Should health professionals be anonymous or non-anonymous online?

This is a topic I’ve been thinking about for quite some time. Today, the General Medical Council announced that doctors should identify themselves on social media. To the best of my knowledge my own regulator, the Nursing and Midwifery Council, has not yet issued a similar rule. However, I wonder if this is an indicator of what other professions are also likely to do.

Professionals blog and tweet under pseudonyms for all kinds of reasons, and by no means all of these reasons are ominous. Ermintrude2 and Dr Grumble not only use their platforms appropriately and ethically; they also write extremely well and passionately. Some people just feel more comfortable under a pseudonym, and feel more able to speak frankly.

I’ve been Zarathustra on various blogs, and more recently on Twitter, over the years. I’ve grown quite fond of and attached to my online alter ego. Look at Zarathustra’s awesome moustache! I can’t actually grow a moustache in real life. Despite being a grown man any attempts turn into something resembling teenage bumfluff. I ask you, who wouldn’t want a tache like Zarathustra’s?

Over the years I’ve noticed attitudes to social media and healthcare steadily evolving. At first it was something of a free-for-all. I remember the anarchic days of NHS Blog Doctor, Dr Rant and Militant Medical Nurse. A lot of those early blogs were expletive-fuelled swearathons, with people yelling all kinds of earthy insults at NHS managers, at politicians and frequently each other. The language was of a variety that would have a fishwife telling people to tone it down a bit.

A lot of those blogs simply aren’t there any more. In some cases, I suspect it’s because people got into trouble. Some people found out the hard way that internet anonymity can be seriously overrated, especially in the long run. As behaviour on social media started to find its way into disciplinary hearings and fitness-for-practice investigations, the professional guidance became more detailed and suddenly everyone became incredibly anxious about social media. It became a demonic creature, waving a P45 in one hand and a letter from the NMC in the other.

That anxiety is still around, but I’ve also noticed a more mature set of thinking around social media starting to emerge. The Royal College of GPs’ Social Media Highway Code, and Victoria Betton and Victoria Tomlinson’s Social Media in Mental Health Practice give good examples of this new maturity. What these publications say is, remember your responsibilities to behave ethically, but also maintain a sense of playfulness to explore this evolving medium, and work out how it can be used as a force for good.

And there’s no doubt that social media can be a force for good. Last night I joined in the #mhnursechat on Twitter, which was on the subject of borderline personality disorder. This is a difficult topic, often laden with mutual suspicion on both sides. Patients with this condition are often regarded as “difficult” or “attention-seeking”. Professionals are accused of dismissing the suffering of people with BPD, and using it as a label to stigmatise and exclude rather than provide support.

The chat was joined not only by mental health nurses but also by a number of people with BPD. For an hour everybody talked openly, equally and respectfully. We talked about what the diagnosis means to people, what helps and what doesn’t help. The feedback from participants at the end spoke for itself.

“brilliant to be able to collaborate with mutual respect for each other, a wonderful experience”

“It was such a nice change to be included instead of being ignored and spoken over so to speak”

“brilliant to see and I am glad that patients welcomed in #mhnursechat not just professionals”

“What a brilliant & informative chat. Thank you all so much for joining in”

It reminded me of some comments by One in Four editor Mark Brown.

Social media, by its nature, puts together people who would never have met.  It creates strong public voices which didn’t get there through traditional routes.  It creates stories that appear from odd angles and at unexpected times.  It makes public issues of things that might once have remained behind closed doors.  It doesn’t let things stay where policy makers have traditionally put them.

It also creates a situation for mental health where it is less ‘them and us’ and more ‘just us’.    There is something hugely satisfying in seeing someone who offline would be seen as a ‘patient’ discussing online with someone who would be seen as an ‘expert’ and both learning from that experience.

Returning to the question of whether to blog and tweet anonymously or non-anonymously, there is the matter of accountability in all this. Ironically my recent Twitter run-in with Dr Christian Jessen has galvanised my thinking on this matter. I’ve been criticised for “calling out” Dr Jessen on his online statements. Personally I don’t think I’ve done anything wrong in that regard. I think he behaved disgracefully in an extremely public manner, and that I’m entitled to criticise that behaviour. But should I be hiding behind an anonymous ID to do so? If I’m confident in what I’m saying, shouldn’t I be willing to put my name to it, and if necessary defend it?

