Doctors shouldn’t reveal so much

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Extreme candour from doctors is now fashionable. On social media and in the press and books doctors are willing to expose their vulnerabilities to all and sundry. Some write in the form of diary entries. A French expression comes to mind: “se metre à nu”—literally, to get naked.

Often, what doctors reveal is not the chiselled frame of Apollo or a callipygous Venus but the wart covered body of Mr Burns, the Simpsons character. Thus an exasperated doctor rants against a rude patient, another describes with pathos how he cried after a shift, and yet another complains about the unfairness of the rotas and the effect on her personal life. All this readily accessible by members of the public—and there lies my concern with these displays of vulnerability.

It may be acceptable, even desirable, to open up in a private setting to let off steam, build rapport, communicate ideas, and instigate change. Settings might also include medical conferences, newsletters, journals, and books for clinicians. To open up to the general public is, however, a transgression of an important professional boundary, which should be crossed only with great caution.

This is not a new idea. In Medical Ethics (1803) Thomas Percival wrote, “A physician should cautiously guard against whatever may injure the general respectability of his profession,” and warned against airing controversial matters to the public, “as they can hardly fail to hurt the general credit of the faculty.”1

In Law and Ethics for Doctors (1958) Stephen Hadfield, then assistant secretary of the BMA, remarked that “discussion of controversial medical matters is more suitable for the medical press.”2

In 2013 the General Medical Council issued guidance on doctors’ use of social media. The guidance refers to a passage the council’s Good Medical Practice: “You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession.” The GMC observed 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.”3

Of course, doctors are human and hence flawed, but many people expect them to have a mental toughness and calm demeanour that set them apart from most other groups. This image doubtless contributes to their high status and patients’ trust.

The trend for public outpourings of emotion by doctors sits uneasily with this image and may lower doctors in the estimations of the public. A doctor who writes about the dread of seeing a particular patient or crying after being verbally abused by a drunk patient in the emergency department is not showing mental fortitude but vulnerability. This may generate sympathy, even pity, but it hardly instils confidence. It is like a boxer announcing before a fight that he is scared of his opponent, or a barrister telling her client she is petrified before entering court, or a pilot declaring her inability to sleep because of nerves before a long haul flight. Not every emotion need be shared with the world, however intensely felt or interesting it is to others.

The public has an appetite for glimpses of the private lives and thoughts of doctors. They demystify a profession that was once deemed blessed with magical powers: “Look! These doctors can sob, cry, whine, be fed up and embarrassed. They are fragile, just like the rest of us.”

This candour may have advantages, such as making doctors more “human” and gathering public support for certain causes, but those advantages may well be outweighed by the damage inflicted on the profession’s image, which some think has lost the lustre it enjoyed just a few years ago.

Whatever the social temptations for doctors to “se metre à nu,” they should keep their fig leaf in place when in the public eye. The imagination is more flattering than the reality.