Doctors speaking out on public health issues or advocating for social justice is beneficial to their patients and the profession, argue these authors

The debate on defining professionalism in medicine is at its peak as both generational and gender divides clash in ever-more-public forums. As young doctors harness social media to advocate on public health issues, or for social justice, top medical organizations continue to recommend the separation of personal and professional social media accounts. While medical schools integrate advocacy into their curricula, healthcare organisations advise clinicians not to speak out. 

One aspect of the so-called hidden curriculum in medicine, is about how medical students and junior doctors conduct themselves at work. But when it comes to advocacy and how doctors can express themselves in public fora, the curriculum falls short and constrains professional activities to historic norms. This is a great disservice to our patients and ourselves. 

In Robert Louis Stevenson’s 1886 classic The Strange Case of Dr. Jekyll and Mr. Hyde, conformist Jekyll invents a potion that transforms him into his alter-ego, Hyde. By doing so, Jekyll escapes the expectations of his profession and society in general, living out the aspects of his darker self when he transforms into the evil Hyde. He describes his experience as a “profound duplicity of life.” 

As physicians, we can relate to Jekyll’s need for an alter ego; except rather than morph into a darker doppelganger, we feel the need to have an alias to conduct well-intentioned advocacy. We feel pressured to separate our personal and professional personas, especially on social media, when the very nature of advocacy demands we use our whole persona as currency to engage an audience, spark awareness, and effect change. 

Most of the major medical organizations across the UK and North America have much to say on the matter. Almost unanimously, professional guiding bodies and medical schools alike suggest that physicians separate their personal and professional social media accounts. They dictate that the two should not mix. 

The debate is not an abstract one confined to policy documents. For example, on the issue of physicians advocating for stricter gun control, many have been told to “stay in their lane” when calling for stricter controls. Najma Ahmed, a Toronto-based surgeon was on call the night of a 2018 mass shooting in the Danforth district of Toronto. Shortly after launching anti-gun activitism, Ahmed was reportedly the target of nearly 70 complaints made to her regulatory College by the pro-firearm community. She also faced harassment online. Elsewhere, there have been reports of healthcare workers, across the world, unable to speak out when they have disagreed with their government’s handling of the covid-19 pandemic, for fear of repurcussions.  

Despite restrictive “social media policies” and attempts to silence physicians who speak publicly, times are changing. Ahmed wasn’t sanctioned for her anti-gun advocacy; in fact, after her regulatory College exonerated her, she was promoted to surgeon-in-chief. Physicians are increasingly participating in social movements such as White Coats for Black Lives, wearing rainbow pins, or taking part in events such as pride parades or the protests after the death of George Floyd. We are ignoring the advice to “stay in our lanes.”  

Separating the personal from the professional promotes the false idea that physicians hold objective opinions only. How can we ask vulnerability of our patients while remaining machine-like or elusive? Some studies show that when doctors do open up more online, it may ease patient anxiety. Making a therapeutic bond with a patient is a two-way street. In times like these, we must also make a therapeutic relationship with the public to advocate effectively, and the work of advocacy requires revealing our true selves. 

Both of our social media profiles, which are open to the public, are a reflection of who we are: dedicated physicians who advocate on issues that are sometimes controversial. We seek solutions through public discourse. Yet our posts could potentially be accused of being non-compliant with the guidelines and policies of our regulators and employers, because we speak out on public health advocacy issues. Are sanctions and disciplinary action in our future?

At a time when trust in medicine and science is low and the consequences of medical misinformation have never been more obvious, forming therapeutic relationships beyond the bricks and mortar of our hospitals has never been more crucial. To better build trust, physicians should be embracing authenticity and reunite their professional and personal selves.

Sarah Fraser is a Canadian family physician and health blogger. She is the Co-Director of the Medical Humanities Program at Dalhousie University. Twitter @sarahfrasermd

Blair Bigham is a Canadian emergency physician and health journalist completing a critical care fellowship at Stanford University. He completed residency at McMaster University and postgraduate training in both journalism and research methods at the University of Toronto. Twitter @BlairBigham

Competing interests: none declared.