As well as being accountable, there’s also the matter of taking credit for what you’ve done well. There are pitfalls in social media, and if I’m honest with myself I think it’s fair to say I’ve made some mistakes along the way. But there’s also things I’m proud of, such as exposing the shocking lack of regulation in the psychotherapy industry. I’m also proud of helping create and maintain the regular This Week in Mentalists round-ups, in which bloggers take it in turns to tell us about their favourite online mental health writing. I’m proud of the #TwentalHealthAwards that I started this year.

So, I guess what I’m trying to say is this.

Hello. My name’s Philip Doré . Pleased to meet you.

The trouble with Dr Jessen

In the last couple of weeks the Royal College of General Practitioners published their Social Media Highway Code. As a professional with a longstanding interest in how social media can be used constructively in mental health, I’ve often been disappointed that most guidance being issued tends to focus only on the negatives and risks of this new form of communication. The Highway Code is a welcome antidote to that: it acknowledges the risks and and the need to behave online in a professional way. However, it also recognises that social media has rewards and opportunities. I highly recommend it not only to doctors but to all health professionals.

Which makes it unfortunate that today I got caught up in the absolutely atrocious online behaviour of a doctor. A TV doctor, no less.

I don’t actually watch the TV show Supersize vs Superskinny, hosted by Dr Christian Jessen. I work with children and adolescents with eating disorders, and watching a show about it feels a little like taking my work home with me. I know that some people with eating disorders have complained of experiencing triggers from the show.

Ilona Burton is a journalist who writes for the Independent about eating disorders. She writes passionaately and well about the subject, not least because she’s in recovery from an eating disorder herself. In 2012 she was nominated for the Mark Hanson Award for Digital Media in the Mind Media Awards. She also holds strong views about the content of Supersize vs Superskinny, which she regards as socially irresponsible.

Early today, an increasingly heated debate was building between Dr Jessen and Ilona.

jessen7 jessen8

Dr Jessen then started retweeting Ilona to his 222,000 followers. The result was that Ilona started receiving tweets from Dr Jessen’s fans, some of them abusive. Ilona was clearly distressed by this, which really didn’t seem to concern Dr Jessen. For that reason I threw my own tuppence into the ring.


I also tweeted him a link to the RCGP Social Media Highway Code, and suggested he pay attention to Section 7, “Treat Others with Consideration, Politeness and Respect.” He didn’t reply directly, but responded by retweeting me.


The result was that I too started getting a large volume of tweets, which quickly turned into a Twitterstorm. As with the content being aimed at Ilona, some of the tweets I received were also hostile or downright abusive. It went on and on, lasting for several hours. This wasn’t helped by Dr Jessen retweeting more of my responses.



Okay, maybe that last tweet by me was a little tetchy, but getting several hours of online abuse does that to me.

I’m a fairly opinionated tweeter, so I’m no stranger to getting hostile messages. I’ve had some nasty stuff thrown my way by supporters of UKIP, and also by people who object to the work of child protections services. I can honestly say that today was the worst and most intense level of trolling I’ve ever been subjected to.

I don’t feel I need any sympathy for that. I’m big enough and ugly enough to handle it. However, I’m saddened that it happened at the instigation of a fellow healthcare professional. I’m even more saddened that the brunt of it was also caught by someone who has lived experience of one of the very conditions that Dr Jessen talks about in his show.

Dr Jessen seems rather unrepentant about all this.


What does the Social Media Highway Code say?

You have a right to express your views openly–but not to do so in a way that causes offence to others or infringes on their own rights….

When part of an online group, don’t be tempted into joining others in making derogatory comments or ‘ganging up’ on another individual – this behaviour could be regarded as ‘cyber-bullying’. Be wary of the power of the mob…

HEALTH WARNING: making derogatory,threatening or defamatory comments about others could have a harmful effect on your career. ‘I was just blowing off steam’ may be an honest explanation, but is not likely to be accepted as a valid justification by professional bodies or employers.

I hope Dr Jessen takes up my suggestion of reading the Highway Code.

Meanwhile, Ilona has posted her own thoughts on the matter in a vlog.