Over the weekend, I saw Dr Doireann O Leary put up an Instagram post referencing a study which looked at the conduct of medical professionals on their personal social media. This study inferred that these professionals, namely vascular surgeons, were being inappropriate in the way that they conducted themselves online, in a number of ways, including the uploading of holiday photographs wearing swimwear, drinking alcoholic drinks and expressing political views. This investigation of social media accounts was done by male “researchers” setting up fake accounts to spy on their medical colleagues to report their findings. Quite rightly, Dr Doireann’s post lambasted this “study” for what it was – an unethical, in many ways misogynistic, double standard holding piece of research which really held little to no value. It professed that this content would negatively impact their future careers if made public to their future patients and employers.
Well. I have a few opinions about unprofessional conduct with regard to doctors. And NONE of it has to do with the fact that they might have gone out with the girls on a Saturday night and grabbed a cocktail, or rocked a bikini on their last well-deserved holiday. None of it.
For me, this issue is where my two hats as a chronic pain/illness patient, and a public health researcher come into play with the one issue. The researcher in me is raging that something like this not only got past ethics committees, but also got into a conference and published in a well respected medical journal. I am at the very start of my research career, having graduated from UCC earlier this year with my Masters in Public Health. However, having worked as a research assistant, as well as seeing the work going into making my thesis an article, it’s not exactly easy or a kind process to the researchers who pour hours of blood, tears and coffee into these things. It goes in, reviewers take a look and rip it to shreds, you cry some more, you make amendments, it might need more, and maybe, maybe, it gets selected. And then something like this happens and you wonder HOW it got through the ringer without someone going “Is this not just a LITTLE problematic?”.
From the pain patient point of view, I have lots of examples of unprofessional conduct from doctors. I have a number of friends who have chronic illnesses, we talk about these things like most people talk about nice baristas in coffee shops. Doctors who tell you NO MATTER WHAT that if you lose three stone, you’ll be completely cured of the thing that you know isn’t weight based. The ones who tell you that because the test results haven’t showed up anything, it must mean there isn’t a problem, despite the fact that you’re in their clinic for that particular reason.
We have a code, us broken people, talking about the angel doctors, the ones who listen. The ones who take what their patients say into account and actually respect that we may have some idea of what our condition is, given that we live it and they may have covered it in part of a lecture 15 years ago. They SHOULD NOT BE THE EXCEPTION. But they are, and so we rave about them.
I have a glorious GP, I started seeing her a month before I got pregnant and she has been on my side through everything my body has given me in the seven years since. She has referred me to a pain consultant who I would trust implicitly because of his behaviour, and a rheumatologist, who while more blunt, took my opinions on board. She’s sent me to therapists, and physiotherapists and has never done me wrong with her recommendations. It feels weird to rave about your dream team of doctors, but when you have had so many bad experiences before, and after, meeting these people, you truly realise that they are the diamonds in the rough.
So, What Am I Classing As Unprofessional Conduct?
I have had well respected consultants in neurology write reports stating that I had nothing wrong with me, that my chronic pain disorder was in my head and that I required psychiatric help, as well as “education on the value of work”. The same doctor, a few years later, reiterated those points and made a comment about how my inability to work as a result of my back injury which had me on medication that made it so I couldn’t be trusted to look after my toddler solo during the day, “suited me fine as a stay at home parent”. Apparently my lack of interest in losing weight and sole focus on my symptoms instead of the goal of not having the symptoms was the issue. I had “no evidence of any acute pain on review”.
Two days after I saw this doctor, my rheumatologist, having had me on immune-suppressant drugs for months to rule out Ankylosing Spondylitis, made my diagnosis of fibromyalgia official. I had been receiving rather painful steroid injections into my lumbar facet joints for a few years up to this, weekly physio and on enough medication to make me rattle. But yes, it was a weight loss plan I needed to fix it, the rest of them were simply not brave enough to say it to me. My GP had seen the report before me and told me to be seated and calm reading it because it was likely to rise my blood pressure as it had done with hers.
