Professionalism, or Prying?

“Professionalism” is a funny thing.  About this time last year, I was struggling to get a new course written for the coming semester; it was on professional ethics for lawyers.  A colleague made a comment along the lines that I must be spending a lot of time looking at the professional codes; I replied that I’d be spending almost none doing that; she looked baffled and wandered off, presumably convinced that I was joking.

I wasn’t joking.  I did look a little at the professional codes, but only as a jumping-off point.  My schtick was more like, “Here’s what the SRA says about client confidentiality; now let’s spend the remaining 98% of this lecture looking at why it might say that, and whether it ought to say something different”.

Yet, as I wrote the lectures, professionalism – not professional codes, but professionalism – did keep cropping up.  After all, if you’re going to talk about lawyers’ ethics, or doctors’ ethics, or engineers’ ethics, the implication has to be that there’s something quite specific that applies to each of those professions, otherwise it just collapses into… well, ethics; and it might be that there is a clear way to define who belongs to the profession, and a clear hierarchy, and that it is proper (or, at least, it may be proper) that there is some sort of pressure exerted by that hierarchy that shapes behaviour in a way that neither the law nor standard social norms do.  There are some things that are regulated by professional ethics that aren’t regulated by bog-standard ethics.  To return to the lawyers’ example, there might be certain things that are acceptable or even required from a lawyer that wouldn’t be in other cases, and other things that are unacceptable that are trivial outside the profession; and the same might apply to medics.  (In passing, I think that that might be one of the fault lines in academic medical ethics: those of us that come from a philosophical background understand “ethics” to mean one thing, and those of us who come from a medical or, in at least some cases, a social science background understand it to mean another.  We normally rub along fine, but sometimes we are talking at cross-purposes.)

A range of problems arises from that, though.  For example, though codes of ethics might attempt to codify what it is that’s demanded by professionals, they’re often rather vague, or presuppose a heck of a lot that’s actually rather important.  That can lead to situations in which it’s impossible to tell what’s required on the ground.  “Maintaining the reputation of the profession” is a concern of some of the professional codes I’ve seen, though quite what that means is anyone’s guess, since it might collapse to “doing whatever keeps the public on side, no matter how senseless”; and while that might maintain esteem in one sense, it does so only by undermining the concept of professional integrity.

A second problem comes from the need to know what things are properly within the “professional” remit, and what professional bodies have any business talking about.  The difficulty here is that “professionalism” implies living a kind of life; being a professional involves being a certain kind of person.  One doesn’t stop being a professional when the end-of-shift klaxon goes.  And yet there’re certain things that do have nothing to do with professional regulation: whether or not to be teetotal is not a professional matter, and a professional body that tried to involve itself in such decisions would be stepping over the line.  Still, where the line should be drawn may not be obvious.

All of this brings me to this blog post over on the BMJ blog, in which Niro Kumar considers doctors and dating apps.

Now, already, I’m a little wary of this, because… well, because why is there anything special to say about doctors and dating apps?  Or about dating apps generally?

Shift patterns and long hours have detrimental effects on doctors’ social and romantic lives. While dating other medics solves this conundrum for some, many junior (and senior) doctors still prefer dating outside the profession.

Around the world 91 million people use dating apps and websites. This provides a network of non-medics for social interaction and can be very time efficient, however, is this safe for individual doctors working in a public facing profession where perception plays an integral role in the trust placed upon them?

Safe in what sense?  Kumar is concerned about public perception, but I don’t see this as a safety problem.  And what has public perception got to do with anything?  Is there a public perception about medics and their personal lives that makes the blindest difference?  In short, what have dating apps to do with trust in the profession?

Kumar explains:

The possibility of patients and work colleagues coming across photos and personal information that we would normally keep separate is also very real.

Unknowingly, doctor-patient relationships can easily form, and fake profiles undoubtedly lead some doctors to reveal personal information to untrustworthy sources.

Well, if they’re separate, it’s not a professional matter.  Unless, of course, the concern is that anything that a doctor may do could, in principle, become public knowledge and so have unacceptable professional knock-ons.  But if that’s a concern, it seems to generate an argument for a rather extreme form of purdah – and it still leaves open the question of what sorts of things count.  Of course patients and colleagues could come across personal information; of course there could be doctor-patient relationships.  But that’s part and parcel of being vaguely socially functional, and it’s not obvious why doctors should have to operate according to special standards of social (dys)function.  There’s nothing particularly special about dating apps on that front.

Maybe the concern is that there might exist photos of someone doing something potentially embarrassing and of which that person is unaware; if they are available, it could damage trust in a particular HCP, or in the profession more widely.  (That’s the implication of point 14 in the GMC’s guidance.)  But then we’d want to know whether that kind of leap actually does happen.  Would trust in that particular HCP really be eroded?  Even if it is, does that have any knock-on effect at all for others?  How would the information be propagated in the first place?  For example: suppose a doctor had a profile on a hookup app that catered for some particular fetish that he might prefer to keep private; and suppose that that became known to outsiders.  Well: patients would presumably only get to know about it if someone decided to spread the news. But why would someone do that?  And there’s no reason to suppose that patients’d give two hoots anyway.  And there’s even less reason to suppose that there’d be any professional reputational damage.  Noone is ever going to be more suspicious of dermatologists as a whole because of a story that one particular dermatologist at the other end of the country once had a taste for sex dungeons.  Finally, Smith’s having revealed personal information to someone untrustworthy hardly makes Smith the proper object of moral scrutiny.  The clue is in the predicate “untrustworthy”, and the way it is not attached to Smith.

Kumar continues:

Referring back to maintaining professional boundaries guidance, the GMC identifies that, “Social media creates risks, particularly where social and professional boundaries become unclear.”

But, again, everything outside of one’s own front door creates some kind of risk; that’s no reason never to leave the house.  Note, too, that the GMC in this line is concerned about the risk to the reputation of the medical profession – which seems to me to be minimal, and not obviously the most important consideration anyway.  That aside, the fact that the GMC says something isn’t – surely – the last word.  There’s more to ethics – hell, there’s more to professional ethics – than just taking your governing body’s word for it.

Kumar admits that “[a] blanket ban on apps would likely be more detrimental than beneficial to the profession, especially in a time where we face challenges in recruitment.”  This is undoubtedly true, because there’d be no benefit to the profession, and a profession is nothing without the professionals that profess it.  But the penultimate line is puzzling:

The risks of dating apps and social media are true for the general public as they are for doctor.

Again, this is probably true – minimal though those risks are – but it gives the game away.  If the problems that dating apps generate hold for the public as well, then it’s not at all obvious why there has to be professional guidance specifically about them.

There is nothing particularly special about dating apps.  There is nothing particularly special about doctors.  A doctor who offered medical advice via Tinder, or who talked about specific and identifiable patients there, would be behaving unprofessionally.  But that it’s on Tinder is not the important bit; and the same basic point would apply to lawyers, accountants, or anyone else.  There is no need for special attention to be paid to dating apps, any more than there’s a need for special attention to be paid to nightclubs or trains.

If you leave your house, you will encounter strangers.  If you use almost any form of social media, you will encounter strangers.  The rules that apply to leaving the house apply to social media, including dating apps.  And it really doesn’t matter what your job is.

It’s not difficult, and it’s certainly not a problem for professional codes of ethics.