressed (denied funding and publication) behind the cloak of “the expert, anonymous reviewer.”

    Whistle blowing is different from posting on the Internet anonymous reviews of the quality and importance of another’s research, clinical judgment, or what governmental funding priorities should be within one’s own discipline. Most medical-health-social research is heavily dependent upon well-founded professional judgment. If someone makes a post that an important psychological test is “garbage,” I want to know which “expert” concluded that. If someone makes a post that an online dating service is effective at matching adults, I want to know who concluded that research and the professional credibility (or not) of the individual proclaiming something to be a “fact.” As any senior professional knows, judgment is a significant part of the advance of knowledge from the usual imperfect, biased, and incomplete data we always have in any scientific field.

    It seems to me that whistle blowers need to be protected in one way (anonymity) and the public needs to be protected by summary pronouncements that something is good or bad by knowing who is making the assertion and the credentials that support the conclusion. At least with Dr Oz and his commercial and media exploits, we know that he often makes pronouncements in areas where he is outside of his area of training (and presumably competence). I want to know who the reviewer of my work is so that I will know if attacks or support are based on true experience, the need to get a promotion or tenure, commercial interest, or something else.

    Anonymity is for whistle blowers and possibly those proposing something new and odd and a possible game-changer. When somebody tells me that “psychologists proved” or “OB/GYNs have a consensus recommendation” or that “research has proven something to be worthless,” I want to know who is saying what and whether they are credible sources.

    I certainly do not want to receive advice (or see it offered to members of the general public) from a dog using a PC. At the same time I do not want to see a professional sued maliciously by a pharmaceutical company or a reader of a blog post who attributes any problems that occur after reading a column to the author. This is actually a fairly complicated situation that is made more unclear by the attorneys, the commercial interests, and the public (often represented by the media) looking for a quick fix to cancer, mental illness, sexual performance difficulties, thinning hair, problems caused by obesity and smoking, and Alzheimer’s disease.


  2. This post and the previous one are emblematic of the politicization of healthcare. If the government is paying the tab, the government calls the tune. The practice of medicine is a licensed privilege and the licensing & paying authority does what it wills without recourse. Every license from medicine to fishing trades privilege for freedom(s). The one who pays and licenses can easily detail the behaviors of a patient encounter, it can demand scripting, it can control how one blogs, how many hours they work, the list will prove to be endless.

    Today, medicine has two customers and soon they will have three – the patient, the insurance company and the government. You must be competent, on time and nice. Your records need to document x, y & z. You will say this and that and wear a lab coat (but no tie). You will blog only under your real name and speak only within your competency.

    I am not saying it is right and I vigorously disagree. I am merely observing the effects of government healthcare.

    The more the government pays, the more it is allowed to control. Government does not give up control easily and the government does not fear patients, physicians or hospitals and certainly does not fear groups like ACOG who change leadership annually and are traditionally led by people who are busy doing other meaningful things.

    This is the unintended effect of government sponsored healthcare – with the cash comes the controls. American bureaucrats LOVE controls and nothing make a BA educated bureaucrat happier than making a doc with alphabet soup after their name dance. This is the law of unintended consequences in full bloom.

    1. The government don’t pay, the people do. Don’t pull out the whole “Wah wah socialised healthcare is evil and Stalinist” schtick, when you have no idea of how it even works.

      1. In a capitalistic nation, there is no question that any mutually conceded to contract where money is exchanged can legally impede speech or demand certain actions. Every contract trades individual freedoms for money. The list is endless NASCAR drivers must mention sponsors. Teachers have “morals” clauses. Coke (the soda) executives are forbidden to have Pepsi in their homes, Ford dealers may not drive BMWs. Such contract demands are common so it is hardly a stretch for payors – who have a contract with docs – may regulate blogging and tweeting – the docs work for the payor (work being defined by who pays you to work or who via licensing sets performance standards for your work). The U.S. has 50 licensing agents and roughly a dozen payors at the moment.

        This politicization of medicine occurs when the “people” concede payment and oversight responsibility to unelected bureaucrats who happily call the shots for patient and doc. If you do not like it replace the president and HOPE that the new president appoints a better bureaucrat. Politics is about power as is capitalism. The “people” had their say when they voted for the reps that made the laws (here or in England) and elected a President or Prime Minister. The “people’s” say is now spent and their individually monetary contribution insignificant. Ultimately, only the people pay but the bureaucrats be them public or private call the shots and blogging is just the beginning. So, it is right that the “people” pay but have no direct “say” because individually what they pay is not significant enough to get a seat at the table and their solitary vote has been spent. In perspective, there are 314 billion Americans who paid $2 trillion in taxes. How this money is spent is delegated to 535 elected officials who divide it over 15 Agencies there is no “say” here, only pay.

        I only observe. No judgement as to the goodness or badness of the judgement of others enacting policy. Maybe having docs sign blog posts is the greatest thing since bottled beer…then again, maybe not but if the market for healthcare is limited to only a few payors, docs will be compelled to dance with them & obey or leave medicine.

  3. If any organisation affects public safety or security, transparency must be imposed on it. Otherwise the natural tendency towards competition, control, secrecy, selective & positive information release etc is bound to flourish unhindered. No public body or private entity is immune. Transparency is only effective if bullying, suppression & enforced silencing can be bypassed externally to counterract any developing climate of fear. If information affecting public safety & security can be withheld from them unilaterally, fascism has already supplanted democracy.

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