Threat to doctors giving medical advice on PPRUNE

[homonculus]

The General Medical Council of the UK has just released advice for UK registered doctors about social media sites. This advice is similar to an AD in aviation terms.

The rules now are that doctors cannot use a site such as pprune without providing their identity if they are known to be a doctor, and secondly that we cannot discuss individual patients or their care with those patients or anyone else

Many of you know my identity, so putting my name and contact details down would not be a big issue although I suspect my sleep might suffer. However there is little point posting if I cannot give my advice about a specific person's questions.

Sadly this effects all doctors, and could have a significant effect on this board. I would be interested in any comments (you may all be pleased to see the back of me!!!!!) as I would like to take this up with the GMC

[Thomas coupling]

Don't leave H!!

What's wrong with giving general rather than specific advice. Possibly with a warning to start with?
Surely it's all about the inference? Does your profession have access to litigation lawyers? See what they advise.
Either way, you are still welcome on Rotorheads :ok:

[homonculus]

Thanks TC

As I read it, if you post that you have condition X I could not then discuss condition X on the board. I presume if you post 'tell me about condition X' without disclosing you have it that is ok but most threads start with worried pilots wanting information about themselves

One cannot challenge the advice. If caught breaking it they can remove our licences and livelihoods and unlike the CAA they themselves hear the charges, not an independent court. So clever lawyers are not the answer

Pprune is not the only site effected but is perhaps one of the most professional so I think it worth raising the matter as it may be they did not even know that we exist

[Thomas coupling]

Let us know how you get on

[gingernut]

I'm not a doctor, just a pain in the arse trumped up Nurse, but I'm sure the GMC advice will filter through to the world of nursing eventually.

I can see the point of the GMC/NMC, there role after all, is to protect the public, but I've always enjoyed the relative anonymity this medium affords,which allows me to be serious on this forum, whilst spouting on about my shed, my views and life in general on Jet Blast. It looks like this will have to stop now. Mt contemporaries on "Twitter" are considering dual usernames, one reflecting their public persona, the other reflecting what they really think ! (This is a view shared by those at "the top")

I think, on balance, we probably haven't done too much harm to the readers, on the whole we are pretty good at mitigating ourselves, (if symptoms persist, go and see your quack etc), but I guess, there's always been a little niggle in my mind about accountability-as clinicians we are often tugged between accountability to our patients/employers/general public at large/civil law/criminal law/employment law/governing bodies etc. I'm always loathe to reply to PM's, as I worry about not being insured to give advice.

My knee jerk reaction was to withdraw from posting, but on reflection, I realised I actually enjoy posting on here. In some ways the reasons are selfish, M&H is quite a good reflective tool, and of course, if you give bad advice, you are mostly "peer reviewed." Sometimes what seems to be a major problem to posters, is often quite easy to solve for us.

I think I'll still post. I'm pretty sure there will be an amicable way round the rules. :)

[Mac the Knife]

This really is one of the more extraordinary things the GMC has come out with.

I doubt whether this will survive a courtroom challenge though.

I'm not a great fan of "Max Pemberton" (a doctor who writes under a pseudonym - he's too submissive for me) but he sums it up pretty well

See: Max Pemberton: General Medical Council rules threaten doctors? free speech - Telegraph (http://www.telegraph.co.uk/health/9977548/Max-Pemberton-General-Medical-Council-rules-threaten-doctors-free-speech.html)

Bear in mind the the GMC of today mostly consists of non-medical bureaucrat jobsworths whose principal aim is to neuter medical practitioners and "prevent another Shipman" (they won't).

They have clearly stated that their mandate is to protect the public from doctors and that any doctor is "fair game".


One of the saddest things for me is that we are being increasingly pushed to practice neither empirically based medicine or even "evidence based medicine" (which most of us have been practicing all along) but legally-driven medicine in which one's main criterion is not the benefit of the patient but the likelihood of being sued.

