The covid-19 pandemic has caused such chaos and misery in hospitals that some doctors are taking to social media and the press to express anger at people who flout covid rules. In an article in The Guardian on 31 December 2020, an anonymous junior doctor fed up with members of the public acting irresponsibly told the reporter “If people clapped for us now, excuse my language but I would probably just tell them to fuck off.” Last week, the dean and vice-dean of the Faculty of Intensive Care Medicine wrote of a “troubling narrative [that] now appears to have crept into some reporting of intensive care bed shortages—blame the public.”
The public interventions by doctors are often well-intentioned, motivated by a desire to protect the public and the NHS from avoidable harm. They may also be fuelled by understandable frustration, grief and exhaustion. Yet, while doctors can encourage the public to act responsibly and provide medical advice, they should be slow to criticise those who fail to do so.
One of the most attractive features of doctors is that they treat their patients without judgement. The non-judgemental stance of doctors reassures patients that they can seek medical help without fear of embarrassment or disapproval. It allows the creation of a relationship of trust and forms an integral part of a doctor’s professionalism. The doctor is a compassionate healer, not a moral arbiter of right and wrong.
The importance of a non-judgemental approach is contained in the guidance of professional bodies. The British Medical Association states that “patients have a right to receive high quality clinically-indicated care in a supportive and non-judgmental manner.” The General Medical Council’s Good Medical Practice instructs doctors to “treat patients fairly and with respect whatever their life choices and beliefs’ and to be ‘polite and considerate.” Just as doctors should treat patients with respect and without judgement, so should they deal with members of the public. After all, a doctor’s current patients may read any tweets or comments online and some readers may later become patients.
The GMC, in its guidance on social media, reminds doctors that “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.” This is the case even if doctors include a proviso in their profile that the posts represent their views alone and not those of the profession or employer. Many readers do not read the fine print or believe it.
Criticisms and insults towards members of the public for covid violations, however heartfelt and benignly intended, risk undermining public confidence in the non-judgmental stance that doctors should adopt when treating patients. Might the victims of the insults, who are perhaps more likely to flout the rules, catch covid and end up in hospital, think less of the medical profession? Surely so, and so too may others who believe that doctors should remain respectful, polite and professional.
There is a world of difference between encouraging people to wear masks, socially distance and respect covid rules, and insulting those who do not. The first is a form of medical education and to be encouraged; the second is unprofessional and potentially causes more harm than good. It could also result in members of the public or colleagues reporting doctors for misconduct. The GMC reminds doctors in its social media guidance that “the standards expected of doctors do not change because they are communicating through social media rather than face to face or through other traditional media.” So by all means, more of the education, advice and insights that have done so much to educate the public and dispel untruths, but please avoid insults.
Daniel Sokol is a medical ethicist and barrister.
Competing interests: DS is the author of ‘Tough Choices: Stories from the Front Line of Medical Ethics’ (Book Guild, 2018).