@cpso_ca draft social media policy profoundly challenging

The College of Physicians and Surgeons of Ontario (@cpso_ca) has published its new draft policy statement on the use of social media by physicians and, I fear, if implemented as written it could have a chilling effect on how physicians represent themselves. In proposing strong new language to enforce professional behavior when using social media, the CPSO risks alienating many of its members and could see doctors in Ontario abandon social media platforms to which they contribute so much.

It’s a fine line because many of the changes proposed are being done for the right reasons to discourage the posting of health information that is not evidence- and science-based and to discourage posts that could be described as harassing, bullying or discriminatory. The new draft can also be applauded for containing a preamble discussing how physician professionalism supports equity, diversity and inclusiveness and also includes specific acknowledgment of the importance of advocacy.

The CPSO has always been in the forefront among Canadian regulatory authorities in considering the impact of social media on physicians and their patients. The current policy statement dates from 2013 and was opened for revisions last year as I noted in a blog at the time. The impact of the policies cannot be overstated because contravening them can leave physician open to charges of professional misconduct.

As noted in a document for its June Council meeting, 366 responses were received from the external consultation on the new draft document with the majority of these coming from physicians. This briefing document also noted that since the original 2013 statement “social media use among physicians has increased significantly and presents new risks and challenges for physicians to navigate …”

Many of the proposed changes are aimed at addressing concern about the current statement being too vague in defining unprofessional behavior by physicians on social media. The council briefing note also explains that the draft policy includes new requirements around disseminating general health information, recognizing the concerning spread of misinformation on social media in past years (e.g. anti-vaccination views, misinformation related to COVID-19).

The new policy statement has a lot of “must and must nots” that were lacking in the current statement, such as:

  • Physicians must conduct themselves in a respectful and professional manner while using social media
  • Physicians must consider the potential impact of their conduct on their own reputation, the reputation of the profession(emphasis mine), and the public trust
  • Physicians must not engage in disruptive behavior … including use of profane language (i.e. no more swearing)

The new draft policy hits all the right buttons linking physician professionalism with values such as altruism and cultural humility. But one wonders how this new statement will be interpreted by those who see strong-handed enforcement of professionalism as maintenance of the traditional, parochial approach to medicine that runs so counter to the outlook of the many women physicians who have taken to social media to advocate for more gender equality.

The statement about not sullying the reputation of the profession on social media also raises a big red flag as we have seen how another health profession in Canada unsuccessfully tried to use this to stop an individual from voicing legitimate concerns on social media about the delivery of care.

As with the existing policy, the new policy also deals with the area of professional relationships and boundaries stressing that physicians “must” maintain professional boundaries with patients, persons closely associated with patients, and colleagues while using social media. While the existing document has an end-note saying some physicians may choose to do this by maintaining separate online presence for personal and professional networks, the guidance document for physicians about the draft policy is more forthright in stating “having a separate professional account can help you maintain appropriate boundaries on social media.”

This advice seems outdated in an era when physicians are moving to be more well-rounded individuals on social media blending professional and personal interests. Some of the most respected physician social media accounts share personal details and professional views in a compelling manner.

I would argue that in any community, a physician can be themselves with personal interests while at the same time maintaining therapeutic relationships with patients. Some of my favourite Ontario physician Twitter accounts mix strong views on a wide variety of topics with questionable cooking tips, wine reviews, family snapshots and more.

Bifurcating physicians on social media is not the way to go. And has been argued recently by two Canadian physicians, creating this artificial divide could impact the effectiveness of physicians as advocates.

While I believe it is flawed, the new @cpso_ca document is a brave attempt to wrestle with defining how physicians should be using social media in 2021 – a world that has changed profoundly since the guidance of 2013.

Those interested have until the end of August to comment on the new draft statement. Given how much there is to unpack in this new important document – beyond what has been discussed in the confines of this current blog – I would urge reading the new draft policy and background document here.


The compleat social physician

For years I have lectured new medical students at @uOttawamed that the best physician Twitter accounts reflect the whole personality of the individual. I argue that maintaining separate professional and personal accounts has little benefit, creates a false dichotomy and can dilute your voice.

Even before the COVID-19 pandemic I noted a growing trend for physicians and others to be more willing to share elements of their own personal life on Twitter in additional to their views on issues.

It’s a trend that has not gone unnoticed both on and off social media.

In a recent interview, CMA president-elect Dr. Alika Lafontaine (@AlikaMD) said this sharing by physicians has been powerfully cathartic. “I’ve never heard so many physicians actually share the pain that they go through day after day. I’m both sad, as I hear the stories, and hopeful, because we’re sharing the lived reality of what we’re going through.

“In supporting colleagues across the country, I’d say keep sharing your story. I hear you, I see you, I feel what you’re going through. The other side of that is figuring out how to take these stories and actually have them impact the thoughts and beliefs of decision makers who create the structures that we work in.”

This perspective contrasts somewhat to views voiced by Drs. Eric Topol and Abraham Verghese (@EricTopol and @Cuttingforstone) in a recent discussion at least when it comes to social media. They made the point that Twitter is not well suited to sharing personal narratives, in large part because of the constraints imposed by the 240 character count on tweets. While it is true that books and other long forms of literature can more completely reflect a person’s story, one should never understimate the ability of smart people to create powerful narratives in just a few words.

I would argue that the most compelling physician Twitter accounts for both their peers and the general population manifest the personality of the person doing the posting. Dr. David Naylor and his dog (@CdavidNaylor), Dr. Brian Goldman and his ruminations on the failings (and very occasional triumphs) of Toronto sports clubs (@NightShiftMD), and the baking adventures of countless other physicians during the pandemic, all come to mind.

The whole issue of physicians maintaining separate personal and professional accounts has recently been given attention by two Canadian physicians @BlairBigham and @sarahfraserMD in a blog post on the BMJ Opinion site.

They argue that while many top medical organizations still recommend that physicians maintain separate personal and professional social media accounts, physicians should “embrace authenticity and reunite their personal and professional selves.”

“In times like these, we must … make a therapeutic relationship with the public to advocate effectively, and the work of advocacy requires revealing our true selves,” they write.  They say this is particularly important when physicians are advocating on public health issues or advocating for social justice.

Recent research suggests the public is more willing to trust pronouncements from individual physicians than professional organizations on issues relating to COVID-19 and surely trust can only be strengthened when the physician posting can clearly be seen as an individual.

Of course, imbuing your Twitter account with personality entails risk and physicians must think hard about how much they are wiling to share. Many draw the line at posting anything about their family on Twitter and this can confer a degree of security against trolls or worse.

And the call to maintain one Twitter account that reflects your whole personality does not mean you should do the same on many social media platforms. Physicians should consider which platform works best for them and use them. Many keep Facebook purely for close, personal interactions and use LinkedIn only for career-oriented interactions, and that makes perfect sense.

However when it comes to Twitter at least, keeping both a personal and professional account can be done but if you want your voice and opinion to count being the whole you makes a lot of sense. And when it comes to professional behavior, the same rules apply no matter which account identifies you.