Pemberton again: The fear of being sued is ruining modern medicine - Telegraph (http://www.telegraph.co.uk/health/9733286/The-fear-of-being-sued-is-ruining-modern-medicine.html)

At a recent ethics lecture (which I am obliged to attend in order to make sure that I have enought ethics points to continue practicing), I suggested to the visiting Professor that we were now not following ethics based ethics but legal based ethics, in which the driving force was no longer the philosophical concept of ethics but avoidance of the courtroom.

He was quite nonplussed but said that he hoped not!

Fundamentally, of course, you don't need religion to have morals.
If you can't determine right from wrong, then you lack empathy, not religion.


By the way, I plan to resolutely ignore this nonsense and continue to post as Mac - if the UK GMC strike me off then it will merely save me a bit of money.

:cool:

[Pace]

I think that is a load of bunkum rubbish!!! Especially regarding aviation it is vitally important that pilots can post anonymously to air and get advice on their concerns!
They are unique in the sense that they have to have medicals to continue their work /livelihood and hence need places or sites to air their concerns knowing that is is not immediately put on a record.
I can understand that a poster needs to know the qualifications and have confidence in the what is being posted here.
Homonculus with his qualifications alongside is plenty and attaching a name is a needless exercise.
It is quite in order for the moderator to know the name attached to the qualifications but totally pointless having to display the posters name in a forum such as this.

[ShyTorque]

If it helps at all, I'm no gynecologist, but I'm always willing to have a look.

[obgraham]

If it helps at all, I'm no gynecologist, but I'm always willing to have a look. Well, I AM a gynecologist, and believe me, looking lost its intrigue decades ago!

Now to the matter here: I've no easy access to the ruling from CAA, but it seems to me this is nothing new. All docs realize that they cannot give specific advice over a web portal, and if you've followed this forum we virtually never do. We may guide someone toward proper treatment, offer support, debate alternatives, or give additional information. Are you telling me that somehow that's now a crime?

Over here we work constantly under the threat of litigation. But somewhere along the line you have to make a decision or take a stand. As attorneys often told me "anyone can sue you for anything they wish -- collecting is another matter". And the final defense is the insurance company. That's why we pay the premium.

It does sound like the differences between the UK and US medicolegal systems are diminishing by the year. Sadly.

[gingernut]

We're accountable through differing channels:-

Civil law (improbable, resultant damage would have to be demonstrated), criminal law (improbable), Professional Bodies (Improbable but this latest ruling makes that less so), Employment Contract Law (Improbable, but employers are getting more twitched about twitter etc of late.)

What's interesting, is the differing channels of accountability often contradict each other..... eg the ambulance driver who was contracted to work x hours, when he crashed, he was found to be committing a criminal offence.

It's a minefield...... which is why we (The NHS) spend 10% on legal costs:(

[Fly-by-Wife]

So should we expect to see subpoenas from the GMC requiring IB to release all the information they have on any poster in this forum whom the GMC suspect might be a doctor and may have "advised" someone or "discussed their case"?

Presumably this will not affect medical professionals outside the UK.

[gingernut]

It won't be a subpoena. Not in the UK. It'd be a conduct hearing.

They have little power to command information, but have the ability to f*ck up your career in a flash.

Unlike the courts, where generally the opposite is true.

[homonculus]

Fly by wire

You are correct - it only effects UK doctors. So the advice on this board may well be slanted to overseas care. Far far more worrying is if someone gives advice that flies in the face of medical knowledge or indeed is openly dangerous. From 22 April I will not be able to counter this.

Theoretically I can PM the original poster to say this advice is dangerous, but others may take up the advice.

I accept this risk has always existed but it is bizarre that the GMC whose strap line is 'protecting patients' is imposing new regulations that may not do that

[Loose rivets]

I have a pal who is a barrister. He had 'friends' who invited him to dinner, got him pi-sed and, and in my opinion, pried advice out of him. Whatever, he gave advice.

It wasn't a terribly serious subject, I can't say what, but nothing to do with crime. Despite my protestations, he decided to pay up. I'd have given them a battle they'd not forget, just on principle.:*



Back to the now.

