Medical

Twitter,doctors and rules.

This blog first appeared in the BMJ online version, in August 2013.

http://blogs.bmj.com/bmj/2013/08/28/richard-cook-twitter-doctors-and-rules/

Ever get frustrated during a consultation? How should doctors deal with that? The patient comes first of course—we, as doctors, know that and have that mantra at the centre of how we work. What if, just if, the doctor came first? How would a consultation look? If you could draw up a list of how to make the perfect consultation, for a doctor, not a patient, what would it look like? Could it be helpful to do this?

We all live by certain rules.

As a keen, but slow, cyclist I have been intrigued by “The Rules” as laid out on the cycling enthusiasts website Velominati. These have clearly been developed for cyclists who have a lot of time on their hands and either take themselves too seriously, or are able to incorporate some of “The Rules” into the enjoyment of their sport, while appreciating that there is no legal obligation to adhere to every last point. In summary, they are there for fun, to be interpreted however the reader wishes.

I am also a doctor. A GP. I have to live by certain rules to carry out my role responsibly. I try to adhere to the GMC guidance on duties of a doctor (http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp). I work in a partnership, I have regular appraisals, and I am working towards revalidation. I enjoy my job, respect my patients and colleagues, and, I like to think that I will always try to help people to the best of my ability.

Sometimes, however, I get frustrated. Who doesn’t? Patients are why we are here; they are who we are here to help; they are our source of work; they test our knowledge, our patience, our skills. They can also be our biggest source of frustration—so how do we deal with that? The first step is recognising our frustrations—what is it specifically each day that can be a source of difficulties for us as doctors? Are there everyday issues, relating to the consultation and things patients say to us, that we might need to recognise? I think there are.

I decided to develop a set of “Rules” to help patients maximise their experience of consulting a GP, and give GPs a chance to vent their frustration. They were inspired by discussion with colleagues after years of work and thousands of consultations with patients. They were helped in their development by the rules of cycling (http://www.velominati.com/the-rules/ ) and were intended as a guide only—one with which I hope doctors could identify, and patients could perhaps use to help them understand the physician’s perspective. “The Rules” are meant to provide an alternative view to the patient centred consultation—some doctors have found them amusing.

I have discovered, the hard way, that it is very difficult to present deadpan tongue in cheek views or humour over the internet. In fact, it is best not to try it. At all. This is particularly important when you are dealing with an area as sacrosanct as the doctor-patient relationship. If you feel it is appropriate to try to apply humour to ease your frustrations, then please keep it behind closed doors, away from patients and certainly away from the public arena or internet and all social media sites.

I published my rules on a public website, and associated them with a new Twitter account @drmoderate. I had never used a social media outlet before and I quickly came to appreciate that it is a very public domain; people have strong views and are not afraid to post them. I also quickly realised that my “Rules,” whatever their intention had been, were not appropriate to be shared in public. I had a lot of feedback and much of it was very positive, from doctors sharing frustrations to patients also supporting the need to let off steam. I also received very negative feedback from doctors and patients with very opposite views—eventually these led to me removing my “Rules” from the public domain and engaging in interesting dialogue via Twitter with educationalists, doctors, and patients of all different backgrounds. I learnt a lot, reflected, apologised for any offence and tried to glean some positives from the whole experience.

What have I learnt about Twitter, medical matters, and how can this help others?

1. Do use Twitter—it’s an excellent resource for information and debate on all matters, including medical. Create an account, observe, follow and post when you are ready.

2. Know your audience. Share your humour only with appropriate groups. Social media may well not be the place for this.

3. Don’t get too disheartened by negative feedback. Everyone is entitled to an opinion—be polite, respect the opinions of others, and try to learn from them.

4. Some people take matters very seriously. It is difficult to judge who does, and who doesn’t, over the internet. Remember this, err on the side of caution and be nice.

5. I still quite like “The Rules.” They make me chuckle. I think this is possible without losing the focus on patients.

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