Julian Sheather: On tweeting black medical humour

I was at a conference on doctors and social media recently, sharing a platform with the GMC. The organisers put up some darkly funny tweets by doctors at the ends of their tethers, usually fired off in the small hours. There were jokes at the expense of patients and juniors, managers and colleagues…The question for the GMC and me was, more or less, should doctors be posting this stuff? Is it ethical and, slightly more urgently, will the GMC be after them if they do?

Social media are powerful tools and in some form or other are probably here to stay. But among a great many things that are useful lurk a few hazards for the unwary doctor. One of these is the way social media can blur the distinction between our public and private lives. Reading those tweets at the conference—so much compressed spleen—was like watching the collective medical unconscious rear its head: a 4 am outpouring of rage, frustration, and plain disbelief.

Most of us, for most of the time, keep these thoughts to ourselves, and for good reason. As Thomas Nagel has it, “each of our inner lives is such a jungle of thoughts, feelings, fantasies, and impulses that civilisation would be impossible if we expressed them all.” But dip a toe in the torrent of new media chatter and that jungle is plain as day. What was once private—held back for ourselves or for a few friends—has become public. And this is where problems can arise. Medical professionalism depends upon boundaries: between doctor and patient, between the clinic and the world, between what is private and what is broadcast. The informality of new media corrodes them. More and more of us are happy to post our own sensitive personal information, but patients retain strong rights of confidentiality with regard to their own data. We feel like we are chatting to our friends on new media, but unless we can properly control our privacy settings, the world can read it. And the ease with which posts can be circulated make it all the more likely that an “anonymous” patient will be identified.

So the first message for doctors using new media has to be: do not post information that can identify patients without their consent. And be wary of your attempts to anonymise the data: it can often be much less successful than you think. Secondly, have a thought about those professional boundaries. Before posting anything, ask yourself if you would like your patients or senior colleagues to see it. The world is full of unintentional humour but doctors should ask what impact it might have on their professional standing if they are seen to be making jokes at the expense of patients. Also, and on the practical side, avoid posting anything when you are angry, at the wrong end of a large drink, or just too tired to think straight. Come back to it later with a clearer head: you might just be thankful for the pause. It is also worth remembering—as Sally Bercow recently discovered—that libel is libel, irrespective of the media. And tempting as it is to vent your spleen in the gamiest Anglo-Saxon; try and be polite. If you’ve got a point, make it respectfully: remember, once it is out there it can never be deleted.

Having no divinatory powers whatsoever, I have no idea what the future holds in terms of social media. I’m not a heavy user: I need to read slowly, and the new media want me to read quickly. I am at a stage in life when I want to reduce distractions, not multiply them. I am also partial to an elegant sentence where the new media wants to collapse and elide them. Knowledge can also be the foe of understanding. But whether cause or effect, or a bit of both, there is little doubt that new media are participating in the general undoing of the idea of a private life. Where that might lead us again I am chary of predicting. But I’ll leave you with a magus of the sentence, Milan Kundera, and a 1985 interview for the New York Times. The Stasi may have gone the way of all flesh, but the general points endure:

We live in an age when private life is being destroyed. The police destroy it in Communist countries, journalists threaten it in democratic countries, and little by little the people themselves lose their taste for private life and their sense of it.

Life when one can’t hide from the eyes of others—that is hell. Those who have lived in totalitarian countries know it, but that system only brings out, like a magnifying glass, the tendencies of all modern society. The devastation of nature; the decline of thinking and of art; bureaucratization, depersonalization; lack of respect before personal life. Without secrecy, nothing is possible – not love, not friendship.

Julian Sheather is ethics manager, BMA. The views he expresses in his blog posts are entirely his own.