I'd be really sorry to lose our stalwarts. I remember a time when there was a dearth of qualified people on here, and I tried to answer some questions - mostly because I know how lonely long nights of worry can be. I often got things right, indeed, three of my post became a sticky, but every so often I'd be just plain wrong, but I gave repeated warnings that I was not a doctor.

Anyway, someone who can only talk about knees, bulging discs, posterior vitreous detachment, classical migraine, and gall bladders is pretty limited. Oh, and I get out of my pram about the use of benzodiazepines, despite it being a fantastic diagnostic tool.

I used to seek advice from qualified people. I'd be very careful in my structuring of the question(s), but it could be very telling just how many times practicing doctors failed to understand the question. It sometimes took two or three goes for them to get the whole picture. It wasn't that they were in anyway lacking, it was just that it's much harder to communicate medical issues accurately than one might expect. And to me, that shouts but one difficulty in dealing with a remote patient.

That brings another thing to mind. The consultant surgeon that did my vitrectomy has a standard answer to my technical questions. 'Pass.' And that's it. He won't be drawn, and I imagine there's a good reason why.

[Pace]

There is a thread going on in the private pilots forum regarding a guy who had a heart attack and is wondering about getting his medical back!
One poster stated that he was a cardiologist and gave advice based on that fact!
Many others including myself made opinions which could be taken as gospel.
The problem here is identifying who knows what they are talking about and who doesnt.
The obvious solution is that PPRUNE attach an emblem to the poster who is confirmed to pprune as being medically qualified in the same way as they attach an emblem to a moderator.
In that way pprune know the identity of the poster and qualifications of that poster while their real names are secret in the forums.
With something so important as this thread that move is vital?

[Bad medicine]

Whilst credentialling all the medical posters on the forum may seem like an attractive option to you, it would be all but impossible to implement. There are advantages and disadvantages to an anonymous forum, and anybody can claim to have any qualifications. I am certainly not in a position to go around confirming credentials with worldwide health registration bodies. This, in part, is the reason for the disclaimer at the top of the page.

For a trained person, it is pretty easy to pick who the untrained providers of advice are, but this may not be so easy for the layperson. We do our best to provide a couter-argument to the more "out there" advice, without trying to stifle discussion too much, but this is not the place to get definitive advice on health issues.

We also try to reduce the amount of direct recommendations of particular practitioners. Being an anonymous forum can lead to a real skewing of perceptions in this regard. Indeed, there has been at least one instance of a medical practitioner posting on this forum under several usernames giving recommendations of his own practice!

It would be a real shame for this forum to wither because of legal practices in individual jurisdictions, so please keep the discussions at a level that you are comfortable with, and which don't expose people to un-necessary risks.

Cheers,

BM

[homonculus]

Thanks BM

Credentialing won't satisfy the GMC in any case - they want a full identity.

This matter effects a lot of people. Most social media is the Twitter and Facebook level and I personally won't lose any sleep over not being able to post on those. However even doctors writing in mainstream media are being caught.

I have formally asked the GMC for advice. I or someone else will post the response

[cattletruck]

Hmmm, the first thing that came into my mind after reading the original post was if licensed practitioners are going to be gagged because of fear of losing their license, then who will fill the void? You guessed it.

Just on this principle alone, the law (or whatever it is) is flawed.

[gingernut]

I'd agree with BM, it's not for PPRuNe to hold some sort of secondary register....it's not practical and doesn't add anything to safety.

Often, just like the real world, a lot of what we paste is "opinion" and we (me included) are often peer reviewed, quite effectively. Those who follow this forum, are likely to be able to sort out the wheat from the chaff.

I expect that the guidance from our regulating bodies can be circumnavigated to everyone's satisfaction, although we may have to a little more "wooly."

For example: "You've got supraventricular tachycardia" may be replaced by "I wonder if your cardiologist has considered supraventricular tachycardia"

Or "take ibuprofen" could be replaced by "ask your pharmacist about ibuprofen"

:mad: I know.:)

[greekboy]

The General Dental Council is even less forgiving than the General Medical Council.

