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Doctors shouldn’t reveal so much

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2495 (Published 11 June 2018) Cite this as: BMJ 2018;361:k2495

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Are physicians wrong for stating the elephant in the room?

Sokol's article reminded me of the tale the Emperor's New Clothes,<1> in which many observers stay quiet due to fear of being ridiculed and punished, until one naive, or brave, individual states the obvious problem. But the main difference between the tale and Sokol's articles is Sokol apparently glorifies individuals who stay quiet, and criticises the ones who state the elephant in the room.

I do not see candour from physicians as rants. Rather, this candour raises concerns about healthcare which many medical and non-medical readers relate, debate, and suggest solutions. The BMJ column No Holds Barred by McCartney is a good example. Sokol mentions that venting in journals and books is acceptable and desirable, and appears to have a double standard between print and social media. Ironically, he later quoted the GMC for advising the same standard on all mass media.

Regardless, information presented in these print media are often accessible to the public through social media like Twitter. Almost anyone can follow the BMJ Latest Twitter account, unless you live in a communist country. Would it be considered "crossing the professional boundary" for posting links to and excerpts from journal articles on Twitter? If yes, then many professionals, including Sokol, would be guilty. A medical ethicist ranting about physicians in a journal would also be guilty.

The BMJ Twitter page explicitly states it is meant to lead debate on health and improve patient outcomes. As per the GMC Good Medical Practice, physicians must promote and encourage a culture that allows all staff to raise concerns openly and safely.<2> Then, does following the GMC guidance to speaking out mean damaging the "profession’s image"?

If physicians were prohibited to speak out, would they become invulnerable then? It would just be hiding the truth. Does the #MeToo Movement on social media make women look vulnerable? Rather, it shows courage against injustice, and encourages others not to suffer in silence. The opposition could argue these matters should be discussed in an even more private manner, inaccessible to the public. If these matters were settled this easily, I am sure the number of people speaking out would be considerably less.

I prefer individuals who are honest rather than faking their confidence. I'd rather have a boxer who admits to his trainer about his lack of confidence, so his team can modify his training to help him put up a good fight. I appreciate a barrister who honestly tells me my slim chance of winning a court case, so that we can work on an alternative settlement. I want a pilot raising concerns about anxiety due to workload, but not silently putting passengers at risk. Similarly, as a patient, I'd rather have an honest physician who tells me the overstretched NHS situation and my expected wait time, than a liar who gives me false hope.

References:
1. Sokol D. Doctors shouldn’t reveal so much. BMJ. 2018;361:k2495.
2. Respond to risks to safety. London, UK: General Medical Council; 2013 Mar 23; cited [Jun 13, 2018]. Available from: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/goo....

Competing interests: I have been paid for working as a physician, but not writing this letter.

15 June 2018
Eugene Y.H. Yeung
Physician
Lancaster, UK