One GP, a few months before I met my current one, scoffed when I asked to change the contraceptive pill I was on as reports had come out stating a higher incidence of blood clots in users of that pill. I had a few months previously lost a cousin who was in her twenties to a blood clot, so was very aware of the family history there. He informed me that the media were taking things out of proportion, but if I really wanted to make a big deal out of things, that he’d switch me to a lighter form of the same one. Oh, and that I definitely didn’t need to take any further precautions in the switchover period between the pills (I asked, twice, but six weeks later had a positive pregnancy test). I saw this same doctor three times before deciding never again, and two out of the three times I came out rage crying.
One friend told me of a psychiatrist who discounted the impact of medication she had been placed on regarding her weight gain between appointments, and accused her of lying about her eating habits, stating that she was clearly eating far too much.
Another story really does go to show the importance of language and tact in medicine which it feels some doctors may have skipped the lecture on while in medical school. While it is true that many patients don’t read the medical letters they are handed to pass to another doctor, lots of us do, and the language used to describe us can be extremely offensive. It is not that we are objecting to official medical terminology or unaware of the health issues which have us in front of these doctors in the first place, however, the words “obvious deformity” to me would belong more in a Victor Hugo novel than a medical correspondence in the 21st century.
Friends who have been seeking treatment for hyper-mobility and Ehler-Danlos Syndrome have similarly been gaslit by medical professionals who don’t believe that they have the symptoms they have, or find alternative reasons for them, despite the Occam’s razor being right there. It isn’t that these patients WANT that diagnosis. It’s that they have it, they just need it in writing to be able to receive the treatment to allow them to live their lives with some semblance of comfort and normality.
These are just a small number of horror stories that are out there. There’s an entire movement out there based around how weight-bias has impacted patients with doctors treating their patients differently based on their BMI and not taking other health indicators into account. Maternal healthcare is riddled with stories of women’s pain not being taken seriously and women not being listened to or treated like their rights came second to the doctor’s ego. We should be screaming in the streets about this stuff, but it continues, and the cycle continues. It’s certainly #notalldoctors but it’s enough of them that there is definitely an issue in healthcare.
But Should They Be Sharing?
Doctors have every right to have a personal life just like you and I. Would I prefer that their extra curricular activities were legal, and not doing harm to others? Absolutely. But is that really any of my business, as long as their conduct in an official capacity as a doctor to patients is professional? I understand that the writers of this paper did state in their limitations that they were not particularly looking at patient views of the doctors, more that of their employers and/or future colleagues. But really, a grown adult holding an alcoholic beverage in their hand while off duty, maybe on holiday, in a photo, should never be considered unprofessional conduct.
One of the interesting points they pulled these vascular surgery graduates up on was the declaration of “controversial” political views on social media. From an Irish perspective, I find this particularly interesting, in light of our recent referendums on social change in our country. Many medical professionals made their views very well known with regard to the referendum on whether or not to repeal the 8th amendment in 2018. Well known doctors, like Dr Maire Higgins, Professor Louise Kenny (Repealers can call me Louise), Dr Rhona Mahony and others spoke out about their reasons for supporting the repeal of the 8th amendment, which gave the unborn equal rights to the mother in the Irish constitution and essentially made abortion for any reason illegal in the Republic of Ireland.
1517 doctors added their names to the Doctors for Yes list prior to the historic vote on 25th May 2018. Their views would potentially have been considered controversial, dependent on the reader of their social media posts. These posts from many of these medical professionals were used to ask for others to go out and vote. Similarly, in 2015, Ireland held a referendum on whether or not same sex couples would be allowed to be married in our country. Under the guidelines outlined in this article, doctors professing views on this referendum would have been considered “unprofessional conduct”. This is despite it being a view which did not affect how their job was performed.
I am not one to say that people shouldn’t be careful what they put up on their social media accounts. The internet is forever, and all of that. Employers may look at some activities differently than others. Dependent on what your work goals are, it may be best to lock down social media accounts. However, when it comes to looking at inappropriate or unprofessional conduct in doctors, I believe that social media isn’t where they should be looking if they’re truly looking to make changes.