I certainly won't be offering any dental advice on here.

kali nixta

[obgraham]

Maybe advice-giving will fall to us retired medics. Our livelihood isn't threatened by some bureaucrat's warnings.

[cockney steve]

Sounds to me , just another "protection-racket"

If the old boy's network can stifle the dissemination of information ,outwith "the club", they can claim to be protecting their venerable profession whilst maintaining a stranglehold on consultancy for those with a vested interest (the membership)

Anyone remember the huge outcry when the property -transfer market was opened to "licensed conveyancers"? Closely-guarded was the knowledge that anyone could do their own conveyancing..arcane procedures, lack of co-operation and the lack of a central land-registry ensured this particular gravy-train remained firmly in the hands of Solicitors. the cost, nowadays, is less than it was 40 years ago...so about 1/3 in true terms.

40 years ago, Medics were infallible Gods. They closed-ranks, covered each -others' backsides and were only answerable to their Professional Body, which would throw it's weight behind the rare occasion where a Member was involved in a Court case.... Even then, ISTR, the "Patient-Confidentiality" and " Hippocratic oath" trump-cards usually got played.
I see no reason why anybody should not give advice over the Internet. It's little different to bar-room gossip and , by and large, most will accept the caveat,"it's worth what you paid for it"

I question the true motives for this rwellian attempt to control the freedom of knowledge.. Have we really not moved on from the days when the printing-press bought literacy to the lower-classes?


The obvious solution is to use an "unqualified" provy to publish your opinions

[homonculus]

CS

Before the iron curtain comes down at midnight let me answer your post

The GMC is no longer the doctors old boy network. They are the equivalent of the CAA to pilots but unlike the CAA they do not give advice or try to help individuals by being flexible with regulations. They merely regulate and in effect operate their own hearings, although they claim that stopping you working is not a punishment. Most doctors are trepedacious of being on the receiving end of this, and I know of doctors who have retired when they have been involved.

Whether this is necessary for patient safety or excessive is something I cannot answer but we dare not risk it by going against their guidance.

[Mac the Knife]

CS: Just to confirm what homunculus said; the GMC is no longer the doctors old boy network.

To be fair, it never really was. It was tough if you really stepped out of line, but fair in that it generally declined to investigate clearly frivolous or insane allegations. When it did investigate it generally accepted a clear explanation so long as the practitioner involved was within the ethical limits of standard practice. The Council were all experienced and qualified so they had a pretty good idea of practicalities.

As I said, the the GMC of today mostly consists of non-medical bureaucrat jobsworths, whose principal aim is to neuter medical practitioners and "prevent another Shipman" (they won't).

This is purely a government exercise to remove the last elements of independence from the profession.

Very sad.


:(

[kilomikedelta]

I will not give medical advice on an internet forum. A diagnosis (and thus a treatment opinion) can only be reached by a face to face interaction with a patient and if necessary, a physical examination and laboratory or imaging investigations. There are many visual and behavioral clues which are important contributors to an assessment.

That said, I will continue to offer my opinions on the psychopathological phenomenology of contributors text and the pronouncements of public officials.

[gingernut]

A diagnosis (and thus a treatment opinion) can only be reached by a face to face interaction with a patient and if necessary, a physical examination and laboratory or imaging investigations. There are many visual and behavioral clues which are important contributors to an assessment.


111 anybody ?

[obgraham]

Well we certainly have the GNC equivalent over here -- each state has its licensing board, now euphemistically referred to as "Quality Assurance Committee". In truth, it is a most undemocratic bureaucracy, with a committee made up of a few docs and a group of lawyers, regulators, non-physician practitioners and "community representatives" (i.e. activists). All power to the complainant, and the doc is largely assumed guilty until proven innocent, after a press release.

I don't disagree with your sentiments about the GNC. Same thing here.

That said, it's unfortunate that discussing any medical topic outside a formal doctor-patient encounter is now considered rendering inappropriate medical advice. Whereas one can spout whatever dangerous advice one wishes so long as you are not medically qualified. This is supposed to be beneficial to patients.