Tuesday, March 26, 2013

Doctors, pseudonyms, social media, Good Medical Practice, an impossible standard and the GMC

The future for doctors on the internet?  I kind of hope so...

The GMC (the UK's General Medical Council) has today published its updated version of good medical practicewhich comes into effect on 22nd April 2013.

Doctors rely on this document as a description of the standards expected of them.  I hope that most of us will find that most of it comes as no surprise.  The areas it covers are below:

Knowledge, skills and performance
Safety and quality
Communication, partnership and teamwork
Maintaining trust
All areas where we should aim for the highest standards.

Those that know me may know that, while I find good medical practice to be extremely helpful guidance overall, I have always taken issue with the very first standard it sets.

According to GMP, doctors should:

  • Make the care of your patient your first concern.

This is, of course, an impossible standard, and often an inhuman one.  Many doctors trying (consciously or unconsciously) to meet this standard over the years have lost perspective, or "burnt out".

But I believe it is reasonable, commendable even, to set a standard for yourself that you know is unattainable.  Therefore I would restate this very first standard:

  • Aim to keep the care of your patient foremost; 
    • Be mindful of situations where you may find this difficult.  
    • Take appropriate action, if your situation may put patient care at risk.  

This is a more sustainable and human approach, and I think, a compatible one.

The accompanying standard in the "Knowledge, skills and performance" section that GMP provides is this:

  • Provide a good standard of practice and care.
    • Keep your professional knowledge and skills up to date.
    • Recognise and work within the limits of your competence.

To my understanding, this should encompass some very real limitations of doctors as human beings, whether they are biological (e.g. hunger, sleep), personal (e.g. illness or responsibilities outside of medicine), or wider concerns (e.g. organizational failings, unsafe working practices or shift patterns).  

Encouragingly, therefore, the GMC has spelled things out, or "added some new duties, or made existing ones more explicit", and has restructured the guidance under the four headings used in appraisal ( licensed doctors must have an annual appraisal based on Good medical practice) - 

  • ensuring continuity of care – for example, checking that a named clinician or team has taken over responsibility when your role has ended
  • taking prompt action if a patient is not receiving basic care to meet their needs
  • taking part in structured support, such as mentoring, if you are new to practice or in a new role
  • mentoring less experienced medical and other colleagues.

My rephrasing of the first standard, then, would fall well within point 2, "taking prompt action if a patient is not receiving basic care to meet their needs".  

I wonder if anyone from the GMC is reading this, and if so, whether they would consider rephrasing that first standard in the next edition?

Social Media:

As well as the revised Good medical practice, we also receive explanatory guidance for certain specific issues.  

One of these, "Doctors' use of social media" (headlined as "The benefits and pitfalls of social media"), is particularly interesting.  Any doctor who blogs, or tweets, or uses facebook, google+, myspace or orkut... etc etc should read it.  

It all boils down to, of course:
"You are personally accountable for your professional practice and must always be
prepared to justify your decisions and actions."
That's the last line of the summary slide of good medical practice, and probably the best principle doctors could stick to; with a little imagination, you'd then know how to act.  

But the theme today seems to be making things explicit - perhaps to spell things out to colleagues whose imaginations are exhausted, perhaps to cover every eventuality ahead of time, so the GMC can say "you can't say we didn't warn you" when someone next pleads ignorance of basic ethics as a defense to Facebook-stalking their patients (or some such transgression).  

Read it, please - I won't cover it all.  

Some selected points, and my take on them:

"The benefits and risks of using social media", 
"To support you in getting the most out of social media and online working, without compromising yourself or your patients, we have introduced the guidance Doctors' use of social media."
YES!  It's a complex area!  With benefits and risks!  But we're going to tackle it!  Yay, go GMC!

"As well as this guidance, you should keep up to date with and follow your organisation’s policy on social media."
NO!  Boo to this!  Have they even read any organizations' policies?  

For example, from my Trust's "Internet Use Policy" - "No member of staff is permitted to access, display or download from internet sites that hold offensive material". 
So I mustn't go to Wikipedia, because it probably has a page about [insert something which offends you here] [if you can't think of anything, I suggest the article about the Daily Mail] [No, I'm not hyperlinking that for you, because it might be offensive, I haven't checked]?  Offensive to whom?  

Actually, having said that, the Daily Mail offends me greatly, but I will defend your right to read its bilious nonsense about underage celebrity immigrant house prices, if you must.  Just don't expect me to link to them.  

"Many doctors use professional social media sites that are not accessible to the public. Such sites can be useful places to find advice about current practice in specific circumstances. However, you must still be careful not to share identifiable information about patients."
Hmmm.  Having never used these sites (disclaimer - I have a doctors.org.uk account, but have never used their forum), I'm not the best person to comment, but I do view these with suspicion.  Light is the best disinfectant.  

"Doctors’ use of social media can benefit patient care by:
a engaging people in public health and policy discussions
b establishing national and international professional networks
c facilitating patients’ access to information about health and services."
YES! Actually, can I pick d, all of the above?  Oh, I'm sorry, that wasn't an MCQ?


Regarding anonymity:

"content uploaded anonymously can, in many cases, be traced back to its point of origin"
YES!  You dun goofed!  Because I BACKTRACED it!  The consequences will never be the same!  (possibly NSFW, link is to reference i.e. knowyourmeme.com).

"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."
YES!  Anything less is not good enough.  

I'm GMC 7140564, Dr Patrick James McNally, by the way.  I have a rubber stamp with that on and everything.  

(Pseudonyms are all well and good, but posting things anonymously should be the rare exception, not the rule).  

Trip to Genetica is a track by Tonic on the seminal 1998 Adam Freeland breaks album, Coastal Breaks II.  A name I use online where unique usernames are required, because usually no-one else does.  

Comments welcome.  


Adam Willington said...

I do like your revision James. We are often put in situations, for example a busy on-call, which test the statement "make the care of your patient your first concern." I think we've all probably been in situations where multiple sick patients require our care, but there is a limit to how much delegation you can do (note the linear relationship between this and how much cake I bring in), and how many places you can be in at once (one, though I accept I have a lot to learn). At some point there has to be a compromise between the ideal and the practical.

I think your revision also neatly takes into account that we should also make care of ourselves an important priority, else how can you truly make the (adequate) care of your patient your first concern if you haven't eaten in 8 hours, and can't remember the last time you drank?

Hope the family and the cycling (really, this weather?) are well.

PJ McNally said...

Thank you; it does sometimes seem as though doctors are humans, but striving (and expected) to be superhumans.

Family are great; furthest bike ride since arrival of baby has been 10.5km to mothercare, but with baby in a sling, so that should count double, at least.